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ALS COMPETITION/ Paramedic school > treatment protocols/ cocktails > Flashcards

treatment protocols/ cocktails Flashcards

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1
Q

anaphylaxis cocktail

A

EPI 1:1000 0.3mg adults, 0.15 Peds
Benadryl: 50mg adults, 1mg/kg peds
solumedrol: 125mg adults, 1mg/kg peds

can also give:
albuterol, Atrovent.
magnesium sulfate as a last resort

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2
Q

crazy cocktail (signal 20) 50,5,2

A

Benadryl 50 mg
Haldol 5mg
versed 2mg

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3
Q

asthma/bronchospasm copd

A

albuterol 2.5mg, 1.25 peds
Atrovent 500mcg,
solumedrol: 125mg, 1mg/kg peds

-
magnesium sulfate: 2g 50ml over 10
epinephrine IM 1:1000
terbutaline sulfate: 0.25 mg subQ no peds under 12

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4
Q

AFIB/ Aflutter RVR

A

stable:
Cardizem 15-20mg over 2 mins (10mg if older then 65) second dose in 15 mins20-25 mg slow over 2 mins

unstable:
cardiovert zoll 75, 120,150,200. life pack 100,200,360

  • if delta wave cardiovert immediately
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5
Q

Cardizem induced hypotension

A

fluids: 500-1000ml
calcium chloride: 500mg-1g in a 100ml D5W bag using a 10-drop set over 5 mins.

ped: 20mg/kg max 1g

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6
Q

unstable brady

A

atropine 1mg rapid every 3-5 mins max 3mg
- bradycardia in the presence of MI, 2nd degree heart block type ll, and third-degree heart block pace.

  • after 2 doses of atropine no improvement pace
  • if no response to pacing give
    dopamine: 5-20mcg/kg/min titrate
    or
    epinephrine: 2-10 mcg/min titrate

sedation for pacing:
ketamine: 1mg/kg
or
versed: 5mg only if pt becomes normotensive after pacing.

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7
Q

bradycardia peds:

A

unstable:
- ensure adequate o2 and ventilation first
neonates: 1 breath every 3 seconds for at least 30 seconds
infants/children: 1 breath every 3 seconds for at least 1 minute

  • chest compression if pt remains unstable and hr remains below 60 bpm
  • if no response to o2 ventilations and chest compressions then
    epinephrine: (1,10:000): 0.01mg/kg every 3-5mins
    atropine (for increased vagal tone or primary av block): 0.02 mg/kg min dose 0.1mg and max 0.5mg
    -identify and treat underlying cause
  • if hypotension still exists pace

sedation for pacing:
versed: 0.1 mg/kg over 30 sec max single dose 5mg may repeat 1x max total 10mg
for IM/IN 0.2mg/kg max single dose 5mg
-same as adults once ped becomes normotensive for age then give versed

ketamine: 1mg/kg

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8
Q

left ventricular failure cardiogenic shock

A

dopamine infusion: 5-20mcg/kg/min
ped: correct hypoxia, reduce preload, reduce afterload, and improve myocardial contractility.

  • transcutaneous pacing may be necessary
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9
Q

right ventricular failure cardiogenic shock

A

normal saline: 0.9% 1L
ped: correct hypoxia reduce preload, reduce afterload and improve myocardial contractility.

  • transcutaneous pacing may be necessary
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10
Q

ACS STEMI/NSTEMI

A

O2: if needed
aspirin: 324 mg
nitroglycerin: 0.4 mg x2
fentanyl: 50mcg x3

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11
Q

ACS V4R positive

A

normal saline: 0.9% 1L
aspirin: 324 mg
fentanyl: 50mcg x3

  • NO NITRO
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12
Q

CHF pulmonary edema

A

CPAP: 5-15 PEEP
nitro: 0.4mg x2

ped: call for orders

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13
Q

SVT

A

stable:
vagal maneuver
adenosine: 6mg, 12mg, 12mg each time flush with 20ml flush
- if fails to convert or adenosine is contraindicated:
Cardizem: 10mg over 2 mins dilute in 10ml if no response repeats in 5 mins with 15mg.

unstable:
-Cardiovert
ketamine for sedation: 1mg/kg

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14
Q

SVT peds

A

infant rate: <220
child rate: <180

stable:
vagal maneuver
adenosine: 0.1mg/kg 10ml flush second dose 0.2mg/kg 10ml flush

unstable:
cardiovert 0.5j/kg increase subsequently 1j/kg, 2j/kg

sedation for cardioversion:
versed: 0.1mg/kg max single dose 5mg
ketamine : 1mg/kg

