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Ventura County EMS Protocols > Initial ALS Test > Flashcards

Initial ALS Test Flashcards

1
Q

What is the Tx for ADULT anaphylaxis without shock

A
  1. IV/IO access
    Benadryl
    IV/IO/IM – 50 mg
  2. Epinephrine 1 mg/mL, if not already administered by
    BLS personnel
    o IM - 0.3 mg
    o May repeat q 5 minutes if patient remains in distress
  3. Albuterol (if wheezing is present)
    o Nebulizer – 5 mg/6 mL
    o May repeat as needed
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2
Q

What is the Tx for ADULT anaphylaxis WITH shock

A

Epinephrine 10mcg/mL
o 1mL (10mcg) every 2 minutes, slow IV/IO push
o Titrate to SBP of greater than or equal to 90mm/Hg
* Initiate 2nd IV/IO
Normal Saline
o IV/IO bolus – 1 Liter
o May repeat x 1 as indicated

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3
Q

Tx for PEDS Anaphylaxis WITHOUT Shock

A

Epinephrine 1 mg/mL, if not already administered by BLS
personnel
o IM – 0.01 mg/kg up to 0.3mg
o May repeat q 5 minutes if patient remains in distress
Albuterol (if wheezing is present)

  • Patient ≤ 30 kg
    o Nebulizer – 2.5 mg/3 mL
    o Repeat as needed
  • Patient > 30kg
    o Nebulizer – 5 mg/6 Ml
    o Repeat as needed
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4
Q

Tx PEDS Anaphylaxis WITH shock

A

Epinephrine 10mcg/mL
o 0.1mL/kg (1mcg/kg) every 2 minutes, slow IV/IO push
o Max single dose of 1mL or 10mcg
o Titrate to SBP of greater than or equal to 80 mm/Hg
* Initiate 2nd IV if possible or establish IO
Normal Saline
o IV/IO bolus – 20 mL/kg
o May repeat x 1 as indicated

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5
Q

Tx for 17kg Peds with Anaphylaxis WITH shock?

A
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6
Q

Tx for ALC (Altered LOC) Adult

A

IV/IO Access
Determine Blood Glucose level, if not already performed
by BLS personnel or post oral glucose administration

If less than 60 mg/dl
* D10W
o IV/IOPB-100 mL (10 g)-Rapid Infusion
* Glucagon (If no IV access)
o IM – 1 mg
Recheck Blood Glucose level 5 min after Dextrose, or 10 min after
Glucagon administration
If still less than60 mg/dl
* D10W
o IV/IOPB-150 mL (15 g)-Rapid Infusion

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7
Q

Tx - PEDS Altered LOC

A

IV/IO Access
Determine Blood Glucose level, if not already performed
by BLS personnel or post oral glucose administration

If less than 60 mg/dl
* D10W
o IV/IOPB-5 mL/kg-Rapid Infusion
o Max 100 mL
* Glucagon (If no IV/IO access)
o IM – 0.1 mL/kg
o Max 1 mg
Recheck Blood Glucose level 5 min after Dextrose or 10 min
after Glucagon administration
If still less than 60 mg/dl
* D10W
o IV/IOPB-7.5 mL/kg-Rapid Infusion
o Max 150 mL

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8
Q

? AEIOUPITS

A

A - Alcohol
O - Overdose. I - Infection
E - Epilepsy U - Uremia P - Psychiatric
I - Insulin T - Trauma
S – Stroke

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9
Q

Tx Adult behavioral emergencies

A

IV/IO Access
For Extreme Agitation
* Midazolam
o IM – 5mg or 10 mg (5mg/ml)
o IV/IO – 2 mg
* Repeat 1 mg q 2 min as
needed
* Max 5 mg
When safe to perform, determine blood
glucose leve

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10
Q

Tx PEDIATRIC behavioral emergencies

A

IV/IO Access
For Extreme Agitation
* Midazolam
o IM – 0.1 mg/kg
* Max 5 mg
o IV/IO – 0.1 mg/kg
* Repeat q 2 min as needed
* Max single dose 2 mg
* Max total dose 5 mg
When safe to perform, determine blood
glucose level

