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Details Title: ems Description: protocol Total Flash Cards: 49 Created: 11/11/2006 07:46:28	To study from this set of flash cards, or to create your own your own study flash cards, register HERE. If you are already a registered user, CLICK HERE.
Cards Term Drug Assisted Intubation (DAI) Definition Indications- trauma,stroke, rr<10, >40, spo2 <92, gcs 8 or less Predoxygenate 12-15 L/nrm or BVM 3 minutes Premedicate Lidocaine 1.5 mg.kg ivp, HTN, stroke, trauma Gag reflex- benzocaine 1-2 sec spray Pain- morphine 2mg ivp up to 10mg Sedate- Versed 5mg ivp, Etomidate .5 mg/kg Term Allergic Reaction (mild) Definition Bp 90 or above warmth, tingling, fullness in mouth and throat, rash, itching. Benadryl 1mg/kg - max 50 mg im or slow ivp Term Allergic Reaction (Moderate) Definition Bp above 90 S&S Same as mild plus wheezing, edema of airway, dyspnea, cough, soft tissue emdema, flushing, nausea, vomiting. Epinephrine (1:1000) .3 mg sub q/IM May repeat in five to ten minutes Do not delay transport waiting for response. Benadryl 50 mg ivp if no iv im If wheezing albuterol 2.5 mg hhn or mask 6l Term Allergic Reaction (Severe, Anaphylactic) Definition Bp less than 90 Life threatening symptoms include all of mild and moderate. Time sensitive Pt If airway/ventilations severely compromised: rx per dai sop Iv NS consecutive 200 ml fluid challenge to attain bp of 90 Epi 1:10000 .1 mg increments up to 1 mg. Reassess after each .1 mg If no iv epi 1:10000 1 mg ett If no ett epi 1:1000 1 mg IM If bp remains below 90 dopamine ivpb 10mcg/kg/min Titrated to 20 mcg/kg/min to attain bp of 90 If on beta or calcium blockers, pregnant or not responding to epi or dopamine Glucagon 1 mh slow ivp if no iv give im may repeat x1 If bp improves > 90 benadryl 50 mg ivp, if no iv give im If wheezing albuterol 2.5mg/neb Term Asthma/COPD (mild to moderate) Definition Wheezing and or cough variant asthma spo2 95% Albuterol 2.5 mg via hhn or mask Begin transport as soon as albuterol is started DO NOT wait for response Continue/Repeat ALBUTEROL while enroute to hospital Term Asthma/COPD (severe) Definition Severe SOB,use of accessory muscles, speaks in syllables, tachypnea, breath sounds diminished or absent, spo2 94 % or less TIME SENSITIVE EPI 1:1000 .3 mg sub-q BEGIN TRANSPORT AS SOON AS EPI IS GIVEN may repeat x in 10 minutes if minimal resonse Sever distress persists: Magnesium 50% 2 gm (4ml) mixed wuth 16 ml ns slow iv push over 2 minutes If wheezing present after epi : Albuterol 2.5 mg Term Acute Coronary Syndrome (ACS) None to Mild Definition Pain, discomfort present. alert, oriented, well perfused bp above 90 ASA 324 mg PO Nitro .4 mg sl or spray pain persists & bp above 100 repeat ntg q. 5 mintues max 3 doses iv ns tko Pain persists after 2nd nitro morphine 2 mg max 10 mg as lon bp above 90 Term Acute Coronary Syndrome (ACS) Moderate Definition Cardiorespiratory compromise + pain, discomfort bp 90 - 100 IMC IV NS 200 ml challenge if lungs clear Nitro .4 mg bp > 100 q. 5 minutes max 3 doses Pain after NTG x 2 Morphine 2 mg max of 10 mg bp maintained of >90 Term Acute Coronary Syndrome (ACS) Severe Definition Altered Sensorium, signs of hypoperfusion, or bp <90 If hr less than 60 treat per bradycardia sop If hr above 60 treat per cardiogenic shock with dopamine ivpb 5 mcg/kg/min; titrate to 20 mcg/kg.min to maintain systolic bp > 90 Term Bradycardia with a Pulse Definition IMC Aspirin 324 mg None to mild cardiorespiratory compromise Well perfused and systolic bp 90 or above. Ongoing assessment Moderate to severe cardio respiratory compromise Altered sensorium bp <90 TCP 70-80 bpm increase ma until capture if capture continue pacing enroute do not turn off if agitated versed 2 mg increments to 10 mg if pain and bp >90 after pacing morphine 2mg to 10 mg slow IVP Pacing ineffective - Atropine .5 mg (1mg ETT) may repeat q. 3 minutes to max of 3 mg or 6mg ETT If pt on beta calcium