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2024/2025 Protocols > 2025 Protocols (NEW) > Flashcards

2025 Protocols (NEW) Flashcards

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1
Q

Anaphylaxis treatment for Adult

A

Epi 1:1,000, 0.5mg IM, MR x 2 q5 minutes

  • then give

Benadryl 50mg IV/IM

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2
Q

Anaphylaxis treatment for adult (if respiratory involvement)

A

Albuterol/Levalbuterol 6ml via nebulizer, MR
Atrovent 2.5ml 0.02% via nebulizer added to first dose of albuterol/levalbuterol

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3
Q

Anaphylaxis treatment for adult (severe anaphylaxis or inadequate response to treatment)

A
  • 500ml fluid bolus IV/IO MR to maintain SBP of 90 or greater
  • Push-dose epi 1:100,000, 1ml IV/IO, MR q3 min, titrate to a SBP of 90 or greater or improvement in status
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4
Q

Once the push-dose epi is mixed what is the concentration?

A

0.01 mg/mL (10mcg/mL) concentration

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5
Q

Describe symptomatic opioid OD with respiratory depression in adult?

A

RR <12
O2 sat <96%
EtCO2 of 40 or greater

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6
Q

Treatment: Symptomatic hypoglycemia with altered LOC or unresponsive to oral glucose agents

A

Dextrose 25 gm IV if BS <60 mg/dl
If patient remains symptomatic and BS remains <60 mg/dl, MR
If no IV, glucagon 1 mL IM if BS <60 mg/dl

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7
Q

Symptomatic hyperglycemia

A

500 ml fluid bolus IV/IO if BS 350 or greater or reads “high” if no rales, MR x1

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8
Q

Adult: Status epilepticus (generalized, ongoing, and recurrent seizures without lucid interval) treatment

A
  • Patients 40kg or greater give versed 10mg IM
  • Patients <40kg give versed 0.2 mg/kg IM

If IV in place, then give versed 0.2 mg/kg IV/IO to max dose of 5mg, MRx1 in 10 minutes. Max 10mg total, d/c if seizure stops.

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9
Q

Partial seizure lasting 5 minutes or greater (includes seizure time prior to arrival of prehospital provider)

A

Versed 0.2 mg/kg IN/IM/IV/IO to max dose of 5mg, MR x 1 in 10 minutes. Max 10 mg total, d/c if seizure stops.

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10
Q

Eclamptic seizure of any duration

A

Direct to labor/delivery area BHO if 20 weeks or greater

—versed IN/IM/IV/IO to a max of 5 mg (d/c if seizure stops), MR x 1 in 10 minutes. Max 10 mg total

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11
Q

How many glucose tabs do we give for hypoglycemia (<60)?

A

(3) 5mg tabs for total of 15mg

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12
Q

Burns: For patients with >20% partial-thickness or >5% full-thickness burns and 15 years and older

A

500 ml fluid bolus IV/IO

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13
Q

Burns: Adult

Respiratory distress with bronchospasm

A

Albuterol/Levalbuterol 6ml via nebulizer, MR

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14
Q

BLS: Adult Thermal Burns treatment

A

For burns <10% BSA, stop burning with non-chilled water or saline

For burns >10% BSA, cover with dry sterile dressing and keep patient warm

Do not allow patient to become hypothermic

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15
Q

BLS: Tar burns treatment

A

Do not remove tar
Cool with water, then transport

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16
Q

Burn center criteria

A
  • > 20% partial-thickness or >5% full-thickness burns over BSA
  • Suspected respiratory involvement or significant smoke inhalation
  • Circumferential burn or burn to face, hands, feet, or perineum
  • Electrical injury due to high voltage (1000 volts or greater)
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17
Q

Adult: Chest Pain

When do a 12-lead?

A

The initial

After rhythm conversation and any change in patient condition

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18
Q

Adult: Chest Pain

How much ASA?

A

324 mg

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19
Q

Adult: Chest Pain

If SBP 100 or greater what’s the treatment?

