Protocols Flashcards
(143 cards)
1
Q
Providers must contact Medical Control to administer other prescribed rescue medications not specifically mentioned in the District of Columbia Fire and EMS Medical Protocols or formulary (i.e.______________________________)
A
Diastat rectal diazepam or Solucortef
2
Q
The EMC Bear symbolizes when Pediatric Care is warranted, and ______________ is required
A
Medical Control
3
Q
_______________ and _______________________ should be completed prior to contacting Medical Control or a receiving facility
A
a complete patient assessment and set of vital signs
4
Q
Medical communications with Medical Control or a receiving facility should be conducted for every _________________
A
Priority 1 patient.
5
Q
For seriously injured or critically ill patients notification to the receiving facility is required. It is preferred that this be accomplished by__________________, however, notification through the _________________________ is acceptable.
A
the transport unit
Office of Unified Communications
6
Q
When the transferring ALS provider has initiated ALS care and the transfer of care might negatively affect patient care, the non-transporting ALS provider should :
A
maintain patient care authority during transport
7
Q
Once a patient has received medications administered by any level of DCFEMS provider, the patient is categorically considered an ____________ level patient
A
ALS
8
Q
No patient will be turned over to BLS care once ALS interventions (Medications, Airway) have been initiated. An exception to this rule can be:
A
made in a Mass Casualty or disaster scenario.
9
Q
Transfer of care can take place if:
The patient has a patent airway, maintained without assistance or adjuncts.
The patient is ______________________ stable. Vital signs should be steady and commensurate with the patient’s condition.
The patient is at his or her baseline mental status and not impaired as a result of medications or drug ingestion.
No mechanism or injury warrants a _____________________.
No cardiac, respiratory, or neurological complaints that warrant ALS intervention exist.
The ALS provider provides the BLS provider with a full patient report to include vital signs and physical assessment.
➢ The EMT who will be in attendance is ________________________ and will assume care.
A
hemodynamically
trauma alert or activation
comfortable with the patient’s condition
10
Q
Hospitals will designate personnel to assess patients brought by EMS transport units with the goal of transferring care and releasing the unit within ______ minutes
A
10
11
Q
Definition of a Patient for purposes of this policy shall be:
* Obtaining a history or ____________________________________
A
interview of a client
11
Q
In the event that transfer of care is delayed for longer than ___ minutes, the EMS provider will contact the ________________________, who will in-turn contact the authorized hospital point of contact and attempt to resolve the delay in patient transfer until release.
A
20
ELO
11
Q
when a patient is unable to express consent because of altered mental status or severe distress.
A
Implied Consent –
12
Q
written or verbal request to be evaluated and treated.
A
Expressed Consent
13
Q
when a competent patient or guardian is informed of the potential benefits and risks of a process or procedure, alternatives to that procedure, and the possible consequences related to each.
A
Informed Consent
14
Q
Legal Capacity to Refuse Care
Ensure that the patient is at least 18 years of age in order to refuse care.
f the patient is a minor, he or she may refuse care if he or she is :
A
emancipated over age 16 by declaration of the court, or is married.
15
Q
Any minor of any age may consent or refuse care for health services for prevention, diagnosis or treatment of the following conditions:
A
Pregnancy or its lawful termination
Substance Abuse to include drug and alcohol abuse
Mental or Emotional Condition
Sexually transmitted disease
16
Q
Refusal of care medical scenarios
If possible, rule out conditions such as_________________, hypoxia, head trauma, _______________________ (e.g., diabetic shock); hypothermia, hyperthermia, etc. o Attempt to determine if patient lost consciousness for any period of time.
A
hypovolemia
metabolic emergencies
17
Q
A parent of a patient who is 18 years of age or older may not refuse care on behalf of his or her child unless:
A
the parent also happens to be a legal guardian
18
Q
A minor (i.e., under 18 years of age) may refuse care for his or her child. Obtain refusal signature from :
A
the minor parent
19
Q
______________________________ will also be requested to the scene to facilitate the FD 12 process with the responding law enforcement officer.
A
A Battalion EMS Supervisor
20
Q
Patients may be transported against their objections if they lack medical or ____________________ to refuse care
A
situational capacity
21
Q
In cases where the patient’s status is unclear and the appropriateness of withholding resuscitation efforts is questioned, FEMS personnel should initiate CPR immediately and then contact an ____________________________ or _______________________________ for further guidance.
