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2nd Year PCP > ALS PCS > Flashcards

ALS PCS Flashcards

(98 cards)

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1
Q

ROSC- Indications

A

Patient with ROSC after the resuscitation was initiated

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2
Q

ROSC- 0.9% NaCl Fluid Bolus Conditions

A

Age: ≥ 2 years
SBP: Hypotensive
Other: Chest auscultation is clear

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3
Q

ROSC- 0.9% NaCl Fluid Bolus Contraindications

A

Fluid Overload

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4
Q

ROSC Treamtent- Consider optimizing ventilation and oxygenation

A

Titrate oxygen 94-98%
Avoid hyperventilation and target ETCO2 to 30-40mmHg with continuous waveform capnography (if available)

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5
Q

ROSC- 0.9% NaCl Fluid Bolus Treatment

A

Age: ≥ 2 years to < 12 years
Route: IV
Infusion: 10ml/kg
Infusion interval: immediate
Reassess every: 100 ml
Max volume: 1000ml

Age: ≥ 12 years
Route: IV
Infusion: 10ml/kg
Infusion interval: immediate
Reassess every: 250 ml
Max volume: 1000ml

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6
Q

ROSC- Clinical Considerations

A

Consider initiating transport in parallel with the above treatment.

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7
Q

Cardiac Ischemia- Indications

A

Suspected cardiac ischemia

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8
Q

Cardiac Ischemia- Conditions ASA

A

Age: ≥ 18 years
LOA: unaltered
Other: Able to chew and swallow

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9
Q

Cardiac Ischemia- Conditions Nitroglycerin

A

Age: ≥ 18 years
LOA: unaltered
HR: 60-159 bpm
SBP: normotensive
Other: prior history of nitro use or IV access obtained

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10
Q

Cardiac Ischemia- Contraindications ASA

A

Allery or sensitivity to NSAIDs
If asthmatic, no prior use of ASA
Current active bleeding
CVA or TBI in the previous 24 hours

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11
Q

Cardiac Ischemia- Contraindications Niroglycerin

A

Allergy or sensitivity to nitrates
Phosphodiesterase inhibitor use within the previous 48 hours
SBP drops by one-third or more of its initial value after nitroglycerin is administered
12-lead ECG compatible with Right Ventricular MI

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12
Q

Cardiac Ischemia- Treatment ASA

A

Route: PO
Dose: 160-162 mg
Max single dose: 162 mg
Max # of doses: 1

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13
Q

Cardiac Ischemia- Treatment Nitroglycerin

A

NON STEMI
Route: SL
Dose: 0.3-0.4 mg
Max single dose: 0.4mg
Dosing interval: 5 min
Max # of doses: 6

STEMI POSITIVE
Route: SL
Dose: 0.3-0.4 mg
Max single dose: 0.4mg
Dosing interval: 5 min
Max # of doses: 3

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14
Q

Cardiac Ischemia- Clinical Considerations

A

Suspect a RV MI in all inferior STEMI’s and perform V4R to confirm (≥1mm of elevation in V4R)
Do not administer nitro to RV MI
Apply defib pads with a STEMI is identified
Get a 12-lead in < 10 mins of patient contact

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15
Q

ACPE- Indications

A

Moderate to severe resp. distress
AND
Suspected ACPE

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16
Q

ACPE- Conditions Nitroglycerin

A

Age: ≥ 18 years
HR: 60-159bpm
SBP: normotension

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17
Q

ACPE- Contraindications Nitroglycerin

A

Allergy or sensitivity to nitrates
Phosphodiesterase inhibitor use within previous 48 hours
SBP drops by one-third of its initial value after nitroglycerin is administered

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18
Q

ACPE- Treatment Nitroglycerin

A

SBP: ≥100 mmHg to <140 mmHg
IV or Hx: yes
Route: SL
Dose: 0.3-0.4 mg
Max single dose: 0.4mg
Dosing interval: 5 min
Max # of doses: 6

SBP: ≥140 mmHg
IV or Hx: no
Route: SL
Dose: 0.3-0.4 mg
Max single dose: 0.4mg
Dosing interval: 5 min
Max # of doses: 6

SBP: ≥140 mmHg
IV or Hx: yes
Route: SL
Dose: 0.6-0.8 mg
Max single dose: 0.8mg
Dosing interval: 5 min
Max # of doses: 6

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19
Q

Hypoglycemia- Indications

A

suspected hypoglycemia

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20
Q

Hypoglycemia- Conditions Dextrose

A

Age: ≥ 2 years
LOA: altered
Other: hypoglycemia

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21
Q

Hypoglycemia- Conditions Glucagon

A

LOA: altered
Other: hypoglycemia

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22
Q

Hypoglycemia- Contraindications Dextrose

A

Alltergy or sensitivity to dextrose

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23
Q

Hypoglycemia- Contraindicaitons Glucagon

A

Allergy or sensitivity to glucagon
Pheochromocytoma

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24
Q

Hypoglycemia- Treatment Dextrose

A

Concentration: 10% dextrose
Route: IV
Dose: 0.2g/kg (2ml/kg)
Max single dose: 25g (250ml)
Dosing Interval: 10 mins
Max # of doses: 2

