Term
| Can someone with power of attorney for health care demand you stop resuscitation? |
|
Definition
| No, not unless the patient has a valid Do Not Resuscitate Order (DNR) |
|
|
Term
| Can someone with power of attorney for healthcare make decisions about a patient's emergency care? |
|
Definition
| Yes, the decisions outlined by the power of attorney document. If in doubt contact medical control |
|
|
Term
| Can paramedics honor a living will? |
|
Definition
| No. Start treatment and contact medical control |
|
|
Term
| Is a copy of a DNR acceptable? |
|
Definition
|
|
Term
| A DNR is limited to resuscitation but not necessarily intubation. What do you do if you want to intubate? |
|
Definition
|
|
Term
| When you get a pronouncement of death in the field, what 2 pieces of information have to be in your report? |
|
Definition
|
|
Term
| What 4 medications do you have to inquire about with a chest pain patient? |
|
Definition
| Cialis (tadalafil), Levitra (vardenafil), Viagra(sildenafil), Revatio (sildenafil citrate) (CLeVeR) |
|
|
Term
| You need to make sure your chest pain patient hasn't taken any erectile dysfunction medication, or pulmonary hypertension meds (Revatio) within the last ____ hours. |
|
Definition
|
|
Term
| If your chest pain patient took Viagra 12 hours ago, what medication CAN'T you give him? |
|
Definition
|
|
Term
| Before giving your chest pain patient baby aspirin, what medication do you have to ask about? |
|
Definition
| Use of ticagrelor (Brilinta). If patient is taking this - contact medical control. |
|
|
Term
| What is the aspirin dose for a chest pain patient? |
|
Definition
| 4, 81 mg baby aspirin (324 mg) |
|
|
Term
| What are contraindications for use of aspirin? |
|
Definition
1. Third trimester pregnancy (cat. D risk)
2. bleeding ulcer
3. bleeding/clotting disorder
4. hemorrhagic stroke |
|
|
Term
| Aspirin should be given with caution to chest pain patients with a hx of _____. |
|
Definition
|
|
Term
| You can omit giving a chest pain patient aspirin if he has taken it within the last _____hours. |
|
Definition
|
|
Term
| If a chest pain patient took 50 mg aspirin less than 8 hours ago - what do you do? |
|
Definition
| Can give enough aspirin to achieve 324 mg. 3 81 mg tablets. |
|
|
Term
| What do you need to get from your chest pain patient before administering NTG? |
|
Definition
| A 12 lead ECG. If you have elevated ST in leads II,III, and aVf - then NTG is contraindicated. |
|
|
Term
| The 12 lead on your chest pain patient indicates ST elevation on leads II,III, and aVf - what do you NOT want to do? |
|
Definition
| Do not administer NTG. It gives more pre-load to an already exhausted left ventrical |
|
|
Term
| In order to give NTG to a chest pain patient, he has to have a systolic BP of at least ____. |
|
Definition
|
|
Term
| Before you give your chest pain patient a second dose of NTG, what 2 things do you need to establish? |
|
Definition
| An IV, and make sure that systolic BP is above 100 mmHG. |
|
|
Term
| What is the dose and route of NTG you administer to a chest pain patient. How long do you have to wait before a second dose? |
|
Definition
| Sublingual (SL), .4mg (one spray). 5 min. |
|
|
Term
| What do you administer to a chest pain patient to control the pain? (initial dose) |
|
Definition
| Fentanyl 1 mcg/kg to a max dose 100 mcg IV/IM slow. |
|
|
Term
| What do you need to make sure of before administering fentanyl to a chest pain patient? |
|
Definition
| That systolic BP is above 100 mmHG |
|
|
Term
| What is the second dose of Fentanyl you can give to a chest pain patient? |
|
Definition
| .5 mcg/kg to a total of 50 mcg |
|
|
Term
| If your chest pain patient is older than __ yrs, the initial fentanyl dose is lower; ______ mcg/kg |
|
Definition
| 65 yrs, .5 mcg/kg to total max dose of 50 mcg. |
|
|
Term
| What is the max repeat dose of fentanyl for a 65 y/o chest pain patient? |
|
Definition
| .25 mcg/kg to max dose of 25 mcg. |
|
|
Term
