MD Protocols Flashcards

Question

N/V - Adult

Answer 1

LR 20mL/kg to systolic of 90mmHg Zofran 8mg IV over 2-5 min or 4-8mg IM or 8mg PO dissolved (2x) MC 3rd dose of Zofran Watch QT Interval Contra pregnant

Answer 2

LR 20mL/kg to systolic of 70+2x age to 10yo (90mmHg) Zofran 28 days to 12 yo - 0.1 mg/kg IV over 2-5 min 13-18 8mg IV over 2-5 min or 8mg PO dissolved or 0.1 mg/kg IM (max 8mg) (2x) MC 3rd dose of Zofran Watch QT Interval

Answer 3

Fent - 1mcg/kg IV/IO/IM/IN (200mcg max) (2x) Ketamine 0.2mg/kg IV/IO over 1-2 min (20mg max) (2x) 0.5mg/kg IM/IN (50mg max) (2x) Toradol - 15mg IV or 30mg IM (1x)

Answer 4

Fent - 1mcg/kg IV/IM/IO (200mcg max) (2x) Ketamine 0.2mg/kg IV/IO over 1-2 min (20mg max) (2x) 0.5mg/kg IM/IN (50mg max) (2x) Toradol < 2 nothing 2+ 0.5mg/kg to 15mg max IV 1mg/kg to 30mg max IM

Answer 5

Blood sugar IM/IN - 5mg Versed IV/IO - 0.1 mg/kg, 2mg at a time to 5mg - SLOW For Pts 69 and over cut dose by 50%

Answer 6

Check blood sugar IM/IN - 5mg Versed IV/IO - 0.1 mg/kg - 2mg at a time up to 5mg - SLOW IV/IO - 4g of Mag in 50-100mL over 10 min

Answer 7

Check BG IM/IN - 0.2mg/kg - 5mg max IV/IO - 0.1 mg/kg - 2mg at a time, 5mg max SLOW

Answer 8

NS via pump up to 3L reassessing after 500ml if SBP < 70 initiate epi infusion 10mcg-20mcg/min Till MAP < 65 or systolic < 90

Answer 9

If PMHx of CHF or end stage renal failure 250mL NS If still hypotensive - levophed infusion 10mcg-200mcg/min Till MAP < 65 or systolic < 90 Consult after that

Answer 10

Source of infection plus 2 of the following Sys BP < 90 HR > 100 RR > 25 or ETCO2 <=32 Temp > 100.4 or < 95.9

Answer 11

Known Infection Plus 3 others HR > 205 RR > 60 Temp 100.4 Cap Refil > 3 sec Sys BP < 60 Mental - Unresponsive, confused, inappropriate or lethargic High risk condition - Cancer, transplants, indwelling catheters, immunodeficiency, immunosuppression

Answer 12

Known Infection Plus 3 others HR > 205 RR > 60 Temp 100.4 Cap Refil > 3 sec Sys BP < 70 Mental - Unresponsive, confused, inappropriate or lethargic High risk condition - Cancer, transplants, indwelling catheters, immunodeficiency, immunosuppression

Answer 13

Known Infection Plus 3 others HR > 190 RR > 40 Temp 100.4 Cap Refil > 3 sec Sys BP < 70+2 x age Mental - Unresponsive, confused, inappropriate or lethargic High risk condition - Cancer, transplants, indwelling catheters, immunodeficiency, immunosuppression

Answer 14

Known Infection Plus 3 others HR > 140 RR > 40 Temp 100.4 Cap Refil > 3 sec Sys BP < 70 + 2 x age Mental - Unresponsive, confused, inappropriate or lethargic High risk condition - Cancer, transplants, indwelling catheters, immunodeficiency, immunosuppression

Answer 15

Known Infection Plus 3 others HR > 140 RR > 35 Temp 100.4 Cap Refil > 3 sec Sys BP < 70 + 2 x age Mental - Unresponsive, confused, inappropriate or lethargic High risk condition - Cancer, transplants, indwelling catheters, immunodeficiency, immunosuppression

Answer 16

Known Infection Plus 3 others HR > 100 RR > 25 Temp 100.4 Cap Refil > 3 sec Sys BP < 90 Mental - Unresponsive, confused, inappropriate or lethargic High risk condition - Cancer, transplants, indwelling catheters, immunodeficiency, immunosuppression

Answer 17

20mL/kg LR over 5-20 min If no improvement additional 20mL/kg LR to 60ml/kg total

