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MD Protocols Flashcards

1
Q

Agitation - Moderate - Adult - Medical Delirium (e.g. Infection)

A

Droperidol 2.5mg IM. (1.25mg IM over 69)
Contraindication- pregnant Pt or QT interval longer than 440ms

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2
Q

Agitation - Moderate - Adult - Psych Emergency (e.g. schitz, off meds)

A

Droperidol 2.5mg IM. (1.25mg IM over 69)

Contraindication- pregnant Pt or QT interval longer than 440ms

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3
Q

Agitation - Moderate - Adult - Drugs or ETOH

A

Versed 5mg IV/IM (2.5mg over 69)

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4
Q

Agitation - Moderate - Adult - Head Injury

A

Versed 5mg IV/IM (2.5mg over 69)

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5
Q

Agitation - Moderate - Adult - Unknown

A

Versed 5mg IV/IM (2.5mg over 69)

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6
Q

Agitation - Severe - Adult

A

Versed 5mg IV/IO (2.5mg over 69)
Or
Ketamine 1mg/kg IM/IO (max 100mg) or 4mg/kg IM (max 400mg) - only if immediate and danger to Pt or EMS

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7
Q

Agitation - Moderate - Pedi < 5yo

A

No meds

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8
Q

Agitation - Moderate - Pedi 5-12

A

Med Control for versed

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9
Q

Agitation - Moderate - Pedi 12-18

A

Doperdol - 2.5 IM or
Med Control for Versed
0.1mg/kg max 5mg IV/IO
0.2mg/kg max 5mg IM/IN (IM Preferred)

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10
Q

Agitation - Severe - Pedi < 13

A

Med Control for ketamine or versed

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11
Q

Agitation - Severe - Pedi 13-18

A

Ketamine 1mg/kg IV/IO (max 100mg) or 4mg/kg IM (max 400mg) - only if immediate and danger to Pt or EMS (If not…Med Control)

Versed

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12
Q

Allergic Reaction - Mild - Adult

A

Benadryl 25mg Slow IV/IM
or
Epi 0.5mg IM

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13
Q

Allergic Reaction - Moderate - Adult

A

Epi 0.5mg IM (3x every 5 min)
Establish IV
Benadryl 50mg IV/IM
DuoNeb 2.5mg albuterol 0.5 mg Atrovent - 2nd dose Albuterol 2.5 mg only

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14
Q

Allergic Reactions - Mild - Pedi

A

Benadryl 1mg/kg Slow IV/IM (max 25mg)
or
Epi
<5 yo 0.15 mg
5yo+ 0.5mg

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15
Q

Allergic Reactions - Moderate - Pedi

A

Epi - <5 yo 0.15 mg or 5yo+ 0.5mg
Establish IV
If hypotensive 20ml/kg LR (2x)
Benadryl 1mg/kg - slow IV/IM (max 50 mg)
DuoNeb
< 1 yo only 1.25 mg Albuterol
1-2 yo 1.25 mg Albuterol and 0.25mg Atrovent
>2 yo 2.5 mg Albuterol and 0.5 mg Atrovent
May repeat Albuterol 1x

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16
Q

Altered Mental Status - Ck

A

Tox/Environment
Hyper/Hypoglycemia
Seizures
Sepsis
Stroke

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17
Q

Anaphylaxis - Adult

A

Epi 0.5mg IM (3x every 5 min)
Establish IV
DuoNeb 2.5mg albuterol 0.5 mg Atrovent - 2nd dose Albuterol 2.5 mg only
Benadryl 50mg IV/IM
If hypotensive 20ml/kg LR (2x)
Dex 10mg IV/IO
Epi Drip after 3 doses of Epi IM - 1mL/min titrate to 2mL/min (1mg in 100mL = 10mcg/mL)

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18
Q

Anaphylaxis - Pedi

A

Epi - <5 yo 0.15 mg or 5yo+ 0.5mg Q5 3x
Establish IV
DuoNeb
< 1 yo only 1.25 mg Albuterol
1-2 yo 1.25 mg Albuterol and 0.25mg Atrovent
>2 yo 2.5 mg Albuterol and 0.5 mg Atrovent
May repeat Albuterol 1x
Benadryl 1mg/kg - slow IV/IM (max 50 mg)
If hypotensive 20ml/kg LR (2x) till 70 +2x age to 10 (90)
Dex 0.5mg/kg IV/IO (max 10mg)

