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medical directives Flashcards

1
Q

Bronchoconstriction Medical Directive

Indications

A

Respiratory Distress
and
Suspected Bronchoconstriction

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2
Q

Bronchoconstriction Medical Directive

Conditions

A

Salbutamol - N/A

Epinephrine - BVM required - Hx of asthma

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3
Q

Bronchoconstriction Medical Directive

Contraindications

A

Salbutamol - Al or Sen to Salbutamol

Epinephrine - Al or Sen to Epi

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4
Q

Bronchoconstriction Medical Directive

Treatment - Consider - Salbutamol

A 
Weight under 25KG (55 lbs)
Route: MDI
Dose:Up to 600mcg (6 puffs)
M.S.D 600 mcg
INT 5-15 min PRN
M#D: 3 
Route: NEB
Dose: 2.5 mg
M.S.D 2.5 mg
INT 5-15 min PRN
M#D: 3 
Weight Equal and over 25KG (55 lbs)
Route: MDI
Dose:Up to 800mcg (8 puffs)
M.S.D 800 mcg
INT 5-15 min PRN
M#D: 3 
Route: NEB
Dose: 5 mg
M.S.D 5 mg
INT 5-15 min PRN
M#D: 3
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5
Q

Bronchoconstriction Medical Directive

Treatment - Consider - Epinephrine

A 
Route: IM
Concentration: 1:1000
Dose: 0.01 mg/Kg
MSD: 0.5 mg
INT N/A
M#D: 1 (*for bronchoconstriction)
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6
Q

Bronchoconstriction Medical Directive

Clinical considerations

A

Epi considered first if apneic
Salbutamol may be considered -> BVM MDI

Do not NEB if patient has fever or area of fever with respiratory illness.

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7
Q

Moderate to Severe Allergic Reaction Medical Directive - Indications

A

Exposure to a probable allergen
AND
Signs and/or symptoms of a moderate to severe allergic reaction (including anaphylaxis)

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8
Q

Moderate to Severe Allergic Reaction Medical Directive - Conditions

A

Epinephrine - For anaphylaxis only

Diphenhydramine
-Weight - equal or over 25 KG

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9
Q

Moderate to Severe Allergic Reaction Medical Directive - Contraindications

A

Epinephrine
-Al or Sen to Epi

Diphenhydramine
-Al or Sen to Diphenhydramine

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10
Q

Moderate to Severe Allergic Reaction Medical Directive

Treatment - Consider - Epinephrine

A 
Route: IM
Concentration: 1:1000
Dose: 0.01 mg/Kg
MSD: 0.5 mg
INT Minimum 5 mins
M#D: 2 (*for Allergy)
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11
Q

Moderate to Severe Allergic Reaction Medical Directive

Treatment - Consider - Diphenhydramine

A

Weight
equal or over 25KG (55 lbs) to 50 KG (110 lbs)

Route: IV
Dose: 25 mg
M.S.D 25 mg
INT N/A
M#D: 1 
Route: IM
Dose: 25 mg
M.S.D 25 mg
INT N/A
M#D: 1

Weight
equal or over 50 KG (110 lbs)

Route: IV
Dose: 50 mg
M.S.D 50 mg
INT N/A
M#D: 1 
Route: IM
Dose: 50 mg
M.S.D 50 mg
INT N/A
M#D: 1
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12
Q

Moderate to Severe Allergic Reaction Medical Directive

Clinical Considerations

A

Epi should be considered 1st in anaphylaxis

IV administration of diphenhydramine applies only to PCPs allowed to auto IV

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13
Q

Croup Medical Directive - Indications

A 
Severe respiratory distress
AND
Stridor at rest
AND
Current history of 
AND
Barking cough or recent history of barking cough
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14
Q

Croup Medical Directive - Conditions

A

AGE: less than 8 years old
HR: less than 200 bpm

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15
Q

Croup Medical Directive - Contraindication

A

Epinephrine

-Al or Sen to Epi

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16
Q

Croup Medical Directive

Treatment - Consider - Epinephrine

A 
Age: less than one year
Weight - weight less than 5 KG (11 lbs)
Route - NEB
Concentration 1mg/mL 1:1000
Dose - 0.5 mg
INT - N/A
M#D - 1

