Protocols Flashcards
(188 cards)
1
Q
Pt has RUQ pain. What DIFF Dx?
A
Gallbladder, liver, pancreas
2
Q
LUQ pain. What diff dx
A
Spleen, pancreas, stomach
3
Q
RLQ PAIN = what issues
A
Appendicitis, kidney stone, PID, ovaries/cyst
4
Q
LLQ pain = what issues
A
Diverticulitis, kidney stone, cyst/ovary
5
Q
Per abdominal shock protocol, what MAP to maintain
A
55-65 mmHg
6
Q
Abdominal pn rx
A
Position of comfort, maintain CO.
Pt is NPO
7
Q
AMS rx
A
rule out SNOT & treat accordingly
sugar, seizure, stroke, narc, oxygen, trauma, toxicity/drugs
MOVAB
8
Q
What’s hypoglycemia criteria
A
<60 mg/dL
Or <80mg/dL in known diabetic
9
Q
Hypoglycemia rx
A
Oral, D10, D50, or glucagon
Reassess per 10min
10
Q
When shouldn’t you give oral glucose to a hypoglycemic pt?
A
Can’t protect airway (rapid LOC decomp or no gag reflex
11
Q
Opioid OD rx
A
Narcan IN IM IV IO until adequat ventilations (NOT loc)
12
Q
Psych disorders often cause AMS. True or false
A
FALSE. Suspect medical involvement if so
13
Q
Non-organic (aka not medically caused) coma rx
A
Inhalants/smelling salts for adult >16
14
Q
GCS less than 8….
A
Intubate
15
Q
Anaphylaxis rx
A
Mild (skin) = Benadryl & dexamethasone
Moderate (dyspnea & bad hives) = Epi IM 1:1000, Albuterol, and mild rx
Severe (shock) = all the above plus fluids and push dose epi (instead of IM)
16
Q
What happens when giving Epi to pt on beta blockers?
A
Can cause severe HTN and brain bleed DT unopposed alpha1 receptors
17
Q
Pt is on beta blockers and having a severe allergic reaction. And Epi doesn’t help. What now?
A
OLMC
Glucagon + cyrstalloid
18
Q
When to tube a burned airway
A
When you think you’re gonna lose it:
High Resp distress
Stridor
New onset hoarse
Blister burns of oropharynx
19
Q
Are 1st degree burns included in TBSA
A
No
20
Q
What total BSA pts go to a burn center? Besides BSA what are other qualifiers for the burn center?
A
> 10% tbsa
Or… chemical, critical spots, airway, electrical, full thickness
21
Q
What can you use to cover burns
A
Blanket, Saran wrap, sheets
22
Q
What carbon monoxide level = hi flo O2
A
> 15%
23
Q
Max time to cool a burn pt
A
5 min
24
Q
Pt has chemical burn. What Rx?
A
Call hazmat
PPE
Dry = brush
Wet = flush
25
Can you use neutralizers on chemical burns?
No
26
2 things to ask during electrical burn?
Arc flash or contact
What voltage?
27
What drugs for cyanide poisoning?
Cyanokit (Hydroxocobalamin)
Sodium Thiosulfate (if Cyanokit no available)
28
Baby vs adult rule of nines
Baby head = 18%
Baby legs = 13.5%
29
Max interruptions in CPR
<5s ideally
30
Ventilation rate for cardiac arrest
30:2
31
Where to place defib pads?
Anterior - Posterior first (heart pad in front)
32
What to do after 3 defibrillations
Double sequential external defib
33
Preferred placement of an IO in a cardiac arrest?
Proximal humerus
34
Where to take all arrest patients?
Nearest PCI
35
When must you call OLMC to terminate CPR?
Pt has organized rhythm & ETCO2 >10 with waveform without CPR.
36
When to give sodium bicarb during an arrest?
Early if tricyclic antidepressant OD, Benadryl, b blocker or hyper K
Prolonged arrest
37
When to OG tube during an arrest?
If tube is placed
38
Do we pre-charge defib prior to checking a pulse?
Yes
39
What Joules to defib pulseless V-fib or V-tach
360J
40
When to give epi during a v-fib/v-tach arrest?
After the 2nd shock
41
When to give Amio 300mg during a VF or VT arrest?