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15
Q

wide complex tachycardia:

A

stable:
amiodarone: 150mg/50ml over 10mins, give all 150mg may repeat 1x
or
procainamide: 20-50mg/min until arrhythmia suppressed hypotension ensues or qrs duration increases >50% or max dose of 17 mg/kg has been given.

maintenance infusion: 1-4 mg/min, avoid if prolonged QT or CHF

unstable:
cardiovert
- sedate versed or ketamine

  • if they convert after cardioversion, 12 lead to rule out amiodarone, then give amio if not given already
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16
Q

peds wide complex tachycardia

A

stable:
amiodarone: 5mg/kg in a 50/100ml bag max single 150mg over 20-60mins using 10 drop set

unstable:
cardiovert 0.5j/kg, 1j/kg, 2j/kg
- if they convert do 12 lead to rule out amiodarone don’t give if given already

sedate:
versed ketamine for cardioversion

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17
Q

torsades de pointes

A

stable:
magnesium sulfate: 2g/100ml over 10mins 10gtts/ml

unstable:
defibrillate life pack 200,300,360 Zoll 120, 150, 200
- give mag if not given already

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18
Q

pediatric torsades de pointes

A

stable:
magnesium sulfate 20-50mg/kg in 100ml over 10-20mins using 10 gtts/ml max dose 2g

unstable:
defibrillate 2j/kg, 4j/kg, 6j/kg, 8j/kg
- give mag if not already administered

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19
Q

determination of death in patient

A

if at least one condition is present:
- lividity
- rigor mortis
- tissue decomposition
- transection of torso
- valid DNR

any is present:
- suspected down time >30 mins
- asystole
- pupils fixed and dilated
- apneic
- without hypothermic mechanism for arrest

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20
Q

adult post resuscitation:

A

12 GOATS:
- assess ABC’s
- if brady transcutaneous pace
- maintain minimum BP of 90 –> 1L titrate to effect fluid bolus may repeat 1x PRN

PERSISTANT HYPOTENSION:
- Push pressor EPI 1:100000 10mcg/ml repeat 1x as needed for max of 0.2mcg
- norepinephrine drip make sure fluids are going 8mcg/min = 1 gtts/sec, can titrate up to 16mcg/min = 2 gtts/sec
- epinephrine drip 2-10mcg/min, start at 30 gtts/min then titrate up using clock method

IF unresponsive still:
TTM; place ice packs to axilla and groin

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21
Q

Pediatric post resuscitation

A

12 GOATS:
- Assess ABC’s
- Treat bradycardia
- treat BP, fluids 20ml/kg, 10ml/kg in infants may repeat 2x PRN for age appropriate BP

^ REMEMBER ^
70 + (AGE X 2) = hypotension in children to ten

  • if PT remains hypotensive, push dose epi, epi drip, dopamine drip, norepi drip.
  • TTM

PEDS ANIARRYTHMIC INFUISION IF NOT GIVEN :
amiodarone 5mg/kg in a 50-100ml max single dose 150mg over 10mins may repeat 1x prn
mag sulfate: 25-50 mg/kg in a 100ml of d5w over 10mins max 2g

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22
Q

cardiac arrest special considerations adult

A

hyperkalemia:
calcium chloride: 1g over 5mins
sodium bicarb: 50 meq
albuterol: continuous neb up to 20mg
fluids: 20ml/kg
insulin: can call for insulin infusion
- pt needs to go to dialysis

hypoglycemia:
D10 250ml rapid infusion

third trimester pregnancy:
displace uterus to left, transport to closest OB hospital

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23
Q

cardiac arrest special considerations adult and peds

A

electrocution:
- defibrillate immediately
- C-SPINE
- trauma alert

lightning strike:
- defib as applicable
- spinal motion restriction
- trauma alert

cyanide exposure:
- cyanokit

hanging:
- spinal imobilization
- closest facility

drowning:
- aggressive airway managment
- remove wet clothing from PT

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24
Q

cardiac arrest special consideration peds

A

hyperkalemia:
calcium chloride: 20mg/kg slow
sodium bicarb: 1 meq/kg slow make sure to dilute to 4.2 percent
albuterol: 5mg-20mg continuous neb
insulin: call for insulin
- need to go to dialysis

hypoglycemia:
D10 250ml rapid infusion

  • In pediatrics remember aggressive airway and hypoxia management, think of all reversible causes and consider treatment for sepsis if indicated
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25
Q

dehydration protocol adult

A

1000ML w/ 10gtts/ml set @ 20 gtts/min

NS 0.9% or lactated ringer for trauma Pt’s: 125 ml/hr titrate fluids to maintain SBP 90-100 mm Hg. Do not attempt to normalize blood pressure.