A
EMS Supervisor or Medical Control Physician
22
Q
Inclusion Criteria for PDOA
There is no Exclusion criteria for PDOA
A
Patient is in cardiac arrest (adult or pediatric).
Patient presentation indicates that an attempt at resuscitation would be futile, inappropriate, or inhumane.
23
PDOA Primary Criteria (ALL must be met)
Pulseless
Apneic
No signs of life (such as spontaneous movement or pupillary response
24
PDOA Secondary Criteria (at LEAST ONE must be met)
Rigor mortis: body stiffening, usually occurring several hours after death o
Dependent lividity: reddish-blue discoloration of the skin resulting from the gravitational pooling of blood in the lower lying parts of the body in the position of death.
Decomposition or putrefaction: skin bloating or rupture, with or
without soft tissue sloughed off. The presence of at least one of these signs indicates death occurred at least 24 hours previously.
Decapitation: the complete severing of the head from the remainder of the patient’s body
Transection of the torso: the body is completely cut across below the
shoulders and above the hips through all major organs and vessels. The spinal column may or may not be severed.
Incineration (i.e. burned beyond recognition): 90% of body surface area with
full thickness burns as exhibited by ash rather than clothing and complete absence of body hair with charred skin
Massive whole-body crush injury
Obvious displacement of brain matter
Valid MOST Form indicating DNR status in Section A or other actionable end-of-life medical order (e.g., POLST From, DNR order, or Advanced
Directive) is present on scene
A valid DC licensed physician on scene, familiar with the patient’s medical status, orders that resuscitation not be attempted (e.g., nursing home or
palliative care physician)
“Compelling reasons” to withhold resuscitation in cases where efforts would be inappropriate and or inhumane. See “compelling reasons” below.
During a mass casualty incident, (MCI) the patient is designated as deceased (black tag) or expectant (grey tag) in accordance with the MCI Protocol. Such patients should be reevaluated as resources allow.
25
BLS providers _______________ need to request an ALS resource simply to perform a rhythm check when the above PDOA criteria are met.
do NOT
26
Compelling reasons to withhold resuscitation can be invoked when written directive (e.g., valid MOST Form or other DNR order) is not readily available on scene, yet the situation suggests that the resuscitation effort will be futile, against the patient’s wishes, and or inhumane. FEMS personnel may withhold resuscitation from a patient in cardiac arrest under “compelling reasons” when two criteria are BOTH present:
➢ End stage of a terminal condition (e.g., cancer, heart failure, dementia etc.) AND
➢ Written or verbal information from family, caregivers or patient stating that the patient did not want aggressive resuscitation efforts such as CPR or intubation.
27
If resuscitation was started (e.g., CPR) and upon further examination the patient has obvious signs of prolonged death or after obtaining additional information such as a valid MOST Form, the patient meets PDOA criteria, resuscitation efforts :
may be terminated immediately
28
The current DC Fire and EMS Medical Director shall be listed on the EPCR as the pronouncing physician. The time the FEMS provider confirmed that the patient was dead shall be listed as the time of death. Wording in the following format must be entered into the ECPR:
“The patient was pronounced dead on date at time by Dr. first and last name of DC Fire and EMS Medical Director by standing order.
29
By _____ hours after death, rigor mortis is usually firmly established.
12
30
Post-mortem dependent lividity also called livor mortis will begin to occur, unless the victim has suffered a large blood loss, about _______ hours after death, and peak at about ___ hours.
1-2
6
31
PDOA MCI color
Black or grey tag during MCI
32
Acronym for "MOST Form" means a set of portable, medical orders on a form issued by DC Health that results from a patient's or a patient's authorized representative's informed decision-making with a health care professional.
"Medical Orders for Scope of Treatment Form
33
MOST FORM Patient means a person who has been determined by an authorized health care professional to be approaching the end stage of a serious, life-limiting illness or frailty such that the person's life expectancy is :
12 months or less
34
The DC MOST Form is typically printed on ________colored paper (e.g., bright blue paper) so that it can be easily located and differentiated from other medical documents in the event of a medical emergency, and to alert healthcare providers that the patient participates in the MOST program.
bright
35
The MOST form is divided into four (4) sections (A-D) simplifying patient preferences for life-sustaining treatments, including:
Cardio-Pulmonary Resuscitation (CPR)
Medical Interventions/Treatment Options
Antibiotics and Medically Assisted Nutrition
36
Sections ______________ of the MOST form are the most important sections for EMS Providers
A, B, and D
37
Section D of the Most Form
Section D: Signatures by a MD/DO/APRN/NP and patient or patient’s authorized representative.