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11
Q

Tx for Bites and Stings

A

Animal/insect bites:
* Flush site with sterile water
* Control bleeding
* Apply bandage
Snake bites/envenomation:
* Mark the edge of the inflammatory process ASAP and then every 10-15
minutes
* Remove rings and constrictions
* Immobilize the affected part in a neutral position
* Avoid excessive activity
Bee stings:
* If present, quickly remove stinger
* Apply ice pack
Jellyfish stings:
* Rinse thoroughly with normal saline
o DO NOT:
* Rinse with fresh water
* Rub with wet sand
* Apply heat
All other marine animal stings:
* If present, remove barb
* Immerse in hot water if available
Administer oxygen as indicated
All bites other than snake bites may be treated as a BLS call

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12
Q

Are snakebites ALS or BLS?

A

ALS

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13
Q

Pediatric Rule of 9s

A
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14
Q

Adult Rule of 9s

A
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15
Q

ALS standing order for ADULT Burns

A

IV/IO access
Pain Control – per Policy 705.19
If TBSA greater than 10% or hypotension is
present:
* Normal Saline
o IV/IO bolus – 1 Liter

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16
Q

PEDS standing order for PEDS Burns

A

IV/IO access
Pain Control – per Policy 705.19
If TBSA greater than 10% or hypotension is
present:
* Normal Saline
o IV/IO bolus – 20 mL/kg

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17
Q

Tx for Pain Control (with and without Fentanyl)

A

IV/IO access
Cardiac Monitor
Pain 5 out of 10 or greater and SBP > 90 mmHg
Fentanyl
* IV/IO - 1 mcg/kg over 1 minute, OR IN/IM – 1mcg/kg
* Max single dose 100 mcg
* May repeat q 5 minutes for persistent pain to a max total dose 200 mcg
* Repeat doses should be administered IV/IO if vascular access obtained

If Fentanyl unavailable;
Ondansetron - Per 705.15 Nausea/Vomiting Policy
* Repeat x 1 in 10 minutes for nausea or > 2 doses of Morphine
Morphine
* IV/IO - 0.1 mg/kg over 1 minute
* Max single dose 10 mg
* May repeat ½ initial dose x 2 q 5 min
OR
Morphine
* IM - 0.1 mg/kg
* Max single dose 10 mg
* May repeat ½ initial dose x 2 q 15 min

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18
Q

PEDS Cardiac Arrest / PEA

A

Assess for and treat underlying cause
IV/IO access
* PRESTO Blood Draw
Epinephrine* 0.1mg/mL
Administer ASAP goal ≤6 minutes
* IV/IO 0.01mg/kg (0.1 mL/kg) q 6 min
* Repeat x 2, max of 3 dose during initial arrest.
* If ROSC then re-arrest an additional 3 doses may
be administered.
Normal Saline
* IV/IO bolus- 20 mL/kg
ALS Airway Management
* If unable to ventilate by BLS measures, initiate
appropriate advanced airway procedures in accordance
with policy 710.
When one of the following is a suspected cause of arrest:
History of Renal Failure/Dialysis
* Calcium Chloride
o IV/IO – 20 mg/kg
o Repeat x 1 in 10 min
* Sodium Bicarbonate
o IV/IO – 1 mEq/kg
o Repeat x 2 0.5 mEq/kg q 5 min
Tricyclic Antidepressant Overdose
* Sodium Bicarbonate
o IV/IO – 1 mEq/kg
o Repeat x 2 0.5 mEq/kg q 5 min
Beta Blocker Overdose
* Glucagon
o IV/IO – 0.1 mg/kg up to 10 mg when available
Calcium Channel Blocker Overdose
* Calcium Chloride
o IV/IO – 20 mg/kg
o Repeat x 1 in 10 min
* Glucagon
o IV/IO – 0.1 mg/kg up to 10 mg when available