Same time as first epi
42
VF/VT drug sequence
Epi 1mg AND Amio 300mg - Epi 1mg - Amio 150mg - Epi 1mg - Esmolol 500mcg/kg - Epi 1mg - Esmolol 500mcg/kg - Epi 1 mg - Lidocaine 1.5mg/kg - Epi - Lidocaine .75mg/kg - epi - lido 0.75
43
What age/weight pts get double sequential defib?
Basically adults only:
>12 years
>40kg
44
You get ROSC without shocking or giving an antidysrhythmic. What drugs to give?
NO antidysrhythmics
45
You get ROSC after SHOCKING but didn’t give any antidysrhythmics. What drugs now?
Amio 150mg-10min (lido if not avail)
46
You get ROSC and the last antidysrhythmic you gave was amio. What drugs now?
Amio
47
You get ROSC and the last antidysrhythmic was Esmolol. What drugs now?
Esmolol drip
48
You get ROSC and gave mag sulfate for torsades during the arrest. What drugs now?
If mag worked = give more mag
Mag no worked = lidocaine
49
How to confirm Asystole
2 leads
Increase GAIN to rule out fine v-fib
50
Asystole/PEA protocol
CPR
Epi per 3-5min
Chilled LR
51
What are the H’s
Hermes the Ox drove to Cali to play Volleyball
HypoThermia
Hypoxia
Hydrogen Ion (acidosis)
Hyper/hypokalemia
Hypovolemia
52
What are the T’s
Thrombo the lesbian raises tension and trauma when she tox about her tampons
Thrombosis (PE or MI)
Tension pneumo
Trauma
Toxicity (narcs, tricyclic)
Tamponade
53
When can you terminate a persistent Asystole arrest?
X3 epi given
Confirmed asystole in x6 limb leads (with full gain)
54
When and How to transport a pregnant >22wk arrest?
Do it EARLY before ROSC
Displace uterus w/ 2 hands
Tilt backboard 30 degrees to the left
55
How does a preggo airway differ during intubations
It’s more difficult
Size 1-2 sizes down
56
When to transport a pregnant arrest >22wks
ASAP regardless of ROSC
57
Where to take a pregnant arrest >22 wks
No ROSC = Closest facility (w/ or w/o OB)
ROSC = closest OB or NICU
58
Preferred antiarrhythmic for preggo arrests
Lidocaine > amio
59
You suspect PE in an arrest pt. How does this change you treatments?
Load and go ASAP
60
You suspect cardiac tamponade in an arrest pt. How does this change your interventions?
Load and go ASAP
61
What signs = unstable for cardiac dysrhythmias
Chest pain, hypotensive, altered, pulmonary edema, shock signs
62
For tachycardia emergencies, what should you do in general? What kind of pt condition determines your cardiac interventions?
MOVAB (put on monitor, O2, vitals/12-lead, airway/IV access, breathing)
Stable vs unstable
63
Stable narrow (regular) tachycardia Rx
Valsalva
Adenosine (6-12-12)
64
Stable narrow irregular tachycardia Rx
Monitor
OLMC if you want
65
Stable, wide irregular tachycardia Rx
Torsades = mag sulfate
Anything else = monitor
66
Stable, wide, regular tachycardia Rx
Maybe adenosine
Amio drip x2
Lidocaine 1.5mg/kg
67
Unstable tachycardia Rx
Cardiovert 360J x2
Consider versed or etomidate sedation
No convert = amio drip
No = cardiovert 360 J
No = OLMC & rapid transport
68
Unstable wide, irregular tachycardia Rx
Defib 360 J
69
When should you half the adenosine dosage?
Heart transplant
Seizure meds - Carbamazepine (tegretol) & dipyridamole
Using a central line
70
Why is adenosine bad for WPW?
Can trigger a-fib RVR
71
How can adenosine risk asthma pts?
Can cause reactive airway response
72
Unstable bradycardia Rx
Atropine vs pace (depends on rhythm type)
No = Epi infusion or norepi infusion
73
When to pace vs atropine an unstable bradycardia
2nd degree type II or 3rd degree, or heart transplant = pace. No capture = atropine x3. no success = pressers
1st deg or 2nd deg type I = atropine. No success = pace. No success = pressers
74
Good troubleshoot for not getting capture for pacing?
Reposition pads
75
Why won’t atropine work on heart transplants?