channel blocker or beta - Glucagon 1 mg ivp If pt remains unstable or cannot recieve Atropine treat per cardiogenic shock Term Supraventricular Tachycardia (Mild to Moderate) Definition Mild to Moderate cardiorespiratory compromise hr greater then 140 and bp above 90. Valsalva manuevers Rhythm persists right carotid massage unless contraindicated Regular R-R svt persists Adenocard 6 mg rapid ivp + 20 ml NS flush SVT persists or recurs adenocard 12 mg rapid ivp + 20 cc lush Irregular R-R A-Fib, A-Flutter Cardizem .25 mg/kg ivp over 2 minutes Term Supraventricular Tachycardia (Severe) Definition Bp less then 90 altered sensorium hr greather then 140 Lungls clear iv fluids 200 hundred cc challenge Assess need for procedural sedation versed 2 Mg to 1 Mg slow ivp Synchronized Cardioversion 10-200-300-360 Term Ventricular Tachycardia with a Pulse (None to Moderate) Definition None to Moderate Hr >140, bp >90 Monomorphic VT Amiodarone 150 mg mixed with 7 ml ns slow ivp over 10 mins Polymorphic VT Magnesium 2 GM mixed with 16 ml NS slow Ivp Term Ventricular Tachycardia with a Pulse (Severe) Definition Severe - bp < 90 Procedural Versed 2 mg to 10 mg slow ivp. Synchronized Cardioversion 100-200-300-360 Vt persists amiodarone 150 mg mixed with 7 ml slow iv bolus over 10 minutes No iv and ett in place seek medical control for order of Lidocaine 1mg/kg ETT q. 3-5 minutes up to 3 mg/kg ETT Synchronized cardiovert after each 1/2 of amiodarone. Term Ventricular Fibrillation or Pulseless V-Tach Definition IMC ,ABC,CPR Defib 200-300-360 Return of spontaneous circulation Assess VS support breathing follow appropriate SOP Persistent VF/VT resume cpr defib 360 after each minute of cpr intubate Establish Iv Vasopressin 40 units ivp No iv epi 1:1000 2 mg with 8 ml ns ETT q. 3-5 min Administer vasopresson as soon as iv estabished Defib 360 Amiodarone 30 mg ivp No IV Seek med order for Lidocaine 2mg/kg ETT q. 3-5 minutes to 6mg/kg Defib 360 sodium Bicarbonate 1meg/kg ivp Continue cpr an transport Defib 360 each minute Pt remains VF for 15 minutes after vasopressin EPI 1:10000 1 mg ivp or 2mg EPI 1:1000 in 8 ml ns ETT EPI supply exhausted Dopamine 10mcg/kg/min to 20 mcg/kg/min ivpb Term Implanted Cardiac Defibrillator (ICD) Definition Begin BLS IMC Establish Unresponsivenss, position airway determine breathlessness,start cpr. ecg monitor soon as possible. If pulseless vt/vf Defib at 200,300,360 Term Pulseless Electrical Activity (PEA) Definition CPR Intubate IV NS 200 challenge to maintain a bp of 90. Reassess breath sounds after each 200 cc Check for pulse and rhythm use proper sop Epinephrine 1:10000 1mg ivp or EPI 1:1000 2 mg mixed with 8 cc NS ETT Rate 60 or less is asystole sop Term Asystole; PEA <60 Definition CPR Vasopressin 40 units Atropine 1mg IVP q. 3-5 minutes If in asystole for 10 minutes or longer request order for termination of resucitation Term Heart Failure/ Pulmonary Edema ( Mild to Moderate) Definition Alert normotensive or hypertensive (SBP >90 and DBP >60. IMC 02 15L/C-Pap fio2 at 60% wih 5 cm of peep. May increase fio2 to 95% and 10 cm of peep to achieve spo2 of 95% or better IF BP falls below 90 systolic remove c pap. Aspirin 324 mg po Nitroglycerin .4 mg sl q. 5 minutes with no limit. SBP must remain >90 If Pedal Edema Lasix 1mg/kg not to exceed 80 mg Pain or anxiety Morphine 2 mg increments to 10 mg slow IVP Term Cardiogenic Shock Definition Pump failure with Bp less than 90 W/S&S of hypoperfusion Dopamine 5 mcg/kg/min titrated to 20 mcg/kg/min to maintain BP above 90 If hypovolemic and/or dehydrated and lungs are clear and respiration are not labored IV NS fluid challenge frequentyl reassess breath sounds If alert with gag reflex aspirin 324 mg PO Term Acute Abdominal/ Flank Pain Definition Morphine 2 mg as long bo above 90 if perotoniitis so pain meds Term Diabetic Definition Blood Sugar 60 or below dextrose 50% 50 ml (25 gm) ivp 60-70 Dextrose 50% 25 ml 12.5 gm ivp No iv glucagon im Term