may repeat 1x PRN

  • use caution in Pts with coronary artery disease, CHF, and renal failure patients.
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26
Q

dehydration protocol pediatrics

A

NS 0.9% / lactated ringer: 20ml/kg

newborn: 10ml/kg

-may repeat 2x PRN for age-appropriate hypotension

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27
Q

following PTS receive 15LP NRB regardless of spo2:

A
  • 3rd trimester pregnancy trauma
  • all head injury
  • decompression sickness
  • carbon monoxide exposure
  • cyanide exposure
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28
Q

auto PEEP for pts with respiratory conditions receiving assisted ventilations protocol:

A

if poor bag compliance or hypotension during assisted ventilations:

allow pt to exhale all air
adults: 20-40 seconds
pediatrics: 10-20 seconds

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29
Q

adult moderate to severe respiratory distress protocol:

A

CPAP - 10 cm H2O for CHF
CPAP - 2.5 to 5cm H2O for asthma, pneumonia, copd

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29
Q

adult bronchospasm protocol:

A

albuterol: 2.5mg
Atrovent: 0.5mg
solumedrol: 125mg (excluding pneumonia)

  • CPAP may be administered simultaneously
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29
Q

adult severe asthma not responding to above treatment protocol:

A

Epinephrine: 1;000 0.3mg IM may repeat 2x PRN in 5-minute intervals

magnesium sulfate: 40mg/kg w a max dose of 2g of mag sulfate in a 100ml D5W bag using 10gtts/ml set over 10 minutes. (100gtts/min)

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30
Q

pediatric bronchospasm protocol:

A

albuterol: 2.5mg <1y/o 1.25mg
Atrovent: 0.5mg <1y/o 0.25mg
may repeat 2x PRN

solumedrol: 2mg/kg over 2 mins max dose 125mg

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31
Q

for severe asthma not responding to above treatment pediatric protocol:

A

epinephrine 1;1000: 0.01mg/kg IM max single dose 0.3mg may repeat 2x PRN in 5 minute intervals

albuterol Atrovent: 2.5mg and 0.5mg may repeat PRN

magnesium sulfate: dilute 50mg/kg in a 100ml D5W using 10gtts/ml administer over 5-10 minutes with a max of 2g

32
Q

pediatric croup/epiglottitis

A

epinephrine: 3mg (3ml total) delivered via neb

  • do not stress PT
  • do not try to place OPA or NPA or intubate
33
Q

pediatric differentiation between croup and epiglottitis criteria protocol:

A

croup:
- usually <3y/o
- sick for a couple of days
- low grade fever

epiglottitis:
- usually 3-6 y/o
- sudden onset
- high grade fever

34
Q

adult abdominal pain differential list

A
  • Gastrointestinal hemorrhage
  • appendicitis
  • liver disorders
  • ulcerative disease
  • pancreatitis
  • gallbladder disorder
  • hernia
  • kidney stones
35
Q

Adult abdominal pain protocol

A

NS:
125ml/hr titrating to maintain BP 90-100 mm hg
- 1000ml bag w/ 10 gtts set @ 20 gtts/min

Pain:

Fentanyl: 50-100mcg with max of 150mcg IV/IM

Zofran: 4mg IV/IO.PO

if no Fent: morphine 2-4mg

36
Q

pediatric abdominal pain protocol

A

NS :
20ml/kg titrating to maintain age appropriate BP

Pain:
fentanyl: 1-2 mcg/kg IV,IM,IN

Zofran: 0.15 mg/kg max dose 4mg (only for ages between 6months and 14 years)

Benadryl: 1-2 mg/kg slow

if no fent: Morphine: 0.1-0.2 mg/kg IV/IM, max dose 5mg

37
Q

Stroke protocol criteria consider sub arachnoid hemorrhage if

A
  • sudden onset of severe headache (thunder clap and worst headache of their life)
  • N & V
  • neck pain/stiffness
  • SBP >_ 180 mm hg
  • altered LOC GCS <_ 10
38
Q