They lack vagal innervation
76
PVC Rx.
Only if suspecting ischemia! (CHAPS)
Amio 150mg/10min
77
When treating PVCS with Amio , when would you need OLMC?
BP < 90
HR < 50
Sinus arrest periods
2nd or 3rd degree block
(When unstable or dissociation)
78
What do ECGs look like with Hyper K?
Peak T
Lower/no P wave
Wide QRS
Long PR
79
What can cause hyper K?
Rhabdo
Renal failure\
Crush injury
80
Wide Complex dysrhythmia w/ suspected hyper K Rx (pulse vs no pulse)
Pulse = calcium gluconate, hi dose albuterol, sodium bicarb
No pulse = hi dose calcium gluconate & bicarb
81
ACS Rx
MOVAB (O2 > 95%)
Nitro (AFTER IV if 1st time)
ASA
Pain meds
82
When should you give Fentanyl to an ACS pt?
After x3 nitro with no pain relief and BP > 100 SBP
83
STEMI criteria
1mm elevation in 2 contiguous LIMB leads
2mm elevation in 2 contiguous CHEST leads
84
STEMI Rx
Activate alert
Defib pads on Pt
ACS protocol
85
What are STEMI mimics
LBBB or RBBB
LVH
SVT
Pacer
pericarditis
Early repol
Digitalis
86
Crush injury
Treat Hyper K if present
Give 1-2L isotonic prior to extrication
Maintain fluid infusion
87
What BGL = hypoglycemia? Hyperglycemia?
Hypo =<60 or <80 (known diabetic)
Hyper = >300 or high
88
Hypoglycemia Rx
Oral (if conscious with gag), D50, or D10
Recheck 10min
Glucagon if no access
89
Hyperglycemia Rx
MOVAB + Etco2
500-1000ml fluids
Monitor for DKA or HNC
90
What ETCO2 correlates with DKA or HNC?
< 25 mmHg
91
Should you tube a pt in DKA or HNC
Try to avoid if possible
92
Epistaxis Rx
Lean forward w/ nose plugs
Still bleed = blow nose to expel clots & oxymetazoline hydrochloride x 2 nose sprays
93
Pt has nosebleed but is on NC oxygen normally
Put it in their mouth
94
Eye emergency Rx
30 degree angle
Chemical burn = Irrigate from center eye
Trauma = eye shield & cover other eye
95
Foreign body in superficial eye Rx
Proparacaine
Consider fluid irrigation
NO wiping.
96
Hyperthermia Rx
Strip & evaporation/convection cooling
MOVAB
Chilled NS
97
Hypothermia Rx
Strip wet clothes & heater w/ blankets
OLMC for arrested pts
98
Should you CPR or pace a hypothermica brady pt?
No
99
How does hypothermia affect meds on pts
Meds might not work until adequate circulation restored.
100
What pts need full immobilization/restriction?
MOI w/ potential spinal injury and ANY of the following:
AMS
Intoxication
Distracting injury
Neuro deficit
Spine pain/deficit
Distracting situation (language, emotion..)
101
When can you remove spinal immobilization stuff? What alternative?
Increases pain or neuro deficit = position of comfort/position found
102
How to spinal immobilize a pregnant pt? What term of gestation is most risk for hypotension?
Backboard elevate 6in on right side
103
What amputation pt’s become trauma systems?
Proximal to wrist or ankle
104
Amputation Rx. What to do with severed limbs?
Cover end w/ wet sterile gauze + dry gauze
Bleeding control
Limb in plastic bag or wrap & ice water. Transport first if delayed extrication
105
Partial amputation Rx
Splint in anatomical position
106
You feel no distal pulse on a fracture/dislocation. What Rx?
Axial traction to anatomical position until PMS. Then splint
107
Open Fracture Rx
Wet then dry dressing.
Splint position found unless PMS compromised
108
Nausea vomiting Rx
Fluids
Alcohol inhalation
Zofran
Prochloperazine ( if zofran not able)
Benadryl (if both aren’t able or extrapyramidal reaction
109
What must you do when giving zofran?
Cardiac monitor
110
What position to transport any 3rd trimester momma
Left side with pillow under hip
Backboard = elevate right side board 6 inches)
111
When should you give oxytocin to a mom?
If mom confirms single pregnancy by prenatal ultrasound
112
What med to give moms if shock is present
TXA
113
Can you call a code with asystole and just the pads on?