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19
Q

ALTE/BRUE

A

Place on cardiac monitor
Establish IV access on if required by Pt condition

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20
Q

Hypoglycemia - Adult

A

If BG is below 70mg/dL
50mL of D10 every minute to max of 250mL (25g) until:
normal mental status and
BG above 90
If still altered and BG below 90 repeat dosing
If no IV access 1mg Glucagon IM/IN
If still altered TX to hospital

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21
Q

Hyperglycemia - Adult

A

If BG is greater than 300mg/dL
10mL/kg bolus of LR unless, rales, wheezing, pedal edema or Hx of renal failure or CHF

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22
Q

Hypoglycemia - Pedi

A

If less than 28 days BG below 40mg/dL
If greater than 28 days BG below 70mg/dL

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23
Q

Hyperkalemia - Adult

A

LR 20mg/kg (per hypoperfusion protocol)
If Brady follow brady protocol
Calcium Chloride 0.5g-1g SLOW IVP 3-5 min
Sodium Chloride 50mEq IVP over 5 min

If crush syndrome or good kidneys
after Sodium Bicarb push add Sodium Bicarb drip of 100mEq in 1 L over 30-60 min

Albuterol 20mg neb - Med Control

Make sure to FLUSH w 5ml of LR b/t calcium and sodium.

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24
Q

Hyperkalemia - Pedi

A

LR 20mg/kg (per hypoperfusion protocol)
If Brady follow brady protocol
Calcium Chloride 20mg/kg SLOW IVP 3-5 min (max 1g)

MC
Albuterol
<2 yo 1.25mg neb
>=2 yo 2.5mg neb
If crush syndrome or good kidneys
Sodium Bicarb 1mEq/kg IV over 5min (50mEq max)
if <1yo dilute 1:1 w LR

Make sure to FLUSH w 5ml of LR b/t calcium and sodium.

