Medical 12/13/15

Question 1

What are the five steps in the Acute Epistaxis protocol?

Answer 1

1) Maintain airway and oxygenation.
2) Have the patient blow their nose free of clots.
3) Administer 2-3 sprays of a vasoconstrictor into each bleeding nostril.
4) Apply pressure by pinching the nostrils together for up to 15 minutes to help control bleeding.
5) If significant blood loss apparent and/or signs of shock, administer IV of NS at a rate that will maintain adequate blood pressure.

147

Question 2

What common vasoconstrictor is used in non-traumatic, acute epistaxis?

Answer 2

Afrin

Question 3

List the five steps for a mild allergic reaction or anaphylaxis.

Answer 3

1) O2.
2) If present, scrape stinger out. Stabilize involved extremity and apply
ice.
3) Apply venous tourniquet on involved extremity above injection or sting site, if present.
4) Apply cardiac monitor and establish IV/IO.
5) Administer 25-50 mg of diphenhydramine IV/IO.

148

Question 4

List the three steps for a moderate allergic reaction or anaphylaxis.

Answer 4

1. Follow steps 1-4 for mild anaphylaxis
2. Administer epinephrine at 1:1 000, 0.01 mg/kg IM, up to a maximum dose of 0.3 mg. Repeat q 5 minutes, as needed.
   3) Administer 25-50mg of diphenhydramine IV/IO.

148

Question 5

List the six steps for a severe allergic reaction or anaphylaxis

Answer 5

1. Administer high flow O2 and Consider ET intubation.
2. Scrape stinger out, if present. Stabilize involved extremity and apply ice.
3. Apply venous tourniquet above injection or sting site, if on an extremity.
4. Apply cardiac monitor.
5. Administer IV of NS, and infuse rapidly if BP < 90.
6. Slowly administer epinephrine at 1:10 000, 0.01 mg/kg IV/IO†‡ , up to a maximum dose of 0.3 mg.

Question 6

Define mild allergic reactions or anaphylaxis.

Answer 6

• Red and itchy skin
• Hives
• If sting present, localized swelling at sting site
• Vital signs within normal limits

148

Question 7

Define moderate allergic reactions or anaphylaxis.

Answer 7

-Red and itchy skin
-Hives
-Swelling of face, lips, tongue, or
pharynx
-Mild to moderate SOB
-Stridor/wheezing
-BP > 70

148

Question 8

Define severe allergic reactions or anaphylaxis.

Answer 8

-Red and itchy skin
-Hives
-Severe swelling of face,
lips, tongue, or pharynx
-Possible sever SOB
-Stridor/wheezing
-BP

Question 9

What is the dose for diphenhydramine in mild or moderated allergic reactions?

Answer 9

25-50mg IV/IO

148

Question 10

What is the dose for diphenhydramine in severe allergic reactions?

Answer 10

50mg IV/IO

149

Question 11

What is the dose for Epi in severe allergic reactions both with and without an established IV?

Answer 11

With - 1:10,000, 0.01 mg/kg
Without - 1:1000, 0.01 mg/kg

Both - up to a maximum dose of 0.3 mg. Repeat q 5 minutes as needed

148-149

Question 12

List the six steps in the Adult Seizure protocol.

Answer 12

1) Protect Patient
2) IV/IO
3) High flow O2
4) Check blood glucose. If

Question 13

In the Adult Seizure protocol, what is the dose for Dw50 if blood glucose

Answer 13

50ml

150

Question 14

In the Adult Seizure protocol, what is the dose for glucagon if blood glucose

Answer 14

1mg

150

Question 15

In the Adult Seizure protocol, what is the dose for midazolam if a patient has recurrent seizures?

Answer 15

1-2mg IV/IM/IO q3 minutes to max of 6mg

or 5mg MAD

150

Question 16

List the eight steps in the Coma of Unknown Origin protocol.

Answer 16

1) Administer high flow O2. Assist ventilation, as needed. Consider ET intubation.
2) Take spinal precautions.
3) Apply cardiac monitor.
4) IV/IO
5) Check blood glucose. If

Question 17

In the Coma of Unknown Origin protocol what is the MAD dose for naloxone?

Answer 17

2mg

151

Question 18

In the Coma of Unknown Origin protocol what is the pediatric MAD dose for naloxone?

Answer 18

0.1mg/kg to a total of 2mg

151

Question 19

In the Coma of Unknown Origin protocol 10mg naloxone may be needed for what six drug overdoses?

Answer 19

• Darvon
• Talwin
• Stadol
• Nubain
• Suboxone
• Fentanyl

151

Question 20

List the nine steps in the Excited Delirium protocol

Answer 20

1) High flow O2
2. Cardiac Monitor
3. Large bore IV with NS at 500 ml/hr unless symptoms of CHF exist.
4) Check blood glucose, if

Question 21

What is the administration rate for NS in the Excited Delirium protocol?

Answer 21

500ml/hr

153

Question 22

At what body temperature should cooling measures be started in the Excited Delirium protocol?

Answer 22

102F

153

Question 23

What is the dose for midazolam in the Excited Delirium protocol?

Answer 23

2.5 mg of midazolam IV/IO/IM q 3-5 minutes, up to a maximum dose of 10 mg

or 5mg MAD

153

Question 24

List the nine steps in the Hypoglycemia protocol

Answer 24

1. Establish IV/IO access
2. Apply cardiac monitor
3. Administer O2.
4. Check blood glucose. If

Question 25

What is the dose for Dw50 in the Hypoglycemia protocol

Answer 25

50ml 154

Question 26

When should glucagon be used in the Hypoglycemia protocol?

Answer 26

Blood glucose

Question 27

When should IO for Dw50 administration in a hypoglycemic patient?

Answer 27

Blood glucose

Question 28

List seven possible medical causes of mental health symptoms

Answer 28

- Head injury - Drugs - Poisoning - Hypoglycemia - Severe infection - Hypothermia - Hypoxia 155

Question 29

List the eight Basic Tenants for EMS personnel in the Mental Health Emergencies protocol

Answer 29

1) Consider possible medical causes of mental health symptoms 2) Prevent health threatening circumstances. 3) Timing is critical. 4) Stay within the limits of your competence. 5) Seek consultation and aid from other professionals. 6) Gain and maintain control of emergency circumstances until control has been taken over by other professionals. 7) Contact Community Mental Health if patient refuses transport and is an apparent danger to self or others. 8) If restraint required, recruit support from law enforcement 155