meds indcation

Question 0

Albuteral

Answer 0

• any wheezing

- allergic reactions with resp signs and sympmtoms

Question 1

Adenosine

Answer 1

• adult complex SVT equal or greater150
• unknown origin wide complex tachycardia (not thought to be V. tac)
• not used to identified a.fib/a.flutter
• pediatric rates for SVT begin 200

Question 2

Albuteral

Answer 2

For Severe hyperkalemia associated with those patients that undergo dialysis or whose kidney are beginning to function poorly. The need for drug treatment by fire rescue on medical advisor order only, will be based on widening of the QRS on EKG: note sodium bicarb/calcium chloride are also indicated for high potassium

Question 3

Amiodarone

Answer 3

1. v.fib/v.tac pulseless >150 not responsive to shock or epi; works especially well in arrest due to acute MI
2. Conscious v.tac with a pulse >150 not responding to Lido hemodynamically stable(if hypotensive sedate and cardiovert)
3. Wide complex tachycardia with pulse> 150 unknown rhythm (orgin)
4. Patients known to have WPW and now have to tachycardia greater than 150 with a pulse
5. A.fib/a.flutter and unstable( >150) after Cardioversion has failed and BP>90

Question 4

Amiodarone

Answer 4

3. Wide complex tachycardia with pulse> 150 unknown rhythm (orgin)
4. Patients known to have WPW and now have to tachycardia greater than 150 with a pulse
5. A.fib/a.flutter and unstable( >150) after Cardioversion has failed and BP>90

Question 5

Amiodarone (Pedi)

Answer 5

1. Stable or unstable narrow complex SVT tachyarrhythmia (>220 infants >180 children)not responsive to vagal maneuvers/adenosine/ cardioversion
2. Stable v.tach or wide complex(>0.9sec) regular rate and monomorphic tachycardia after adenosine with medical advisor order only
3. unstable v.tach or wide complex(0.9sec) unkown orgin, not responsive to cardioversion with med.adv. only
4. v.fib/ pulseless v.tach; not responding to shock or epi

Question 6

Amiodrone (pedi)

Answer 6

3. unstable v.tach or wide complex(0.9sec) unkown orgin, not responsive to cardioversion with med.adv. only
4. v.fib/ pulseless v.tach; not responding to shock or epi

Question 7

asprin

Answer 7

Chest pain/pressure or other signs and symptoms suggesting the possibility of an MI or ischemia heart event

Question 8

asaprin (notes)

Answer 8

patients taking their own Anti-coagulant medication (aspirin plavix etc.) except Coumadin, should still have aspirin administer by EMS. If they reported having taken aspirin prior to EMS arrival confirm by checking the bottle that it was just not 80mg, enteric coated or a nonaspirin products such as Tylenol or ibuprofen yeah EMS administration of aspirin should be given as soon as contraindications are ruled out

Question 9

aspirin (notes)

Answer 9

such as Tylenol or ibuprofen yeah EMS administration of aspirin should be given as soon as contraindications are ruled

Question 10

atropine

Answer 10

1. Symptomatic bradycardia
2. Bradycardia with PVCs (goal heart rate of 600)/ brady PEA
3. Asytole
4. chemical exposures (organophoste)with p.control /med.adv.order only

Question 11

Benadryl

Answer 11

Acute allergic reaction including anaphylaxis upper airway response hives/itching(W.Meynard bee sting)
note The use of Benadryl and anaphylaxis or respiratory distress allergic reaction should not delete or take the place of subq epi

Question 12

Calcium chloride

Answer 12

1. Dialysis patients with symptomatic whide complex brady/ cardia arresst asystole PEA EMD (particularly slow)

Question 13

calcium chloride

Answer 13

2.For Severe hyperkalemia associated with those patients that undergo dialysis or whose kidney are beginning to function poorly. The need for drug treatment by fire rescue on medical advisor order only, will be based on widening of the QRS on EKG: note sodium bicarb/calcium chloride are also indicated for high potassium