A

NTG 0.4 mg SL, MR q3-5 minutes

Treat pain with opioids per Pain Management

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20
Q

Adult: Chest Pain

Discomfort/pain of suspected cardiac origin with associated shock

A

250 ml fluid bolus IV/IO with no rales, MR to maintain SBP 90 or greater

If no change in BP after second bolus, give 1 ml of Push-dose EPI

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21
Q

Adult: Chest Pain

If BP refractory to second fluid bolus

A

Push-dose EPI 1:100,000, 1ML IV/IO, MR q3 minutes, titrate to SBP 90 or greater

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22
Q

Define unstable bradycardia

A

SBP <90 and exhibiting any of the following signs/symptoms of inadequate perfusion
- ALOC
- Pallor
- Diaphoresis
- Significant chest pain of suspected cardiac origin
- Severe dyspnea

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23
Q

Adult: Unstable Bradycardia treatment

A
  • 12-lead
  • Atropine 1mg IV/IO, MR q3-5 minutes to max 3mg (may omit atropine in patients unlikely to have clinical benefit heart transplant, 3rd degree block, 2nd degree type II)
  • If SBP <90 and rales not present , 250 ml fluid bolus IV/IO, MR
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24
Q

Adult: Unstable Bradycardia (rhythm unresponsive to atropine)

A

Give Versed 1-5mg IV/IO PRN pre-pacing
External cardiac pacing
If captures occurs and SBP 100 and greater, treat per Pain Management Protocol