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19
Q

ALS Tx for VF/VT

A

Defibrillate
* Defibrillate q 2 minutes as indicated
o Lifepak 360 Joules
o Zoll 200 Joules
IV or IO access & PRESTO Blood draw
Epinephrine* 0.1 mg/mL
Administer ASAP goal ≤6 minutes
* IV/IO –1 mg (10 mL) q 6min
* Repeat x 2 for max of 3 doses during initial arrest.
* If ROSC then re-arrest an additional 3 doses may be
administered.
Amiodarone
* IV/IO – 300 mg – after second defibrillation
* If VT/VF persists, 150 mg IV/IO in 3-5 minutes
Normal Saline
* IV/IO bolus 1 Liter
ALS Airway Management
* If unable to ventilate by BLS measures, initiate
appropriate advanced airway procedures in
accordance with policy 710.
When Torsades de Pointes is identified:
o Magnesium Sulfate
o IV/IO – 2 g over 2 min
o Repeat x 1 in 5 min
Treat underlying causes when identified:
Renal Failure / History of Dialysis:
o Calcium Chloride
o IV/IO – 1g
o Repeat x 1 in 10 min
o Sodium Bicarbonate
o IV/IO – 1 mEq/kg
o Repeat 0.5 mEq/kg x 2 q 5 min
Tricyclic Antidepressant Overdose:
* Sodium Bicarbonate
o IV/IO – 1 mEq/kg
o Repeat 0.5 mEq/kg x 2 q 5 min

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20
Q

When is Amiodarone administered in VF?

A

After second defibrillation

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21
Q

For PEDS VCF/VT, what is the drug dosing and Joule setting

A

Defibrillate
* Defibrillate q 2 minutes as indicated using escalating
joules doses
o 2, 4, 6, 8 joules/kg
IV or IO access & PRESTO Blood Draw
Epinephrine* 0.1mg/mL
Administer ASAP goal ≤ 6 minutes
* IV/IO – 0.01mg/kg (0.1 mL/kg) q 6 min
* Repeat x 2 for max of 3 dose during initial arrest.
* If ROSC then re-arrest and additional 3 doses may
be administered.
Amiodarone
* IV/IO – 5 mg/kg – after second defibrillation
* If VT/VF-persists, repeat 5 mg/kg x 2 q 3-5 minutes
Normal Saline
* IV/IO 20 mL/kg bolus

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22
Q

What dos APGAR stand for?

A
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23
Q

Tx for Crush Syndrome

A

Crush Syndrome
* Initiate 2nd IV/IO access
* Normal Saline
o IV/IO bolus – 1 Liter
* Sodium Bicarbonate
o IV/IO mix – 1 mEq/kg
* Added to 1st Liter of Normal Saline
* Albuterol
o Nebulizer – 5 mg/6 mL
* Repeat as needed
* Pain Control– Per Policy 705.19
* Release compression
* Monitor for cardiac dysrhythmias
* For cardiac dysrhythmias:
o Calcium Chloride
* IV/IO slow push – 1 g over 1 min
For continued shock
* Repeat Normal Saline
o IV/IO bolus – 1 Liter
For persistent hypotension after fluid bolus:
* Epinephrine 10 mcg/mL
o IV/IO slow push - 1 mL (10 mcg) every 2
minutes
o Titrate to SBP of greater than or equal to 90
mm/Hg

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24
Q

Additional info on Crush Syndrome

A

Additional Information:
* Potential Crush Syndrome – Continuous crush injury to torso or extremity above wrist or ankle for 2 hours or less.
* Crush Syndrome – Continuous crush injury to torso or extremity above wrist or ankle for greater than 2 hours.
* Dysrhythmias are usually secondary to Hyperkalemia. ECG monitor may show: Peaked T-waves, Absent P-waves, widened QRS
complexes, bradycardia
* Calcium Chloride and Sodium Bicarbonate precipitate when mixed. Strongly consider starting a second IV (if feasible) for
administration of Calcium Chloride

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25
Q

Tx for Heat Emergencies (Adult)

A

If patient is altered, determine blood glucose
if not already performed by BLS personnel or
post oral glucose administration
If less than 60 mg/dl, refer to Policy 705.03
IV/IO access
Normal Saline
* IV/IO bolus – 1 Liter
o Caution with cardiac and/or
renal history
o Repeat x 1 for persistent
hypotension

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26
Q

? Acceptable heart rates and respiratory rates for hypothermia?

A

Acceptable range for severe hypothermia:
 Respiratory Rate: at least 4 breaths per minute
 Heart rate: at least 20 beats per minute

27
Q

ALS Tx for hypothermia

A

If patient is altered, determine blood glucose if not already performed by BLS
personnel or post oral glucose administration
If less than 60 mg/dl, refer to Policy 705.03
IV/IO access (if needed for medication or fluid administration)
* If administering fluid, avoid administering cold fluids.

