Adult Medical Protocol

Question 1

340.17
Cardiac STEMI (ST Elevation MI)
STEMI Alert criteria :

Answer 1

II-Paramedic interpretation of new ST elevation at the J point of >1mm (0.1) in at least 2 contiguous chest or limb leads or LBBB not known to be old in a pt w symptoms

III-cardiac symptoms (continuous or intermittent) lasting for greater than 15 min and less than 12 hrs.

Question 2

340.01

Acute Abdomen

Answer 2

1. Basic ALS treatment
2. ALS transport criteria:

a. All pts w signs and symptoms of acute abdomen or abnormal vital signs.
b. Call Medic-1 for pain control orders if appropriate

Question 3

II, III, AVF

Answer 3

Inferior wall MI

Question 4

V3, V4

Answer 4

Anterior

Question 5

V1, V2

Answer 5

Anteroseptal

Question 6

I, AVL, V5, V6

Answer 6

Anterolateral

Question 7

Any pt <28 days old or < 5 kg in body weight

Answer 7

Neonate

Question 8

Any pt < 1 year of age and greater than or equal to 28 days of age also > or = to 5 kg body weight

Answer 8

Infant

Question 9

Pediatric pt - legal standpoint

Answer 9

Any pt < 18 yrs of age

1. Exception; emancipated minors, pregnant minors and/or married minors

Question 10

Pediatric pt - Medical standpoint

Answer 10

Pts who weigh < 50 kg (110 lbs)

1. Drug dosage for pediatric pts assume a body weight of < 50 kg

Question 11

Pediatric pt - trauma standpoint

Answer 11

Any pt < or = to 15 yrs of age

1. Anatomical and physical characteristics of a person this age.

Question 12

Although not a narcotic medical drug, it too shall be treated as such and doubled locked on each apparatus.

Answer 12

Etomidate

Question 13

What are the 4 situations which it is Permissible to withhold CPR? These conditions are termed “evidence of irreversible death”

Answer 13

1. Decapitation
2. Rigor Mortis
3. Dependent lividity
4. Tissue decomposition

Question 14

Albuterol Pediatric dose

Answer 14

< 20kg, 2.5mg q 20 min PRN nebulized

> 20kg, 5.0mg q 20 min PRN nebulized

Question 15

Epinephrine SQ pedi dose

Answer 15

0.01 mg/kg of 1:1,000 max dose of 0.4 mg SQ

Question 16

Diphenhydramine pedi dose

Answer 16

1.0 mg/kg (max dose 50mg) IM or IV flush thoroughly

Question 17

Methylprednisolone pedi dose

Answer 17

2.0 mg/kg (max dose of 80mg) over 1-2 min IV

Question 18

Altered state of consciousness (340.02)

Answer 18

A. D50 (for known hypoglycemia <60 mg/dl) 12.5g IV over 1-2 min. May repeat 1 time.

B. Oral dextrose (gag reflex) 25-30g PO may be repeated every 5 min to a level > 90 mg/dl

C. Glucagon (when unable to establish IV) 1.0 mg only once

D. Naloxone (Narcan) when narcotics are suspected 0.5 mg IV,IM,SC or IN repeat q2 min as needed (titrate to desired effect)

Question 19

Anaphylaxis/ Allergic Reaction 340.03

Answer 19

A. Epi 0.3 mg 1:1,000 SQ may be repeated q3 min PRN for ongoing severe symptoms. IF UNRESPONSIVE TO SQ EPI 0.3mg 1:10,000 IV q5 min PRN for ongoing life threatening symptoms

B. Diphenhydramine (Benadryl) 50mg IM or IV once flush thoroughly

C. Methyprednisolone (Solumedrol) 125 mg IV over 2 min once

D. Albuterol 5.0 mg nebulized may repeat q20 not exceeding 15 mg per hour PRN ongoing bronchospasms

• if pts tidal volume is inadequate consider Albuterol via BVM in line nebulizer or ETT after airway has been secured

Question 20

Asthma 340.04

Answer 20

Albuterol - 5.0 mg nebulized may be repeated q20 min (not exceeding 15 mg per hr)

Albuterol and Atrovent - ( Preferred for COPD and Emphysema pts) may be repeated up to 2 times if there has been a response to initial tx. 1.5 mg bromide and 7.5 albuterol

Methylprednisolon- 125mg IV over 2 min once. No steroids in past 24 hrs.