Answer 18

10ml/kg to 250mL fluid sensitive includes neonates (,28 days), congenital heart disease, chronic lung disease or chronic renal failure

Answer 19

NS on pump If still hypotensive - levophed infusion 10mcg-200mcg/min Till MAP < 65 or systolic < 90

Answer 20

LR bolus up to 250 at a time. Levophed to systolic > 90 If head injury Sys BP >110

Answer 21

DuoNeb 2.5mg albuterol 0.5 mg Atrovent - 2nd dose Albuterol 2.5 mg only Dexamethasone 15mg IV CPAP Mag 2g in 100ml over 10min (MED CONTROL)

Answer 22

Epi .5mg x3 DuoNeb 2.5mg albuterol 0.5 mg Atrovent 2nd dose Albuterol 2.5 mg only Dexamethasone 15mg IV CPAP Mag 1-2g over 10min

Answer 23

< 1 yo only 1.25 mg Albuterol 1-2 yo 1.25 mg Albuterol and 0.25mg Atrovent >2 yo 2.5 mg Albuterol and 0.5 mg Atrovent May repeat Albuterol 1x Epi - <5 yo 0.15 mg or 5yo+ 0.5mg 5q 3x Establish IV Dex 0.5mg/kg IV/IO (max 15mg) (**med control**) Mag 50mg/kg - 2g max over 10 min

Answer 24

For wheezing and bronchospasm 2.5mg Albuterol Dex - 0.5mg/kg 15mg max IV/IO For rales or suspected pulmonary edema O2 and CPAP per CHF protocol

Answer 25

SPO2 < 94 O2 Nitro 0.4mg q5 3x

Answer 26

CPAP Assess BP bf each Nitro If SBP>150 Nitro 0.4 and 1" nitro paste Nitro 0.8mg 5q until 20% drop in SBP If SBP drops < 90 250ml of LR 2x

Answer 27

CPAP No nitro 250 mL LR (MED Control for more) Epi drip 1mg in 100ml LR 10mcg/min max of 20mcg/min Titrate to 90SBP or MAP of 65 (MED Control for more)

Answer 28

NRB/CPAP MED Control Albuterol <2 1.25mg >2 2.5mg Epi Drip

Answer 29

Dex 0.5mg/kg PO - max 10mg

Answer 30

Dex 0.5mg/kg PO - max 15mg Epi neb - 2.5mg

Answer 31

Epi 0.01mg/kg IM 0.5mg max Dex 0.5mg/kg IV/IM - max 15mg Epi neb - 2.5mg

Answer 32

Consider hyperbaric if carboxyhemoglobin > 25% or any of the following carboxyhemoglobin > 15% EMS/Fire Carbon Monoxide alarm goes off AND LOC at any point GCS<14 Rapid decline of neuro Pregnancy (fetus has high affinity for CO so mom can b OK) Chest Pain Very young or old

Answer 33

Narcan - 2mg IVP/IO/IM/IN 1mg each nare Narcan - 4mg/0.1mL in one nare

Answer 34

Calcium Chloride 0.5-1g IVP over 10 min (UNLESS Pt in on Digoxin)

Answer 35

Benadryl - 25mg IV or IM

Answer 36

Charcoal - 1g/kg charcoal

Answer 37

Glucagon - 1mg q5 IVP

Answer 38

Atropine 2-4mg q5 until Pt has dry secretions/adequate O2

Answer 39

Sodium Bicarb - 1mEq/kg IVP up to 50mEq. q10 2nd dose 0.5mEq/kg

Answer 40

Narcan - 2mg IVP/IO/IM/IN 1mg each nare Narcan - 4mg/0.1mL in one nare

Answer 41

Calcium Chloride 20mg/kg - 1g max IVP over 10 min (UNLESS Pt in on Digoxin)

Answer 42

Benadryl - 1mg/kg, 25 mg max IVP/IM

Answer 43

1g/kg charcoal

Answer 44

Glucagon - 1mg IVP q5

Answer 45

Glucagon - 0.5mg IVP q5

Answer 46

Atropine - 0.02 mg/kg - max 2mg q5-10min until dry secretions and adequate breathing

Answer 47

Sodium Bicarb - 1mEq/kg

Answer 48

Sodium Bicarb - 1mEq/kg diluted 1:1 with LR

Answer 49

Immobilize extremity Take a pic if possible 20mL/kg LR titrate SBP to appropriate levels (e.g. 70+2x age or 90 - whichever is less)

