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TCFD Pearls > Medical > Flashcards

Medical Flashcards

1
Q

Allergic Rxn/Anaphylaxis- Adult

A

Minimal/Localized- Benadryl 50mg. If wheezing: Albuterol/Duoneb.

Symptoms persist- Epi (1:1) 0.5mg IM; repeat as needed.

Anaphylaxis w/hypotension: Epi (1:10), 0.5mg IV. NS Bolus 500ml (repeat once, titrate to BP>90)

Acute Laryngeal Edema Refractory to Epi: Epi (1:10), 0.5mg nebulized. (Repeat as needed).

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2
Q

Allergic Rxn/Anaphylaxis-Pedi

A

Minimal/Localized- Benadryl 1mg/kg(up to 25mg). If wheezing- duoneb. Repeat as needed. Symptoms persist: Epi (1:1) 0.01mg/kg (up to 0.5mg) IM repeat as needed.

Anaphylaxis w/hypotension: Epi (1:10) 0.01mg/kg. (Up to 0.5mg) IV. NS bolus of 20ml/kg (up to 500). Repeat once.

Acute Laryngeal Edema Refractory to Epi: Epi (1:10) 0.5mg nebulized. Repeat as needed.

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3
Q

Allergic Rxn/Anaphylaxis-Pearls

A

Epi 1:1 may be given IM prior to other treatments if Resp distress is present.

USE CAUTION WITH EPI IN PT’S OVER 40 AND KNOWN CARDIAC Hx.

Dystonic Rxn’s are not allergic Rxn’s, however ADULT Pt’s should be treated with Benadryl 50mg IM or IV/IO over two minutes.

May allow pt/parent to self medicate with Benadryl. Pedi- 1-4yrs may take 12.5mg; >4 may take 25mg

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4
Q

Anxiety-Adults

A

Versed up to 2.5mg IV,IO,IM,IN titrate to effect. May repeat as needed.

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5
Q

Anxiety- Pedi

A

Contact OLMCP.

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6
Q

Anxiety-Pearls

A

Verbal coaching prior to medication.

Lower doses of benzodiazepines if alcohol intoxication present

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7
Q

Behavioral Emergency- Adult

A

Chemical Restraint if and when all other acceptable options to safely restrain a pt (who poses a threat to themselves or others) have been unsuccessful.
Versed 5-10mg (repeat once if needed).
Severe behavior: Ketamine 4mg/kg IM

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8
Q

Behavioral Emergency-Pedi

A

Versed- 0.1mg/kg (up to 5mg) slow IV or Versed 0.2mg/kg (up to 5mg) IN/IM

CONTACT OLMCP FOR PATIENTS < 8

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9
Q

Behavioral Emergency-Pearls

A

Second attendant in back.
Life threatening conditions can present as agitation or delirium.
Suicidal are not allowed to refuse transport.

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10
Q

Behavioral Emergencies Reference Guidelines

A

Safety first. Involve law enforcement. Document restraints. Use soft restraints if possible. Patient should be able to take full tidal breaths.
CUFFS =COP
Chemical Restraints-ETCO2, EKG, Vitals. Intranasal dosing is preferred route in regards to provider safety.

IF AT ANY POINT DURING THE TREATMENT/TRANSPORT OF THE AGGRESSIVE PT,IF THE PT BECOMES QUIET AND COMPLIANT THE EMS PROVIDER SHOULD CONSIDER THIS AN OMINOUS SIGN. This type of marked change is often an indicator of imminent cardiac arrest due to catecholamine excess effect on the myocardium. Further treatments (contact OLMCP) may be cooling of pt with ice packs and administration of sodium bicarb 50mEq IVP

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11
Q

Diabetic -Adult

A

Hypoglycemia (<70)- oral glucose up to 30 grams. D10% titrate to effect
Hyperglycemia (>400): NS 500mL

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12
Q

Diabetic-Pedi

A

Hypo (<70): Oral Glucose to 15g or D10 titrate to effect

Hyper (>400): NS bolus 20ml/kg

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13
Q

Diabetic Pearls

A

Turn insulin pumps off.
D25%: Remove 25ml of D50 and add 25ml of NS.
Use caution with Glucose in Pt’s exhibiting S/S of stroke (worsen neurological conditions)

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14
Q

Diabetic Refusal

A

Pt takes insulin or metformin.
Reasonable explanation for hypoglycemia.
Glucose is above 100 after treatment.
No other medical complaints.
Pt is AOx4 with normal vitals.
Pt can tolerate food and drink.
Responsible adult is present to monitor pt and recontact EMS if needed.
Pt will not be put in a situation where others are at risk (driving car)

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15
Q

Drowning/Submersion-Adult

A

Manage Airway- CPAP/intubation
*if Pulseless refer to cardiac arrest protocol.

