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Medical Directives Flashcards

(71 cards)

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1
Q

Bronchoconstriction - contraindications

A

—-Salbutamol—-
allergy or sensitivity
—-Epinephrine—-
allergy or sensitivity

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2
Q

Analgesia - Treatment

A 
----Acetaminophen----
≥ 12 years to < 18 years
- 500-650 mg
- max of 1 dose
----Ibuprofen----
≥ 12 years old
- 400 mg
- max of 1 dose
----Ketorolac----
≥ 12 years old
- IM/IV
- 10-15 mg
- max of 1 dose
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3
Q

Cardiac Ischemia - Indications

A

Suspected cardiac ischemia

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4
Q

Suspected Adrenal crisis - Indications

A

A patient with primary adrenal failure who is experiencing clinical signs of an adrenal crisis

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5
Q

Trauma Cardiac Arrest - Conditions

A
  • —–CPR——-
  • Altered LOA
  • Performed in 2-minute intervals
    - —Manual Defib—–
  • ≥ 30 days old
  • Altered LOA
  • VF or pulseless VT
    - —Trauma TOR—-
  • ≥ 16 years old
  • Altered LOA
  • no palpable pulse AND no defib delivered AND monitored HR = 0 OR Monitored HR >0 with closest ED ≥ 30 min transport time away
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6
Q

Nausea / vomiting - conditions

A
  • —Dimenhydrinate—-
  • ≥ 25kg
  • Unaltered
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7
Q

Foreign Body Airway Obstruction Cardiac Arrest - Indications

A

Cardiac arrest secondary to airway obstruction

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8
Q

Cardiac Ischemia - treatment

A

—-ASA—-
- 160-162 mg (PO-chew)
- max does of 1
—-Nitro—-
No STEMI
SBP ≥ 100
- 0.3mg or 0.4mg (SL)
- 5 Minute dosing interval
- Max of 6 doses
STEMI
SBP ≥ 100
- 0.3mg or 0.4mg (SL)
- 5 Minute dosing interval
- Max of 3 doses

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9
Q

Suspected Adrenal crisis - treatment

A
  • —Hydrocortisone—-
  • 2mg/kg IM (round to the nearest 10mg)
  • Max of 1 dose
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10
Q

Medical Cardiac arrest - Contraindications

A

——CPR——-
- Obviously dead
- DNR
—-Manual Defib—–
Rhythms other than VF or pulseless VT
—Epinephrine—-
- Allergy or sensitivity to epi
—-Medical TOR—-
Arrest thought to be of non-cardiac origin

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11
Q

Analgesia - Acetaminophen contraindications

A
  • Active vomiting
  • Allergy or sensitivity to acetaminophen
  • Prior use within the past 4 hours
  • Hx of liver disease
  • unable to tolerate oral medication
  • suspected ischemic chest pain
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12
Q

Continuous Positive Airway Pressure - treatment

A
  • 5cm H2O initial
  • 2.5cm increment
  • 5-minute titrating interval
  • Max of 15cm H2O
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13
Q

Nausea / vomiting - indications

A

Nausea or vomiting

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14
Q

Hypoglycemia- conditions

A
  • —Dextrose—-
  • ≥ 2years old
  • altered LOA
  • hypoglycemia
  • —Glucagon—-
  • altered LOA
  • hypoglycemia
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15
Q

Medical Cardiac Arrest - Indications

A

Non-traumatic cardiac arrest

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16
Q

Analgesia - Ketorolac contraindications

A
  • Pregnant
  • NSAID or Ibuprofen use within last 6 hours
  • Allergy or sensitivity to ASA or NSAIDS
  • Patient on anticoagulant therapy
  • Current active bleeding
  • Hx of peptic ulcer or GI bleen
  • If asthmatic, no prior use of ASA or other NSAIDS
  • CVA or TBI in the previous 24 hours
  • known renal impairment
  • Suspected ischemic chest pain
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17
Q