28
Q

Adult ALS Tx for Hypovolemic Shock

A

IV/IO access
Normal Saline
* IV/IO bolus – 1 Liter
o Repeat x 1 for persistent signs of shock
Traumatic Injury
* Do not delay transport for IV/IO attempts
* Tranexamic Acid – For patients 15 years of
age and older as indicated in VCEMS
Policy 734
o IV/IOPB - 1g TXA in 100mL NS over 10
minutes
* Refer to Policy 705.01- Trauma Treatment
Guidelines, for fluid administration
o Goal is to maintain SBP of ≥ 80 mmHg
o Patients 65 years and older, maintain
SBP of ≥ 100 mmHg

29
Q

? Indications for Zofran?

A

Indications for Ondansetron:
1. Moderate to severe nausea or
vomiting.
2. Potential for airway compromise
secondary to suspected/actual
head injury when cervical
immobilization is used.
3. Prior to MS administration

30
Q

Zofran dosing (ADULT & PEDS)

A

ADULT
IV/IO access
* Cardiac Monitor
* Ondansetron
o PO – 4 mg ODT
* May repeat x 1 in 10 min
o IV/IM/IO – 4 mg
* May repeat x 1 in 10 min

PEDS
Ages 6 months up to 5 years
* Ondansetron
o PO – 2 mg ODT
o IV/IM/IO – 0.1 mg/kg
Ages ≥ 5 Years
* Ondansetron
o PO – 4 mg ODT
o IV/IM/IO – 0.1 mg/kg

31
Q

? Parameters for withholding resuscitation in extreme preterm neonates (</= 48hrs)

A
  • Resuscitation efforts may be withheld for extremely preterm infants (< 21 weeks or < 9 inches long).
    Sensitivity to
    the desires of the parent(s) may be considered.
    If uncertain as to gestational age, begin resuscitation.
  • A rising heart rate is the best indicator of adequate PPV.
32
Q

? neonatal CPR parameters

A

If HR < 60 bpm
◦ CPR at 3:1 ratio
 Continue CPR until HR > 60 bpm

33
Q

? parameters for ensuring adequate circulation whilst resuscitating neonate

A

If HR between 60 and 100 bpm
◦ PPV with BVM and ROOM AIR at 40-60 breaths per minute
 Continue PPV until infant maintains HR >100 bpm

34
Q

How do you correct hypoxia in a neonate

A

Correct Hypoxia
* If no improvement after 90 seconds of ROOM AIR CPR, add supplemental O2 until HR > 100

35
Q

Tx for NEONATAL Aystole / PEA OR persistent bradycardia (<60 bpm)

A

For asystole/PEA or persistent bradycardia < 60 bpm
* Epinephrine 0.1mg/mL
o IV/IO – 0.01mg/kg (0.1mL/kg) q 3-5 min
* Normal Saline
o IV/IO bolus – 10mL/kg

36
Q

Adult ALS for Overdose

A

IV/IO access
Suspected opioid overdose with respirations less than 12/min and
significant ALOC
* Naloxone, if not already administered by BLS
personnel or if patient continues with decreased
resp rate and significant ALOC
o IN – 4 mg in 0.1 mL, may repeat x1, Max of 8 mg
o IM – 2 mg q 5 min
o IV/IO – 0.4 mg q 1min
* Initial max 6 mg
o May repeat as needed to maintain respirations
greater than 12/min

37
Q

Adult ALS for Stimulant / Hallucinogenic Overdose

A

Stimulant/Hallucinogen Overdose
* Midazolam
o IV/IO – 2 mg
* Repeat 1 mg q 2 min as needed
* Max 5 mg
o IM – 0.1 mg/kg
o Max 5 mg

38
Q

Tx for dystonic Rxn (in an O/D)

A

Dystonic Reaction
* Benadryl
* IV/IO/IM – 50 mg

39
Q

? Fentanyl dosing for ADULTS

Max single dose?

Max TOTAL dose?

A

Fentanyl
* IV/IO - 1 mcg/kg over 1 minute, OR IN/IM – 1mcg/kg
* Max single dose 100 mcg
* May repeat q 5 minutes for persistent pain to a max total dose 200 mcg
* Repeat doses should be administered IV/IO if vascular access obtained

40
Q

? Parameters for treating a seizure as a BLS call?