Answer 50

Versed 0.1 mg/kg 2 mg dose 5mg max slow IVP half dose for over 69 or IM/IN 5mg

Answer 51

Versed 0.1 mg/kg 2 mg dose 5mg max slow IVP or 0.2 mg/kg IM/IN 5mg max

Answer 52

All full thickness Partial thickness > 10% BSA Burns to hands, face, feet, major joints, genitalia or perineum Electrical burns from greater than 120V. Suspected smoke inhalation Circumfrencial burns involving extremities or torso

Answer 53

Younger than 15yo - peds burn center

Answer 54

manage airway no need for fluids

Answer 55

No shock Airway 500mL/hr LR up to 2L. (MED Consult for more) If in shock 250mL LR. SBP ck after each bolus to maintain 90SBP or 65MAP. If head injury target 110 SBP

Answer 56

No shock Airway No fluids unless in shock If in shock 250mL LR. SBP check after each bolus to maintain (70+2x age)

Answer 57

4 - Spntanious 3 - Voice 2 - Pain 1 - No response

Answer 58

6 - Verbal 5 - Localizes pain 4 - Withdrawal from pain 3 - Abnormal flexion - decorticate 2 - Extended/rigid - decerebrate 1 - No response

Answer 59

5 - Appropriate 4 - Confused but able to answer 3 - Inappropriate words 2 - Gibberish 1 - No response

Answer 60

MOI and Midline Pt tenderness New paraplegia/quadriplegia Focal neuro deficit Altered Mental/Disoriented Distracting Injury Neck pain or torticollis High Impact crash Death in same crash Substantial torso injury

Answer 61

Pt found to be standing or ambulatory GCS of 15 No neuro No gross deformities No distracting injuries

Answer 62

If clear lungs 250mL of LR

Answer 63

ASA Nitro Pain mgmt Cardiac center if within 45 min

Answer 64

12 lead w/in 10 min IV access ASA 324 Nitro 0.4 SL q5 3x if SBP>90 SBP does not drop 20mmHg after 1st dose HR b/t 60-150 ED w/in 48hrs If Pt does not have nitro script you need to have IV access before nitro

Answer 65

Last know well 22 hrs Blood thinners BG LAMS 0-3 closest acute/primary stroke ctr or comprehensive stroke center LAMS 4 or greater - comprehensive stroke center or thrombectomy capable primary stroke center Face droop No Yes Arm drift Absent Drifts slow Drifts fast Grip strength Normal Weak No grip

Answer 66

Motor<6 SBP<90 (10yo+) RR <10 or > 29 RR < 20 if less than 1YO

Answer 67

2 or more proximal long bones Amputation proximal to wrist of ankle Chest wall instability Crushed, degloved, mangled or pulseless extremity Open or depressed skull fracture Penetrating injuries to anything other than distal to elbow or knees Pelvic fracture Paralysis

Answer 68

High risk auto crash greater than 12" on occupant side or 20" anywhere Ejection including partial Death in same compartment Vehicle telemetry data consistent with high risk of injury Rollover without restraint Auto v ped/cyclist thrown, run over or over 20mph impact Falls - 20' for adult - 10' or 3x of child's height Exposure to blast or explosion

Answer 69

>55YO SBP < 110 if Pt older then 65 Peds Burns wo trauma - burn ctr Burns w trauma - trauma ctr Pregnancy > 20 weeks Blood thinners/bleeding disorder EMS judgement

Answer 70

DuoNeb 2.5mg albuterol 0.5 mg Atrovent - 2nd dose Albuterol 2.5 mg only Epi 0.5mg IM 5q 3x Dexamethasone 15mg CPAP Mag 2g in 100ml over 10min (MED CONTROL)

Answer 71

Pregnant Hypothermic Submersion

Answer 72

15 2-min cycles of CPR Asystole Vtach, Vfib or PEA and ETCO2 < 15 1 Epi on board

Answer 73

15 2-min cycles of CPR 1 dose of Epi Asystole AND ETCO2 < 15 AND PD & EMS believe the scene can handle leaving child If VT, VF or PEA transport after 3 epi

Answer 74

Decapitation Rigor Mortis Decomposition Dependent Lividity Injury nor comparable with life At MCI - pulseless and apneic pt my be left

Answer 75

Everything

Answer 76

Same as A-1 except no intubation

Answer 77

Palliative care. Passive O2. no BVM You can suction No IVs You may admin pain meds

Answer 78

15 YO+ Asystole - u can stop immediately PEA, VF or VT 20ml/kg LR Bilateral needle decompression if penetrating neck, chest or abdominal trauma 12-lead and ID and treat rhythm Usually do not use Epi! Treat reversible causes and transport to trauma center is within 15 min otherwise closest ED

Answer 79

15 yo+ Asystole - u can stop immediately PEA, VT or VF 20ml/kg LR Bilateral needle decompression if multi-system blunt trauma 12-lead and ID and treat rhythm Usually do not use Epi! If all reversible causes have been treated and still in arrest after 5 2min cycles of CPR consider TOR.