Concentration: 10% dextrose
Route: IV
Dose: 0.5g/kg (1ml/kg)
Max single dose: 25g (50ml)
Dosing Interval: 10 mins
Max # of doses: 2

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25
Hypoglycemia- Glucagon Treatment
Weight: <25kg Route: IM Dose: 0.5mg Max single dose: 0.5mg Dosing interval: 20 mins Max # of doses: 2 Weight: ≥ 25kg Route: IM Dose: 1mg Max single dose: 1mg Dosing interval: 20 mins Max # of doses: 2
26
Hypoglycemia- Clinical Considerations
If the patient responds to dectrose or glucagon, they may recieve oral glucose or other simple carbohydrates If only mild signs or symptoms are exhibited, the pt may recieve oral glucose or other simple carbohydrates instead of medications. If a patient initiates an informed refusal os transport, a final set of vital signs including blood glucometry must be attempted and documented
27
Bronchoconstriction- Indications
Resp. distress AND Suspected bronchoconstriction
28
Bronchoconstriction- Conditions Epinepherine
RR: BVM ventilation required Other: Hx of asthma
29
Bronchoconstriction- Conditions Salbutamol
NONE
30
Bronchoconstriction- Conditions Dexamethasone
Hx of asthma OR COPD OR 20-pack-year history of smoking
31
Bronchoconstriction- Contraindications Salbutamol
Allergy or sensitivity to salbutamol
32
Bronchoconstriction- Contraindications Epinepherine
Allergy or sensitivity to epinepherine
33
Bronchoconstriction- Contraindications Dexamethasone
Allergy or sensitivity to steroids Currently on PO or parental steroids
34
Bronchoconstriction- Treatment Salbutamol
Weight: < 25 kg Route: MDI Dose: up to 600 mcg (6 puffs) Max single dose: 600 mcg Dosing interval 5-15 mins PRN Max # of doses: 3 Weight: < 25 kg Route: NEB Dose: 2.5mg Dosing interval: 5-15 min PRN Max # of doses: 3 Weight: ≥ 25 kg Route: MDI Dose: Up to 800 mcg Max single dose: 800 mcg Dosing interval 5-15 mins PRN Max # of doses: 3 Weight: ≥ 25 kg Route: NEB Dose: 5mg Dosing interval: 5-15 min PRN Max # of doses: 3
35
Bronchoconstriction- Treatment Epinepherine
Route: IM Concentration: 1mg/ml= 1:1000 Dose: 0.01mg/kg Max single dose: 0.5mg Max # of doses: 1
36
Bronchoconstriction- Treatment Dexamethasone
Route: PO/IM/IV Dose: 0.5mg/kg Max singl dose: 8mg Max # of doses: 1
37
Bronchoconstriction- Clinical Considerations
Epi should be the first med administered if the pt is apneic. Salbutamol MDI may be administered subsequently using a BVM MDI adapter. Nebulization is contraindicated in patients with a known or suspected fever or in the setting of a declared febrile respiratory illness outbreak by the local medical officer of health. When administering salbutamol MDI, the rate of administration should be 100 mcg approx. every 4 breaths. A spacer should be used when administering salbutamol MDI.
38
Mod to Severe Allergic Rx.- Indications
Exposure to a probable allergen AND Signs and symptoms of a moderate to severe allergic reaction (including anaphylaxis)
39
Mod to Severe Allergic Rx.- Conditions Epinepherine
FOR ANAPHYLAXIS ONLY
40
Mod to Severe Allergic RX.- Conditions Diphenhydramine
Weight: ≥ 25 kg
41
Mod to Severe Allergic Rx.- Epinepherine Contraindications
Allergy or sensitivity to epinepherine
42
Mod to Severe Allergic Rx.- Diphenhydramine Contraindications
Allergy or sensitivity to diphenhyramine
43
Mod to Severe Allergic Rx.- Treatment Epinepherine
Route: IM Concentration: 1mg/ml=1:1000 Dose: 0.01mg/kg Max single dose: 0.5mg Dosing interval: 5 min Max # of doses: 2
44
Mod to Severe Allergic Rx.- Treatment Diphenhydramine
Weight: ≥ 25 to < 50 kg Route: IV/IM Dose: 25 mg Max single dose: 25 mg Max # of doses: 1 Weight: ≥ 50 kg Route: IV/IM Dose: 50 mg Max single dose: 50 mg Max # of doses: 1
45
Mod to Severe Allergic Rx.- Clinical Considerations
Epinepherine administration takes priority over IV access.
46
Croup- Indications
Current history of URTI AND Barking cough or recent history of barking cough
47
Croup- Conditions Epinepherine
Age: ≥ 6 months to < 8 years HR: <200 bpm Other: Stridor at rest
48
Croup- Conditions Dexamethasone