A

Patients with a known seizure disorder or uncomplicated, apparent pediatric febrile seizures, no longer
seizing and with a normal postictal state, may be treated as a BLS call.

41
Q

? Midazolam dose (IM) for seizures?

? Max dose?

A

IV/IO access
If not already performed by BLS personnel, determine
Blood Glucose level, and treat according to VC EMS
policy 705.03 – Altered Neurologic Function
Persistent Seizure Activity
* Midazolam (Give to actively seizing
pregnant patients prior to magnesium)
* IM – 0.1 mg/kg
Max 5 mg

42
Q

? Midazolam dose (IV/IO) for seizures?

? Max dose?

A
  • IV/IO – 2 mg
    Repeat 1 mg q 2 min as needed
    Max 5 mg
43
Q

? PEDS Midazolam (IV/IO) dosing?

How often can you repeat?

What is the MAX DOSE

A

IV/IO – 0.1mg/kg,
Repeat q 2 min as needed.
Max single dose 2 mg
Max total dose 5 mg

44
Q

When do you use MgSO4 during seizures?

A

Women 20 weeks gestation to one week postpartum & No
Known Seizure History

  • Magnesium Sulfate
    o IV/IOPB – 4 g in 50 mL D5W infused
    over 10 min
  • Slow or stop infusion if bradycardia,
    heart block, or decreased
    respiratory effort occur
45
Q

ALS x for SOB / Pulmonary Edema

A

Nitroglycerin
* SL or lingual spray – 0.4 mg q 1 min x 3
o Repeat 0.4 mg q 2 min
o No max dosage
o Hold for SBP < 100 mmHg
If not already performed by BLS personnel, Initiate CPAP for moderate to severe distress
Perform 12-lead ECG (Per VCEMS Policy 726)
IV/IO access
If wheezes are present and suspect COPD/Asthma, consider:
* Albuterol
o Nebulizer – 5 mg/6 mL
* Repeat as needed

46
Q

? If pulmonary edema patient becomes hypotensive?

A

If patient presents or becomes hypotensive * Epinephrine 10 mcg/mL
o 1mL (10 mcg) q 2 minutes, slow IV/IO push
o Titrate to SBP of greater than or equal to 90 mm/Hg

47
Q

Adult SOB / Wheezes protocol

A

If not already performed by BLS personnel, consider CPAP for both
moderate and severe distress
Moderate Distress
* Albuterol
o Nebulizer – 5 mg/6 mL
o MDI with spacer -4 puffs (360 mcg) is an acceptable
alternative to nebulized Albuterol
o Repeat Albuterol as needed
Severe distress
* Epinephrine 1 mg/mL, if not already administered by
BLS personnel
o IM - 0.3mg
 May repeat q 5 minutes if patient still in distress
and unable to obtain vascular access.
* Albuterol
o Nebulizer – 5 mg/6 mL
* Repeat as needed

48
Q

? SOB / wheezes that does not improve with initial epinephrine administration

A

Severe Distress, not improving with prior epinephrine administration
* Epinephrine 10 mcg/mL
o 1 mL (10 mcg) q 2 minutes, slow IV/IO push
o Titrate to overall improvement in work of breathing

49
Q

PEDS - SOB/Wheezes (Moderate Distress)

A

Moderate Distress
* Albuterol
o Patients ≤ 30 kg
o Nebulizer – 2.5 mg/3 mL
o MDI with spacer -2 puffs (180 mcg) is an
acceptable alternative to nebulized Albuterol
o Patients > 30 kg
o Nebulizer – 5 mg/6 mL
o MDI with spacer -4 puffs (360 mcg) is an
acceptable alternative to nebulized Albuterol
o Repeat Albuterol as needed

50
Q

PEDS - SOB/Wheezes (Severe Distress)

What is distress persists beyond initial Epi?

A

Severe Distress
* Epinephrine 1 mg/mL, if not already administered by BLS
personnel
o IM – 0.01 mg/kg up to 0.3mg
* May repeat q 5 minutes, if patient remains in
distress and unable to obtain vascular access.
Establish IV/IO access

Severe Distress, not improving with prior epinephrine administration
* Epinephrine 10mcg/mL
o 0.1mL/kg (1mcg/kg) every 2 minutes, slow IV/IO
push
o Max single dose of 1mL or 10mcg
o Titrate to overall improvement in work of
breathing.

