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188 Cards in this Set
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Standard Dopeamine dose
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400mg in 250ml of NS to infuse at 5-20mcg/kg/min
You can give to anyone 9 years or older..... |
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What's the Fluid bolus for pediatrics under 9?
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20ml/kg not to exceed 300ml N/S
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What to communicate during the radio communications policy?
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Unit #, Paramedic Caldwell with a run
Pt Age, Sex, Weight in KG Pt’s Chief Complaint, Signs/symptoms and mechanism of injury vital signs, BP, Pulse, Respiratory rate OPQRST, Sample Prior to contact therapy and medications and route given |
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What 4 things qualify something as an MCI
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1.Incident requires 5 or more ambulances
2. Incident involves ten or more patients 3. requires triage tags 4. require patient distribution to more than one hospital. |
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MCI ways to assess
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Jump start = Pediatric
Start = Adult |
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Paramedic blood draws 6080 policy
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At no time shall a request for blood draw for alcohol level take precedence over the medical treatment
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Paramedic blood draws 6080 procedure
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Must document everything as well be approved to operate in that scope, must document officers badge number name ETC
No base station required |
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Paramedic blood draws 6080 What're the contraindications (5 total)
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1. patient has an allergy to antiseptic
2. Patient can't be on anti-coagulant (must be applied for 1 minute) 3. Can't have a history of hemophilia 4. can't be combatic 5. can't be done if they're struggling or restrained and must be cooperative. |
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IFT guidelines (ALS) (8010).
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1.Patient's can't be transported with drips not in our scope,
2. cant be transported with blood products. 3. can be transported with Lidocaine, dopeamine, procainamide, mag sulfate, pitocin and potassium < or = to 40 meq/L |
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What classifies as a minor pediatric burn?
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<5% TBSA
<2% full thickness |
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What classifies as a moderate pediatric burn? (hint range minor-double minor)
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5-10% TBSA
2-5% fullthickness High Voltage Inhalation Circumfrential Medical problem (DM, Sickle Cell |
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What classifies as a Major pediatric burn? (hint Moderate +)
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10% TBSA
> 5% full thickness known burn of critical parts) |
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What classifies as a minor adult burn? (HINT DOUBLE PEDS)
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< 10% TBSA
<2% Full thickness |
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What classifies as a moderate adult burn? (hint range minor-double minor + double PEDS)
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10-20% TBSA
2-5% full thickness |
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What classifies as a Major adult burn? (hint Moderate +)
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20%+ TBSA
>5% full thickness + criticial burn areas |
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Destination policy for Minor and moderate burns
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Closest Most appropriate Receiving Facility
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Destination policy for Major burns
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Closest Most appropriate Burn Center (ARMC)
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General patient guidelines
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just need to know that here is where I establish vitals, IV manage abc's etc.... with no treatment outside of oxygen and IV....
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Organ Donors
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Just know to make a reasonable search, but either treat them or terminate resuscitation don't just transfer to harvest donors....
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What classifies as a Minor pediatric burn? (two things)
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less than 5% TBSA
less than 2% full thickness |
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What classifies as a Moderate Pediatric Burn? 6
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5-10% TBSA
2-5% Full thickness High Voltage Suspected inhalation Circumfrential burn Predisposing medical issues |
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What classifies as a Major pediatric Burn?
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greater than 10% TBSA
Greater than 5% full thickness burns to face, eyes, ears, genitalia or joints. |
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What's considered a minor burn for adults? 2 (note: full thickness is the same as pediatrics)
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less than 10%
less than 2% |
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What's considered a moderate burn for adults?? 2 (note: full thickness is the same as pediatrics)
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10-20% TBSA
2-5% full thickness |
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What's considered a major burn for adults?? 2 items (note: full thickness is the same as pediatrics)
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greater than 20% TBSA
greater 5% Full thickness |
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What're the destinations for the Minor and moderate burns?
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Closest Most appropriate Receiving Facility
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What's the destination for a Major burn?
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Closest most appropriate Burn Center (ARMC)?
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What two type of restraints are allowed?
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You may only use padded leather restraints or soft restraints( e.g velcro or seat-belt, posey)
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What must you do when you transport a patient with restraints?
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1. You must evaluate and re-evaluate
2. must document the reason and who applied them. 3. Restraints should be evaluated for PMSC's every 15 minutes respiratory status should be monitored too. |
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Nause and Vomiting 9120 contraindications
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Patients under 4
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What's the dosage for Zofran?
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4mg IM, SLOW IVP or Orally
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How much zofran can you give prior to base contact for patients 4-8?
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one dose prior to contact
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How much zofran can you give to patients over 9 prior to base station contact?
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3 can be given prior to base contact
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What's another drug that you give that you should consider giving Zofran prophylactically prior to administration?