Acute Cardiogenic Pulmonary Edema - Treatment

A 
----Nitro----
SBP ≥ 100 to 140
- IV or prior history of nitro use
- 0.3mg or 0.4mg (SL)
- 5 Minute dosing interval
- Max of 6 doses
SBP ≥ 140
NO IV or prior history of nitro use
- 0.3mg or 0.4mg (SL)
- 5 Minute dosing interval
- Max of 6 doses
IV or prior history of nitro use
- 0.3mg or 0.8mg (SL)
- 5 Minute dosing interval
- Max of 6 doses
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18
Q

Trauma Cardiac Arrest - treatment

A

——CPR——-
- Immediately
—-Manual Defib—–
≥ 30 day old to < 8 years
- 2 j/kg initial dose
- max of 1 dose
≥ 8 years
- 120 j
- max of 1 dose

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19
Q

Bronchoconstriction - Conditions

A 
----Salbutamol----
n/a
----Epinephrine----
- BVM ventilation required
- Hx of asthma
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20
Q

Bronchoconstriction - When shouldn’t you nebulize

A

Suspected fever or febrile respiratory illness

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21
Q

Opioid Toxicity - Treatment

A 
----Naloxone----
SC/IM/IN
- 0.8 mg
- 10-minute dosing interval
- Max of 3 doses
IV
- up to 0.4 mg
- immediate dosing interval
- max of 3 doses (Only to restore respiratory status)
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22
Q

Supraglottic Airway - Indications

A

Need for ventilatory assistance or airway control
AND
Other airway management is ineffective

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23
Q

Cardiac Ischemia - Conditions

A
  • —ASA—-
  • ≥ 18 years
  • Unaltered LOA
  • Able to chew and swallow
  • —Nitro—-
  • ≥ 18 years
  • Unaltered LOA
  • HR 60-159 bpm
  • SBP normotension
  • Prior history of nitro use OR IV access obtained
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24
Q