Stroke protocol consider neurologic etiology if RACE score is zero and paramedic jugment

A

PARAMEDIC JUDGMENT:
- AMS
- vision loss, double vision
- loss of sensation
- poor coordination and balance
- sever headache
- N & V
- dizziness and severe vertigo
- dysarthria: difficulty speaking and slurred speech
- decorticate or decerebrate posturing

39
Q

stroke protocol must obtain information

A

pertinent PT info:
- Last time seen symptomatic
- witness name
- witness phone number
-PT meds (anticoagulation meds specifically)

  • minimizes time on scene to 10 mins or less
40
Q

Stroke care protocol

A

Positioning:
supine except: Diagnosed intracerebral hemorrhage, SOB place these pTS W/ head of the bed 15 degrees

O2:
2lpm if SOPo2 is less then 94%, if respiratory distress is present manage airway as needed

IV:
- aim for 2 IV’S

41
Q

Pediatric stroke care protocol

A

positioning:
supine expect: Diagnosed intracerebral hemorrhage, SOB place these pTS W/ head of the bed 15 degrees

O2:
2lpm if SOPo2 is less then 94%, if respiratory distress is present manage airway as needed

IV:
- aim for 2

Transport: pediatric strokes must go to pediatric Stroke center

42
Q

Adult sepsis protocol

A

Start 2 Ivs if possible
NS:
30 ml/kg max being 1l regardless of BP

If hypotension remains:
Push dose pressor epinephrine (1:100,000)
- discard 9ml of epinephrine 1:10,000 (0.1mg/ml) and draw up 9ml of NS to create a new concentration of 10mcg/ml 1:100,000

  • administer 1ml/min
  • may repeat 1x prn for max total dose of 0.2mg (20ml)
43
Q

Pediatric sepsis protocol

A

NS:
20 ml/kg, newborn 10 ml/kg may repeat 2x prn for age-appropriate hypotension.

If PT remains hypotensive:
Push dose pressor epinephrine (1:100,000)
- discard 9ml of epinephrine 1:10,000 (0.1mg/ml) and draw up 9ml of NS to create a new concentration of 10mcg/ml 1:100,000

  • administer 1ml/min
  • may repeat 1x prn for max total dose of 0.2mg (20ml)
44
Q

Seizure protocol differential list

A
  • meningitis
  • fever
  • head trauma
  • hemorrhagic stroke
  • drugs
  • alcohol
  • diabetic
  • poisoning
45
Q

Seizure protocol adult and pediatric

A

versed: 0.1 mg/kg IV/IO max 4mg
may repeat 1x PRN in 5 mins if seizure reoccurs or does not subside max total dose 10mg

Diazepam: 0.2 mg/kg maximum 10mg IV/IO

IF FEBRILE:
PEDS:
Acetaminophen 15 mg/kg max dose 650mg PR/IV/IO/PO, not for infants less then 6 months of age
- remove excess layers of clothes for febrile seizures

46
Q

Beta blocker overdose protocol

A

12 lead

Glucagon 5mg IV/IO slow. can repeat in 5-10 minutes for total of 10mg

-symptomatic bradycardia treat according to Symptomatic protocol

Isolated hypotension:
NS 0.9% 500ml may repat 1x

47
Q

Beta blocker overdose Peds protocol

A

12 lead

Isolated hypotension:
NS 0.9% 20ml/kg, 10ml/kg newborn. may repeat 2xprn for age appropriate hypotension

Glucagon 0.05-0.15 mg/kg IV/IO over 5 minutes. Followed by 0.05-0.10 mg/kg/hr infusion.

  • symptomatic bradycardia treat according to peds bradycardia protocol
48
Q

calcium channel blocker OD protocol

A

12 lead

Isolated Hypotension:
calcium chloride 1g IV/IO in a 100ml 10gtts/ml over 2-5 mins

NS: 20ml/kg IV/IO

Hypotension w/ bradycardia or non-responsive to above treatment:
- bradycardia protocol

49
Q

Calcium channel blocker OD ped

A

12 lead

Isolated hypotension:
calcium chloride 20mg/kg in a 100ml 10gtts/ml over 2-5 mins may repeat every 10 mins until symptoms resolve w/ a max dose of 1g.

