Stan Co Adults

Question 1

Atropine

Answer 1

Symptomatic bradycardia
.5–1.0 mg IV push every 3 minutes max of 3mg.

Beta blocker calcium channel blocker
.5-1.0 mg Iv/IO if BP is <90 and HR <50/min with serious signs and symptoms. Repeat once in 5 minutes.

Organophosphate
2mg IV/IO or IM. Repeat every 3 min as needed to control secretions bronchorrhea and dysthymia.

Question 2

Midazolam (verses)

Answer 2

Symptomatic bradycardia, pulsing Vtach and SVT
2.0 mg IV prior to TCP

Status seizure
2.0mg IV/IO titrate 1mg increments for seizure control. Max of 6mg.
Or
5mg IM. May repeat ONCE in 10 min.

Question 3

Dopamine

Answer 3

Bradycardia
BASE ORDER 10mcg/min bp < 90. Titration to bp 90-100.

ROSC
10mcg/kg/min IV titrare by 5mcg/kg/min increments every 5 min to achieve bp >90 max dose 20mcg/kg/min

Question 4

Adenosine

Answer 4

SVT or unknown wide tachycardia (BP < 90 AND severe CP,SOB, decreased LOC or CHF

6mg rapid iv push
12 mg rapid iv push as second

dose if needed.

Question 5

Nitroglycerin

Answer 5

Chest pain
.4 mg sublingual (bp >100) repeat every 3 minutes.
Base container for Pts who have had viagra (sildenafil) within the last 6 hours.

CHF
.4 mg SL for SBP 120-150 
.8 mg SL for SBP 150-200
1.2 mg SL for SBP >200
Repeat every 5 min

If CPAP applied
Nitropaste 1” paste

Question 6

Albuterol

Answer 6

Bronchi spasm  asthma COPD
Mild (nebulized) 
2.5 mg May repeat 3 times for total of 7.5 mg
Moderate 
2.5 mg nebulized reasses 
5.0 mg nebulized if still wheezing

Severe
CPAP with 5mg nebulized.
CHF exacerbation with wheezes
2.5 mg nebulized.

Allergic reaction
3.0 ml in 15 ml or 6 unit dose vials nebulized or CPAP over 1 hour.

Question 7

Amiodarone

Answer 7

Pulseless VTACH/Vfib
300 mg IV/IO May repeat 150 mg IV/IO once in 4 min if persistent VF/VT

VTACH with a pulse
150 mg IV/IO infusion over 10 min.

Question 8

Lidocaine

Answer 8

Pulsing Vtach
.5 mg/kg IV/IO repeat very 10 min max of 3mg/kg.

Pulseless VTACH Vfib
1.5 mg/kg IV/IO repeat once in 4 minutes.

Question 9

Sodium bicarbonate

Answer 9

VFIB/Vtach

1 mEQ/kg IV/IO Max of 100 mEQ for dialysis or suspected hyperkalemia.

Question 10

Dextrose

Answer 10

25 grams iv push if bg is less than 60 mg/dL. Repeat once after 5 minutes if needed.

Question 11

Glucagon

Answer 11

Hypoglycemia
1 unit IM if BG less than 60mg/dL. May repeat once

Beta blocker or calcium channel blocker OD
2mg IV/IO/IM

Question 12

Calcium chloride

Answer 12

Cardiac arrest

1 gram IV/IO for suspected hyperkalemia

Question 13

Group/epiglottitis

Answer 13

Nebulized saline with high flow

Question 14

Epinephrine

Answer 14

Cardiac arrest
1mg 1:10,000 IV/IO every 3-5 min.

Bronchospasm (copd/asthma)
Severe distress
.3mg of 1:1,000 IM if age <40 and SBP <180
Base order : age <40 and/or SBP >180

Question 15

Naloxone (Narcan)

Answer 15

Overdose
R/R less than 10 or SBP less than 90 with suspected narcotic overdose: pinpoint pupils, track marks, drug paraphernalia, hx of narcotic use. May repeat once in 3 minutes if inadequate response

Question 16

Cardiogenic shock

Answer 16

MI, infection (myocarditis,endocarditis)
IV FLUIDS

Base orders
Dopamine 10mcg/kg/min SBP <90 unresponsive to fluids.

Question 17

Hypovolemic shock

Answer 17

Hemorrhagic shock from dehydration, diarrhea, burns, vomiting, sweating

IV fluids

Base orders
Dopamine 10mcg/kg/min SBP <90 unresponsive to fluids.

Question 18

Distributive shock

Answer 18

Sepsis, SIRS, infection, TSS, anaphylaxis

Epi .3 mg of 1:1,000 IM May repeat every 15 min.

Diphenhydramine 50mg IV/IO or IM IF IV/IO not available.

Albuterol 6 units as needed for wheezing

BASE ORDER 0.1 mg (1.0 ml) of 1:10,000 IV/IO push if BP less than 90 and severe respiratory distress. May repeat 1-2 minutes to SBP 90-100or improves ventilation

Base orders
Dopamine 10mcg/kg/min SBP <90 unresponsive to fluids.

Question 19

Obstructive shock

Answer 19

PE, cardiac tampanade, obstruction of great vessels.

Fluids

Base orders
Dopamine 10mcg/kg/min SBP <90 unresponsive to fluids.

Question 20

Diphenhydramine (Benadryl)

Answer 20

Allergic reaction (hives,rash,swelling)

25 mg IV OR IM if IV not available.

Anaphylaxis
50 mg IV/IO push or IM if IV not available.

Dystonic reaction
25 mg IV/IO push. May repeat once if needed. IM if IV not available.

Question 21

Morphine

Answer 21

.1 mg/kg slow IV/IO max of 10mg. If SBP >90
Repeat .05 mg/kg IV/IO MAX of 5mg as needed 5 min increments. (NO MORE THAN 20 mg)

Intramuscular
May give 5-10 mg IM if no IV/IO available ONCE ONLY!

Base order
Additional opioid above 20 mg
Or if needing to switch between morphine and fentanyl on same pt.

Question 22

Fentanyl

Answer 22

1 mcg/kg slow IV/IO MAX of 100 mcg if SNP > than 90

Repeat dose .5 mcg/kg max of 50 mcg as needed at 5 min increments.

Intranasal
1.5 mcg/kg (max of 75mcg) IN. Repeat every 10 min.

Intramuscular
May give 1 mcg/kg IM max of 100mcg if no IV/IO access ONLY ONCE! Consider IN instead.

MAX OF 200mcg