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25
Adult: Unstable Bradycardia If SBP <90 after atropine or initiation of pacing
250 ml fluid bolus IV/IO, MR x 1 Push-dose EPI 1:100,000, 1ML, IV/IO….MR q3 minutes, titrate to SBP of 90 or greater
26
External Cardiac Pacing Procedure
- Set rate and energy per manufacturer’s recommendations - Increase energy setting until capture occurs, usually between 50 mA and 100 mA - After electrical and mechanical capture achieved, increase energy by 10% - If patient remains hypotension, increase rate in 5 bpm increments (not to exceed 100 bpm) to achieve and maintain adequate perfusion
27
Adult: SVT Stable (symptomatic)
- If SBP <90 and rales not present, 250 mL fluid bolus IV/IO, MR - VSM - Adenosine 6mg rapid IV/IO followed by 20 mL NS rapid IV/IO - Adenosine 12 mg rapid IV/IO followed by 20 mL, MR x 1
28
Adult: SVT Unstable
Consider versed 1-5mg IV/IO pre-cardioversion Synch cardiovert at manufacture’s recommended energy dose, MR x 2, MR BHO (4th shock is BHO) After successful cardioversion: - Check BP. If SBP <90 and rales not present, 250 ml fluid bolus IV/IO, MR - 12-lead
29
Adult: Atrial Fibrillation/Flutter Initial treatment
12-lead If SBP <90 and rales not present, 250 mL fluid bolus IV/IO, MR
30
Adult: Atrial Fibrillation/Flutter Rate 180 or greater and unstable:
Consider versed 1-5mg IV/IO pre-cardioversion Synch per manufacturer’s recommended energy dose, MR x 2, MR BHO After successful cardioversion - Check BP. If SBP <90 and rales not present give 250 mL bolus IV/IO, MR - Obtain 12-lead ECG
31
Ventricular Tachycardia with Pulse (Stable)
12-lead If SBP <90 and rales not present give 250ml NS bolus IV/IO, MR Amio 150mg in 100ml of NS over 10 minutes IV/IO, MR x 1 in 10 minutes —or— Lidocaine 1.5mg/kg IV/IO, MR at 0.5mg/kg IV/IO q5minutes to max 3mg/kg
32
Ventricular Tachycardia (Unstable)
12-lead Consider versed 1-5mg IV/IO pre-cardioversion Synch cardiovert per manufacturer’s recommended dose, MR x 2, MR per BHO (4th shock is BHO) After successful cardioversion: - Check BP. If SBP <90 and rales not present, give 250 ml NS IV/IO, MR - 12- lead
33
What are the signs/symptoms for “unstable” criteria for adults?
SBP <90 and any of the following ALOC Pallor Diaphoresis Significant chest pain of suspected cardiac origin Severe dyspnea
34
V-Fib and Pulseless V-Tach
CPR Defibrillate at manufacturer’s recommended energy dose as soon as monitor charged Defibrillate at manufacturer’s recommended energy dose q2minutes while in VF/VT Epi 1:10,000, 1mg, IV/IO after second shock and q3-5 minutes thereafter Persistent VF/VT (after 3 defibrillation attempts) Amiodarone 300mg IV/IO, MR 150 mg q3-5 minutes (max 450mg) —or— Lidocaine 1.5 mg/kg IV/IO, MR at 0.5 mg/kg IV/IO q5 minutes to max 3mg/kg
35
PEA
CPR Epi 1:10,000 1 mg IV/IO q3-5 minutes H’s (Hypovolemia, Hypoxia, Hypernatremia, Hypo/Hyperkalemia, and Hypothermia) T’s (Toxins (drugs), Tension Pneumothorax, Tamponade, Thrombosis, Trauma) Hyperkalemia Calcium 1 gram IV/IO Bicarbonate 1 mEq/kg IV/IO Continuous albuterol 6ml via nebulizer
36
PEA Hyperkalemia
Calcium 1 gram IV/IO Bicarbonate 1 mEq/kg IV/IO Continuous albuterol 6ml via nebulizer
37
PEA Hypovolemia
1 liter fluid bolus IV/IO, MR x2
38
PEA Suspected poisoning/OD (suspected tricyclic, antidepressant OD with Cardiac effects)
Bicarbonate 1 mEq/kg IV/IO
39
Asystole
CPR EPI 1:10,000 IV/IO q3-5 minutes
40
Asystole TOR only applies to what?
Cardiac origin
41
Asystole TOR criteria
Persistent Asystole (no other rhythms detected) Unwitnessed arrest (by bystanders or EMS) No bystander CPR No AED or other defibrillation No return of pulses 20 minutes or greater on-scene resuscitation time
42
Under TOR pronouncement what should get documented by the medic pronouncing?
Time and full name of medic and circumstances under TOR determination
43
ROSC
ETC02 range 35-45 but ideally 40 Obtain full set of VS 12-lead Transport to closest STEMI hospital regardless of 12-lead reading Upload to QA/QI Blood sugar
44
ROSC with SBP <90
If rales not present, 250mL fluid bolus IV/IO, MR Push-dose Epi 1:100,000, 1mL IV/IO. MR q3 minutes, titrate to SBP 90 or greater
45
AICD reported/witnessed 2 or more - Pulse 60 or greater
Pulse 60 or greater Lidocaine 1.5mg/kg IV/IO, MR at 0.5mg/kg IV/IO q5 minutes to max 3 mg/kg —or— Amio 150mg in 100ml of NS over 10 minutes IV/IO, MR x 1 in 10 minutes
46
ECKMO criteria
18-70 Witnessed cardiac arrest CPR - must be established within 5 minutes of cardiac arrest - high-quality compressions throughout resuscitation, including during transport Use LUCAS 2 defibrillation attempts (includes AED, but not AICD) Time from cardiac arrest to ECPR center 45 minutes or less