NS 20ml/kg IV/IO newborn: 10ml/kg may repat 2xprn for age-appropriate hypotension.

Does not respond to above treatment:
- bradycardia protocol.

50
Q

Cocaine OD protocol

A

12 Lead

PT w/ stable SVT ,WCT ,chest pain, HTN or seizures: (HTN s >160 d > 110)

Versed:
5mg IV/IO may repeat 1x prn max total 10mg

  • follow appropriate treatment if this is unsuccessful or if pt has unstable cardiac arrythmia.
51
Q

Cocaine OD ped

A

12 lead

versed: 0.1mg/kg IV/IO max single dose 2.5mg
0.2mg/kg IN/IM max doze 5mg.

52
Q

Narcotic OD protocol adults and peds

A

Narcan:
adult- 0.4-2mg IV/IO/IN/IM
ped- 0.1-0.2mg/kg IN max dose 2mg

  • may repeat every 2 mins for max dose of 10mg
53
Q

Tricyclic antidepressant protocol

A

12 lead

QRS > 0.10:
sodium bicarb 8.4% 1mEq/kg IV/IO over 2 mins

Isolated hypotension:
NS 20ml/kg may repeat 1x prn

54
Q

Tricyclic antidepressant protocol peds

A

12 lead

QRS > 0.08:
sodium bicarb 4.2% 1 mEq/kg (dilute 8.4% by half with normal saline)
- may repeat 1x prn and discontinue when QRS < 0.08

Isolated hypotension:
NS 0.9% 20ml/kg, newborn: 10ml/kg IV/IO may repat 2x prn for age appropriate hypotension. max total dose 60ml/kg

55
Q

Dystonic reaction adult and peds

A

Benadryl:
adult- 25-50mg IV/IO

peds- 1mg/kg over 2 mins max single dose 50mg

56
Q

Nausea and vomiting Protocol

A

consider Diff diagnosis:
- cardiac
-stroke
-diabetic
-abdominal origin
- head injury
-other

NS 0.9%:
1L IV/IO

Zofran:
4mg IV/IO

Benadryl:
25-50mg IV/IO

57
Q

N/V ped protocol

A

NS 0.9%:
20ml/kg, newborn 10ml/kg IV/IO may repeat 2x prn, consider age appropriate hypotension

Zofran ( 6 months to 14 years):
0.15 mg/kg IV/IM max dose 4mg

Benadryl:
1mg/kg IV or IM slow.

58
Q

Hypoglycemia protocol

A

BGL < 60:
oral glucose

Dextrose IV:
100ml of 250 ml D10% bag 10gtts/ml
ped- 1g/kg

NO vascular access:
glucagon 1mg IM/IN adult
0.5mg IM/IN ped less then 20kg or less then 5yrs

59
Q

Hyperglycemia protocol

A

BGL >250mg/dl:
NS 0.9%:

adult
20ml/kg/hr
1000ml bag 10 gtts/ml 3 gtts/sec

ped
10ml/kg bolus, Reassess up to 40ml/kg total, if bgl >300mg/dl use 20/ml/kg.

60
Q

Chemical restraint protocol:

A

VIOLENT/COMBATIVE/DELIRIUM W AGITATED BEHAVIOR:
ketamine 2mg/kg IV/IO
4mg/kg IM/IN

laryngospasm reaction to ketamine administration:
High flow o2, assisted BVM, consider advanced airway procedures

Hypersalivation reaction to ketamine:
atropine 0.5mg IV/IO may repeat in 3 min intervals max total dose 3mg

after ketamine:
versed 5mg IV/IO max dose 10mg

  • obtain temperature
61
Q

Chemical restraint Ped protocol

A

When considering chemical restraint for a pediatric patent the child must show signs of puberty

Ketamine:
1mg/kg IV/IO
3 mg/kg IM

or

Versed:
0.1mg/kg IV/IO/IM w Benadryl 1 mg/kg SLOW, 0.2mg/kg IN versed max total dose 10mg for versed and 50mg for Benadryl.

