Shared Flashcard Set

Details

EMS SOGs
Good Samairtan Hospital SOGs Region 8
120
Health Care
Undergraduate 2
01/01/2015

Additional Health Care Flashcards

 


 

Cards

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
Yes
Term
A DNR is limited to resuscitation but not necessarily intubation. What do you do if you want to intubate?
Definition
Contact medical control
Term
When you get a pronouncement of death in the field, what 2 pieces of information have to be in your report?
Definition
doctor's name and time
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
36 hours
Term
If your chest pain patient took Viagra 12 hours ago, what medication CAN'T you give him?
Definition
Nitroglycerin
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
Asthma
Term
You can omit giving a chest pain patient aspirin if he has taken it within the last _____hours.
Definition
8 hours
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
100 mmHg
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
100, 120, and 150J.
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
True
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
defibrillation at 120J
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
90mmHG
Term
Where do you put the ice packs when inducing hypothermia in a patient with return of spontaneous circulation?
Definition
axilla, groin, neck
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
CPAP
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
400 mg/250 ml D5W.
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
Pheochromocytoma
Term
What 2 medications will cause tissue necrosis if the IV infiltrates?
Definition
Dextrose and Dopamine
Term
How many abdominal thrusts should you attempt on a choking patient?
Definition
5 abdominal thrusts
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
15 yrs old
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
4
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
Contact medical control
Term
If you have a stable adult patient with partial airway obstruction due to illness/ epiglottitis, administer_____
Definition
6ml NS via nebulizer
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
Benadryl 50mg SLOW IV/IO
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
200ml NS
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
run a 12 lead ECG
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
True
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
at least 5min.
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
1-2min.
Term
what is the market name of fentanyl, and what type of drug is it?
Definition
Sublimaze, opiod.
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
Blood sugar
Term
Aside from cold packs, how else can you cool down your heat stroke/ exhaustion patient?
Definition
wrap patient in wet sheet and fan.
Supporting users have an ad free experience!