38
Section A of the MOST Form
medical orders for when the patient has no pulse and is not breathing. (i.e., Attempt Resuscitation/CPR or Do Not Attempt Resuscitation / Allow Natural Death)
39
Section B of the MOST Form
medical orders for when the patient has a pulse and/or is breathing. (i.e., Full Treatment or Selective Treatment or Comfort Focused Treatment)
40
To be considered valid, the MOST form must be signed in Section _____ by a MD/DO/APRN/NP and patient or the patient’s authorized representative.
➢ Exception: Inside of a healthcare facility, verbal orders are acceptable with follow-up signature by a MD/DO/APRN/NP in accordance with the facility policy.
D
41
.The MOST Form may be revoked at any time by the patient or patient’s authorized representative:
➢ To cancel the form, patients or their authorized representative are instructed to write the words ________________ across the form and put a line through “Medical Orders for Scope of Treatment” at the top of the first page.
➢ Revocation can also occur verbally to EMS providers or an authorized DC-licensed healthcare provider.
“VOID”
42
Pt with a MOST form MUST BE resuscitated if:
➢ The MOST form is revoked, unreadable, or not valid as determined above. ➢ The MOST form has been defaced or tampered with in any way.
➢ The patient has attempted suicide, or is the victim of a homicide.
43
is the primary scene
response air medical resource within the District of
Columbia.
United States Park Police
(USPP) Aviation Unit “Eagle One”
44
High-Risk “Red” Zones: areas within the District where
depending on the time of day and traffic congestion,
ground ambulance transport may exceed _____ minutes and
the total prehospital event time for a critically injured
patient may approach or even exceed _____ minutes. These
areas in general correspond with the first due response
areas of engine 15, 19, 25, 27, 30, 32, and 33
15
60
45
Patient assessment and the decision to fly should take less than :
60 seconds
46
Pink:
Red:
> 15-minute transport at an average transport speed of 15 mph
> 15- minute transport at an average transport speed of 30 mph
47
If a DC Fire and EMS member is requested to assist with/continue patient care during air medical transport, the member shall:
➢ Be an independent ALS Provider
➢ Follow DC Fire and EMS Pre-Hospital Treatment Protocols
➢ Operate within the established scope of practice
➢ Wear a helmet and protective eye wear
48
Contraindications for use of air medical transport
➢ Cardiac arrest or high likelihood to arrest during transport
➢ Penetrating trauma to the head
➢ Contaminated with hazardous materials
➢ Violent or erratic behavior
➢ If the transport by ground will be faster than by air
49
Transported directly to the Office of the Chief Medical Examiner
Imminent danger exists that requires the patient to be rapidly moved to an ambulance and or removed from the scene for safe assessment, treatment, and disposition. (e.g., shooting victim with aggressive or hostile bystanders)
OR
The deceased is in such a public place that not removing the body from the scene would cause significant public disruption or distress. (e.g., motorcycle crash in the middle of the highway with all lanes of traffic blocked)
50
Transport to OCME shall be documented as Hospital _______ in the electronic Patient Care Record.
30
51
In cases of a lightning strike a reverse triage process should be utilized and patients in cardiac arrest should be :
treated first.
52
ventilate with a bag-valve-mask (BVM) every __ seconds or ____ times a minute.
6
10
53
DCAPBTLS IC
D -- Deformities ➢ T -- Tenderness
➢ C -- Contusions ➢ L -- Lacerations
➢ A -- Abrasions ➢ S -- Swelling/edema
➢ P -- Penetrations/punctures ➢ I -- Instability
➢ B -- Burns ➢ C -- Crepitus
54
OPQRST
Onset – When did the pain/discomfort begin?
➢ Provocation/Palliative – What worsens or lessens the pain/discomfort? ➢ Quality – What does the pain/discomfort feel like?
➢ Region/Radiation/Referral – Where is the pain/discomfort? Does it move anywhere?
➢ Severity – How severe is the pain/discomfort?
➢ Timing – How long/often has this been occurring?
➢ Interventions – Any intervention performed prior to EMS arrival and any effect they may have had?