Mag Sulfate ( for severe symptoms ) 2 gms in 50ml over 20 min IV once.

CPAP ( primarily for COPD pts)

Epinephrine ( for near fatal asthma or COPD) if unable to nebulize pt and tidal volume is inadequate
0.3 mg of 1:1,000 SQ q 20 min PRN

Question 21

• Incompatible with Lactated ringers solution

- must avoid contact with catecholamines

Answer 21

Sodium bicarbonate

Question 22

Atropine for organophosphate poisoning dose

Answer 22

2 mg IVP until secretions dry up. No max dose

Question 23

340.05

Behavioral Emergencies

Answer 23

Midazolam 2.5 mg IV/IM or IN may repeat once after 5 min.

1.25 mg in pts > 60 yrs of age and those with COPD

Question 24

Class - depolarizing neuromuscular blocking agent

Onset - 1 min
Duration - 4-10 min

Dose- 1.5 mg/kg over 30 sec
If initial dose is not effective give a second dose at: 1 mg/kg IV over 30 sec.

Be prepared to give atropine for bradycardia if giving a 2nd dose of succinylcholine

Adult dose 0.5 - 1.0 mg IV
Pedi dose 0.02 mg/kg IV - minimum dose 0.1 mg, max dose = 1.0 mg

Answer 24

Succinylcholine

Question 25

Class- hypnotic Dose- 0.3 mg/kg Duration 3-5 min If contraindicated use 0.2mg/kg Midazolam If pt has a head injury use Lidocane 1 mg/kg

Answer 25

Etomidate

Question 26

Organophosphate poisoning medication and dose

Answer 26

Atropine- 2.0 mg repeat as needed every 5-10 minutes no max dose. > 65 y/o 1 mg IM repeat every 5-10 min for severe cases admin 4 mg IM

Question 27

340.10 Cardiac Arrest Algorithm- V fib, pulseless V- Tach

Answer 27

- If cardio version is successful begin an infusion Amiderone at 0.5 mg w adequate signs of perfusion. - for recurrent VF/VT while on the drip admin and additional 150mg/min IV/IO and restart protocol - Torsades de points - mag sulfate 2 gms IV/IO as a bolus. IV drip of 1.0 mg/min if successful cardio version - Lidocaine - 1 mg/kg IV/IO loading dose If cardio version is successful begin an infusion at 2 mg/min IV/IO and repeat the bolus if he infusion is started more than 15 min after initial bolus. If pt is in CHF, renal failure, liver failure the dose of the infusion is halved to 1mg/min IV/IO

Question 28

340.11 | Cardiac Dysrhythmias - AFIB/ A Flutter

Answer 28

Stable - diltiazem 0.25 mg/kg IV over 2 min. May repeat once after 15 min at 0.35mg/kg IV over 2 min. Unstable - paramedic discretion to use one round of meds Cardio version for- AFib 125j, 200j,300j,360j A Flutter 50j, 100j, 200j, 300j, 360j If systolic BP > 100 mmHg - midazolam 1.25 mg IV may repeat once in 5 min - fentanyl 50 mcg IV may repeat once in 5 min

Question 29

340.12 Bradycardia/ Block

Answer 29

- Atropine 0.5 mg rapid IVP q 3-5 min max dose 3.0 mg - Transcutaneous pacing - Dopamine infusion starting at 5mcg/kg/min q 5min PRN titration to effect. Max dose 20 mcg/kg/min - Epi infusion starting at 2mcg/min IV/IO increase by 2.0 mcg/kg/min q 5 min titration to effect max dose of 10mcg/min

Question 30

Not effective for infranodal blocks (i.e. Type 2 AV block and 3rd degree block with wide QRS complexes) may cause a paradoxical slowing, be prepared to initiate transcutaneous pacing

Answer 30

Atropine in bradycardia / heart blocks

Question 31

340.13 - SVT

Answer 31

- vagal maneuvers - adenosine 6 mg IV over 1-3 sec followed by 20 cc flush If no response in 1-2 min give 12 mg Unstable pt: paramedic discretion may give 12 mg IV before cardioversion Synchronized cardioversion : 50j, 100j, 200j, 300j, 360j Adjuncts to cardioversion if systolic > 100 mmHg - sedation - midazolam 1.25 mg IV q 5 min PRN anxiety - Analgesia- fentanyl 50 mcg IV q 5 min PRN pain max dose 250 mcg 12 lead as soon as pt is stabilized