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25
N/V - Adult
LR 20mL/kg to systolic of 90mmHg Zofran 8mg IV over 2-5 min or 4-8mg IM or 8mg PO dissolved (2x) MC 3rd dose of Zofran Watch QT Interval Contra pregnant
26
N/V - Peds
LR 20mL/kg to systolic of 70+2x age to 10yo (90mmHg) Zofran 28 days to 12 yo - 0.1 mg/kg IV over 2-5 min 13-18 8mg IV over 2-5 min or 8mg PO dissolved or 0.1 mg/kg IM (max 8mg) (2x) MC 3rd dose of Zofran Watch QT Interval
27
Pain - Adult
Fent - 1mcg/kg IV/IO/IM/IN (200mcg max) (2x) Ketamine 0.2mg/kg IV/IO over 1-2 min (20mg max) (2x) 0.5mg/kg IM/IN (50mg max) (2x) Toradol - 15mg IV or 30mg IM (1x)
28
Pain - Pedi
Fent - 1mcg/kg IV/IM/IO (200mcg max) (2x) Ketamine 0.2mg/kg IV/IO over 1-2 min (20mg max) (2x) 0.5mg/kg IM/IN (50mg max) (2x) Toradol < 2 nothing 2+ 0.5mg/kg to 15mg max IV 1mg/kg to 30mg max IM
29
Seizures - Adult
Blood sugar IM/IN - 5mg Versed IV/IO - 0.1 mg/kg, 2mg at a time to 5mg - SLOW For Pts 69 and over cut dose by 50%
30
Seizures - Pregnant
Check blood sugar IM/IN - 5mg Versed IV/IO - 0.1 mg/kg - 2mg at a time up to 5mg - SLOW IV/IO - 4g of Mag in 50-100mL over 10 min
31
Seizures - Pedi
Check BG IM/IN - 0.2mg/kg - 5mg max IV/IO - 0.1 mg/kg - 2mg at a time, 5mg max SLOW
32
Sepsis - Adult (not fluid sensitive)
NS via pump If still hypotensive - levophed 0.1 mcg/kg/min to 2mcg/kg/min Till MAP < 65 or systolic < 90
33
Sepsis - Adult (fluid sensitive)
If PMHx of CHF or end stage renal failure 250mL NS If still hypotensive - levophed 0.1 mcg/kg/min to 2mcg/kg/min Till MAP < 65 or systolic < 90 Consult after that
34
Sepsis Definition
Source of infection plus 2 of the following Sys BP < 90 HR > 100 RR > 25 or ETCO2 <=32 Temp > 100.4 or < 95.9
35
Sepsis Definition - Peds < 28 days
Known Infection Plus 3 others HR > 205 RR > 60 Temp 100.4 Cap Refil > 3 sec Sys BP < 60 Mental - Unresponsive, confused, inappropriate or lethargic High risk condition - Cancer, transplants, indwelling catheters, immunodeficiency, immunosuppression
36
Sepsis Definition - Peds 1-12 Mos
Known Infection Plus 3 others HR > 205 RR > 60 Temp 100.4 Cap Refil > 3 sec Sys BP < 70 Mental - Unresponsive, confused, inappropriate or lethargic High risk condition - Cancer, transplants, indwelling catheters, immunodeficiency, immunosuppression
37
Sepsis Definition - Peds 1-<2
Known Infection Plus 3 others HR > 190 RR > 40 Temp 100.4 Cap Refil > 3 sec Sys BP < 70+2 x age Mental - Unresponsive, confused, inappropriate or lethargic High risk condition - Cancer, transplants, indwelling catheters, immunodeficiency, immunosuppression
38
Sepsis Definition - Peds 2-4
Known Infection Plus 3 others HR > 140 RR > 40 Temp 100.4 Cap Refil > 3 sec Sys BP < 70 + 2 x age Mental - Unresponsive, confused, inappropriate or lethargic High risk condition - Cancer, transplants, indwelling catheters, immunodeficiency, immunosuppression
39
Sepsis Definition - Peds 5-12
Known Infection Plus 3 others HR > 140 RR > 35 Temp 100.4 Cap Refil > 3 sec Sys BP < 70 + 2 x age Mental - Unresponsive, confused, inappropriate or lethargic High risk condition - Cancer, transplants, indwelling catheters, immunodeficiency, immunosuppression
40
Sepsis Definition - Peds 13-17
Known Infection Plus 3 others HR > 100 RR > 25 Temp 100.4 Cap Refil > 3 sec Sys BP < 90 Mental - Unresponsive, confused, inappropriate or lethargic High risk condition - Cancer, transplants, indwelling catheters, immunodeficiency, immunosuppression
41
Sepsis TX - Peds
20mL/kg LR over 5-20 min If no improvement additional 20mL/kg LR to 60ml/kg total
42
Sepsis Peds - fluid sensitive
10ml/kg to 250mL fluid sensitive includes neonates (,28 days), congenital heart disease, chronic lung disease or chronic renal failure
43
Cardiogenic shock
NS on pump If still hypotensive - levophed 0.1 mcg/kg/min to 2mcg/kg/min Till MAP < 65 or systolic < 90
44
Hemorrhagic Shock
LR bolus up to 250 at a time. If still hypotensive - levophed 0.1 mcg/kg/min to 2mcg/kg/min Till MAP < 65 or systolic < 90 If head injury Sys BP >110
45
COPD - Adult
DuoNeb 2.5mg albuterol 0.5 mg Atrovent - 2nd dose Albuterol 2.5 mg only Dexamethasone 10mg IV CPAP Mag 2g in 100ml over 10min (MED CONTROL)
46
Asthma - Peds