Question 14

calcium chloride

Answer 14

3.Calcium channel blocker overdose

note when given before and after sodium bicarb there must be a 20 cc flush

Question 15

cardizem

Answer 15

1. Conscious a.fib or flutter ventricular response =or>150 &BP =or>90.
2. Unconscious a.fib or flutter and vent response =or >150& BP =or>90 after initial cardiovers. sequence a.fib200 300 360–a.flutter100 200 300 360

Question 16

cardeziem

Answer 16

3. Other SVT narrow complex rhythm with vent. resp. =or>150& BP =/> 90 in which adenosine is not effective or effect has been temporary

Question 17

charcoal(activated)

Answer 17

Completely conscious pt. and able to maintain airway after oral ingesting of a non-caustic substance; does not routinely cause vomiting now flavored and tolerate it well by patients

Question 18

cyanokit
high suspicious of smoking inhalation

or probable exposure to cyanide.
+

Answer 18

1. unconscious wtih glucose >60 mg/ml after adm of 2mgs of narcan
2. Persistent shock after 100 ml NS (Pedi 20cc/Kg boluses of NS/LR)
3. cardiac arrest along with appropriate treatment according to presenting rhythm also give early sodium bicarb

Question 19

cyanokit notes

Answer 19

high suspicion for smoke inhalation(cyanide is common in house fires and can form any time there is a combustion of materials contain carbon or nitrogen some Plastics particularly arclylonitries release significant amount when burn)

Question 20

cyanokit notes

Answer 20

Provable exposure to industrial cyanide(i.e. jewelry making glass etching, chemical production, electroplating, dyeing, printing manufacture of plastic paper and textiles)

Question 21

dextrose

Answer 21

Unconscious or AMS GCS <60

note; if suspected stroke or head injury glucometer readings must be done before any sugar is given and the results must be below 50

Question 22

Dopamine

Answer 22

Hypotension BP <90 after Fluid challenges with S/S; not indicated when shock is caused by severe hemorrhage until fluids have been given (persistent hypotension may indicate internal hemorrhage so considerate IV fluids first.) infusion rate Star low end when patient is in PE or renal failure

Question 23

Dopamine

Answer 23

for PE after initial attempts with appropriate for boluses and attempt to identify manage underlying cause

Question 24

EPI

Answer 24

1. Any cardiac arrest 2. Severe anaphylaxis not responsive to other measures 3. Severe nonresponsive bronchospasm

Question 25

EPI sub q or im

Answer 25

1. Allergic reaction with respiratory or circulatory compromise 2. Status asthmatic diminish or absent breaths sound (use with albuetral aerosol)

Question 26

Epi drip

Answer 26

For critically adults with anaphylactic bradycardic shock not responding to other treatments

Question 27

etomidate

Answer 27

1. Intubation needed but clenched or fighting or otherwise unable to manage(pedi/adult) 2. Procedural sedation such as Cardioversion or not tolerated patient(pedi/adult) 3. shivering Post Rosc induce hypothermia(adult only)

Question 28

Glucagon

Answer 28

1. Symptomatic hypoglycemia with GCS < 60 unless S/Ss suggest a stroke or head injury then < 50 and no IV access after two attempts 2. Beta blocker overdose by medical advisor or poison control only

Question 29

Glutose

Answer 29

Appropriate in the hypoglycemic patient when the patient has a GCS of 14 or 15 is capable of swallowing and maintaining their own airway

Question 30

Hurricane spray

Answer 30

1. To suppress gag flex for orotracheal/nasotracheal intubation

Question 31

hurricane spray notes

Answer 31

Note this is not a meter dose spray and the amount of spray determine by position of the canister and force applied to the spray nozzle and the content in the canister time must be the limiting factor never administer more than one second total of spray, you special precaution with the elderly/children

Question 32

Lasix

Answer 32

CHF, cardiogenic pulmonary edema with normal to High BP after at least two doses of nitro and CPAP have not provided adequate relief not to be giving if hypotensive BP <110 or for HTN only

Question 33

lidocaine

Answer 33

1. PVCs and multiform and >5 minutes , 3 in a row/runs of v tach or increasing and in spite of other treatment 2. adult only: v.tach with a pulse non-polymorphic (first-line except for torsades) 3. v.fib or pulseless v.tachycardia second line after Amiodarone