Continuous Positive Airway Pressure - indications

A

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

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25
Hypoglycemia - Treatment
``` ----Dextrose---- D10W - ≥ 2 years - 0.2 g / kg (2ml/kg) - 10g max single dose (100ml) - 10 minute dosing interval - max of 2 doses D50W - 0.5 g/kg (1ml/kg) - 25g (50ml) max dose - 10 minute dosing interval - max of 2 doses ----Glucagon---- < 25kg - 0.5 mg - 20 minute dosing interval - max of 2 doses ≥ 25kg - 1 mg - 20 minute dosing interval - max of 2 doses ```
26
Analgesia - Ibuprofen contraindications
- Active vomiting - Pregnant - NSAID or Ibuprofen use within last 6 hours - Allergy or sensitivity to ASA or NSAIDS - Patient on anticoagulant therapy - Current active bleeding - Hx of peptic ulcer or GI bleen - If asthmatic, no prior use of ASA or other NSAIDS - CVA or TBI in the previous 24 hours - known renal impairment - Unable to tolerate oral medications - Suspected ischemic chest pain
27
Continuous Positive Airway Pressure - contraindications
- Unable to cooperate - Tracheostomy - suspected pneumothorax - Asthma exacerbation - Inability to sit upright - Major trauma or burns to head or torso - Unprotected or unstable airway
28
Moderate to severe Allergic reaction - Contraindications
----Epi---- - allergy or sensitivity to epinephrine ----Diphenhydramine---- allergy or sensitivity to diphenhydramine
29
Foreign Body Airway Obstruction Cardiac Arrest - Conditions
- -----CPR------- - Altered LOA - Performed in 2-minute intervals - ---Manual Defib----- - ≥ 30 days old - Altered LOA - VF or pulseless VT
30
Foreign Body Airway Obstruction Cardiac Arrest - contraindications
------CPR------- - Obviously dead - DNR ----Manual Defib----- Rhythms other than VF or pulseless VT
31
Hypothermic Cardiac Arrest - Indications
Cardiac arrest secondary to hypothermia
32
Acute Cardiogenic Pulmonary Edema - Indications
Moderate to severe respiratory distress -AND- Suspected acute cardiogenic pulmonary edema
33
Croup - Contraindications
----Epi---- | Allergy or sensitivity to epi
34
Continuous Positive Airway Pressure - conditions
- ≥ 18 years old - RR tachypnea - SBP normotension - SpO2 < 90% OR accessory muscle use
35
Croup - Conditions
- ---Epi---- - < 8 years old - HR < 200 bpm
36
Supraglottic Airway - contraindications
- active vomiting - inability to clear the airway - airway edema - strider - caustic ingestion
37
Nausea / vomiting - contraindications
- ---Dimenhydrinate---- - Allergy or sensitivity to Dimenhydrinate or other antihistamines - Overdose on antihistamines or anticholinergics or tricyclic antidepressants
38
Medical Cardiac arrest - When to consider early transport (6)
- Pregnancy ≥ 20 weeks gestation - hypothermia - airway obstructions - suspected pulmonary embolus - medication overdose / toxicology - Any known reversible cause of arrest
39
Medical cardiac arrest - treatment
------CPR------- - Immediately ----Manual Defib----- ≥ 30 day old to < 8 years - 2 j/kg initial dose - 4 j/kg subsequent doses - max of 4 doses - 2-minute dosing interval ≥ 8 years - 120 j, 150 j, 200 j, 200 j - max of 4 doses - 2-minute dosing interval ----Epinephrine------ - 1:1000 IM - 0.01 mg/kg - max dose of 0.5mg - max of 1 dose
40
Opioid Toxicity - Contraindications
- ---Naloxone---- - Allergy or sensitivity to naloxone - Uncorrected hypoglycemia
41
Supraglottic Airway - conditions
Patient must be in cardiac arrest
42
Foreign Body Airway Obstruction Cardiac Arrest - treatment
------CPR------- - Immediately ----Manual Defib----- ≥ 30 day old to < 8 years - 2 j/kg initial dose - max of 1 dose ≥ 8 years - 120 j - max of 1 dose
43
Hypoglycemia - contraindications
- ---Dextrose---- - Allergy or sensitivity - ---Glucagon---- - allergy or sensitivity - pheochromocytoma
44
Suspected Adrenal crisis - conditions
----Hydrocortisone---- - Paramedics are presented with hydrocortisone for the identified patient AND - age-related hypoglycemia OR - GI symptoms (vomiting, diarrhea, abdominal pain) OR - Syncope OR - Temperature ≥ 38C or suspected/history of fever OR - age-related tachycardia OR - age-related hypotension
45
Moderate to severe Allergic reaction - Treatment
----Epi---- - 0.01 mg / kg - max of 0.5mg - 5-minute dosing interval - Max of 2 doses ----Diphenhydramine---- ≥25 kg to <50kg - 25 mg IV or IM - Max of 1 dose ≥ 50kg - 50 mg IV or IM - Max of 1 dose