Age: ≥ 6 months to < 8 years LOA: unaltered Other: mild, moderate to severe croup
49
Croup- Contraindications Epinepherine
Allergy or sensitivity to epinepherine
50
Croup- Contraindications Dexamethasone
Allergy or sensitivity to steroids Steroids received within the last 48 hours Unable to tolerate oral meds
51
Croup- Treatment Epinepherine
Weight: <10 kg Route: NEB Concentration: 1mg/ml=1:1000 Dose: 2.5mg Max single dose: 2.5mg Max # of doses: 1 Weight: ≥ 10 kg Route: NEB Concentration: 1mg/ml=1:1000 Dose: 5 mg Max single dose: 5 mg Max # of doses: 1
52
Croup- Treatment Dexamethasone
Route: PO Dose: 0.5 mg/kg Max single dose: 8 mg Max # of doses: 1
53
Supraglottic Airway- Indications
Need for ventilatory assistance or airway control AND Other airway management is ineffective
54
Supraglottic Airway- Conditions
Other: Absent gag reflex
55
Supraglottic Airway- Contraindications
Airway obstructed by a foreign object Known esophageal disease (varices) Trauma to the oropharynx Caustic ingestion
56
Supraglottic Airway- What is the maximum number of insertion attempts?
2
57
Supraglottic Airways- Primary and Secondary methods of confirmation
Primary- ETCO2 (waveform capnography) Secondary- ETCO2 (non waveform device), auscultation, chest rise
58
Supraglottic Airways- Clinical Considerations
An attempt at supraglottic airway insertion is defined as the insertion of a supraglottic airway into the mouth. Confirmation of supraglottic airway should use ETCO2 (Waveform capnography). If waveform capnography is not available or is not working, then at least 2 secondary methods must be used.
59
N/V- Indications
Nausea or vomiting
60
N/V- Conditions Ondansetron
Weight: ≥25 kg LOA: unaltered
61
N/V- Conditions Dimenhydrinate
Age: < 65 years Weight: ≥25 kg LOA: unaltered
62
N/V- Contraindications Ondansetron
Allergy to ondansetron Prolonged QT syndrome Apomorphine use
63
N/V- Contraindications Dimenhydrinate
Allergy or sensitivity to dimenhydrinate Overdose on antihistamines or anticholinergics or tryclic antidepressant Co-administration of diphenhydramine
64
N/V- Treatment Ondansetron
Route: PO Dose: 4mg Max single dose: 4mg Max # of doses: 1
65
N/V- Treatment Dimenhydrinate
Weight: ≥25 kg to <50 kg Route: IV/IM Dose: 25mg Max single dose: 25mg Max # of doses: 1 Weight: ≥50 kg Route: IV/IM Dose: 50 mg Max single dose: 50 mg Max # of doses: 1
66
N/V- Clinical Considerations
Prior to IV administration, dilute dimenhydrinate (concentration of 50mg/1ml) 1:9 with normal saline or D5W. If IM, do not dilute. If a patient has received Ondansetron and has no relief of their nausea & vomiting symptoms after 30 mins, dimenhydrinate may be considered.
67
Opioid Toxicity- Indications
Altered LOC AND Resp. depression AND Inability to adequately ventilate OR persistent need for ventilation AND Suspected overdose
68
Opioid Toxicity- Conditions Naloxone
Age: ≥ 24 hours LOA: altered RR: < 10 breaths/min
69
Opioid Toxicity- Contraindications Naloxone
Allergy or sensitivity to naloxone
70
Opioid Toxicity- Treatment Naloxone
Route: IV Dose: up to 0.4mg Max single dose: 0.4mg Dosing interval: 5 min Max # of doses: 3 Route: IM Dose: 0.4mg Max single dose: 0.4mg Dosing interval: 5 min Max # of doses: 3 Route: IN Dose: 2-4mg Max single dose: 2-4mg Dosing interval: 5 min Max # of doses: 3 Route: SC Dose: 0.8mg Max single dose: 0.8mg Dosing interval: 5 min Max # of doses: 3
71
Opioid Toxicity- Clinical Considerations
Upfront aggressive management of the airway is paramount and the initial priority. If no response to initial treatment; consider patching for further doses. If the pt does not respond to airway management and the administration of naloxone, glucometry should be considered. Combative behaviour should be anticipated following naloxone administration and paramedics should protect themselves accordingly, thus the importance of gradual titrating (if given IV) to desired clinical effect; RR: ≥ 10, adequate airway and ventilation, not full alertness.
72
Adrenal Crisis- Indications