DuoNeb < 1 yo only 1.25 mg Albuterol 1-2 yo 1.25 mg Albuterol and 0.25mg Atrovent >2 yo 2.5 mg Albuterol and 0.5 mg Atrovent May repeat Albuterol 1x Epi - <5 yo 0.15 mg or 5yo+ 0.5mg 5q 3x Establish IV Dex 0.5mg/kg IV/IO (max 10mg) Mag 50mg/kg - 2g max IV/IO in 100mL over 10 min (med control)
47
Chlorine/Phosgene Exposure
For wheezing and bronchospasm 2.5mg Albuterol Dex - 0.5mg/kg 10mg max IV/IO For rales or suspected pulmonary edema O2 and CPAP per CHF protocol
48
CHF/Pulmonary Edema - Adult - Mild
SPO2 < 94 O2 Nitro 0.4mg q5 3x
49
CHF/Pulmonary Edema - Adult - Moderate to Severe
CPAP Assess BP bf each Nitro If SBP>150 Nitro 0.4 and 1" nitro paste Nitro 0.8mg 5q until 20% drop in SBP If SBP drops < 90 250ml of LR 2x
50
CHF/Pulmonary Edema - Adult - Hypotensive
250 mL LR (MED Control for more) Epi drip 1mg in 100ml LR 10mcg/min max of 20mcg/min Titrate to 90SBP or MAP of 65 (MED Control for more)
51
CHF/Pulmonary Edema - Peds
NRB/CPAP MED Control Albuterol <2 1.25mg >2 2.5mg Epi Drip
52
Croup - Mild
Dex 0.5mg/kg PO - max 10mg
53
Croup - Moderate
Dex 0.5mg/kg PO - max 10mg Epi neb - 2.5mg
54
Croup - Severe
Epi 0.01mg/kg IM 0.5mg max Dex 0.5mg/kg IV/IM - max 10mg Epi neb - 2.5mg
55
Carbon Monoxide/Smoke Inhalation
Consider hyperbaric if carboxyhemoglobin > 25% or any of the following carboxyhemoglobin > 15% EMS/Fire Carbon Monoxide alarm goes off AND LOC at any point GCS<14 Rapid decline of neuro Pregnancy (fetus has high affinity for CO so mom can b OK) Chest Pain Very young or old
56
OD/Poison - Adult - Opioids
Narcan - 2mg IVP/IO/IM/IN 1mg each nare Narcan - 4mg/0.1mL in one nare
57
OD/Poison - Adult -CCB
Calcium Chloride 0.5-1g IVP over 10 min (UNLESS Pt in on Digoxin)
58
OD/Poison - Adult - Dystonic reaction
Benadryl - 25mg IV or IM
59
OD/Poison - Adult - General Ingestion
Charcoal - 1g/kg charcoal
60
OD/Poison - Adult - BB
Glucagon - 1mg q5 IVP
61
OD/Poison - Adult - Organophosphate
Atropine 2-4mg q5 until Pt has dry secretions/adequate O2
62
OD/Poison - Adult - Tricyclics
Sodium Bicarb - 1mEq/kg IVP up to 50mEq. q10 2nd dose 0.5mEq/kg
63
OD/Poison - Peds - Opioids
Narcan - 2mg IVP/IO/IM/IN 1mg each nare Narcan - 4mg/0.1mL in one nare
64
OD/Poison - Peds -CCB
Calcium Chloride 20mg/kg - 1g max IVP over 10 min (UNLESS Pt in on Digoxin)
65
OD/Poison - Peds - Dystonic reaction
Benadryl - 1mg/kg, 25 mg max IVP/IM
66
OD/Poison - Peds - General Ingestion
1g/kg charcoal
67
OD/Poison - Peds - BB - 5yo+
Glucagon - 1mg IVP q5
68
OD/Poison - Peds - BB - 28 days to 5yo
Glucagon - 0.5mg IVP q5
69
OD/Poison - Peds - Organophosphate
Atropine - 0.02 mg/kg - max 2mg q5-10min until dry secretions and adequate breathing
70
OD/Poison - Peds - Tricyclics - 1yo+
Sodium Bicarb - 1mEq/kg
71
OD/Poison - Peds - Tyicyclics - <1 yo
Sodium Bicarb - 1mEq/kg diluted 1:1 with LR
72
Snakebites
Immobilize extremity Take a pic if possible 20mL/kg LR titrate SBP to appropriate levels (e.g. 70+2x age or 90 - whichever is less)
73
OD/Poison - Adult - Stimulant
Versed 0.1 mg/kg 2 mg dose 5mg max slow IVP half dose for over 69 or IM/IN 5mg
74
OD/Poison - Peds - Stimulant
Versed 0.1 mg/kg 2 mg dose 5mg max slow IVP or 0.2 mg/kg IM/IN 5mg max
75
Burns - Burn Center Criteria
All full thickness Partial thickness > 10% BSA Burns to hands, face, feet, major joints, genitalia or perineum Electrical burns from greater than 120V. Suspected smoke inhalation Circumfrencial burns involving extremities or torso
76
Burns - Peds - Destination
Younger than 15yo - peds burn center
77
Burns - TX - < 20% BSA or superficial
manage airway no need for fluids
78
Burns - TX - 20%+ BSA - 15yo+
No shock Airway 500mL/hr LR up to 2L. (MED Consult for more) If in shock 250mL LR. SBP ck after each bolus to maintain 90SBP or 65MAP. If head injury target 110 SBP
79
Burns - TX - 20%+ - <15yo
No shock Airway No fluids unless in shock If in shock 250mL LR. SBP check after each bolus to maintain (70+2x age)
80
GCS - Eye
4 - Spntanious 3 - Voice 2 - Pain 1 - No response
81
GCS - Motor
6 - Verbal 5 - Localizes pain 4 - Withdrawal from pain 3 - Abnormal flexion - decorticate 2 - Extended/rigid - decerebrate 1 - No response
82
GCS - Verbal
5 - Appropriate 4 - Confused but able to answer 3 - Inappropriate words 2 - Gibberish 1 - No response