Bronchospasm- Duoneb and repeat as needed

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16
Q

Drowning Submersion-Pedi

A

Airway Mngmt- BVM/Intubation. Cardiac arrest protocol if Pulseless.
Bronchospasm/wheezing- Duoneb and repeat as needed

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17
Q

Drowning-Pearls

A

Process of experiencing respiratory impairment resulting from submersion in a liquid medium.
THREE OUTCOMES: no morbidity(no injury); morbidity(injury); mortality(death). Report as “fatal” or “non fatal” drownings.

Can have complications 24 hours after injury.

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18
Q

Heat Disorder

A 
Heat Exhaustion (<105, fatigue, dizzy, headache, nausea, tachycardia, and dry membranes): Adult: 500mL NS bolus (repeat once in 5 minutes)
Pedi: NS bolus @ 20ml/kg
Heat Stroke (>105, sweating stopped, altered mental status): aggressive cooling
Adult/Pedi same as exhaustion Tx
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19
Q

Cold Disorder

A

Move to warm environment, remove wet clothing, begin external warming

Frostbite: remove clothing, do not rub area, do not allow refreezing, cover with lose dressing, pain mngmt

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20
Q

Heat/Cold Disorder-Pearls

A

External cooling: evaporative cooling.
Athlete may have ice bath prior to arrival.
Vfib in hypothermic Pt’s
Cardiac arrest when body temp < 90: only one defibrillation may be performed before contacting OLMCP.

21
Q

Nausea/Vomiting-Adult

A

Zofran- 4mg PO repeat as needed

Or

Zofran 4mg IV,IM,IO repeat as needed

22
Q

Nausea/Vomiting- Pedi

A

> 1 yr Zofran 4mg PO repeat once if needed

OR

Zofran 2mg IV,IO,IM repeat once.

<1yr contact OLMCP

23
Q

Nausea/Vomiting-Pearls

A

Intended for use for nausea/vomiting or nausea prophylaxis when administered with narcotic pain med and is NOT intended for routine use in all patients

24
Q

Non-Traumatic Shock-Adult

A

12 lead, 500mL bolus (repeat as needed).

CONTACT OLMCP FOR DISCONTINUATION OF FLUID THERPAY AND REMOVAL OF IV IF PT REFUSAL.

25
Q

Non-Traumatic Shock-Pedi

A

12 lead. NS 20ml/kg IV/IO repeat once as needed. Contact OLMCP for additional fluid.

CONTACT OLMCP FOR DISCONTINUATION OF FLUID THERPAY AND REMOVAL OF IV IF PT REFUSAL.

26
Q

Non-Traumatic Shock- Pearls

A

Adult- altered LOC, light headed upon standing, tachycardia, hypotension, poor skin turgor, delayed cap refill. If BP remains below 90 after 1L of NS and there is no evidence of cardiogenic shock; continue the administration of 500mL boluses with a total not to exceed 2 liters.

Pedi- altered LOC, light headed upon standing, tachycardia, hypotension, poor skin turgor, delayed cap refill, sunken fontanels. If hypotensive child has Hx of cardiac disease, administer NS 5-10ml/kg IV/IO

27
Q

Pain Management- Adult

A

Fentanyl 2mcg/kg Iv, Io, Im, In. Do not exceed 300mcg

Severe Pain: ketamine 25mg IV, IO, IM, IN

Headaches: Ibuprofen 400mg PO

28
Q

Pain Management-Pedi

A

Fentanyl 2mcg/kg IV, IO, IM, IN. Do not exceed 150mcg.

Severe: Ketamine 10mg (if pt >10kg) IV, IO, IM, IN
May repeat once.

29
Q

Pain Management- Pearls

A

It is not necessary to provide the maximum dose of analgesic before administering ketamine.

FOR SEVERE PAIN NOT RELIEVED BY ABOVE MEDICATION, CONTACT OLMCP FOR KETAMINE FOR SEDATION AND ANALGESIA

CONTRAINDICATIONS: BP<90, Resp depression, controlled substance abuse.

Document pain scale.

Sickle Cell: administer 1000ml over 10-15 minutes as well as pain meds (Adult).
Adminster 20ml/kg NS over 10-15 minutes as well as pain meds (pedi).

