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Paramedic Protocols Flashcards

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1
Q

3 Indications for Intubation

A
  1. Cardiac or respiratory arrest
  2. GCS < 8 w/o gag reflex
  3. GCS < 8 respirations < 8/min.
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2
Q

ET tube placement checklist

A
  1. Breath sounds
  2. No gastric sounds
  3. End tidal CO2
  4. Chest rise and good compliance
  5. Positive fogging.
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3
Q

ET tube medications

A
  1. Naloxone
  2. Atropine
  3. Midazolam
  4. Epinephrine
    a. adult- 2 mg (1:1000) q 3-5 in a code.
    b. ped- .1 mg/kg (1:1000) flush w/2ml NS
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4
Q

6 Indications for O2

A
  1. AMS
  2. Respiratory distress
  3. Chest pain
  4. Shock
  5. Abnormal heart rate
  6. Multiple system trauma
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5
Q

O2 delivery

A
  1. Low flow 6L NC
  2. High flow 15L NRB
  3. COPD start at 2L NC. Titrate to effect.
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6
Q

BVM

A
  1. Not breathing
  2. Breathing is too shallow
  3. GCS < 8.
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7
Q

IV

A
  1. Pt. may deteriorate
  2. Saline lock for meds per protocol
  3. EJ if essential and poor access
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8
Q

I/O

A
  1. Critically ill
  2. IV is essential
  3. One attempt, OR
  4. No immediately apparent vein!!!
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9
Q

IV fluid dosage

A
  1. In traumatic arrest or who require fluid replacement:
    a. 2L, or
    b. Systolic BP>100
  2. Fluid challenge: 500ml. Lungs/ BP.
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10
Q

Spinal Immobilization: 7 indications

A
  1. Posterior midline spinal pain or tenderness w/ trauma
  2. Blunt trauma: trauma score <14
  3. Distracting injuries.
  4. Severe head or facial trauma
  5. Extremity numbness/ weakness w/ trauma
  6. LOC secondary to trauma
  7. AMS
    a. no history
    b. found in setting of trauma
    c. Near drowning w/ possible diving injury.
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11
Q

Pacing Indications

A

HR < 60bpm who do not respond to medications with severe chest pain, severe shortness of breath, pulmonary edema, acutely AMS, or shock.

  1. Adult after 1mg atropine.
  2. Ped after O2, BVM, epi, atropine .02mg/kg
  3. Asystole < 10min electrocution
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12
Q

Pacing procedure

A
  1. Pads on chest and back
  2. Set TCP rate at 80 beats per min.
  3. Begin at 0mA, increase until capture. +10% at capture.
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13
Q

12 Lead Indications

A
  1. Coronary Ischemic chest discomfort
  2. Shortness of breath with pulmonary edema if acute onset
  3. Hypotension in presumable cardiogenic shock.
  4. ROSC.
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14
Q

CPAP Indications

A

Severe…

  1. SOB with wheezes
  2. SOB with pulmonary edema CHF.
  3. Allergic reactions with wheezes
  4. Must be conscious, breathing, able to follow commands
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15
Q

CPAP Contraindications

A
  1. Peds under 14.
  2. vomiting
  3. hypotensive. SBP<90
  4. Suspected pneumothorax
  5. Cannot obtain a good seal with mask.
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16
Q

Cardiac Arrest Medical

A
  1. Chest pain prior to arrest
  2. GI bleed or other blood loss
  3. Meds and allergies?
  4. Depression or hx of drug use
  5. Downtime prior to CPR
  6. Duration of CPR
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17
Q

Traumatic Arrest

A
  1. Defibrillate
  2. C-spine
  3. Airway
  4. Bilateral needle thoracostomy
  5. Transport
  6. IV large bore. 2. en route.
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18
Q

Dysrhythmia

A 
Stabilize PRIOR to transport.
Treat the patient, not the monitor
Print a strip
Breath sounds
Skin color temperature moisture
Hemodynamics
Dependent/ pulmonary edema
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19
Q

Symptomatic, according to ACLS

A
  1. Hypotension
  2. Acute AMS
  3. Signs of shock
  4. Ischemic chest discomfort
  5. Acute heart failure (pulmonary edema)
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20
Q

