Scenerio

Question 1

Pain management: What do you do if the patient is hypotensive?

Answer 1

Administer fluid bolus

20cc/kg

Question 2

Pain management: What do you do for moderate pain? Wong scale: 1-4

Answer 2

Acetaminophen 15mg/kg

Toradol: 15mg IM/IV

Question 3

Pain management: What do you do for pain >7 on the wong scale?

Answer 3

Morphine: .1mg/kg IV/IO 
-Max dose of 10mg
-May repeat one time; total max 20mg
Fentanyl: 1mcg/kg IV/IO
-Max single dose of 100mcg
-Max total 200mcg

Question 4

Pain management: What should you consider after giving Morphine or fentanyl?

Answer 4

If pt begins feeling N/V

-Zofran

Question 5

Pleural Decompression: When would you perform?

Answer 5

Suspected tension Pneumothorax

-H’s and T’s

Question 6

Pleural Decompression: What is the procedure?

Answer 6

1. Assemble equipment (14g at least 3” in length, antiseptic swab, dressing and tape)
2. Identify landmarks (Insertion site is the mid-clavicular line at the second intercostal space just above the third rib
3. Prep the area with swab
4. Remove flash chamber cap from IV catheter
5. Insert the catheter over the top of the rib until air rushes out. Advance catheter over the needle. Remove needle leaving catheter in place.
6. Reassess breath sounds and patient’s condition (patient’s condition should improve
   almost immediately).
7. Secure catheter with tape

Question 7

Abdominal pain: What is the treatment

Answer 7

1. If symptoms of shock, refer to shock protocol
2. N/V?: Zofran 4mg IV (nothing by mouth)
3. Pain: refer to pain protocol
4. Position of comfort

Question 8

Shock: What is the shock treatment?

Answer 8

• Primary assessment then…* POHT
  1. If bleeding, control
  2. Prompt transport
  3. Obtain IV
  4. NS fluid bolus (1 liter)
• Fluid bolus contraindicated with pulmonary edema
• Fluid should be slowed to TKO when SBP is greater than 90mm/Hg
• Peds is 20mL/kg
  5. Consider a second large bore IV en route

Question 9

Shock: What is the dose for additional IV fluid bolus?

Answer 9

Adult: Max 2L
Ped: Max 40mL/kg

Question 10

Anaphylaxis/Allergic rxn: What is the treatment if initial SBP >90?

Answer 10

Initial medical care
1. Facial swelling, wheezing, or tongue swelling?: Epi autoinjector .3mg IM
2. Benadryl: 50mg IV (slowly over 2 minutes)
3. Improved?
Yes: Transport
No: Duoneb tx

Question 11

Anaphylaxis/Allergic rxn: What is the treatment if initial SBP <90?

Answer 11

• Initial medical care*
  1. Maintain airway (if obstructed, attempt ET. If unsuccessful: Needle cric)
• Oxygen 100%
  2. IV NS wide open
  3. Epi .3mg IM
  4. Benadryl: 50mg IV (over 2 min)
  5. If respiratory distress: Duo neb

Question 12

Adrenal Crisis: What is the treatment?

Answer 12

Initial medical care
For patients with known history of adrenal insufficiency
Has signs and symptoms of Addison’s crisis?:
1. Fluid bolus NS
2. Methylpresnisolone 125mg IV

Question 13

Behavioral emergencies: What can be used as sedation?

Answer 13

Versed 10mg IM

5mg IV

Question 14

Adult acute asthma: What is the treatment?

Answer 14

Initial medical care
1. Duoneb
2. Methylprednisolone 125mg IV
severe
3. epi .3mg IM (impending respiratory failure)
4. Mag 2g in 100mL NS over 10 min

Question 15

Adult COPD: What is the treatment?

