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Standing Orders > Adult SO > Flashcards

Adult SO Flashcards

1
Q

Allergic Reaction w/out Shock

A
  • O2 via NRM 10-15 LPM
  • Epi IM 1:1k 0.3 mg
  • IV, 300 cc NS bolus
  • 25 mg Diphenhydramine IV, repeat in 10 mins (If no IV 50 mg Diphenhydramine IM)
  • 125 mg Methylprednisone IV (if severe)
  • IF wheezing, 5 mg Albuterol Nebulized
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2
Q

Allergic Reaction w/ Shock

A
  • O2 via NRM 10-15 LPM
  • Epi 1:1k IM 0.3 mg
  • IV/IO w/ 300 cc bolus
  • no change, go to Shock Hypovolemia SO A-20
  • Still in shock after SO A-20 1:10k Epi IV titrate 0.1-0.5 mg IV
  • Benadryl 50 mg IV
  • Solu-Medrol 125 mg IV
  • Wheezing: 5 mg albuterol neb
  • No IV/IO, repeat epi IM and give (1 dose) benadryl 50 mg IM
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3
Q

Bronchospasm

A
  • O2 via NRM/BVM
  • 5 mg Albuterol updraft
  • **No response to Albuterol go to CHF SO
  • 2nd 5mg Albuterol and 0.5 mg Atrovent
  • 125 mg Solumedrol after 2nd albuterol
  • 3rd 5 mg Albuterol
  • If pt intubated due to severe bronchospasm and difficult to ventilate, give 10 cc of 1:10k Epi via ET
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4
Q

Bradycardia (indications)

A

Sinus brady, junctional, idio, afib w/ slow ventricular response, Mobitz I&II, 3 degree heart block, w/ HR 60> /min. with BP 90>
WITH CP, SOB, and/or pale/cool/diaphoretic skin.

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5
Q

Bradycardia

A
  • O2 via NRM
  • Apply PM pads
  • IV
  • turn on external pacemaker and assure capture IF unstable OR no IV
  • If BP 90> mmHg, and pt still symptomatic, give 300 cc NS bolus (no CHF) and 0.5 mg atropine every 3-5 mins titrate to 3mg
  • IF BP 90> mmHg and pt still symptomatic after 2nd dose atropine, give dopamine 5-20 mcg/kg/mins to maintain BP of 100-110 mmHg
  • commo for analgesia for pacing
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6
Q

Burn (indication)

A

Any burned person who is conscious and in considerable pain

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7
Q

Burn

A
  • Intubate if necessary or O2 via NC/NRM, maintain SpO2 >90%
  • IV w/ NS, if burns 2nd/3rd AND >15%, give 500 cc NS bolus
  • IF BP >100 mmHg, give MS 2 mg or Fent 50 mcg
  • Repeat MS every 3-5 mins, max dose of 10 mg (5 doses) as long as BP maintains
    or
  • Repeat Fent every 3-5 mins, Max dose of 150 mcg (3 doses) as long as BP maintains
  • if resp depression after analgesia, give Narcan 0.5 mg IV titrate to 2 mg, if no IV, give 2mg Narcan IN
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8
Q

Isolated Extremity Fracture (Indication)

A

For painful extremity injury w/ high probability of Fx or dislocation in person who is otherwise not significantly ill or injured

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9
Q

Isolated Extremity Fracture

A
  • O2 via NC/NRM
  • IV @TKO
  • IF BP >100 mmHg, give MS 2 mg or Fent 50 mcg
  • Repeat MS every 3-5 mins, max dose of 10 mg (5 doses) as long as BP maintains
    or
  • Repeat Fent every 3-5 mins, Max dose of 150 mcg (3 doses) as long as BP maintains
  • if resp depression after analgesia, give Narcan 0.5 mg IV titrate to 2 mg, if no IV, give 2mg Narcan IN
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10
Q

Hypoglycemia

A

Check BGL and IF 70> mg/dl:
- pt alert and able to swallow/maintain airway, give 50 g oral glucose PO
or
- pt unable to swallow/unconscious, give 25g IV D50
or
- If no IV unavailable, give 2mg glucagon IM

Recheck BGL

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11
Q

Tension Pneumothorax (indication)

A
  • Decreased breath sounds unilaterally or throughout the lungs
  • persistent hypoxia w/ poor lung compliance
  • Pt’s with severe blunt/penetrating trauma to chest/abdomen w/ positive pressure ventilation
  • Possible JVD/tracheal deviation and/or SubCu emphysema
  • RO impromper ET placement or equipment failure FIRST
  • SpO2 90>% OR BP 80> mmHg
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12
Q