Answer 80

ID rhythm and treat If VF or VT were present during arrest and currently a sinus rhythm consider amiodarone if not previously given. 150 in 100ml over 10 Target 90 SBP w LR or levo drip 1mg in 100ml Begin transport to cardiac center unless further than 45 min

Answer 81

100, 200, 300 and 360

Answer 82

200, 300 and 360

Answer 83

0.5, 1, 2 Joules/kg If they go to VFib DEFIB @ 2 to 4 joules/kg

Answer 84

13+ - 80 1-12 - 100 < 1yo 120

Answer 85

HR < 60 TCP at 80 Atropine .5-1mg IVP if TCP is unavial or ineffective. Epi 2-10mcg/min via pump Versed 5mg IV for pain

Answer 86

Leave alone unless unstable. Then TCP

Answer 87

Begin HPCPR if HR<60 If brady persists epi 0.01mg/kg IV every 3-5 min atropine 0.02mg/kg IV x2 Consider TCP >1yo 100 < 1yo 120 Versed 0.1mg/kg yo (max 5mg) or Ketamine 0.2 mg/kg IV (max 20mg) for pain

Answer 88

HR > 130 Sys BP > 100 PUSH - Dilt 0.25 mg/kg to 20mg IV/IO over 2 min 2nd dose PUSH - Dilt 0.30 mg/kg to 25mg over 2 min

Answer 89

Amio 150mg in 50/100ml over 10 min x 2

Answer 90

Mag 1-2g over 2 min

Answer 91

Leave alone unless unstable then cardiovert

Answer 92

Amio 150mg in 50/100 over 10 min x2

Answer 93

Sinus Tach - treat cause SVT - vagal Adenosine 0.1mg/kg (6mg) 0.2mg/kg (12mg) x2 Consider cardiovert

Answer 94

Probably VT Cardiovert (med control) .5 1 2 Amio

Answer 95

Consider Adenosine 0.1mg/kg (6mg) 0.2mg/kg (12mg) x2 MED CONTROL - Amio 5mg/kg (150max) in 100ml of 20 min

Answer 96

Shock IV Access w LR Shock Amio 300mg Epi 1mg Shock Shock (vector change or dual-sequental) Amio 150mg Shock (vector change or dual-sequental) Esmolol 0.5mg/kg Shock (vector change or dual-sequental) - Total of 15

Answer 97

Pregnant 20+weeks or < 6 weeks postpartum Moderate 140-159 SBP and 90-109 DBP with diagnosiss of preeclampsia or s/s of severe preeclampsia including proteinuria, severe headache, visual disturbances, severe rt flank pain or unrelieved epigastric pain Severe - 160+SBP or 110+ DBP

Answer 98

4g of Mag in 50/100ml over 10 min

Answer 99

2 BP over 160 Sys or 110 Dias over 15 min. Labetalol 20mg IVP over 2 min after 10 min if SBP/DBP >160/110 40mg IVP over 2 min MED CONTROL FOR 3rd dose AND At the same time 4 mg of mag in 100ml over 10 min

Answer 100

4mg of mag in 100ml over 10 min if seizure is still active or no IV/IO 5mg of versed

Answer 101

1. Tremor 2. Diaphoresis 3. Agitation - RASS 4. Confusion/Orientation 5. Hallucinations (visual, auditory, tactile) Scale 0 - None 1 - Mild 2 - Moderate 3 - Severe

Answer 102

BAWS score < 3 zofran 4-8 mg droperidol 2.5 mg

Answer 103

BAWS 3+ Versed 2-2.5 mg 3x

Answer 104

If clear lungs 20ml/kg of LR. Titrate to 110SBP or 85mmHg MAP Initiate epi infusion of 10-20mcg/min if SBP < 110

Answer 105

20ml/kg NS x2 SBP < 90 1g TXA in 100ml over 2-5 min

Answer 106

20ml/kg NS x2 SBP < 70+2xage 500mg TXA in 100ml over 2-5 min

MD Protocols Flashcards

(131 cards)