Treatment Per Protocol

Question 1

Abdominal Discomfort; GI/GU (nontraumatic)
- For Nausea or Vomiting

Answer 1

• Zofran (Ondansetron)
  
  • 4mg IV/IM/ODT. SO, MR x1 q10 min, SO
• (Treat per Pain management protocol). (S-141)

Question 2

Abdominal Discomfort; GI/GU (nontraumatic)
- Suspected volume depletion

Answer 2

500mL fluid bolus IV/IO, MR x1 SO

Question 3

Abdominal Discomfort; GI/GU (nontraumatic)
- Suspected AAA

Answer 3

• 500 mL fluid bolus IV/IO, SO to maintain SBP of 80, MR x1 SO
  
  • (treat per pain management protocol)

Question 4

Allergic Reaction/Anaphylaxis:
- Allergic Reaction: Skin signs only

Answer 4

• Urticaria (hives, rash)
• Erythema (flushing)
• Pruritus (itching)

Question 5

Allergic Reaction/Anaphylaxis
- Tx for SKIN-only Allergic Reaction

Answer 5

Benadryl (Diphenhydramine) 50mg IV/IM, SO

Question 6

Allergic Reaction/Anaphylaxis:
- Suspected anaphylactic reactions (RESPIRATORY

Answer 6

• Respiratory: throat tightness, hoarse voice, wheezing/strider, cough, SOB

Question 7

Allergic Reaction/Anaphylaxis:
- Suspected anaphylactic reactions (CARDIOVASCULAR)

Answer 7

Fainting, dizziness, tachycardia, low BP

Question 8

Allergic Reaction/Anaphylaxis:
- Suspected anaphylactic reactions (GI)

Answer 8

Nausea, vomiting, abdominal cramping

Question 9

Allergic Reaction/Anaphylaxis:
- Suspected anaphylactic reactions (Tissues)

Answer 9

Angioedema (swelling) of eyelids, lips, tongue, face

Question 10

Allergic Reaction/Anaphylaxis
- Tx for Anaphylactic Reactions

Answer 10

• Epinephrine 1:1,000 (1mg/mL) 0.3mg IM, SO. MR x2 q5 min SO… THEN…
• /Benadryl (Diphenhydramine), 50mg IV/IM, SO

W/ Respiratory involvement:
- Albuterol 6mL 0.083% via nebulizer SO, MR SO
- Atropine (Ipratropium bromide). 2.5mL. 0.02% via nebulizer — added to first dose of albuterol, SO

Question 11

Allergic Reaction/Anaphylaxis
- w/ BP <90 mmHg

Answer 11

• 500mL fluid bolus IV/IO MR to maintain SBP ≥90 mmHg, SO
• Push-dose Epi, 1:100,000 (0.01mg/mL)
  
  • 1mL IV/IO BHO, MR q3 min, titration to SBP ≥90 mmHg, BHO

Question 12

Suspected Opioid OD w/ respiratory depression
- (RR <12, SpO2 <96%, or EtCO2 ≥40 mmHg)

Answer 12

• Narcan, 2mg IN/IM/IV SO. MR, SO.
• If Pt refuses transport, give additional Narcan, 2mg IM, SO
  
  • consider leaving behind Narcan 4mg nasal spray preloaded device

Question 13

Symptomatic Hypoglycemia w/ Altered LOC (or unresponsive to Oral Glucose tabs)

Answer 13

• D50, (25g) IV, SO… if BS >60 mg/dL
• If pt remains symptomatic and BS >60
  
  • MR, SO
• If no IV access: Glucagon 1mL, IM SO (if BS <60)

Question 14

Symptomatic Hyperglycemia with diabetic history

Answer 14

• 500mL fluid bolus IV/IO, if BS ≥ 350 mg/dL — or reads “high”… SO x1.
• MR, BHO

Question 15

Status Epilepticus (generalized, ongoing, and recurrent seizures without Lucid Interval)

Answer 15

• Patients ≥40 kg (88lbs): Versed (midazolam), 10mg IM, SO
• Patients <40 kg: Versed, 0.2mg/kg IM, SO

Question 16

Partial seizure lasting >5 min (includes seizure time prior to our arrival)

Answer 16

• Versed (midazolam) 0.2mg/kg, IN/IM/IV/IO, SO. — MAX dose of 5mg, SO.
• MR x1 in 10 min, SO
• Max = 10mg total, d/c if seizure stops