83
Spinal Motion Restrictions
MOI and Midline Pt tenderness New paraplegia/quadriplegia Focal neuro deficit Altered Mental/Disoriented Distracting Injury Neck pain or torticollis High Impact crash Death in same crash Substantial torso injury
84
Spinal Motion Restrictions - C-collar only
Pt found to be standing or ambulatory GCS of 15 No neuro No gross deformities No distracting injuries
85
STEMI w hypotension
If clear lungs 250mL of LR
86
STEMI
ASA Nitro Pain mgmt Cardiac center if within 45 min
87
ACS
12 lead w/in 10 min IV access ASA 324 Nitro 0.4 SL q5 3x if SBP>90 SBP does not drop 20mmHg after 1st dose HR b/t 60-150 ED w/in 48hrs If Pt does not have nitro script you need to have IV access before nitro
88
Stroke
Last know well 22 hrs Blood thinners BG LAMS 0-3 closest acute/primary stroke ctr or comprehensive stroke center LAMS 4 or greater - comprehensive stroke center or thrombectomy capable primary stroke center Face droop No Yes Arm drift Absent Drifts slow Drifts fast Grip strength Normal Weak No grip
89
Category Alpha
Motor<6 SBP<90 (10yo+) RR <10 or > 29 RR < 20 if less than 1YO
90
Category Bravo
2 or more proximal long bones Amputation proximal to wrist of ankle Chest wall instability Crushed, degloved, mangled or pulseless extremity Open or depressed skull fracture Penetrating injuries to anything other than distal to elbow or knees Pelvic fracture Paralysis
91
Category Charlie
High risk auto crash greater than 12" on occupant side or 20" anywhere Ejection including partial Death in same compartment Vehicle telemetry data consistent with high risk of injury Rollover without restraint Auto v ped/cyclist thrown, run over or over 20mph impact Falls - 20' for adult - 10' or 3x of child's height Exposure to blast or explosion
92
Category Delta
>55YO SBP < 110 if Pt older then 65 Peds Burns wo trauma - burn ctr Burns w trauma - trauma ctr Pregnancy > 20 weeks Blood thinners/bleeding disorder EMS judgement
93
Asthma - Adult
DuoNeb 2.5mg albuterol 0.5 mg Atrovent - 2nd dose Albuterol 2.5 mg only Epi 0.5mg IM 5q 3x Dexamethasone 10mg CPAP Mag 2g in 100ml over 10min (MED CONTROL)
94
TOR - Adult Exclusions
Pregnant Hypothermic Submersion
95
TOR - Adult
15 2-min cycles of CPR Asystole Vtach, Vfib or PEA and ETCO2 < 15 1 Epi on board
96
TOR - Peds (< 18yo)
15 2-min cycles of CPR 1 dose of Epi Asystole AND ETCO2 < 15 AND PD & EMS believe the scene can handle leaving child If VT, VF or PEA transport after 3 epi
97
Pronouncement of Death in the Field
Decapitation Rigor Mortis Decomposition Dependent Lividity Injury nor comparable with life At MCI - pulseless and apneic pt my be left
98
Pronouncement of death in the field exception
Pregnancy
99
MOLST A-1 prior to arrest
Everything
100
MOLST A-2 prior to arrest
Same as A-1 except no intubation
101
MOLST B prior to arrest
Palliative care. Passive O2. no BVM You can suction No IVs You may admin pain meds
102
Penetrating Trauma Arrest
15 YO+ Asystole - u can stop immediately PEA, VF or VT 20ml/kg LR Bilateral needle decompression if penetrating neck, chest or abdominal trauma 12-lead and ID and treat rhythm Usually do not use Epi! Treat reversible causes and transport to trauma center is within 15 min otherwise closest ED
103
Blunt Trauma Arrest
15 yo+ Asystole - u can stop immediately PEA, VT or VF 20ml/kg LR Bilateral needle decompression if multi-system blunt trauma 12-lead and ID and treat rhythm Usually do not use Epi! If all reversible causes have been treated and still in arrest after 5 2min cycles of CPR consider TOR.
104
ROSC - Adult
ID rhythm and treat If VF or VT were present during arrest and currently a sinus rhythm consider amiodarone if not previously given. 150 in 100ml over 10 Target 90 SBP w LR or epi drip 1mg in 100ml Begin transport to cardiac center unless further than 45 min
105
Synchronized Cardioversion (adult) SVT, A Flutter Vtach w pulse
100, 200, 300 and 360
106
Synchronized Cardioversion (adult) Afib
200, 300 and 360
107
Synchronized Cardioversion (peds) SVT, A Flutter, Vtach
0.5, 1, 2 Joules/kg If they go to VFib DEFIB @ 2 to 4 joules/kg
108
Pacing
13+ - 80 1-12 - 100 < 1yo 120

MD Protocols (2 decks)

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