55
Secondary assessment
vitals
ekg
inquire about current health status
56
A 12 lead EKG will be obtained on patients with any one of the complaints mentioned in line item # 5 and who is greater than ____ years of age and reports to have a history of any one of the following cardiac risk factors:
➢ Coronary Artery Disease ➢ Diabetes
➢ Hypertension ➢ Obesity
➢ Family History of Cardiac Issues ➢ Smoker
➢ Use of recreational drugs ➢ High Cholesterol ➢ Use of medications not prescribed to that individual
➢ Is a member of an at risk population
30
57
Vital signs should be monitored at a minimum of every __ minutes for all critical patients and every ___ minutes for all other patients
5
15
58
Major trauma and burn patients less than ____ years of age should be transported to Children’s National Medical Center (H02).
15
59
Sexual assault patients less than 18 years of age should be transported to :
Children’s National Medical Center (H02)
60
Patients with isolated eye trauma should be transported to :
Howard University Hospital.
61
Adult sexual assault patients with no trauma or minor trauma will be transported to :
Washington Hospital Center (H13)
62
. Patients with left ventricular assist devices (LVAD) should be transported to an LVAD referral facility. Currently the only facility in the District of Columbia is :
Washington Hospital Center (H13)
63
Pediatric doses apply to pediatric patients weighing less than :
45 kg (100 lbs.).
64
For pediatric patients equal to or greater than _______________, utilize adult dosing
45 kg (100 lbs.)
65
Suctioning Time Limits
infant
child
adult
5
10
15
66
artificial ventilation when
less than 8 or greater than 26 bpm
67
Vent rate
adult
child/infant
6-8
3-5
68
trach tube
Ventilations should be delivered over 1-2 seconds
69
Nebulized medications shall be driven by a flow rate of ___ liters per minute
10
70
Intubation with a King Airway or ET Tube requires the attachment of continuous quantitative waveform capnography. ETCO2 readings should be maintained at a level of ______ mmHg.
35-45
71
Priority 3: Stable Patients
Seizure patients with a return of a GCS 15.
Any patient that is deemed stable by the senior provider.
72
Medical Control may be contacted at _____ step in patient care, and if a patient’s condition is unusual and is not covered by a specific protocol
any
73
______________________________ will be the designated Medical Control for ALL Pediatric patients
Children’s National Medical Center (H02)
74
A ___________________ is one who upon EMS arrival presents in extremis and or is at risk of rapidly deteriorating into cardiac arrest
crashing patient
75
This deterioration into cardiac arrest often occurs while___________, _____________, or ______________the patient into a transport unit
attempting to move, package, or load
76
Exclusion Criteria for Crashing Patient
➢ Patient is in cardiac arrest.
➢ Patient is a crashing trauma patient.
➢ Patient is not in extremis.
77
Inclusion Criteria for Crashing Patient
Patient in whom cardiac or respiratory arrest appears imminent.
➢ Patient with provider impression of extremis. This includes but is not limited to: o New onset altered mental status (“not following commands” – motor GCS < 6) o
Airway compromise
Severe respiratory distress/failure
Signs and symptoms of shock/poor perfusion
78
unless logistically impossible, every effort shall be made to ensure that crashing patients are cared for by____________________ on scene and throughout transport to an emergency department.
two paramedics
79
Insert 2 NPAs and an OPA as indicated and tolerated if not following commands on _________ patients
crashing
80
Utilize a Pit Crew CPR approach for resuscitation. See Pit Crew CPR Procedure Protocol.
➢ Push hard (______________ inches in adults, or greater than 1/3 chest diameter in pediatrics). ➢ Push fast (100-120 compressions per minute).
2.0-2.4
81
“Red to Bed” or “Red to Rear”: the red Zoll pad is placed to the left of the spine just below the scapula at the level of the heart.
The _____________ apex pad is placed over the anterior heart. Position under breast on a female.
purple
82
Each medication given through an IV/IO should be followed by a ____ mL flush
10
83
____________ of victims of out of hospital cardiac arrest (OHCA) have agonal breathing on presentation. Agonal breathing is a common reason to misdiagnose a patient as not being in cardiac arrest.
40-60%
84
The five components of high-quality CPR are:
1) Ensuring chest compressions of adequate rate
2) Ensuring chest compression of adequate depth
3) Allowing full chest recoil between compressions
4) Minimizing interruptions in chest compressions
5) Avoiding excessive ventilation.
85
Sodium bicarbonate should NOT be administered for ______________
“prolonged down time.”