62
Q

Pain management protocol

A

fentanyl:
1 mcg/kg IV/IN/IM max single dose 100mcg may repeat 1x prn for max of 150-200 mcg

Severe pain:
ketamine 500mg/5ml concentration 0.5mg/kg IN max single dose 55mg may repeat 1x prn

63
Q

pediatric pain management protocol

A

fentanyl:
1mcg/kg IV/IN/IM over 2 mins max single dose 100mcg

64
Q

Eye emergency’s adult and pediatric protocols

A

Chemical exposures:
Remove constant lenses, irrigate with NS 0.9% for 20 mins

Penetrating:
Stabilize, cover both eyes w/gauze and eye shield
Keep Pt calm
Do not attempt to remove or replace protruding tissue

Protruding eye:
If eye has been forced out cover Yee with ridged container, cover other eye w/gauze

Pain management:
Consider tetracaine 1-2 drops in affected eye, do not give for penetrating eye injuries

65
Q

Bites and stings protocol adult and Peds

A

Cal 1-800-222-1222

All bites and stings:
Clean with sterile water, no hydrogen peroxide on deep wounds or if fat is exposed

Snake bites:
Mark area, remove constricting jewelry or clothes split any extremity that has revived a bite and ensure it has remained below the heart

Insect stings:
Remove with a credit card

Treat hypotension according to hypotension protocol

66
Q

Hip fractures and hip dislocation adult and peds

A

Treat pain and shock as needed

Use scoop stretcher to move pt, splint jn position of comfort with pillows and blankets, reassess neurovascualr status before and after moving pt.

Posterior dislocation:
Most common, leg flexed internally and internally rotated. Will not tolerate extremity movement

Anterior dislocation:
Present with lateral rotation and shortening of affected leg

67
Q

Pelvic fracture adult and peds

A

Treat shock and pain as needed

Do not pelvic rock, assess by gently pressing anterior to posterior and from the sides to identify crepitis and instability, don’t repeat

Move with scoop and stabilize with pillows and blankets

Splint in position of comfort, reassess neurovascualr status after moving

68
Q

Closed fracture adult and peds

A

Treat shock and pain as needed

Splint in position found except:
- no pulse present
- unable to transport due to unusual position

Then:
1 attempt to place in normal position or regain PMS
STOP IF
Severe pain, resistance to movement

Closed femur fracture:
Traction splint, reassess PMS

69
Q

Open fracture adult and Peds protocal

A

Treat pain and shock and needed

Remove gross contamination(leaves, gravel)
Cover w/moist sterile dressing
Splint In position found

May move extremity if appropriate criteria is met.

70
Q

Extremity and junctional hemorrhage protocol adult peds

A

Direct pressure
CAT (tourniquet), apply second If bleeding does not stop

If second tourniquet does not stop bleeding:
Hemostatic agent, pack the wound maintain pressure for minimum of three minutes, apply pressure dressing

Junctional hemorrhage:
Pack with hemostatic agent, maintain pressure for minimum of three minutes

71
Q

Amputation and abdominal trauma protocal

A

Amputation:
Rinse off, wrap in saline moistened gauze and place in sealed bag (do not submerge in saline) place bag w/ice packs

Label w/ pt name date time of amputation and time part was wrapped

Abdominal trauma:
Impaled objects; stabilize, control bleeding w/ direct pressure, do not apply excessive pressure. Do not palpate the abdomen

Evisceration:
Protect tissue, cover with moist sterile gauze then cover that with dry sterile dressing.

72
Q

Head injuries trauma protocol:

A
  • If pt becomes combative refer to chemical restraint
  • oxygenation is critical

INTRACRANIAL PRESSURE/HERNIATION SIGNS INCLUDE:

decline in GCS of 2 or more points

development of sluggish or nonreactive pupils

decorticate/decerebrate posturing

Cushing triad

ADULT AND PEDIATRIC:
o2 15 LPM regardless of sp02, BVM as needed for respiratory support.

BVM for( adult rr <10, child rr<20, infant rr <25)
maintain EtCO2 between 35-40 and Sp02 > 90%.

Normal saline 0.9% (maintain minimum systolic of 90) :
adult 500ml iv/io may repeat 1x prn

ped (maintain age appropriate SBP):
20 ml/kg iv/io 10 ml/kg for infants may repeat 2x prn for age appropriate hypotension

Positioning:
head of bed 15 degrees

73
Q

Chest trauma protocol adult and peds

A

Flail chest:
occurs when 2 or more adjacent ribs are fractured, stabilize with bulky dressing o2 and ventilation as needed

Open pneumothorax:
chest seal applies on expiration, monitor for signs of tension pneumothorax.

Tension pneumothorax:
Needle decompression 2nd and 3rd intercostal space midclavicular line or 5th intercostal space of the midaxillary line.