Myocardial Ischemia symptoms

A
  1. Sever chest pain
  2. Cold sweats
  3. Nausea
  4. Shortness of breath
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21
Q

Shock signs and symptoms

A
  1. low bp
  2. cold clammy skin
  3. weak pulse
  4. dizziness
  5. rapid shallow breathing
  6. AMS!!!
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22
Q

Coronary Chest Discomfort

A
  1. O2, low flow
  2. Monitor
  3. ASA, 2x81
  4. NTG .4mg SL q 5” if cp continues. BP>100, no ED Rx
  5. IV
  6. Amio, 150mg/10” if runs of vtach, frequent couplets
  7. 12 Lead
  8. Stat transport
  9. Nitro paste 1” BP>100.
  10. Midazolam 4mg slow IVP if cocaine use.
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23
Q

SOB with wheezes. COPD/ asthma

A
  1. O2 low flow/ high flow
  2. Monitor
  3. Albuterol. Transport after first dose. 2.5mg
    If patient in sever distress:
  4. Epinephrine .01mg/kg 1:1000 IM.
    a. Not over 70
    b. Hx asthma & COPD
    c. No signs of MI, Hx of angina, MI, or CVA.
  5. TRANSPORT
  6. CPAP.
  7. IV if needed.
  8. MgSO4 2g in 250ml/ 2”
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24
Q