Drug Overdose Definition Beta Blockers- p<60+bp < 90 glucagon ivp Cocaine- Valium 2mg-10mg ivp or ir. Versed 5 mg im >200 10 mg im Cyclic Atidepressant-Sodium Bicarb 1meg/kg ivp Ecstacy-manage airway GHB- manage airway Narcotic- narcan .4 mg increments up to 2 mg ivp or 2 mg im Organophosphates- atropine 1 mg ivp/2mg ett q. 3 minutes no limit. Term Seizues Definition Valium 2 mg - 10 mg ivp or i.5 mg/kg ir . no iv versed 5 mg im. Term Traumatic Arrest Definition Chest injury - Bilateral needle pleural decompression cpr Epi- 1:10000 1 mg ivp or Epi 1:1000 2 mg with 8 ml ns ett Term Neurogenic Shock Definition Atropine- .5 mg reapid iv push q. 3 minutes Dopamine -1omcg/kg/min titrated to 20 Term Tension Pnuemothorax Definition Needle Decompression on affected side Term Open Pneumothorax Definition Occlusice Dressing Term Pericardial Tamponade Definition NS Iv Widle open up to 2 L Term Eye Emergency- Chemical Burn Definition Tetracaine .5% 1 gtt each affected eye Term Eye Emergency Corneal Abrasion Definition Tetracaine- .5% 1 gtt each affected eye Term Eye Emergency Penetrating Injury/ Ruptured Globe Definition Cover with shield or cup Term Eye Emergency Centrail Retinal Artery Occlusion Definition Massage globe, ntg .4 mg sl or spray Term Crush syndrome Definition Sodium Bicarb 1 mg/kg ivp Albuterol 5 mg Term Cyanide Poisoning Definition IN NS wide open Amyl nitrate inhalants 1 per minute x 12 if available Term Pre-Eclampsia Definition Magnesium 2gm with 16 ml ns slow ivp over 2 mins. Valium 2mg to 10 Term Peds DAI Definition Atropine .02 mg/kg Lidocaine 1 mg/kg Morphine for pain .1 mg/kg Versed .1mg/kg Term Peds Allerigc Reaction Definition Benadryl 1 mg/kg im or slow ivp epi 1:1000 .01 mg /kg sub q/IM Term Peds Anaphylactic Shock Definition Epi 1:10000 .01 mg/kg up to 1 m ivp/io No IV Epi 1:1000 .1mg/kg up to 1 mg ett No ETT Epi 1:1000 .1mg/kg up to 1 mg im Benadryl 1 mg/kg Albuterol 2.5mg Dopamine IVPB 10 mcg/kg/min Term Peds Asthma Definition Albuterol 2.5 mg Epi 1:1000 .01 mg/kg sub q Magnesium 25mg/kg mixed with 16 ml NS over 10 o 20 mins Term Croup Definition NS 6 ml in neb mask Wheezing Albuterol 2.5 mg Epi 1:1000 3 ml (3mg) via neb Term Epiglottitis Definition Epi 1:1000 3 ml (3mg) Neb mask Term Peds Bradycardia Definition Epi 1:10000 .01 mg/kg ivp/io or 1:1000 .1mg/kg ett q. 3-5 min Atropine .02 mg/kg rapid ivp/io Dopamine 5mcg/kg.min Term Peds narrow complex Tachycardia Definition Adenocard .1mg/kg rapid ivp with 5-10 ml flush may double an repeat once max second dose 12 mg Synchronized Cardiovert at .5-1-2j/kg Term Peds Ventricular Tachycardia with Pulse Definition Monomorphic- Amiodarone 5 mg/kg mixed with ns to total volume of 20 ml slow ivp over 20 mins Polymorphic- Magnesium 25mg/kg up to 2 gm mix with 16 ml ns iv over 10-20 mins. Synchronized Cardiovert .5-1-2 j/kg Successful Cardiovert amiodarone 5mg/kg with ns to make to 20ml total over 20 minutes, or lidocaine 1mg/kg ett cardiovert at 4 j/kg each minute during and or after drug therapy Term Peds V-Fib Definition Defib at 2-4-4 j/kg Epi 1:10000 .01 mg /kg ivp/io or epi 1:1000 .1mg/kg ett amiodarone 5mg/kg ivp/io or lidocaine 2mg/kg ett long arrest sodium bicarb 1meq/kg in/io Term Peds Asystole Definition CPR Epinephrine 1:10000 .01 mg/kg ivp/io or 1:1000 .1mg/kg ett If arrest due to hyperkalemia, hypermagnesemia, tricyclic od, or other sodium channel blocking agents Sodium bicarb 1meq/kg Term Ped Diabetic Emergency Definition If blood sugar between 60-70 and symptomatic give 1/2 dose If less than 60 1-8 yrs old dextrose 25% 2 ml/kg ivp/io less than 1 dextrose 12.5% 2-4ml/kg ivp/io No iv glucagon .03 mg/kg im Term Peds Drug Overdose Definition Beta Blockers- glucagon .03 mg/kg iv/io if wide qrs sodium bicarb 1meq/kg ivp Cocaine-Valium .3 mg/kg slow ivp i fno iv ir or versed .1mg/kg im Cyclic Antidepressant- Sodium 1meq/kg ivp Valium .3mg/kg ivp/io Narcotic- narcan .1mg/kg ivp/ett/io Organophosphates- Atropine .02mg/kg rapid ivp