86
The goal is to have the patient arrive in the emergency department within _____minutes of collapse.
30
87
All adult patients that are successfully resuscitated from a medical cardiac
arrest, regardless of initial cardiac arrest rhythm and 12-lead EKG findings, MUST be transported directly to a __________________________ receiving facility. All pediatric patients that are successfully resuscitated from cardiac arrest shall be transported to Children’s National Hospital.
(H2)
STEMI/ROSC
88
Goal is to maintain an
ETCO2 of _____________ mmHg.
o Adult: 10 breaths per minute
o Child: 20 breaths per minute
o Infant: 30 breaths per minute
35-45
89
Resuscitation efforts shall occur for at least _____ minutes of ALS care. ALS care starts when the monitor/defibrillator is both turned on and attached to the patient in cardiac arrest.
30
90
If termination of resuscitation is NOT granted: Obtain any additional patient care orders from the medical control physician. Unless medical
control recommends immediate transport, remain on scene to continue high quality CPR and ALS care for an additional _____ minutes.
10
91
BLS providers should assist patients in taking their own previously prescribed Nitroglycerin SL 0.4 mg or may use EMS stock medications if the patient’s prescribed Nitroglycerin is not available. BLS providers can only assist the patient with ______ dose of 0.4 mg Nitroglycerin
SL.
1
92
Washington Metropolitan VAD (LVAD, RVAD, BIVAD) Centers:
➢ George Washington University Hospital (H8)
➢ MedStar Washington Hospital Center (H13)
➢ Inova Fairfax Hospital (H29)
93
DO NOT USE THE LUCAS DEVICE, when CPR is indicated,
perform only manual chest compressions on __________ patients
VAD
94
Albuterol
2.5 mg via nebulizer
95
Atrovent
500 mcg nebulized
96
For COPD patients experiencing significant respiratory distress, consider Continuous Positive Airway Pressure Device (CPAP) and start at a pressure of ____cmH2O with an in-line nebulizer.
5
97
If the patient presents with respiratory distress with clinical evidence of croup, administer ___________ 3 ml via Nebulizer. Repeat 2 additional times as necessary if the patient improves with the initial administration.
Normal Saline
98
Treatable Causes of Altered Mental Status
(AEIOU-TIPS)
99
EPI
0.3 mg IM via adult auto-
0.15 mg IM via pediatric auto-
injector (under 9 years old)
100
FAST EXAM STROKE
FAST Exam is positive (+) if the patient has one or more of the following new clinical
abnormalities:
➢ Facial droop or weakness on either side.
o Ask patient to smile and show their teeth.
➢ Arm and/or Leg weakness.
o Ask patient to extend arms, palms up, with eyes closed. Watch to see if one
arm drifts down. If only one arm drifts, the test is positive. If both arms drift
down, the results are unclear.
➢ Speech is slurred or impaired.
o Ask patient to say, “You can’t teach an old dog new tricks.”
➢ Time: Determine the “last known well” time and transport immediately to a stroke
center as outlined below
101
pain level (using scales noted above) should be documented before
and regularly (i.e., every ____ minutes) after analgesic medication administration and upon arrival at the receiving hospital.
15
102
If non-pharmaceutical techniques are not sufficient to relieve mild to moderate pain (pain scale of _________), then consider use of ____________
1-5
acetaminphin
103
Acetaminophen:
160 mg chewable tablet x 4 for a total of 640 mg by mouth
contraindication: (within the past 6 hours) of acetaminophen
104
FUCK YOU
Age
< 3
months
3
months
4-11
months
12-23
months
2-4 yo 5-12 yo ≥ 13 yo
Acetaminophen
liquid
Not
indicated
1.25 ml
(40 mg)
2.5 ml
(80 mg)
3.75 ml
(120 mg)
5 ml
(160 mg)
or
10 ml
(320 mg)
or
20 ml
(640 mg)
or
Four
160 mg
chewable
tablets
105
Status Epilepticus: a seizure lasting ≥ _____ minutes or two or more successive seizures without a return to baseline mental status in between.
5
106
Circulation and motor sensory function shall be checked every _____
minutes while in physical restraints.
5
107
Nausea and vomitting
Open a single isopropyl alcohol wipe and place 1-2 cm from the patient’s nose.
Isopropyl alcohol wipe
(i.e., an alcohol prep)
Inhale 3 times through the nose
every 15 minutes, as tolerated.
