Directives

Question 1

Contraindications for adenosine

Answer 1

Allergy
Sinus tach, a fib, a flutter
Taking carbamazepine (Tegretol) or dipyridamole (persantine)
Broncho construction on exam

Question 2

Amiodarone dose for tachydysthymia

Answer 2

150mg q10 mins
2 doses

Question 3

Lidocaine dose for tachydysrhytmia

Answer 3

1.5mg/kg
Subsequent dose 0.75mg/kg
3 doses q10 mins

Question 4

Dopamine contraindications for ROSC

Answer 4

Allergy
Pheochromocytoma
Tachydysrhythmia
Mechanical shock

Question 5

Morphine dose for cardiac ischemia vs pain

Answer 5

2mg q5 minutes (5 doses)

Vs

0.05-0.1mg/kg (>1- <18), Max 5mg, q15, max 10mg

2-10mg (>18yo), q15, max 20mg

Question 6

What age do you have to patch for dose verification in pain medication?

Answer 6

Less than 12 years old.

Question 7

What are the indications for needle thoracostomy in traumatic arrest?

Answer 7

Age N/A
LOA N/A
HR N/A
RR N/A
SBP N/A
Other: suspected tension pneumothorax AND absent or severely diminished breath sounds on affected side.

Question 8

What are the indications and conditions for needle thoracostomy in the tension pneumothorax medical directive?

Answer 8

Indications: pre-arrest or VSA AND absent or diminished breath sounds on affected side

Age N/A
LOA N/A
HR N/A
RR N/A
SBP: hypotension or VSA
Other N/A

Question 9

What are the contraindications for dopamine in cardiogenic shock?

Answer 9

Allergy
Tachydysrhymias
Mechanical shock
Hypovolemia
Pheochcomocytoma

Question 10

What are the contraindications for dopamine in cardiogenic shock?

Answer 10

Allergy
Tachydysrhymias
Mechanical shock
Hypovolemia
Pheochcomocytoma

Question 11

What are the routes for fentanyl in procedural sedation directive?

Answer 11

IV, IO, CVAD, IN

Question 12

What are the routes for fentanyl in procedural sedation directive?

Answer 12

IV, IO, CVAD, IN

Question 13

What are the routes for Midazolam in procedural sedation?

Answer 13

IV, IO, CVAD, IN

Question 14

Can you give fentanyl and midazolam for procedural sedation if hypotension was present but corrected?

Answer 14

Yes

Question 15

What are the routes of administration for calcium gluconate?

Answer 15

IV, IO, CVAD

Question 16

What is the ETT epi dose in neonate resus?

Answer 16

1:10,000
0.1mg/kg
Max dose 0.3mg (3ml)
Max # of doses 1

Question 17

What are the indications for tension pneumothorax directive?

Answer 17

Pre-arrest or VSA

AND

Absent or severely diminished breath sounds

Question 18

What are the routes for fentanyl for pain?

Answer 18

IV/IN

Question 19

What are the routes for morphine for the pain directive?

Answer 19

IV/SC

Question 20

What is the route for dopamine in ROSC medical directive?

Answer 20

IV

Question 21

What is the route if administration for midazolam in combative directive?

Answer 21

IV/IM/IN

Question 22

What is the route of administration for ketamine in combative patient directive?

Answer 22

IM

Question 23

What are the indications for pediatric/adult IO

Answer 23

Need for fluid/meds

AND

IV unobtainable

AND

Pre arrest or VSA

Question 24

What are the routes for midazolam in seizure activity?

Answer 24

IV, IO, IM, IN, Buccal

Double dose for IM, IN, Buccal

Question 25

What are the indications for cricothyrotomy?

Answer 25

Need to advanced airway management AND Intubation and supraglottic airway unsuccessful AND Unable to ventilate

Question 26

What are the indications for CVAD access

Answer 26

Actual or potential need for fluid/meds And IV unsuccessful AND cardiac arrest or prearrest

Question 27

What are the contraindications for CVAD

Answer 27

Inability to confirm patency Inability to flush or aspirate Injury or fracture proximal Swelling of involved limb Bleeding at insertion site

Question 28

What is the route of admin for atropine?

Answer 28

IV

Question 29

What is the route of administration for dopamine in bradycardia?

Answer 29

IV

Question 30

What type of medication is atropine?

Answer 30

Antimuscarinic

Question 31

How does atropine work?

Answer 31

Works through the inhibition of post synaptic acetylcholine receptors. Blocks the parasympathetic response and allows sympathetic drive to take over.

Question 32

How does dopamine work?

Answer 32

Dopamine is a catecholamine that works on the alpha and beta receptors. 5mcg is beta dose increasing heart rate and contractility. Alpha dose causes vasoconstriction.

Question 33

What is the route of administration for amiodarone in cardiac arrest?

Answer 33

IV/IO/CVAD

Question 34

What is the route of administration of lidocaine in cardiac arrest?

Answer 34

IV/IO/CVAD/ETT

Question 35

What are the contraindications of intubation?

Answer 35

Age <50 AND asthma AND not in or near cardiac arrest

Question 36

What are the routes of administration of amiodarone in tachydysrhythmia directive?

Answer 36

IV

Question 37

What is the classification of adenosine? And how does it work?

Answer 37

Purine nucleoside Across on purinergic adenosine receptors which are located in AV node. Drives K+ outside of cells and inhibits Ca+ influx leading to HYPERpolarization.

Question 38

What is the classification and effect of amiodarone?

Answer 38

Class III antiarryhtmic Works by inhibiting influx of Na+, as well as Ca+ Has alpha and beta ANTAGONIST effects Blocks K+ during phase 3 of cardiac action potential (repolarization) Prolongs refractory period of cardiac myocytes

Question 39

What is the classification of lidocaine and what is its effect?

Answer 39

Class 1B antiarrythmic Binds to sodium channels and slows down influx of Na+ into cardiac myocytes.