Protocols

Question 1

BVM rates

Answer 1

Adult 12-20 unless ETT then 8-10
Pedi 12-20 unless ETT then 8-10
Infant 20-30 unless ETT then 18-20

Question 2

EtCO2 range

Answer 2

Normal: 35-45 mmHg
Greater than 45 equals hypercarbia
Lower than 35 equals hypocarbia

Question 3

Glascow Coma Scale part one

eye responses

Answer 3

Eye responses

• open = 4
• to voice = 3
• to pain = 2
• no response = 1

Question 4

GCS part two

verbal responses

Answer 4

Alert and oriented = 5 (Pedi = babbles)
Disoriented = 4 (Pedi = Irritable)
Inappropriate words = 3 (Pedi = cries to pain)
Moans/ Unintelligable = 2 (Pedi = moans)
No response = 1

Question 5

GCS part 3

motor responses

Answer 5

Obeys commands/ spontaneous = 6
Localizes pain = 5
Withdraws to pain = 4
Decorticate flexion = 3
Decerebrate extension = 2
No response = 1

Question 6

Abdominal Pain for an adult

Answer 6

Routine ALS

• consider nausea/vomiting protocol
• consider pain management protocol
• check abdomen for tenderness, distension, rigidity, guarding or masses
• with acute abdominal pain consider a possible surgical emergency

Question 7

Adrenal Insufficiency for adult and pedi

Answer 7

Adult: with history of adrenal insufficiency, Hydrocortisone 100mg IV/IO/IM or Methylprednisone 125mg IV/IO/IM

Pedi: with history of adrenal insufficiency, Hydrocortisone 2mg/kg to a max dose of 100mg IV/IO/IM or Methylprednisone 2mg/kg IV/IO/IM up to a max dose of 125mg.
If they go in to shock consider the shock protocol

Question 8

Contributing factors to adrenal insufficiency

Answer 8

-Congenital or acquired disorders of the adrenal gland
-Same disorders but involving the pituitary gland
long term use of steroids (COPD, Asthma, Rheumatoid arthritis, and transplant patients

Question 9

Alcohol withdrawel

Answer 9

• For seizures go to seizure protocol
• Lorazapam 1-2mg IV/IO (preferred) or IM/IN may repeat dose once in 5min
• Diazapam 5-10mg IV/IO (preferred) or IM/IN may repeat once in 5 minutes
• Midazolam 2.5mg IV/IO (prefered), may repeat every 5 minutes or 5mg IM/IN, may repeat every 10 minutes

Question 10

Allergic reactions

Answer 10

After Epi:
-Diphenhydramine 25-50mg IV/IO/IM, if hives persist consider Pepcid 20mg IV/IO

For anaphylaxis refractory, after 3 or more doses of IM Epi, persistent BP issues or bronchospasm consider:

• Epi infusion 2-10mcg/min until symptoms resolve
• If patient is taking a beta blocker consider 1mg Glucagon IV/IO or IM

Question 11

Allegic reactions for Pedis

Answer 11

After Epi:
Dipenhydramine 1.25mg/kg by mouth or 1mg/kg IV/IO/IM with a max dose of 50mg
For anaphylaxis refractory after 3 or more doses of IM epi consider 0.1-0.2 mcg/kg/minute. Start low and titrate to effect

Question 12

Brief resolved unexplained event (BRUE)

Answer 12

investigate the event

contact medical control if the parents refuse

Question 13

Asthma, COPD, and RAD

Answer 13

-Levalbuterol 1.5mg via nebulizer repeat every 20 minutes
-Dexamthasone 10mg IV/IO or by mouth or Methylprednisone 125mg IV/IO
*for people who don’t respond or in danger resp. failure consider:
Epinephrine 1mg/ml (1:1000) 0.3mg (0.3mL) IM, lateral thigh preferred.
-Magnesium sulfate 2gams in 100mL NS IV/IO over 10 minutes

Question 14

Hyperkalemia

Answer 14

1gram of calcium chloride of 5 min

or nebulizer albuterol up 20mg

Question 15

hypoglycemia

Answer 15

D10 drip (25grams) until a BS of 70 or more
or Glucagon 1mg IM
Pedi: 5ml/kg same drug

Question 16

Nausea/Vomiting

Answer 16

Ondansetron 4mg IV/IO/IN
Prochlorperazine 5-10mg IV/IO/ or 5mg IM
Metoclorpramide 5-10mg IV/IO infusion ver 15 min or IM
for a diatonic reaction use Benadryl

Question 17

Pre eclampsia

Answer 17

4g IV in 100mL of NS over 10 min then consider 1gram/hr infusion

Question 18

Pain management

Answer 18

Fentanyl 1mcg/kg up to 100 mcgs
Hydromorphone 0.5-1mg every 5 min up too 4mg
Morphine 0.1mg/kg, single max dose of 10mg, every 5min for a total of 20mg as long as BP stays above 100
Ketamine 0.3mg/kg, max of 30mg
*consider midazolam 2.5mg if dysphoria or emergence reaction develops
Keterorlac 15mg IV
Acetominophen 1gram PO
Metoclopramide for migraines or prochlorperazine10mg over 15min and Benadryl

Question 19

Seizures

Answer 19

Midazolam 10mg IM or 5mg if less than 39 kilos or 5mg IV/IO/IN if given IV
Lorazapam 4mg IV/IO/IM
Diazapam 10mg/IV/IO then 2.5 every 5 min up to 20mg

Question 20

Sepsis

Answer 20

Norepi 1-30mcg/min titrate in increments of 4mcg

Epi infusion 2-10mcg/min

Question 21

ACS

Answer 21

324 aspirin

0.4 nitro every 3-5 min with a BP over 100

Question 22

Bradycardia

Answer 22

atropine 0.5 ever 3-5min up to 3mg (watch for heart blocks)
consider pacing and sedate if possible prior
Midazolam 2.5mg
Lorazapam 1mg
Diazapam 2mg
Also consider spy 2-10mcg/min

Question 23

tachycardia

Answer 23

Unstable consider cardiovert and if time sedate with Midazolam 2.5mg or 5mg IM, Lorazapam 1mg, or Diazepam 2mg all repeat at 5min
*For medication route condider vegan manuevers
Adensine 6mg then 12mg (SVT)
for rapid a-fid consider cardizem 0.25mg/kg IV/IO, may try again at 0.35mg/kg
Metoprol 5mg over 2-5min, may repeat every 5min up to 15min

Question 24

Tachycardia continued for V-tach/V-fib (wide conmplex tachycardia)

Answer 24

Adenosine same 6 then 12
Procainamide 25-50mg/min
Amiodarone 150mg over 10min
Lidocaine 1-1.5MG/KG with a max done of 3mg/kg
for Torsades de pointes 1-2 grams IV/IO over 5min