46
Bronchoconstriction - Indications
Respiratory distress AND suspected bronchoconstriction
47
Moderate to severe Allergic reaction - Indications
Exposure to a probable allergen OR Signs and symptoms of a moderate to severe allergic reaction (including anaphylaxis)
48
Croup - Treatment
``` ----Epi---- < 1 year and < 5kg - 0.5mg NEB - max of 1 dose < 1 year ≥ 5 kg - 2.5 mg NEB - max of 1 dose ≥ 1 year to < 8 years - 5 mg NEB - max of 1 dose ```
49
Opioid Toxicity - Conditions
- ---Naloxone---- - ≥ 12 years old - Altered - RR < 10 breaths/min
50
Supraglottic Airway - treatment
- max of 2 insertion attempts
51
Bronchoconstriction - treatment
``` ----Salbutamol---- < 25kg - 600 mcg MDI (6 puffs every 4 breaths) OR - 2.5 mg NEB - 5 - 15 minute dosing interval - Max # of doses is 3 ≥ 25kg - 800mcg MDI (8 puffs every 4 breaths) OR - 5 mg NEB - 5 - 15 minute dosing interval - Max # of doses is 3 ----Epinephrine---- - 0.01 mg / kg IM - Max dose of 0.5 mg - Max # of doses is 1 ```
52
Suspected Adrenal crisis - contraindications
- ---Hydrocortisone---- | - Allergy or sensitivity to hydrocortisone
53
Analgesia - Indications
Pain
54
Cardiac Ischemia - contraindications
- ---ASA---- - Allergy - Asthma, no prior use of ASA - Bleeding - CVA (TBI) in the last 24 hours - ---Nitro---- - Right ventricular MI - Allergy - SBP drops 1/3 or more of its initial value after nitro administered - Phosphodiesterase inhibitor use within 48 hours
55
Trauma Cardiac Arrest - Contraindications
------CPR------- - Obviously dead - DNR ----Manual Defib----- Rhythms other than VF or pulseless VT ----Trauma TOR---- - < 16 years old - Defib delivered - Monitored HR > 0 and closest ED < 30 minutes away
56
Hypothermic Cardiac Arrest - conditions
- -----CPR------- - Altered LOA - Performed in 2-minute intervals - ---Manual Defib----- - ≥ 30 days old - Altered LOA - VF or pulseless VT
57
Croup - Indications
``` Severe respiratory distress AND Stridor at rest AND Current Hx of URTI AND Barking cough or recent Hx of barking cough ```
58
Medical Cardiac arrest - Conditions
- -----CPR------- - Altered LOA - Performed in 2-minute intervals - ---Manual Defib----- - ≥ 30 days old - Altered LOA - VF or pulseless VT - --Epinephrine---- - Altered LOA - Anaphylaxis suspected as the causative event - ---Medical TOR---- - ≥ 18 years old - Altered LOA - Arrest not witnessed by EMS -AND- No ROSC -AND- No defib delivered
59
Nausea / vomiting - treatment
``` ----Dimenhydrinate---- ≥ 25kg to < 50kg - 25mg IV/IM - max of 1 dose ≥ 50kg - 50mg IV/IM - max of 1 dose ```
60
Acute Cardiogenic Pulmonary Edema - Nitro conditions
- ≥ 18 years - HR 60-159 bpm - SBP normotension
61
Return of spontaneous circulation - conditions
- ---0.9% NaCl Fluid Bolus---- - ≥ 2 years - SBP - hypotension - chest auscultation is clear
62
Opioid Toxicity - Indications
``` Altered LOC AND Respiratory depression AND Inability to adequately ventilate AND Suspected Opioid overdose ```
63
Analgesia - What condition requires Ketorolac as the elective drug?
Renal colic
64
Analgesia - Conditions
- ---Acetaminophen---- - ≥ 12 years old - Unaltered - ---Ibuprofen---- - ≥ 12 years old - Unaltered - ---Ketorolac---- - ≥ 12 years old - Unaltered - Normotension - Restricted to those who are unable to tolerate oral medications
65
Hypoglycemia - Indications
``` Agitation -or- Altered LOA -or- Seizure -or- Symptoms of stroke ```
66
Acute Cardiogenic Pulmonary Edema - Nitro contraindications
- Allergy or sensitivity - Phosphodiesterase inhibitor use with 48 hours - SBP drops by 1/3 or more of initial value after nitro administered
67
Hypothermic Cardiac Arrest - treatment
------CPR------- - Immediately ----Manual Defib----- ≥ 30 day old to < 8 years - 2 j/kg initial dose - max of 1 dose ≥ 8 years - 120 j - max of 1 dose
68
Trauma Cardiac Arrest - Indications
Cardiac arrest secondary to severe blunt or penetrating trauma
69
Hypothermic Cardiac Arrest - contraindications
------CPR------- - Obviously dead - DNR ----Manual Defib----- Rhythms other than VF or pulseless VT
70
Supraglottic Airway - placement confirmation
- ETCO2 - auscultation - chest rise
71
Moderate to severe Allergic reaction - Conditions
----Epinephrine---- - For anaphylaxis only ----Diphenhydramine---- weight is ≥ 25kg

BLS and Medical Directives (2 decks)

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