| for a patient with ST elevation in II,III, and aVf, what 2 drugs are you supposed to avoid? |
|
Definition
| NTG and Lidocaine - you're just asking the left ventrical to work harder. |
|
|
Term
| What do you give to a symptomatic bradycardic patient? |
|
Definition
| Atropine .5 mg IV/IO q 3-5 min up to 3mg (can give up to 6 times) |
|
|
Term
| What are the three brady rhythms you can treat with atropine? |
|
Definition
| bradycardia, 1st degree blocks, and second degree type I blocks (high heart blocks) |
|
|
Term
| How do you treat a badycardic symptomatic patient with a second degree type II or third degree heart block or IVR? |
|
Definition
| Transcutaneuous Pacing (TCP) at 70 BPM. Starting at 30 mA and tritating up to 140 mA until reach physical capture. |
|
|
Term
| What are the 3 brady rhythms that should be treated with TCP? |
|
Definition
| Second degree type II, Third Degree, and IVR. |
|
|
Term
| If the atropine you give a bradycardic patient doesn't work, what is your next step? |
|
Definition
| TCP at 70 bpm, starting at 30 mA and increasing until you get mechanical capture to a max of 140 mA. |
|
|
Term
| Transcutaneous pacing can be painful, so what do you do to make the patient more comfortable? |
|
Definition
| Sedate with versed in 2 mg increments q 2 min to a maximum of 10 mg. |
|
|
Term
| After TCP, if your symptomatic bradycardic patient continues to decline - what next? |
|
Definition
| Go to the cardiogenic shock protocol. Dopamine 5mcg/kg tritate up to 10 mcg/kg until you get systolic BP of 90 mmHG. |
|
|
Term
| What is your first intervention with a stable supraventricular tachycardia patient? |
|
Definition
| Have patient attempt the Valsalva maneuver |
|
|
Term
| What med. do you treat stable supraventricular tachycadia with? |
|
Definition
| Adenosine 6 mg in proximal vein pushed quickly with 10 ml flush. If that doesn't work, try it again. If that doesn't work - 12 mg. |
|
|
Term
| NTG is contraindicated for patients with hypotension, ST elevation in II,III, and aVf,and recent use of erectile dysfunction drugs. Wha are the other 2 contraindications? |
|
Definition
| Increased intra-cranial pressure, and glaucoma. |
|
|
Term
| Unstable patients with supraventricular tachycardia should be treated with |
|
Definition
| Cadioversion starting at 100J. |
|
|
Term
| Cadioversion can be uncomfortable for a patient, so what do you administer? |
|
Definition
| Sedate patient with versed in 2 mg increments q 2 min to a max. of 10 mg. |
|
|
Term
| What are the three cardioversion energy levels |
|
Definition
|
|
Term
| If cadioversion doesn't work for your SVT patient - what can you do? |
|
Definition
| Go to cardiogenic shock protocol. Dopamine 5mcg/kg/min IVPB tritate to 20 mcg/kg/min IVPB until you get at least 90 mmHG systolic. |
|
|
Term
| Whenever you give adenosine - what do you have to follow it with? |
|
Definition
| a rapid 10 ml flush - it has a very short half life. |
|
|
Term
| What are the 6 side-effects of versed? |
|
Definition
| Dizziness, Agitation, Amnesia, Respiratory Depression, Tremors, Hypotension (DAARTH) |
|
|
Term
| What is your initial treatment of choice for a stable patient experiencing ventricular tachycardia? |
|
Definition
| Amiodarone 150mg IV/IO over 10 min. Administer in D5W solution as an IVPB. |
|
|
Term
| The amiodarone you have been dripping into your stable VT patient isn't working - what are you supposed to do? |
|
Definition
| Contact medical control to get permission to try adenosine. Maybe your VT is actually supra-ventricular. |
|
|
Term
| A patient with unstable VT should be treated with |
|
Definition
| Synchronized cardioversion starting at 100J |
|
|
Term
| True or False, whether a patient is in ustable VT or SVT with a pulse, the treatment is the same - cardioversion |
|
Definition
|
|
Term
| For unstable VT with a pulse - what do you do first - cardioversion, or amiodarone? |
|
Definition
| Cardioversion - but bear in mind you probably want to sedate the patient with versed if he is not already unconscious. |