51
Q

Tx Croup

Mild

Severe (Stridor or respiratory distress)

A

Suspected Croup- Mild
* Normal Saline
o Nebulizer/Aerosolized Mask – 5 mL

Suspected croup - Severe (stridor or respiratory distress)
* Nebulized 1 mg/mL Epinephrine
o Patients less than 30 kg
o Nebulizer – 2.5 mg/2.5 mL
o Patients 30 kg and greater
o Nebulizer – 5 mg/5 mL

52
Q

Tx SVT - ADULT (Mild to moderate)

What are the max doses of the med?

A

Valsalva maneuver
IV/IO access
Stable - Mild to moderate chest pain/SOB

Adenosine
o IV/IO – 6 mg rapid push immediately
followed by 10-20 mL NS flush

No conversion or rate control
Adenosine
o IV/IO –12 mg rapid push immediately
followed by 10-20 mL NS flush
o May repeat x 1 if no conversion or rate
control. (TOTAL MAX = 30mg)

53
Q

? Tx ADULT Unstable SVT

A

Unstable - ALOC, signs of shock or CHF
Synchronized Cardioversion
o Zoll 100, 120, 150, 200 Joules
o Lifepak 100, 200, 300, 360 Joules
o Consider sedation prior to cardioversion
for special circumstances.

54
Q

? Pain / sedation med prior to cardioversion?

A

Fentanyl
o 1 mcg/kg IV/ IO / IN prior to electrical therapy

55
Q

? Adult cardioversion settings?

A

Zoll 100, 120, 150, 200 Joules
Lifepak 100, 200, 300, 360 Joules

56
Q

PEDS cardioversion settings

A

0.5, 1, 2, 4, 6, 8 joules/kg

57
Q

PEDS SVT Protocol

A

Valsalva maneuver
IV/IO access

Stable - Mild to moderate chest pain/SOB
Adenosine
o IV/IO – 0.1 mg/kg (max 6 mg) rapid push
immediately followed by 10-20 mL NS flush

No conversion or rate control
Adenosine
o IV/IO – 0.2 mg/kg (max 12 mg) rapid push
immediately followed by 10-20 mL NS flush
o May repeat x 1 if no conversion or rate
control

58
Q

ADULT initial Tx for symptomatic bradycardia

A

IV/IO access
Obtain 12-lead ECG
Atropine
* IV/IO – 0.5 mg (0.1 MG/mL)
If initial Atropine is transiently effective, or patient
remains bradycardic without hemodynamic compromise.
* May repeat Atropine 0.5 mg IV/IO q 5 min to a
total max dose of 3 mg.

59
Q

With symptomatic brady, what is the next line of Tx (ADULT) after intial drug intervention?

A

Transcutaneous Pacing (TCP)
* Should be initiated only if patient has signs of
hypoperfusion
* Should be started immediately for 3º heart
blocks and 2º Type 2 (Mobitz II) heart blocks
* If pain is present during TCP
o Pain Control– per policy 705.19

60
Q

With symptomatic brady what If patient remains hypotensive (SBP less than 90mmHg)

A

Normal Saline
* 500 mL IV/IO bolus
* May repeat x 1 for total of 1,000 mL

61
Q

Tx for For suspected hyperkalemia (during symptomatic bradycardia)

A

For suspected hyperkalemia
* Calcium Chloride
o IV/IO – 1 g
 Withhold if suspected
digitalis toxicity
* Sodium Bicarbonate
o IV/IO – 1 mEq/kg
o Repeat 0.5 mEq/kg x 2 q 5 min

62
Q

Tx for symptomatic bradycardia for a 15Kg patient

A

IV/IO access
* IV/IO access only if patient in extremis
* Epinephrine 10 mcg/mL
o 0.1 mL/kg (1 mcg/kg) q 2 minutes, slow IV/IO
push
o Max single dose of 1 mL or 10 mcg
o Titrate to SBP of greater than or equal to 80
mm/Hg

63
Q

When should transcutaneous pacing (TCP) be initiated?

A

Should be initiated only if patient has signs of
hypoperfus.on

Ventura County EMS Protocols (3 decks)

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