Age: less than one year
Weight - weight equal to greater than 5 KG (11 lbs)

Route - NEB
Concentration 1mg/mL 1:1000
Dose - 2.5 mg
INT - N/A
M#D - 1
Age: equal to over 1 year up to 8 years
Weight - N/A
Route - NEB
Concentration 1mg/mL 1:1000
Dose - 5 mg
INT - N/A
M#D - 1
17
Q

Croup Medical Directive - Clinical Considerations

A

The minimum initial volume for NEB is 2.5 ml

18
Q

Continuous Positive Airway Pressure (CPAP)

Indications

A

Severe respiratory distress
AND
Signs and/or symptoms of acute pulmonary edema or COPD

19
Q

Continuous Positive Airway Pressure (CPAP)

Conditions

A 
AGE: greater than or equal to 18 years
RR: Tachypnea 
(greater than equal to 28 breaths per minute)
SBP: Normotension 
Other: SPO2 < 90% or AUX muscle use
20
Q

Continuous Positive Airway Pressure (CPAP)

Contraindications

A 
Asthma exacerbation
Suspected pneumothroax
Unprotected or unstable airway
Major trauma or burns to the head or torso
Tracheostomy
Unable to sit upright
Unable to cooperate
21
Q

Continuous Positive Airway Pressure (CPAP)

Treatment

A

Consider CPAP
Initial setting - 5cm H2O
(Or equivalent flow rate of device as per BH hospital)
Titration increment - 2.5 cm H2O
(Or equivalent flow rate of device as per BH hospital)
Titration interval - 5 mins
Max. Setting - 15 cm H2O
(Or equivalent flow rate of device as per BH hospital)

22
Q

Continuous Positive Airway Pressure (CPAP)

Medical Considerations

A

Consider increasing FiO2

Initial FiO2 - 50-100%

Fi02 increment (if available on device)
- SpO2 less than 92% despite treatment and/or 10cm H2O pressure or equivalent flow rate of device as per BH direction

Max. Fi02 - 100%

23
Q

Nausea / Vomiting Medical Directive - Indications

A

Nausea OR Vomiting

24
Q

Nausea / Vomiting Medical Directive - Conditions

A

Dimenhydrinate
Weight = equal to greater than 25KG (55 lbs)
LOA = Unaltered

25
Q

Nausea / Vomiting Medical Directive - Contraindications

A

Allergy or sensitivity to dimenhydrinate or other antihistamines

Overdose on antihistamines or anticholinergics or tricyclic antidepressants

26
Q

Nausea / Vomiting Medical Directive - Treatment Consider Dimenhydrinate

A

Weight
equal or over 25KG (55 lbs) to 50 KG (110 lbs)

Route: IV
Dose: 25 mg
M.S.D 25 mg
INT N/A
M#D: 1 
Route: IM
Dose: 25 mg
M.S.D 25 mg
INT N/A
M#D: 1

Weight
equal or over 50 KG (110 lbs)

Route: IV
Dose: 50 mg
M.S.D 50 mg
INT N/A
M#D: 1 
Route: IM
Dose: 50 mg
M.S.D 50 mg
INT N/A
M#D: 1
27
Q

Nausea / Vomiting Medical Directive -

Clinical Considerations

A

IV only to PCP’s for PCP auto IV

Dilute dimenhydrinate ( 50 mg / ml)

1:9 Normal Saline or sterile water

28
Q

Adult Analgesia Medical Directive

Indications

A 
Mild to Moderate ( Acetaminphen / Ibuprofen)
Moderate to Severe  ( Keterolac )
AND
Isolated hip injury or extremity trauma 
OR
Burns
OR
Renal colic with prior history 
OR
Acute musculoskeletal back strain
OR 
Current history of cancer related pain
29
Q

Adult Analgesia Medical Directive

Conditions

A

Acetaminophen
AGE - equal or greater than 18
LOA - unaltered

Ibuprofen
AGE - equal or greater than 18
LOA - unaltered

Ketorolac
AGE - equal or greater than 18
LOA - unaltered 
SBP - Normotension
Other - Unable to tolerate oral meds

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