SOB with pulmonary edema

A
  1. Sit them up!!! Legs lower than heart.
  2. O2 low/high
  3. Monitor
  4. NTG
    a. .4mg BP > 100
    b. .8mg BP > 120
    c. .12mg BP > 200
  5. Transport
  6. 12 Lead
  7. CPAP
  8. Nitro paste. BP>100 1”. BP>120 2”.
  9. IV
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25
Respiratory distress assessment
1. Mental status 2. Breath sounds 3. Peripheral edema 4. cyanosis 5. ins/exp ratio 6. accessory muscle use 7. retractions 8. neck vein distension 9. tracheal position 10. chest diameter 11. diaphoresis
26
Respiratory distress mgmt
1. BVM? 2. Monitor for ALL patients 3. Ins difficulty/ stridor= upper airway 4. Exp. difficulty/ wheezes, rales lower airway 5. Fever? 6. Lower airway, albuterol 7. Use PASTMED.
27
PASTMED
``` PROGRESSION ASSOCIATED CHEST PAIN SPUTUM TIREDNESS/ TIME MEDICATIONS EXERTION DIAGNOSIS OF LAST SIMILAR EPISODE ```
28
Partial Airway obstruction
1. Calm patient. DNE 2. O2 lowflow 3. Suction secretions 4. Monitor 5. Transport in position of comfort 6. IV lock. 7. Contact hospital
29
Complete airway obstruction: Conscious pt.
1. Defined: Awake, cyanotic, unable to speak 2. Speak! Cough! 3. Abdominal thrusts 4. Speak! Cough! 5. Transport code 3.
30
Complete airway obstruction: Unconscious pt.
1. Open airway. Ventilate 2. Clear mouth. Visible? Finger sweep 3. Ventilations 4. Chest compressions 5. Repeat. Visualize 6. Transtracheal Jet Insufflation for complete obstruction. 7. Stat transport
31
AMS/ stroke/ syncope
1. AMS, high flow O2, syncope, low flow 2. Monitor 3. Naloxone 2mg IN. 1mg IM. 1mg IV slow. RESP < 8!!! 4. IV. 5. BG, BEFAST stroke scale. 6. Dextrose peds 1ml/kg D50. Infants 1ml/kg D25. 7. Glucagon 1mg IN if BG<80, and no IV 8. Transport.
32
BEFAST
1. Loss of balance? 2. Blurry/ double vision? 3. Smile. Stick out your tongue 4. Hold out your hands supine for 10s. 5. You can't teach a dog old tricks
33
Seizures
1. C-Spine!!! 2. O2. Low/High 3. Monitor 4. Midazolam 4mg IN (0.1 mg/kg). 5. IV 6. Accucheck. 7. Dextrose. 25g if AMS > Time. BG 10. Transport stat if unstable 11. Passive cooling for febrile seizure.
34
FACTS
``` Focus generalized vs. local Activity tonic-clonic vs. absence Color pink, blue, ashen. Hypoxia. Time onset and duration Supplemental Hx. Med compliance. Trauma, last seizure ```
35
Ingestion Poisoning
1. O2 low/ high 2. Monitor 3. IV lock 4. Transport Stat if unstable 5. Base
36
Shock
1. O2 high flow 2. Monitor 3. Transport. Therapy en route 4. IV. 1 or 2. No pulm. ed., wide open BP<80. 80-100, 500ml challenge. 5. 12 Lead 6. Base. Profound shock? 1mg epi 1:10,000 in 250 bag, titrate to BP100. .5-1.5ml/min 7. Hypovolemic? Cardiogenic? Obstructive? Distributive, sepsis, anaphylaxis?
37
Wet lung sounds
Cardiac history, medications. | Consider pulmonary edema with cardiogenic shock
38
Dry lungs and JVD
``` Consider PE 1. females on bc 2. immobility 3. recent surgery Consider TP: Thoracentesis 1. absent lung sounds on one side 2. recent trauma 3. hypotensive 4. tracheal deviation Pericardial Tamponade: Treat with fluids 1. recent trauma 2. muffled heart tones 3. recent MI. ```
39
Dry lung, no JVD
1. Hypovolemia a. vomiting and diarrhea, fever, GI bleeding, dehydration, trauma 2. Septic shock a. warm skin, no pallor, flushed b. fever c. recent infectious illness 3. Anaphylactic shock a. wheezes b. hives c. red skin d. exposure to allergen, history.
40
Allergic reactions and Anaphylactic Shock: Mild
1. No O2, Remove allergen 2. Benadryl 50mg IM, 1mg/kg ped 3. Transport
41
Allergic reaction and Anaphylactic Shock: Severe
Unstable: hypotension, severe respiratory depression, wheezing, oral swelling, AMS, chest tightness 1. Remove allergen 2. Monitor 3. Epinephrine .4mg 1:1,000 IM mrq 15". a. ped dose: .01mg/kg 1:1,000 IM max .4ml. 4. IV a. BP< 80, wide open b. BP 80-100, fluid challenge 500ml. c. BP>100, saline lock. 5. Epinephrine a. BP<80 with signs and symptoms of shock, .1mg (1ml) 1:10,000 IVP very slow push b. peds .025ml/kg of 1:10,000 very slow IV push to max 1.0ml. 6. Transport 7. Nebulized epinephrine 2.5mg/3ml. mr 2. 8. CPAP 9. Benadryl 50mg IVP, IM. Peds: 1mg/kg slow IVP, IM.
42
Profound shock Epinephrine