No. X3 epi and limb leads with full gain to confirm and call
114
Women can still have eclampsia for how long after pregnancy?
6 weeks
115
What BP (and duration) to treat eclampsia or notify hospital?
SBP 140+ DBP 100+ = notify
SBP 160+ DBP 110+ = treat
116
Eclampsia Rx. What BP is your target goal
Labetalol - < 150/100
117
When treating eclampsia with labetalol, at what HR should you stop?
HR < 60
118
Pregnant mom seizing. Can you do versed?
Yep
119
During child delivery, when and how to suction neonate airway?
Only when it’s necessary (ex meconium staining)
Mouth first and nose second
120
How and when to cut a baby cord
1-3 min after delivery. 6 inches
121
Should you wait for the placenta to delivery before transport?
No
122
At what point during delivery to massage fundus?
After placenta delivery
123
What to do during a breech delivery (but first)
If head doesn’t come out in 3 min = fingers on vagina and make a V
124
Prolapsed cord RX (3 things)
L lateral tendelenburg (20 degrees), push baby up vagina several inches, move baby off the cord if it’s visible
125
Limb presentation delivery Rx
Drive fast
126
What’s placenta previa? Rx?
Placenta over cervix opening = major bleed. Drive fast for a c-section
127
What does APGAR stand for
Appearance, pulse, grimace, activity, respirations
128
What meds for pain
Tylenol
Ibuprofen
Ketorolac
Fentanyl
Sufentinal
Morphine
Ketamine
129
When to use ketamine for pain?
- Chronic pain pts
-Used opiates daily
-Recovering addicts on methadone, suboxen etc
130
Don’t give pain meds if 1/4 of these are present
- Resp distress or SPo2 <90
- known allergy
- AMS
- SBP < 100
131
Compared to fentanyl, how much narcan is necessary for methadone and designer drugs
Much more narcan needed than typical 2mg
132
Aspirin or Tylenol overdose RX
<2 hours = activated charcoal
Call OLMC before charcoal if more other meds combined
133
Intubation considerations for Aspirin OD
avoid it until absolutely necessary
134
Beta blocker OD RX
push dose Epi for symptomatic bradycardia
Consider Epi drip
135
Calcium channel blocker
Calcium gluconate
136
Carbon monoxide Rx
Use spCO monitor if possible
Cpap high flow O2
Hyperbaric Hosp preferred
137
What level of spCO is bad and needs a hyperbaric (if severe symptoms)
15+ (RAD-57)
138
If you suspect Co and cyanide poisoning, what vital assessment should be done first? Why?
Measure the spCO. The cyanide kit will mess with CO readings once administered
139
Chlorine inhalation rx
Albuterol
Dex
Nebulized Bicarb 2.5ml
140
Cyanide rx
Cyanokit (hydroxocobalamin)
Sodium thiosulfate (2nd choice)
141
Difference between giving cyanokit for awake vs arrest pt
Awake = IV drip
Arrest = rapid fluid bolus
142
What meds are Sodium channel blockers
Tricyclic antidepressant
Benadryl
Lidocaine & anti arrhythmics
Seizure meds
143
Sodium channel blocker rx
Bicarb
144
Cocaine/meth rx
Benzo (OLMC)
145
Cholinergic RX
Atropine
146
Benzo/barbiturate rx
No antidote
147
Severe anxiety/agitation rx
Alprazolam (xanax)
Olanazapine (zyprexa)
148
What broset score requires restraints
>3 (verbal, physical threats or attacks on objects)
149
You can give chemical sedation If pt is immediate threat or RASS score is _
3+
150
When sedating a pt what drugs to use
Versed AND geodon
151
If violent pt needs sedation and you don’t know why they’re acting psycho or you think it’s psychiatric… what meds
- Geodon first
- Add versed 10min later if no improvement
152
Someone is going psych from drugs, alcohol or postictal and you need to sedate. What meds?
- Versed
- geodon later if pt doesn’t improve
153
After sedation you need to repeat the RASS score how often?
Every 10 minutes until 0 to -1
154
If someone has shortness of breath from unknown cause, what breathing treatments can you give?