107
Hypoglycemia
less than 70
less than 45 for less than one month old
108
One single dose tube in the buccal space
(space in the cheek)
May repeat once in ____ minutes if needed to
correct blood glucose level
10
109
After successful treatment of a hypoglycemic diabetic emergency, the patient or legal
guardian may refuse further treatment or transport if all the following criteria are met:
➢ Repeat blood glucose level is > _____ mg/dL.
100
110
Contact Poison Control on channel _____
H-11
111
Once delivery is accomplished, clamp the cord at___________ from the navel and cut between the clamps.
6 inches and 8 inches
112
MARCH
Massive Hemorrhage
Airway
Respiratory / Breathing
Circulation
Head Injury / Hypothermia Prevention
113
ATMIST
A – age
T – time of incident
M – mechanism
I – injuries noted
S – symptoms/signs
T – treatments provided
114
General Trauma Management Scene time should NOT exceed ____ minutes.
10
115
Clinicians should be alert to this
phenomenon, especially on calls for lift assist and similar incidents involving prolonged
immobilization.
Crush Injuries / Compartment Syndrome
116
injuries to the spine
(diving into shallow water) and falls greater than ___ feet.
10
117
Level 1 Trauma Center:
Hospital 2 (Children’s National Hospital) ***PEDIATRIC ONLY***
Hospital 4 (Medstar) ***ALSO ADULT BURN CENTER***
Hospital 5 (Howard University Hospital)
Hospital 8 (George Washington University Hospital)
Hospital 29 (Inova Fairfax Hospital)
118
All Fire/EMS personnel are required to report cases of suspected child / elder abuse or neglect to the Police agency responsible for the area in which the call occurred or the:
DC Child and family Services Agency
119
DO NOT REMOVE darts and instead transport to the hospital for removal if any of the following apply:
o Patient is not under control.
o Head, eye, face, neck, breast, hands, feet, genitalia or groin is involved.
120
Grasp the dart itself firmly with one hand and pull to remove one dart at a time. Place the other hand on the patient’s skin at least _______ inches away from the puncture.
4
121
Patients will be categorized into one of the five categories.
Red yellow green grey black
122
Patients who not deceased but are unlikely to survive
given the available resources. Reevaluated/re-
categorized as resources become available.
grey (Expectant) patients
123
SALT Mass Casualty Triage Algorithm
(Sort, Assess, Lifesaving Interventions, and
Treatment/Transport)
124
Administer pre-packaged Nerve Agent Antidote Kits (NAAK) every 10-15 minutes,
to a maximum of a total of ___ doses of auto-injectors.
3
125
Nerve agent triage
Immediate (1) red
Delayed (2) yellow
Minor (3) green
Non-
Salvageable (4) black
126
Metered Dose Inhaler Albuterol
BLS or ALS: ______ “puffs” with a
spacer. May repeat once in 5
minutes.
8
127
If the patient is in respiratory extremis with a history of asthma/COPD or has
wheezing on physical exam, all providers shall consider early administration of
:
epinephrine
128
A reading of >_______% indicates mild carbon monoxide inhalation.
A reading of >____% indicates severe carbon monoxide inhalation.
12
25
129
When using an AED on infants and children 8 years old or less or weighing less than
___ lbs (25 kg), use of reduced energy pediatric specific pads is recommended.
55
130
Perform manual chest compression for at least ______, two-minute cycles prior to deploying the
LUCAS chest compression system.
2
131
Applies the AED if applicable
CPR Leader Coach
132
First member to arrive at the patient's side.
Runner/Compressor
133
Medications that can be administered by intranasal route:
➢ Narcan
➢ Glucagon
➢ Midazolam (Versed)
➢ Fentanyl
134
Acetylsalicylic Acid (Aspirin)
324 mg / 4-81 mg baby aspirin PO if not taken during the previous 24 hours.
135
Albuterol
2.5 mg administered by nebulizer.
➢ BLS Providers may administer 5.0 mg without medical control.
136
anaphylactic
asthma
Administer 0.3 mg IM via epinephrine auto-injector, repeat every 5-15 minutes as
necessary (BLS or ALS).
137
Nitro
Cardiac Chest Pain
➢ 0.4 mg SL every 5 minutes, up to a maximum of 3 doses.
Congestive Heart Failure
➢ 0.4 mg SL every 5 minutes, no maximum dose.
138
APGAR
Activity
pulse
grimace
appearance
respiration
139
140