Question 34

Morphine sulfate

Answer 34

1 severe pain management when not contraindicated according pain management/palliative protocol; consult with radio and before giving for abdominal pain 2. Chest pain relieved by second dose of nitro (third dose of nitro should still be giving if indicated) 3. Pedi; if unable to obtain IV/IO: instead of etomidate for procedural sedation (to gain necessary immobilization) for all but intubation (which would use percent if no IV/IO) 4. Not to be used cardiogenic PE

Question 35

narcan

Answer 35

1. Unconscious or depressed mental status with blood sugar >60 GCS< 12 2. known or suspected OD with depressed mental status or unconscious; give to maintain airway establish adequate breathing

Question 36

nitro

Answer 36

1. CP (to complete or near complete relief) | 2. Cardiogenic PE with or without CP

Question 37

sodium bicarb

Answer 37

1. Uses a second line tx renal failure patients with symptomatic brady cardia ventricular dysrhythmias, v.fib/ pulseless v.tach, asystole, PEA that do not respond to standard protocol 2. Victim with weight crushing legs for more than one hour

Question 38

sodium bicarb

Answer 38

3.Use early in C.A. algorithms to treat drowing/ known tricyclic antidepressant OD or other scenarios where there was prolonged hypoxia metabolic acidosis before c.a.(i.e.obstruction choking strangulation,status asthmatic,resp involved anaphylaxis; ketoacidosis, siezure long intraptment)

Question 39

sodium biacarb

Answer 39

4. After initial algorithm approaches in cardiac arrest are not working and there is good respiratory support ET or combi in place 100%02 and adequate ventilation 8-10 breaths/min for adults;14-16 for child/infant;20/min for neonate

Question 40

Sodium bicarb

Answer 40

5. Consult with med. advice for bicarb order in Pre arrest scenarios (i.e known tricyclic OD will prolong QT intervals, widening QRS >100ms, coma, seizure, ventricular arrhythmias, treatable hypotension)or for patients who may have been lying in one position (typically a hard surface) and unable to move/shift body weight

Question 41

sodium Thiosulfate: cyanide antidote -High suspicion for smoke in halation -Probable exposure to industrial cyanide &

Answer 41

1. Unconscious will blood glucose >60 after adm.to 2mgs of Narcan 2. Persistent shock after 1000 ml NS/LR 3. Cardiac arrest along with other appropriate tx. according Presenting rhythm also give early sodium bicarb(cyanide victims have lactic acidosis)

Question 42

versed (when etomidate not available)

Answer 42

1. Seizure activity /excited delirium /wildly agitated 2. Procedural sedation 3. Assist intubation 4. Post ROSC. induce hypothermia

Question 43

D5w 100 m

Answer 43

1. As a mixed with amiodarone for infusion with Maxi drip tubing 2. As a mixed with Hydroxocobalamin (cyanokit) with kit supplied vented tubing(20drops/ml)

Question 44

Normal saline

Answer 44

1 appropriate for all patients except PE or HTN 2 hypotension other S/Ss of shock 3 thermal illnesses or (injuries including dehydration) 4 any pedi pt 5 suspected stroke or head injury 6 electrolyte imbalance 7 trauma 8 any patient who has potential for 9 pregnancy what IV is indicating 10 can use as they diluent/flush for all meds including amiodarone (which is not to be mixed with LR)

Question 45

normal saline

Answer 45

5 suspected stroke or head injury 6 electrolyte imbalance 7 trauma

Question 46

normal saline

Answer 46

8 any patient who has potential for rapid decompsation 9 pregnancy when IV is indicating 10 can use as they diluent/flush for all meds including amiodarone (which is not to be mixed with LR)

Question 47

lacated ringers

Answer 47

1 appropriate for all patients 2 hypertension or other signs and symptoms of shock 3 thermal illnesses or injuries (including dehydration) 4 trauma when IV is indicated 5 any patient has the potential for rapid decompensation 6 suspected stroke or head 7 electrolyte imbalance

Question 48

lactated ringers

Answer 48

5 any patient has the potential for rapid decompensation 6 suspected stroke or head injury 7 electrolyte imbalance