A patient with primary adrenal failure who is experiencing clinical signs of adrenal crisis.
73
Adrenal Crisis- Conditions Hydrocortisone
Paramedics are presented with a vial of hydrocortisone for the identified patient AND Age-related hypoglycemia OR GI symptoms (vomiting, diarrhea, abdo pain) OR Syncope OR Temp ≥ 38 degrees or suspected/history of fever OR Altered LOA OR Age-related tachycardia OR Age-related hypotension
74
Adrenal Crisis- Contraindications Hydrocortisone
Allergy or sensitivity to hydrocortisone
75
Adrenal Crisis- Treatment Hydrocortisone
Route: IM/IV Dose: 2mg/kg Max single dose: 100mg Max # of doses: 1
76
Emergency Childbirth- Indications
Pregnant patient experiencing labour OR Post-partum patient immediately following delivery and/or placenta
77
Emergency Childbirth- Conditions Oxytocin
Age: Childbearing years SBP: <160 mmHg Other: Postpartum delivery AND/OR Placental delivery
78
Emergency Childbirth- Contraindications Oxytocin
Allergy or sensitivity to oxytocin Undelivered fetus Suspected or known pre-eclampsia with current pregnancy Eclampsia (seizures) with current pregnancy ≥ 4 hours post placenta delivery
79
Emergency Childbirth- Treatment Oxytocin
Route: IM Dose: 10 units Max single dose: 10 units Max # of doses: 1
80
IV and Fluid Therapy- Indications
Actual or potential need for intravenous medication OR fluid therapy
81
IV and Fluid Therapy- Conditions IV Cannulation
Age: ≥ 2 years
82
IV and Fluid Therapy- Conditions 0.9% NaCl Fluid Bolus
Age: ≥ 2 years SBP: hypotensive
83
IV and Fluid Therapy- Contraindications IV Cannulation
Suspected fracture proximal to the access site
84
IV and Fluid Therapy Contraindications 0.9% NaCl Fluid Bolus
Fluid Overload
85
IV and Fluid Therapy- 0.9% NaCl Maintenance Infusion
Age: ≥ 2 years to < 12 years Route: IV Infusion 15 ml/hr Age: ≥ 12 years Route: IV Infusion 30-60 ml/hr
86
IV and Fluid Therapy- Mandatory Patch Point
Patch to BHP for authorization to administer 0.9% NaCl fluid bolus to hypotensive patients ≥ 2 years to < 12 years with suspected DKA
87
IV and Fluid Therapy- Treatment 0.9% NaCl Fluid Bolus
Age: ≥ 2 years to < 12 years Route: IV Infusion: 20 ml/kg Reassess every: 100 ml Max volume: 2000 ml Age: ≥ 12 years Route: IV Infusion: 20 ml/kg Reassess every: 250 ml Max volume: 2000 ml
88
IV and Fluid Therapy- Clinical Considerations
Microdrips and/or volume control administration sets should be considered when IV access is indicated for patients < 12 years of age. An IV fluid bolus may be considered for a patient who does not meet trauma TOR criteria, where it does not delay transport and should not be prioritized over management of other reversible causes.
89
Cardiogenic Shock- Indications
STEMI positive 12 lead ECG AND Cardiogenic shock
90
Cardiogenic Shock- Conditions 0.9% NaCl Fluid Bolus
Age: ≥ 18 years SBP: hypotensive Other: chest auscultation
91
Cardiogenic Shock- Contraindications 0.9% NaCl Fluid Bolus
Fluid Overload SBP ≥ 90 mmHg
92
Cardiogenic Shock- Treatment 0.9% NaCl Fluid Bolus
Route: IV Infusion: 10 ml/kg Reassess every: 250 ml Max Volume: 1000 ml
93
CPAP- Indications
Severe resp. distress AND signs and/or symptoms of acute pulmonary edema or COPD
94
CPAP- Conditions
Age: ≥ 18 years old RR: tachypnea SBP: normotension Other: Spo2 < 90% or accessory muscle use
95
CPAP- Contraindications
Asthma exacerbation Suspected pneumothorax Unprotected or unstable airway Major trauma or burns to the head or torso Tracheostomy Inability to sit upright Unable to cooperate
96
CPAP- Treatment
Initial Setting: 5 cm H2O or equivalent flow rate of device as per RBHP direction Titration increment: 2.5 cm H2O or equivalent... Titration interval: 5 min Max setting: 15 cm H2O or equvalent...
97
CPAP- Consider increasing FiO2 (if available)
Initial FiO2: 50-100% FiO2 increment (if available on device): Spo2 <92% despite treatment and/or 10 cm H2O pressure or equivalent flow rate of device as per RBHP direction Max FiO2: 100%
98

2nd Year PCP (11 decks)

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