30
Q

Seizure- Adult

A

Versed 5mg IV, IO, IM, IN

Do not exceed 20mg

31
Q

Seizure- Pedi

A

Versed 0.1mg/kg (up to 5) IV/IO OR
Versed 0.2mg/kg (up to 5) IM/IN
Do not exceed 10mg

32
Q

Seizure-PEARLS

A

For status epilepticus contact OLMCP

33
Q

Sepsi-Adult

A

Efficient scene times and rapid transport.
Identify (ALL OF THE FOLLOWING):
1. Suspected infection
2. Two or more of: a) temp >100.4 or <96. b) Resp rate > 20. c) HR> 90.
3. ETCO2 < 30

Administrater fluid bolus 1L and notify of sepsis alert

34
Q

Sepsis-Pedi (<14 years old)

A

Aggressive fluid administration and rapid transport. Assess cap refill.

ALL of the following: 1. Suspected infection. 2. Two or more: a) temp>101.3 or <96.8 b) abnormal cap refill c) Hx of being sick > 5 days

35
Q

Stroke

A

Efficient scene times and transport to stroke center is key priority.

Check blood sugar.

Cardiac monitor/12 lead.

Place 20g or larger IV in AC.

36
Q

Stroke- Cincinnati Stroke Scale

A

Facial Drift.
Arm Drift- hold out for 10 seconds.
Speech- “cant teach an old dogs new tricks”

72% chance of being a stroke if any one of the three are abnormal.

If LKN is <3.5 hours then perform LA motor scale assessment.

37
Q

LA Motor Scale (0-5)

A

Facial droop- absent (0), present (1)
Arm drift- absent (0), drifts (1), falls (2)
Grip strength- normal(0), weak (1), none (2)

If LKN<3.5 hours and LAMS 0-3= any stroke center.
If LKN <3.5 hours and LAMS 4-5= comprehensive center.
If LKN 3.5-24 hours= comprehensive
If LKN> 24 hours= any stroke center

38
Q

Stroke Pearls

A

Determine time of onset.
Early radio notification.
Bring medical list to ED and/or family member.
Glucose/dextrose administration is contraindicated.
If patient is on anticoagulants or hemorrhagic stroke suspected, transport to comprehensive stroke center.

39
Q

Toxicological (adult). Beta Blocker/Calcium Channel Blocker

A

glucagon 1mg IV/IO (optional).
Consider atropine 0.5mg IV/IO. Prepare for pacing at a rate of 80/minute.
NS bolus 500ml IV/IO. Repeat once
If still hypotensive, Calcium chloride 500mg slow IV/IO (may repeat once in five minutes)

40
Q

Toxicological (adult) TCA overdose

A

Sodium bicarb 1mEq/kg IV/IO.

NS 500ml bolus IV/IO (repeat once).

41
Q

Toxicological (adult) Organophosphate

A

Atropine 2mg IV/IO/IM repeat every three minutes

42
Q

Toxicological (adult) Narcotic

A

Naloxone 0.5mg IV/IO. Repeat as needed.
Or
Naloxone 1mg IM/IN. Repeat as needed.

43
Q

Toxicological (adult) CO2 poisoning

A

Obtain CO level. High flow O2,ECG, ETCO2, Transport.

If CO level > 20 and pt is symptomatic, transport to hyperbaric facility.

44
Q

Toxicological (pedi) Beta blocker/Calcium Channel Blocker

A

Glucagon 1mg IV/IO.
Consider Atropine 0.02mg/kg IV/IO minimum dose 0.1mg.
Prepare for pacing at 100/minute.
NS 20ml/kg IV/IO. (May repeat once as needed)

45
Q

Toxicological (pedi) TCA overdose

A

Sodium bicarb 1mEq/kg IV/IO.

NS 20ml/kg bolus IV/IO. Repeat once.

46
Q

Toxicological (pedi) Organophosphate

A

Atropine 0.02 mg/kg IV/IO/IM minimum dose 0.1mg. Repeat every 3 minutes as needed.

47
Q

Toxicological (pedi) narcotic overdose

A

Naloxone 0.1mg/kg (up to 0.5mg) IV/IO/IM
OR
Naloxone 0.2 mg/kg (up to 1mg) IN.
May repeat as needed.

48
Q

Toxicilogical (pedi) CO poisoning

A

Obtain CO level. High flow O2, ECG, ETCO2, and transport.

If CO level >20 then transport to hyperbaric chamber.

49
Q

OB/GYN Treatment

A

TCFD Pearls (8 decks)

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