|
|
Term
| For pulseless VT or VF what is your very first intervention if possible? |
|
Definition
|
|
Term
| what is the sequence of a full arrest in terms of interventions and drug therapies? |
|
Definition
1. Defib 120 - CPR 2 min
2. Defib 150 - CPR 2 min
3. EPI 1mg - CPR - Defib 200
4. Amiodarone 300 mg - CPR- Defib 200
5. EPI 1mg - CPR - Defib 200
6. Amiodarone 150 mg - CPR - Defib 200
7. EPI 1mg - CPR - Defib 200 q 2-3 min |
|
|
Term
| What are the two treatments for Pulseless Electrical Activity/Asystole? |
|
Definition
| CPR and EPI 1:10,000 1 mg IV/IO q 3 min |
|
|
Term
| There are 8 exclusion criteria for inducing hypothermia in a patient with spontaneous return of circulation they are |
|
Definition
1. Already hypothermic
2. Drug induced cardiac problem
3. Frank pulmonary edema
4. Traumatic injury
5. Major surgery within the last 14 days
6. Active bleeding
7. Isolated respiratory arrest |
|
|
Term
| Before you induce hypothermia on a cardiac patient - they have to have a systolic BP of at least ___. |
|
Definition
|
|
Term
| Where do you put the ice packs when inducing hypothermia in a patient with return of spontaneous circulation? |
|
Definition
|
|
Term
| If you induce hypothermia in a return of spontaneous circulation patient - and he begins to shiver - what do you do? |
|
Definition
| Administer versed 5mg IV/IO as long as the patient's BP remains above 100mmHG systolic. |
|
|
Term
| What medication do you administer to a pulmonary edema patient (dose, route) |
|
Definition
| NTG .4mg SL q 5 min as long as systolic BP remains above 100mmHG. |
|
|
Term
| What treatment do you administer to a stable pulmonary edema patient? |
|
Definition
|
|
Term
| If your pulmonary edema patient becomes hypotensive, or has altered level of consciousness - what do you do? |
|
Definition
| If HR is above 60 BPM go to the cardiogenic shock protocol. If HR is below 60 BPM go to bradycardia protocol. |
|
|
Term
| Before you give Dopamine to a cardiogenic shock patient, what do you need to assure |
|
Definition
| That the patient isn't just hypovolemic. The protocol calls for up to 400 ml NS |
|
|
Term
| What is the starting dose of Dopamine for a patient in cardiogenic shock? |
|
Definition
| 5mcg/kg/min IVPB and increase every 3 min until you get systolic BP of at least 90 mmHg to a max of 20 mcg/kg/min |
|
|
Term
| What is our concentration of dopamine on the ambulance? |
|
Definition
|
|
Term
| Dopamine is a positive ____ and ______ drug (cardiac effect) |
|
Definition
| chronotropic and inotropic |
|
|
Term
| What disease state is a contraindication for use of dopamine? |
|
Definition
|
|
Term
| What 2 medications will cause tissue necrosis if the IV infiltrates? |
|
Definition
|
|
Term
| How many abdominal thrusts should you attempt on a choking patient? |
|
Definition
|
|
Term
| There are 4 progressively more invasive ways to clear the airway of a choking victim, they are: |
|
Definition
1. visualize with laryngoscope and clear
2. attempt to force ventilation past obstruction
3. intubate and force obstruction into right mainstem
4. cricothyroidotomy |
|
|
Term
| What is the age cut off for drug assisted intubation with etomidate? |
|
Definition
|
|
Term
| Prior to administering Etomidate for intubation, what do you give? |
|
Definition
| Benzocaine to posterior pharynx 1/2-1 second spray X2, 30 seconds apart. |
|
|
Term
| When administering etomidate for intubation - what is the dose and route? |
|
Definition
| .6mg/kg to max 40mg IV/IO |
|
|
Term
| Post intubation what drug do you use and in what dose/route to maintain sedation? |
|
Definition
| versed 2mg q 2min to effect, up to max of 10mg. |
|
|
Term
| You should consider using fentanyl for pain management if the patient reports pain as a __ of higher on the 1-10 scale |
|
Definition
|
|
Term
| The main danger if fentanyl is administered too quickly is _____. |
|
Definition
| It can cause chest wall rigidity, and difficulty breathing. |