Answer 15

Initial medical care
1. Duoneb
2. Methylprednisolone 125mg IV
severe
3. epi .3mg IM (impending respiratory failure)
4. Mag 2g in 100mL NS over 10 min

Question 16

ALOC: What are you considering for ALOC?

Answer 16

BGL
Opiate
sepsis
UTIs
Head trauma
Addison crisis

Question 17

ALOC: Treatment

Answer 17

• Initial medical care*
  1. No suspected trauma, place in recovery position
  2. BGL (<60 Dextrose 25g IV)

Question 18

Stroke: What is the treatment?

Answer 18

• Initial medical care*
  1. Perform Cincinnati scale
• Transport right away
  2. Identify patients “last known normal”
  3. Check blood glucose
  4. IV
  5. 12-lead if available

Question 19

Seizure: What is the treatment for seizure?

Answer 19

Initial Medical care
Actively seizing:
1. Midazolam: 10mg IM or 5mg IV
2. BGL <60: dextrose 25g IV

Question 20

Sepsis: What are the suspicion criteria for sepsis?

Answer 20

1. Hyperthermia (>100.4)
2. Hypothermia (<96.8)
3. HR >90
4. RR: <10 or >20
5. SBP<90mmHg

Question 21

Sepsis: What is the treatment for sepsis?

Answer 21

• Initial medical care*
  1. Place patient supine
  2. IV
  3. Cardiac monitor
  4. Measure BGL
  5. Fluid bolus 20ml/kg

Question 22

Cardiac chest pain: Treatment if SBP >110?

Answer 22

• initial medical care*
• O2 if low spo2
  1. Aspirin
  2. Nitro
• Have IV in line (TKO) (if BP less than 100mmhg, fluid bolus, recheck after 250mL)
• ED meds contraindicated
• make sure 12-lead isnt inferior
  3. Fentanyl or morphine

Question 23

Pulmonary Edema/CHF: Treatment?

Answer 23

• Initial medical care*
  1. Initiate O2
  2. Position patient upright
  3. Consider CPAP
  4. Nitro (BP above 100. IV in) (ED contra)
  5. If wheezing: Albuterol (or duoneb)

Question 24

Pulmonary Edema/CHF: what are the signs for CHF?

Answer 24

1. Respiratory noises: Rales
2. Vitals: Increased BP (200/100)
3. Positive JVD
4. SOB

Question 25

CPAP: What are the indications?

Answer 25

Severe respiratory distress not responding to initial treatment with: 1. CHF/Pulmonary edema/ near drowing 2. Asthma/COPD

Question 26

CPAP: Contraindications?

Answer 26

1. Respiratory/cardiac arrest 2. BP <90mmHg 3. Unresponsive to speech 4. Inability to maintain patent airway 5. Major trauma, pneumothorax, penetrating chest trauma. 6. Vomiting or active GI bleeding with emesis. 7. Unstable facial fractures.

Question 27

CPAP: procedure?

Answer 27

1. EXPLAIN THE PROCEDURE TO THE PATIENT. 2. Apply CPAP/BiPAP per manufacturer’s recommendations. 3. Place the patient on continuous pulse oximetry. 4. Secure the mask with provided straps and tighten to obtain a good seal, check for air leaks 5. Continue to coach the patient to keep the mask in place, readjust as needed. 6. Advise medical control of CPAP/BiPAP use during radio report. 7. If respiratory status deteriorates, remove the device and assist ventilations with a BVM/supplemental O2; place an appropriate airway control device. 8. Place the patient on cardiac monitor and record rhythm and vital signs. 9. Administer medications, per respiratory distress protocol, as indicated.

Question 28

CPAP: CPAP removal.

Answer 28

1. CPAP/BiPAP therapy needs to be continuous and should not be removed unless the patient cannot tolerate the mask or has marked deterioration including respiratory arrest, decreasing LOC or patient may vomit. 2. Assist ventilations as necessary *Do not remove CPAP/BiPAP until hospital therapy is ready to be placed on the patient*