74
Q

crush injury protocol adult and pediatric

A

DO BEFORE RELEASING PATIENT:
2 large bore ivs, io access may be used.
adult:

NS 0.9% 1L, sodium bicarbonate 1mEq/kg iv/io, calcium chloride 1g over 5 mins, albuterol 5mg

pediatric:
- maintain minimum age-appropriate pediatric systolic blood pressure.

NS 0.9% 20 ml/kg, sodium bicarbonate 1mEQ/kg 4.2%, calcium chloride 20mg/kg slow IV push over 5 mins. albuterol 2.5mg if hyperkalemic.

75
Q

Hemorrhagic shock compensated versus decompensated.

A

compensated shock:
- anxiety
- agitation
- restlessness
- normotensive
-capillary refill normal to delayed
- tachycardia

decompensated shock:
- decreased LOC
- Hypotensive
- peripheral cyanosis
- delayed capillary refill
- inequality of central/distal pulses
- tachycardia

76
Q

hemorrhagic shock adult and pediatric protocol.

A
  • splint pelvic fractures
  • keep warm
  • bilateral vascular access
  • first liter should be LC

adult:
fluids 250ml iv/io, repeat for desired results

pediatric:
fluids 20ml/kg, newborn 10ml/kg may repeat 2x prn for age appropriate hypotension

WHOLE BLOOD

77
Q

neurogenic shock protocol adult and peds

A
  • warm dry skin (below area of injury) with hypotension, Hr in normal limits, paralysis.

immobilize the patient, maintain body temperature with blankets and consider increasing temp in pt compartment.

Adult:

NS 0.9% to maintain minimum systolic of 90, max 2L

Bradycardia:
atropine 0.5mg may repeat for max total dose of 3mg

Not responding to atropine: dopamine 10 mcg/kg/min titrating to 20 mcg/kg/min.

Pediatric:
NS 0.9% 20ml/kg, 10ml/kg in infants may repeat 2x prn for age-appropriate hypotension.

Bradycardia:
atropine 0.02mg/kg, may repeat prn, max single dose 3mg.

78
Q

Trauma in pregnancy

A

, may be 15-20 beats above normal
- systolic and diastolic drop by 5-15 in second trimester
- mothers CO and blood volume increases, shock may not become apparent until 30-35%of blood volume loss
- supine hypotension occurs in third semester
- uterus presses against the diaphragm in third trimester causing ventilations to become difficult

Adult:
- determine gestational age of the fetus
- control external bleeding of course
- assess for non menstrual vaginal bleeding and rigid abdomen ( in third trimester this may indicate abruptio placenta or ruptured uterus)

Positioning: place 6 inches of padding under pt right side while maintaining normal anatomical alignment.

O2 15 LPM regardless of Sp02 unless pt requires ventilatory support, assist bvm with higher minute volume then normal.

hypotensive:
establish with largest catheter possible. NS 0.9% enough to maintain minimum systolic at 90

79
Q

Burn injuries Protocol

A
  • aggressive airway management as needed

Superficial:
involves only epidermis and is characterized as red and painful

Partial thickness burns:
Involves the epidermis and varying portions of the underlying dermis with blistering

Full thickness burns:
involves deep tissue damage and will appear as thick, dry, white, leathery burns.

Adult and pediatric:
-Stop burn immediately by irrigating with copious amounts of room temperature water or NS
- Determine TBSA
- don’t attempt to remove clothing, tar, etc if adhered to skin.
- remove jewelry and watches from burned areas
- consider pain management protocols
- do not use IM route for medication administration.
-consider carbon monoxide and cyanide exposure

1st and second degree burns< 15 TBSA or third degree < 5 TBSA
- apply sterile dressing or burn gel

2nd degree burns >15 TBSA or 3rd degree burns > 5TBSA
- apply dry sterile burn sheet
-02 regardless of sp02, airway management as needed

FOR 2nd and 3rd degree burns >20TBSA utilize parkland formula, 2-4 ml x kg x TBSA over 24 hours first half over 8 second half over 16.

Electrical burns:
treat associated burns as indicated.

chemical burns :
irrigate liquid chemicals with copious amounts of water or sterile saline for 15 minutes. brush off dry chemicals prior to irrigation.
WEAR PPE AND DECON PT as appropriate

ALS COMPETITION/ Paramedic school (8 decks)

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