|
|
Term
| What is the treatment for adult asthma? |
|
Definition
| albuterol 2.5mg in 3ml via nebulizer or xoponex 1.25mg in 3ml with repeat dose if necessary. |
|
|
Term
| If an adult asthma patient continues to decline despite albuterol treatments, what is the next medication? |
|
Definition
| Epinephrine 1:1000 .3mg IM |
|
|
Term
| If your asthmatic patient is less than ___ yrs old and does not have a hx of _____, you may administer epinephrine .3mg 1:1000. |
|
Definition
| 50 yrs old, no hx cardiac disease. |
|
|
Term
| You can give epinephrine 1:1000, .3mg IV/IO to an asthma patient over the age of 50 or even with cardiac disease as long as ______ |
|
Definition
|
|
Term
| If you have a stable adult patient with partial airway obstruction due to illness/ epiglottitis, administer_____ |
|
Definition
|
|
Term
| If your stable patient with partial upper airway obstruction due to illness or epiglottitis is wheezing, you can administer |
|
Definition
| Albuterol 2.5mg/3ml or Xoponex 1.25mg/3ml |
|
|
Term
| If you have an unstable adult patient with upper airway obstruction due to illness or epiglottitis - what can you give? |
|
Definition
| Epinephrine 1:1000 3MG via nebulizer |
|
|
Term
| Your patient is having an allergic reaction (hives, wheezing) - what is the first medication you give? (dose/route) |
|
Definition
|
|
Term
| What is the dose and route of epinephrine you give to an adult with an allergic reaction (hives/wheezes) |
|
Definition
| Epinephrine 1:1000 .3mg IM may repeat w/in 15 min if minimal response |
|
|
Term
| What can you give your patient with an allergic reaction to address wheezing? |
|
Definition
| Albuterol 2.5mg/3ml or Xoponex 1.25mg/3ml via nebulizer |
|
|
Term
| Albuterol should be used with caution on patients who are either_____ or have hx of _________ |
|
Definition
| Lactating or cardiovascular disease |
|
|
Term
| An allergic reaction becomes anaphylaxis when the pt. develops either ____,____, or _______. |
|
Definition
| hypoperfusion, AMS, or hypoxia |
|
|
Term
| The initial dose of epinephrine for an anaphylaxis pt. is _________. |
|
Definition
| Epinephrine 1:10,000 .5mg IV/IO or Epinephrine 1:1000 .5mg IM, or Epinephrine 1:1000 1mg down ET tube may repeat dose every 3 min. |
|
|
Term
| To combat hypotension in the anaphylaxis patient what do you administer? |
|
Definition
|
|
Term
| The side effect of most concern with Benadryl is |
|
Definition
| Thickens bronchial secretions - so it can worsen asthma |
|
|
Term
| If you have a patient with intact gag reflex and blood sugar below 60 - what is your medication of choice? |
|
Definition
| oral glucose, monitor every 5 min until blood sugar returns/trends toward normal. |
|
|
Term
| Pts. with symptomatic hypoglycemia should be treated with |
|
Definition
| Dextrose 50% 25 grams, can repeat after 5 min. |
|
|
Term
| For patients with syncope or near syncope you should ____ |
|
Definition
|
|
Term
| For patients with syncope or near syncope, and pinpoint pupils you should administer |
|
Definition
| 1mg Narcan IV/IN. Repeat dose .5mg q2min until response, or max dose of 2mg if response observed. |
|
|
Term
| For an actively seizing patient you should administer |
|
Definition
| versed 2mg increments up to 10 IV. If no IV access then 10mg in 2ml IN, OR if over 70kg, 10mg IM, or if under 70kg, 5mg IM |
|
|
Term
| For a stroke patient the three diagnostic pieces of information you need are |
|
Definition
| Last known normal, blood sugar, and 12 lead ECG. |
|
|
Term
| What is the primary treatment for stroke patient? |
|
Definition
| elevate head of cot 15-30 degrees if BP is over 90mmHg. |
|
|
Term
| The three components of the Cincinnati Stroke scale are: |
|
Definition
| Arm drift, speech changes, facial droop. |
|
|
Term
| True or false; all of our regional hospitals are primary stroke centers |
|
Definition
|
|
Term
| If your patient has abdominal pain greater than 4 on a 1-10 scale, how do you treat it? |
