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Advanced Care Paramedic > Treatment Guidelines > Flashcards

Treatment Guidelines Flashcards

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1
Q

What features indicate pt is at high risk of being peri-arrest? (5)

A

Hypotension/shock, syncope, ischemic CP or ischemia on 12 lead, heart failure: increased JVP/pulmonary edema, arrhythmias

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2
Q

In what patient population is Atropine potentially harmful?

A

Heart transplant patients. (Denervation of parasympathetic pathways)

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3
Q

What is BRASH syndrome?

A

Bradycardia, renal failure, AV blockade, Shock, Hyper K

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4
Q

What are some reversible causes of bradycardia? (5)

A

Hypoxia, increased parasympathetic tone, drugs/overdose, Hyper K, Myocardial ischemia

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5
Q

What is circum-rescue collapse

A

collapse of a pt in VF or cardiac arrest either before, during or shortly after rescue from cold environment

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6
Q

At what body temperature will a pt likely develop cardiac arrhythmias progressing to VF

A

30 degrees

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7
Q

Why should Epi be limited to 3 doses in hypothermic patients?

A

Drugs are metabolized more slowly and there is a potential for toxic build-up

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8
Q

At what ETCO2 level should an improvement in CPR quality be considered

A

10mmHg

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9
Q

What are the components of the Post Arrest checklist? (4)

A

Airway: Check tube position, air entry, tube tie
Breathing: 1/4-1/3 of BVM, 10-12/min, SPO2 of 94%, PEEP 5cmH2o
Circulation: Rhythm-5 mins for SVT, Map 65, 12 lead
Disability:HOB 30 degrees, Glucose, Temp neutral

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10
Q

How much fluid should an adult be resuscitated with?

A

20mL/kg

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11
Q

Cerebral and cardiac dysfunction accompanied by prolonged systemic ischemia (hypoperfusion/cardiac arrest) is known as?

A

Post cardiac arrest syndrome

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12
Q

What is the most common cause of traumatic cardiac arrest?

A

Haemorrhage

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13
Q

What are the reversible causes of traumatic arrest?

A

Hypovolemia, Hypoxia, Tension Pneumothorax

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14
Q

What is the transport window for a pt in cardiac arrest secondary to a traumatic cause?

A

15 minutes (20 in Vancouver Coastal)

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15
Q

When should a pelvic binder be applied in traumatic arrest?

A

After other reversible causes are treated, unless pelvic fx is suspected as being a leading cause of hemorrhage.

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16
Q

What is coagulopathy?

A

A derangement in hemostasis resulting in either excessive bleeding or clotting

17
Q

What is the calculation for initial and subsequent defibrillation in pediatric patients

A

2J/kg, repeat at 4J/kg

18
Q

Where are the 2 sites for needle thoracentesis placement

A

2nd intercostal mid-clavicular

5th intercostal mid-axilla

19
Q

What are the 6 criteria for recognition of life extinct (ROLE)

A 
No palpable pulse for 90 s
No heart sounds for 90s
No breath sounds/resp effort for 90 s
Fixed non-reactive pupils
No response to central stimuli
Observe Asystole or PEA < 30 for 60s
20
Q

What is the Pediatric assessment triangle (PAT)

A

General appearance (Tone, Inconsolability, Gaze, Color)
Work of breathing
Skin (Circulation)

21
Q

How do you calculate mean and lower BP limits in pediatrics?

A

Mean: 80+ (2x Age (years))
Lower: 70+ (2x Age (years))

22
Q

How do you calculate the ET tube size in pediatrics?

A

Uncuffed:(Age/4)+4
Cuffed: (Age/4)+3

23
Q

What is the SIRS criteria?

A

Systemic Inflammatory Response Syndrome

Tachypnea, Tachycardia, Fever, Increased WBC

24
Q

What is qSOFA

A

Quick Sequential Organ Failure Assessment

Altered LOC, Tachypnea, Hypotension

25
Q

Exposure to CO with levels above (?) require conveyance to hospital?

A

Above 10%

26
Q

How long does CO remain bound to hemoglobin?

A

4-5 hours at R/A
1-2 hours at 100% O2
20 mins in hyperbaric chamber

27
Q

How does a hyperbaric chamber treat CO poisoning?

A

By producing a 10x increase in the amount of O2 dissolved in plasma, thereby increasing oxygen delivery to the tissue, and increasing CO elimination.

28
Q

What are normal CO levels for a smoker?

A

2%, may be as high as 9% in heavy smokers

29
Q

What causes a right shift (reduced affinity) in the oxyhemoglobin dissociation curve? (5)

A 
Low pH
High temp
High CO2
High 2,3-BPG
Low affinity hb variants
30
Q

Organophosphates and Carbamates inhibit what?

Leading to what?

A

Acetylcholinesterase, causing stimulation of muscinaric (parasympathetic) and nicotinic (sympathetic) receptors

31
Q

What is the mneumonic for organophosphate toxicity?

A 
Sludge and the killer B's
Salivation
Lacrimation
Urination
Defecation
GI upset
Emesis
Bronchospasm
Bronchorrhea
Bradycardia
32
Q

What is the goal of Atropine in treating organophosphate poisoning? What receptors does it affect?

A

Control secretions, and correct bradycardia and hypotension. Reverses muscinaric, but not nicotonic

33
Q

What are some symptoms of beta-blocker OD? (7)

A 
Bradycardia
Hypotension
Mental status changes
Ventricular dysrhythmias
Cardiogenic shock
Bronchospasm
Hypoglycemia
34
Q

What are common ECG findings in beta-blocker OD?

A

PR prolongation, QRS prolongation, bradydysrhythmia

35
Q

What are the steps in treating beta-blocker OD?

What treatments are unlikely to be successful?

A

Glucagon-increasing cardiac inotropy by activating adenyl cyclase by a secondary mechanism bypassing beta-blockade
Calcium-improve BP and contractility
Sodium bicarb- Wide QRS, increases sodium and initiation of action potential
Mag sulfate-Torsades,
Epi infusion- Increases chrono/ino/dromo-tropy

Atropine and pacing are unlikely to be successful

36
Q

What are the common S&S of TCA OD?

A

Sedation/Unconciousness
Seizures
Wide complex tachycardia
Hypotension

37
Q

What is the cardiac consequence of TCA OD?

A

Sodium channel blockade

38
Q

What are the common ECG finding of TCA OD?

A

QRS> 100ms
Deep S in I and aVL
Tall R in aVR
Tachycardia

Advanced Care Paramedic (3 decks)

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