Tension Pneumothorax

A

Indicated:: exacerbated tachycardia/dyspnea/decreased LS with decreased mental status and JVD
Needle decompression:
- 2nd intercostal space mid clavicular (ride 3rd rib)
or
- 4th intercostal space mid axillary (right 5th rib)
use 16-14 g 2.25” or longer with syringe attached, secure and attach K-52, burp dressing if indicated

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13
Q

Hypovolemic Shock (indications)

A

Systollic BP 90> mmHg secondary to hypovolemia

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14
Q

Hypovolemic Shock

A
  • O2 via NRM
  • IV @ rapid rate to maintain BP >90 mmHg
  • if no improvement check for S/S of obstructive shock (IE: JVD), put IV TKO
  • no IV after 2 mins, start IO
  • Transport immediately, start 2nd IV enroute
    IF
  • Trauma w/ hemorrhagic shock, use 200 cc bolus until BP 80 mmHg if no head injury, with head injury bring BP to 100 mmHg and drop IV to TKO
  • Keep pt warm with blanket and no AC, cover wounds
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15
Q

Severe Vomiting

A
  • EKG/SpO2
  • IV or Oral Zofran 4 mg
  • repeat once in 5 mins if vomiting not controlled (max 8 mg zofran)
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16
Q

Pulmonary Edema/CHF - Indications

A

For pt’s w/ dyspnea and rales present in both lungs, WITHOUT fever

17
Q

Pulmonary Edema/CHF

A
  • O2
  • NTG 0.4 mg SL (IF BP >100 mmHg) every 5 mins (x5 max dose and BP maintains)
  • CPAP applied if no contraindications
  • IV @ TKO
  • Dopamine 5-20 mcg IV (if BP 90> mmHg to maintain 100-110 mmHg)
18
Q

Pulmonary Edema/CHF - CPAP Contraindications (4)

A
  • BP >90 mmHg w/out dopamine
  • Pt awake and able to follow commands
  • Face mask fits
  • Pt able to maintain open airway
19
Q

Dyspnea/Near Drowning

A
  • O2 via NRM or BVM
  • IF pulmonary edema/CHF suspected, go to SO
  • CPAP applied if pt suspected near drowning without contraindications
20
Q

Dyspnea/Near Drowning - CPAP Indication/Contraindication

A
  • Pt awake and able to follow commands
  • Mask fits pt
  • Pt able to maintain an open airway
  • Pt exhibits two or more of the following:
  • **RR >25 BPM
  • **SpO2 94>%
  • **Accessory muscles are used during respiration
  • **Rales audible
21
Q

Chest Pain - Indications

A

For ongoing or recent chest discomfort suggestive of myocardial ischemia

22
Q

Chest Pain

A
  • O2 via NC/NRM if SpO2 94>%
  • 12 lead EKG, Transmit if S-T elevation present
  • NTG 0.4 mg (if BP >100 mmHg and no contraindications) every 5 mins if BP maintains
  • 162 mg ASA PO if no contraindications
  • IV @ TKO
  • after NTG x3, commo for additional orders
23
Q

Sz - indications

A

continuous generalized sz or repeated sz w/out return of consciousness

24
Q

Sz

A
  • O2 NRM/BVM
  • BGL check
  • if Sz 5> mins since onset, versed 10 mg IN or IM
  • IV @ TKO
  • if Sz 2> mins 5mg valium IV, repeat in 2 mins
  • if sz persists after 2 dose valium, commo for orders after 5 mins
    no valium, use lorazepam or versed 2 mg, repeat in 2 mins, commo after 5
  • intubate if SpO2 cannot maintain 90% w/ O2
25
Q

Cardiac Arrest - Renal Dialysis - Indications

A

CPA pt with hx of renal dialysis due to possible hyper K

26
Q

Cardiac Arrest - Renal Dialysis

A

IV @ TKO

  • 1g Calcium Chloride IV
  • flush line thoroughly
  • 1 mEq/kg IV
  • repeat once
27
Q

AMS

A
  • Check BGL 70> mg/dL, go to hypoglycemia SO
  • if BGL >70 mg/dL and SpO2 >94%
  • give Narcan IV 2 mg IN
    or
  • Narcan IV 0.5 mg titrate to 2mg
    No IV, give Narcan 2 mg IM

Standing Orders (2 decks)

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