47
Envenomation injuries (Jellyfish, Stingray or Sculpin, Snakebite)
IV Pain meds
48
Cardiac arrest with hypothermia
CPR Persistent VF/VT, defibrillate EPI 1:10,000 IV/IO (limit to one dose until patient becomes warmer 86 degrees or more) withhold Amio and Lido until body warms to 86 degrees or warmer
49
Defibrillation attempts may be unsuccessful during rewarming until temperature reaches what?
86 or warmer
50
Heat Exhaustion/Heat Stroke
500 ml fluid bolus IV/IO, if no rales MR x 1
51
Drowning with respiratory distress
CPAP at 5-10 cmH2O for respiratory distress
52
Hemodialysis Patient How much do we aspirate from a graft/AV fistula?
5 mL
53
Hemodialysis Patient For immediate life threat only access what?
EJ/IO access preferred over accessing percutaneous dialysis catheter or shunt/graft
54
Hemodialysis Patient Fluid overload with rales
NTG = systolic BP 100-149, 0.4mg SL, MR q3-5 minutes NTG = systolic BP 150 or greater, 0.8 mg SL, MR q3-5 minutes - CPAP 5-10 cmH2O
55
Hemodialysis Patient Suspected Hyperkalemia (peaked T-waves or widened QRS complex)
12-Lead ECG If widened QRS complex, immediately administer calcium 1 gram IV/IO Bicarbonate 1 mEq/kg IV/IO Continuous albuterol 6ml via nebulizer
56
Patients not on hemodialysis with suspected Hyperkalemia
12-lead If findings consistent with Hyperkalemia (peaked T-waves -OR- widened QRS complex) —contact BH
57
Diving incidents: What do you want to bring to the hospital?
Bring dive computer and gear if available
58
Postpartum Hemorrhage
500 mL fluid bolus IV/IO, MR x 2 q10 minutes to maintain SBP 90 or greater If blood loss 500 mL or greater and within 3 hours of delivery, TXA acid 1gm/10mL in a 50-100 ml NS over 10 minutes
59
Extrapyramidal reactions
Benadryl 50 mg slow IV/IM
60
Suspected Beta Blocker OD with cardiac effects (bradycardia with hypotension)
Glucagon 1-5mg IV, MR 5-10 minutes, for a total of 10 mg
61
Calcium Channel Blocker OD
Calcium 1gm IV/IO
62
Intubated patients with agitation and potential for airway compromise
Versed 2-5mg IM/IV/IN, MR x 1 in 5-10 minutes
63
If patient unable to tolerate CPAP, what medication/amount do we give?
Versed 0.5-1mg IN/IV/IM
64
CPAP is started at what range?
5-10cmH20
65
Use EPI with caution in what cardiac patients?
Those with SBP greater than 150 Age: greater than 40
66
If suspected AAA, fluid boluses to maintain SBP of what?
80 or greater
67
Non-traumatic, Hypovolemic shock
500mL fluid bolus IV/IO, MR to maintain SBP of 90
68
Distributive shock (neurogenic, drug and toxin-induced, and endocrine shock) treatment?
500 mL fluid bolus IV/IO, MR to maintain SBP of 90 or greater
69
Adult Trauma: SBP <90 or signs of shock
500mL fluid bolus IV/IO, MR x3 q15 minute to maintain SBP 90 or greater
70
TXA can be given for what in Adult Trauma?
SBP <90 mmHG Shock Index 1.0 or greater (HR equal to or greater of SBP) Uncontrolled external bleeding
71
Crush injury requiring extrication with compression of extremity or torso 2 hours greater
1000 ml fluid bolus IV/IO Bicarbonate 1 mEq/kg IV/IO Calcium 1gm IV/IO over 30 seconds Continuous albuterol/levalbuterol 6mL
72
Ketamine (IV dosing)
0.3 mg/kg in 100mL of NS over 10 minutes IV. Max for any IV dose is 30mg MR x 1 in 15 minutes if pain remains moderate or severe
73
Ketamine (IN dosing)
0.5 mg/kg IN (50 mg/mL concentration). Maximum for any IN dose is 50mg MR x 1 in 15 minutes if pain remains moderate or severe
74
Requirements for Ketamine use:
15 years of age or older GCS of 15 Not pregnant No known or suspected alcohol or drug intoxication
75
If SBP <100, what pain medication is preferred?
Ketamine Over opioids that cause hypotension
76
Adult: Severely agitated and/or combative patient requiring restraint for patient or provider safety
Versed 5mg IM/IN/IV, MR x 1 in 5-10 minutes - 500 mL fluid bolus IV/IO PRN, MR x 1, MR BHO
77
Adult: Suspected Sepsis Signs/Symptoms
Temperature 100.4 or greater or <96.8 Heart rate 90 or greater RR 20 or greater ALOC SBP <90
78
Adult: Sepsis treatment
500 mL fluid bolus IV/IO regardless of initial BP or lung sounds - If no rales or SBP <90, give additional 500 mL fluid bolus IV/IO, MR x 2 SBP <90 after fluid boluses — Push-dose EPI 1:100,000 (0.01mg/mL)—1mL IV/IO, MR q3 minutes, titrate to SBP of 90 or greater
79
Adult: Stroke or TIA treatment
IV (large bore in AC) 250 mL fluid bolus IV/IO to maintain SBP of 120 or greater if no rales, MR

2024/2025 Protocols (2 decks)

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