1mg 1:10,000 in 250ml, .5-1.5ml/min. 100 Systolic.
43
Trauma
1. Airway/ C-spine 2. Control bleeding. Moist dressing for evisceration. 3. Isolated extremity injury: Fentanyl 25mcg-100mcg IVIMIN q 5'', Bp>100. 4. Transport 5. Advanced airway 6. O2. Low if stable. High if unstable. 7. IV. Lock. Y tubing. a. BP100 TKO. d. peds: 20ml/kg. if BP<80 with signs of shock. 8. Monitor if indicated.
44
On scene trauma treatment
1. BLS airway 2. Occlude sucking chest wounds, eviscerations 3. C-Spine 4. Bleeding control
45
En route trauma treatment
1. ALS airway 2. IV 3. Repeated neuro assessment: pupils, loc, respirations, motor response.
46
MIVT
Mechanism Injuries Vital Signs Treatment
47
Burns
1. O2 low/high 2. Monitor 3. Transport 4. IV. LR 150ml/hr. Defer for Trn15% Dry sterile dressing. NO facial dressing 6. FENTANYL for severe pain, no AMS, SBP>100. 25-100 q5". Peds: 1mcg/kg/dose
48
Burn History
``` Thermal, chemical, electrical, radiation enclosed space blast trauma duration of exposure time of occurrence type of chemical voltage, if electrical LOC ```
49
Burn airway assessment
1. Oral or nasal burns 2. Nasal hairs burnt 3. Blisters or soot in mouth 4. Soot in sputum?
50
Near Drowning
1. O2 low flow high flow 2. Remove wet clothing. Dry blankets 3. C-Spine 4. Monitor 5. Transport 6. IV, Lock. 7. Asst: lung sounds, LOC, C-spine. 8. Drugs, EtOH.
51
Snakebite
1. ABCs, Airway, O2 low/high, Transport 2. Remove jewelry! 3. Elastic bandage. 4. Immobilize extremity BELOW LEVEL OF HEART!!!! 5. IV LR TKO. 6. NO ICE.
52
Behavioral Health Emergency
1. Scene safety 2. Restraints 3. Transport
53
Phenothiazine OD
Reglan/metoclopramide, Phenergan/promethazine, Thorazine, Compazine Benadryl 50mg. ped: 1mg/kg.
54
Vag bleed
1. O2 low flow/ symptomatic. High flow/ unstable. 2. Transport. Vitals en route 3. IV: 80 wide open. 80-100 challenge. 100. TKO. 4. Left side 5. Tissue remains
55
Childbirth
1. O2 low, stable. High if complications 2. IV. 3. Transport 4. BASE 5. Suction nose, then mouth. Warm. Dry. Stimulate. O2 Crowning: Deliver Prolapsed cord, breech: Transport.
56
Breech
Lights and sirens. | 1. Reach in. Make a V. Mom in shock position
57
Prolapsed cord
``` Mom in shock position. 1. O2 high flow. 2. Protect cord. 3. Cover exposed cord with saline soaked gauze TRANSPORT lights and sirens. ```
58
Pediatric Respiratory Distress 1. Epiglottitis 2. Asthma 3. Bronchiolitis 4. Croup
1. Lung sounds 2. O2 100% NRB. 3. Position of comfort 4. Albuterol under 14 yrs. 10mg/2ml. mr 2x. Transport immediately after first treatment. 5. 0.3mg 1:10,000 in 3ml nebulized epinephrine for croup ONLY 6. Transport 7. Severe distress: epi 1:1,000 IM .01mg.kg.
59
Pediatric Shock
1. O2 high flow 2. Transport 3. IV/IO. 2 large gauge. Unconscious? I/O!!! 4. Fluids: 20ml/kg. mr 2x. Intubate if needed.
60
Pediatric Shock Symptoms
Weak and thready tachycardic pulse changes in mental status including lethargy, irritability, or confusion cold clammy, cyanotic skin. Mottled. Poor capillary refill. HYPOTENSION IS A LATE SIGN!!!!!!!!!!!!!!!!!!!!!!!!
61
Causes of shock
hypovolemia from trauma, vomiting, diarrhea, and DKA. sepsis, cardiogenic, neurogenic as in OD and IC hemorrhage. anaphylaxis: bee sting. peanuts. penicillin.
62
Adult Bradycardia HR< 50, HASIA
``` O2 high flow. Atropine 0.5mg. Fluid challenge. Stat Transport. Atropine .5mg TCP ```
63
Pediatric Bradycardia | HR<80 infant
``` 100% O2.NRB. CPR if child is unconscious IV/IO TRANSPORT Epinephrine.01mg/kg 1:10,000 Atropine .02mg/kg, max .5. Fluid challenge 20ml/kg ```
64
Pedi Tachy w/pulses
``` All get ABC, High flow O2, IV/IO access. HASIA: QRS < .08 ST---> T. F. SVT----> U. M.F.C. .5J/KG T. VT---> U. M.F.C. 1J/KG. T. A. 5mg/kg Base: Vagals/ adensosine. .1mg/kg, .2mg/kg. ```
65
Ring Down
``` Unit ID. Name ETA Age, Sex, Weight CC, STAT/Non-STAT/Medical or Trauma/Code Blue Big Six? BB, R, AL, CM, O2, Resp Trauma GCS Mechanism and Trauma Score V/S ```
66
Needle Thoracostomy
S/S: 1. Severe respdep. 2. Lateralizing exam. 3. Hemodynamic compromise
67
3 indications for ET tube
1. Cardiac or Respiratory Arrest | 2. GCS <8 unable to protect airway

Paramedic (2 decks)

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