Albertol x2 before adding a duoneb
155
Pulmonary edema rx
Nitro SL every 3-5m
Cpap
Consider albuterol
Lasix
Nitro dip if really bad
BP < 100 = carcinogenic shock Rx
156
Copd asthma rx
Duo x1
Albuterol prn
Dex
Mag
Cpap
157
Status seizure rx
Versed IM/IN
Repeat versed IM
Repeat third time IV 5mg
Repeat x4 IV 10mg
OLMC for versed infusion
If IV available immediately, so 2.5-5 then repeat at 5-10 then OLMC
158
Why should you check for pulse immediately after pt has a seizure?
Seizure can be first sign of cerebral hypoxia/dysrythmia
159
T or F: New onset seizures should always get medical evaluation
True
160
When is it okay not to transport a seizure
Finished poetical within 20m
They have seizure meds and hx
Seizure frequency is normal
161
What rsi meds should you avoid giving a seizure patient. Why?
Vec or roc can mask continuing seizure activity
162
What map is shock in a sepsis pt
<65
163
Sepsis alert if:
Suspected infection
Etco2 < 25 and…
2 of the following:
- 36C(98.6F) > temp > 38C (100.4F)
- hr > 90
- Resp > 20 (confirmed by etco2)
164
What map to maintain for the following shock types: trauma, AAA, cardiogenic (all others) head trauma
Trauma & AAA = 55-65
HEAD TRAUMA = >75
Cardiac& all others = >65
165
Cardiogenic shock rx
Fluid (max 1000)
Pressers (push dose or norepi)
166
Distributive shock treatment (anaphylaxis, sepsis, neurogenic)
Fluid boluses PRN
PRESSERS (norepi is preferred)
167
Obstructive shock treatment (tamponade, tension pneumothorax, PE, dissecting aneurysm)
Needle decompress prn
Fluid boluses prn
Pressers
168
What extra drug to give for shock patients with known/ suspected adrenal insufficiency
Dex
169
What two assessments for stroke patients
BEFAST, CSTAT
170
What are all the comprehensive stroke centers in the county
Emanuel
OHSU
Providence
St V
Sunnyside
SW Washington
171
BEFAST stroke exam
Balance (finger/nose, trunk/gait ataxia)
Eyes (double or vision loss, side-side movement)
Face (puff cheeks, show teeth)
Arms/legs (arms and legs up, sensation)
Speech (slur, commands, recognize objects)
Time (last known)
172
What are common blood thinners (8)
Pradaxa (dabigatran)
Rivaroxaban (xarelto)
Apixaban (eliquis)
Edoxaban
Betrixaban
Clopidogrel (plavix)
Prasugrel (effient)
Ticagrelor (brilinta)
173
Explain CSTAT
2+ = positive
Gaze (eyes move independently)= 2
Arm drift
LOC (2 commands, 2 AO questions)
174
Submerged patient treatment
Airway
Spinal precautions
Hypothermia
175
When don’t you resuscitate drowning patients?
>30 minutes UNLESS
KID <6yrs and water is cold
Pt was trapped in underwater pocket
Waters cold <40F
176
Neck hemorrhage treatment
Clotting agents and direct pressure
177
What gcs to intubate
Less than 8 intubate
178
What etco2 range to maintain when ventilating trauma patients? Signs of herniating?
35-40
Herniated = 30-35
179
What SP02 to maintain for trauma patients
>90%
180
When to chest decompress patients?
Trauma in severe respiratory distress/shock with suspected pneumothorax
Bilateral decompress witnessed trauma arrest
181
What IVs for trauma patients?
2 large bore IVs or humeral IO WITH LR
182
Which patients get TXA
Isolated head injury with GCS 3-12 & reactive pupils
Trauma shock with no head injury with MAP <55 or SBP <70
Multi system trauma with any: GCS 3-12 with reactive pupils, map <55 SBP <70
183
What age can get TXA
Adults 15+ or KG 50+
184
What contraindications for TXA
Gcs 3 with no reactive pupils
>1hr from injury
CPR
Seizures, stroke, MI or dialysis
Drowning
Hanging
185
At what point of a trauma call should you place a pelvic binder
Before spider straps
186
What’s more important in a trauma: cpr or reversible causes
Reversible causes
187
Patients with neurogenic shock and no other injuries should get what preferred medications
Pressers > fluid or TXA
188
Trauma entry patients shouldn’t get what pain medication
Ketorolac
