Standing or trippin

Question 1

SO: Sepsis including criteria

Answer 1

O2 PRN, IV
Sepsis (2+) - 15 ml/kg max. 1 L NS

• RR > 20
  -T > 100 F
• HR > 100
• SBP < 100
• AMS

Severe Sepsis (1) - 30 ml/kg max. 2 L NS

• RR > 30
• HR > 130
• SBP < 90
• EtCO2 ≤ 25 mm Hg

Question 2

SO: CPAP

Answer 2

Patient is awake and able to cooperate, mask fits appropriately, is able to maintain an open airway and exhibits (2+):

a. RR > 20
b. Accessory muscle use
c. Continued dyspnea/ SpO2 < 94% despite O2

Question 3

SO: Pulmonary edema/ CHF

Answer 3

Dyspnea, bilateral rales, afebrile

1- O2
2- CPAP
3- IV TKO
4- SBP < 90 mm Hg, norepinephrine 4-12 mcg/ min to maintain SBP 100-110 mm Hg
- mix 4 mg/ 500 ml NS [8mcg/ml] and start at 0.5 ml/min titrated to SBP

Question 4

SO: CP

Answer 4

CP suggestive of MI
- O2 (SpO2 < 94% or SOB)
- ASA 324 mg PO chewed
- no recent GI bleeds- contact med control
-no allergies
- 12 lead if STEMI criteria transmit ECG and report STEMI Alert
- NTG 0.4 mg SL x3 q 5 min if SBP > 100 mm Hg - AND:
-no ED or pulmonary HTN meds
-allergies
- RV MI - inferior MI with hypotension

Question 5

SO: Respiratory Failure

Answer 5

Impending respiratory arrest
1- inability to maintain SpO2 @ 90% >
2- RR < 6 bpm
3- extreme work of breathing

WIth pulse:
1- SpO2 & EtCO2
2- Rescue breathing via BVM with O2 consider ETI
3- Unsuccessful- SGA

Question 6

SO: AMS

Answer 6

Assess for:

1- hypoxia- RR & SpO2 and provide oxygenation and/or ventilation if RR < 6 or SpO2 < 94%
2- BGL- provide glucose < 70 mg/dl
3- if opiate OD is suspected by Hx or PE administer naloxone
- IN [1 mg/ml] no improvement administer 2 mg IM

Question 7

SO: Seizure & Status Epilepticus

Answer 7

Continuous generalized seizures or repeated seizures without return to consciousness:
1- O2 maintain SpO2 > 90%
2- BGL
3- > 5 minutes midazolam 10 mg IN/ IM [5mg/ml]
- if midazolam unavailable or continues an additional 2 min:
- IV diazepam5 mg SIVP may repeat x 1 if seizure continues for 2 minutes. If continues for > 5 minutes, contact med control
- If diazepam is not available, lorazepam 2 mg IV should be used OR midazolam 2 mg IV as initial dose

Question 8

SO: Stroke (include LAPSS criteria & CSTAT criteria)

Answer 8

CVA suspected:
- LAPSS
- minimal scene time
- BGL, IV, cardiac monitor
- time of onset & last seen normal
- Stroke Alert: LAPSS Positive

LAPSS:
- age > 45
- no hx seizures
- ambulatory
-BGL- 60-400 mg/dl
+ unilateral deficits

CSS: positive
- equal grip
- facial droop
-arm drift
- speech

CSTAT: 2+ = LVO
- preferential gaze- 2 pts
- arm weakness- 1 pt
- mental status- 1 pt
- Answer: age AND month
- Follow commands- open eyes AND make
a fist

Question 9

SO: Bronchospasm

Answer 9

1- O2- SpO2 & EtCO2
2- Nebulizer (may repeat x 2)
a- albuterol 5 mg
b- ipratropium bromide 0.5 mg
3- Consider potential presence of CHF/ PE > CPAP
4- No response:
a- epi [1:1000] 0.3 mg IM
b- MgSO4-2 gm/ 100 ml NS over 10 min.
c- epi 1 mcg/ min (mix 1 mg/ 1 L NS) [ 1mcg/ml]
4- permissive hypocapnea increase I:E ratio

Question 10

SO: CPA in renal dialysis patients

Answer 10

Patients who have not received dialysis as prescribed are likely to be in fluid overload and potentially hyperkalemic. Patients with recent dialysis are likely to be hypotensive. However, utilize SO regardless.

In addition to ACLS guidelines:
1- Ca gluconate 1 gm (10 ml) IV/ IO
2- FLUSH COMPLETELY or 2nd line
3- NaHCO3- 1 mEq/kg IV/ IO
4- Repeat if no change