|
Definition
| Fentanyl (Sublimaze) 1mcg/kg IV/IM to a max dose of 100mcg. If 65 yrs or older, .5mcg\kg IV/IM to max dose of 50mcg. |
|
|
Term
| If your patient continues to complain of abdominal pain after the first dose, what is the repeat dose? |
|
Definition
| Second dose fentanyl.5mcg/kg IV/IM to max dose 50mcg. If 65 or over .25 mcg/kg IV/IM to max dose of 25mcg. |
|
|
Term
| How long do you have to wait before doses of fentanyl? |
|
Definition
|
|
Term
| What is the major risk/ side-effect of pushing fentanyl too fast? |
|
Definition
| Chest wall rigidity which will compromise respirations. |
|
|
Term
| Pushing fentanyl "slow" means over what period of time? |
|
Definition
|
|
Term
| what is the market name of fentanyl, and what type of drug is it? |
|
Definition
|
|
Term
| For a patient experiencing nausea or vomiting, you can administer |
|
Definition
| Zofran (Ondansetron) 4mg ODT or slow IV X1 only. |
|
|
Term
| If your abdominal pain patient is unstable, should you push fentanyl? |
|
Definition
| NO. You should start pushing IV fluids. |
|
|
Term
| If your patient drank bleach (caustic) what is your limitation on airway management? |
|
Definition
| You can't use an alternate airway (King or Combi) on someone who ingested caustics because of risk of inhalation of the caustic, and further damage. |
|
|
Term
| If your patient has pinpoint pupils and lowered GCS what should you administer? |
|
Definition
| Narcan 1mg IV/IN, and tritate in .5mg increments q2min up to 2mg total. |
|
|
Term
| With a patient who has overdosed on narcotics, what should you prioritize? Airway support or narcan? |
|
Definition
| If you can maintain an airway with adequate ventilations, then try Narcan before intubating. |
|
|
Term
| What is the ECG sign of a tricyclic overdose like Elavil or Doxepine? |
|
Definition
| widened QRS complex with accompanying hypoperfusion. |
|
|
Term
| What is the drug treatment for a tricyclic overdose like Pamelor or Tofranil? |
|
Definition
| Sodium BiCarb 8.4% 1mEq/kg IV |
|
|
Term
| What is the treatment for a patient who overdoses on calcium channel blockers (verapamil) or beta blockers (propanolol) |
|
Definition
| Glucagon 1mg slow IV, may repeat once |
|
|
Term
| If your patient who has overdosed on beta blockers doesn't respond to glucagon - what's next? |
|
Definition
| Transcutaneous Pacing (TCP) |
|
|
Term
| How do you treat a patient who has been exposed to organophosphates? |
|
Definition
| Atropine in 2mg increments every 3min until condition improves |
|
|
Term
| How do you treat a patient who has been exposed to hydrogen cyanide? |
|
Definition
| 1 Amyl Nitrate tablet broken in a NRB, 1per min to a max of 12 tablets. |
|
|
Term
| What do you have to remember about airway management with a hydrogen cyanide exposed patient? |
|
Definition
| You should intubate as a last resort. |
|
|
Term
| With a snakebite patient, where should the bitten limb rest? |
|
Definition
| At the level of the heart. |
|
|
Term
| How do you manage the wound of a snake bite patient? |
|
Definition
| cover the wound with gauze, and remove any constrictive jewelry on affected limb. |
|
|
Term
| If you encounter a symptomatic dialysis patient (hypotensive,AMS) with a wide QRS complex, what is the treatment? |
|
Definition
| Sodium Bicarb 8.4% 1mEq/kg IV/IO and IV fluid bolus 200 mL |
|
|
Term
| If you encounter a dialysis patient in cardiac arrest, how does it change your treatment? |
|
Definition
| In addition to cardiac arrest protocol, also need to administer sodium bicarb 8.4% 1mEq/kg IV/IO. |
|
|
Term
| For a heat exhaustion/ heat stroke patient, where do you put the cold packs? |
|
Definition
| Axilla, groin, carotids, temples and behind the knees. |
|
|
Term
| For a heat stroke/ exhaustion patient, what vital do you need to check? |
|
Definition
|
|
Term
| Aside from cold packs, how else can you cool down your heat stroke/ exhaustion patient? |
|
Definition
| wrap patient in wet sheet and fan. |
|
|