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You should consider giving Zofran prior to giving Morphine IVP.
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What're the Field assessment/treatment indicators for a King airway?
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Unresponsive and apneic (less than 6 breaths per minute)
No gag reflex Over 4 feet high. |
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What are the two keys regarding the king airway and things we shouldn't can't do?
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1. Never remove the king airway unless it malfunctions.
2. Can't give drugs down it. |
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When should administration of Lidocaine be given prior to intubation?
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if you think they have had a head or brain injury.
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What's the dose of lidocaine in a head injury patient?
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1.5mg/kg IVP
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In regards to a pediatric intubation what type of tube should you use for patients under 8?
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use an uncuffed tube
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What're the maximum number of pediatric intubation attempts allowed prior to base hospital contact?
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2 attempts can be made before you have to contact base, note an attempt is when the tube passes the gums.
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When should Nasotracheal intubation be attempted (3 reasons)?
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Cervical spine injury with blenched Jaw and gag reflex
trapped and inaccessible to director laryngoscope Large nare able to accomodate 7, 7.5 and 8. |
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What're the treatment indicators for a Needle thor?
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Increased agitation, hypotension, JVD, tracheal deviation away from the affected side
decreased or diminished breath sounds on the affected side dyspnea or worsening cyanosis. |
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NG/OG Field assessment/Treatment Indicators
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Any intubated patient with gastric distension
oral route for patients with mid-facial trauma on all patients less than 6 months of age. |
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What're the contraindications for NG/OG?
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Caustic ingestion, Significant Facial and head trauma, history of bleeding disorders, history of esophageal disease.
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what're the appropriate NG/OG tube size for adults ?
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16-18 FR
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what're the appropriate NG/OG tube size for adolescents?
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12-14 FR
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what're the appropriate NG/OG tube size for Children?
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8-10 FR
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what're the appropriate NG/OG tube size for Infants?
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5-6 FR
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When should vagal maneuvers be performed?
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Stable Narrow Complex Tachycardias
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What are the 3 ways to have a patient perform a vagal maneuver?
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1. Pinch Nostrils, Close mouth and blow
2. Have patients bare down like they're having a bowel movement Have patient submerge their face in ice water or apply cold wet washcloth against face. |
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What's the preferred method for vagal maneuvers for infants?
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submerge face in ice water or apply cold wet washcloth against face.
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on what patients is pacing not indicated?
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if the patient is 8 years or younger.
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What's the procedure for symptomatic bradycardia for pacing patients?
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Start rate at 60 then adjust output control starting at 0 mili amps until capture
then reassess patient for adequate perfusion. |
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If you're pacing a patient at 60 bpm and they still have signs of inadequate perfusion what can you do?
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You can increase the rate not to exceed 100.
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What can you give your patient and how much? if your patients awake while you're pacing him?
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Midazolam 1-2mg slow IVP or 1-2mg IN if patient is awake and alert
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What's the dose of Midazolam for pacing a patient in symptomatic bradycardia?
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1-2mg slow IVP or 1-2mg IN if patient is awake and alert.
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If your patient can't tolerate midazolam and you're pacing them, what else can you give them?
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Morphine in 1-2mg increments up to 10mg for a patient with adequate tissue perfusion.
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When is cardioversion not indicated (age)
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on patients 8 years or younger.
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What's the dose of Midazolam for Synchronized cardioversion? (same as for pacing)
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1-2mg IVP or 1-2mg IN.
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What's the procedure for cardioversion?
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Give midazolam 1-2mg IVP or 1-2mg IN, Start at 100, 200, 300, then 360 till rhythm converts.
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What're the 4 joule settings for synchronized cardioversion and what do you start on?
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100, then 200 then 300, then 360. you start at 100.
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What are the Two reasons IOs are mainly used?
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it's typically used for vascular access on kids under 8 years of age, they're used for patients who you're unable to obtain any other venous access.
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what're the two contraindications for IO??
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1. Fracture of target bone
2. Previous IO attempt and marrow entry at target site. |
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What's the primary site for IO on a patient 8 years or younger?
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Anterior medial surface of the tibia 2cm below the tuberosity.
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What's the primary site for an IO on a patient 9 years of age or older?
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Lower end of the tibia 2cm below the medial malleous or proximal humerus, when approaching the top grasp the humeral head between your fingers and thumb, it’s centerally located between the two prominence
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with base station contact where can you place an IO?
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Anterior Deistal femure 2cm above the patella
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What's the dose of Lidocaine when you're doing an IO on a patient? (also what are you supposed to not exceed and what time frame.
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0.5mg/kg of Lidocain and infuse slowly over 30-60 seconds not to exceed 50mg. Wait 1 minute...
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when should axial spinal immobilzation occur?
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soft tissue damage associated with trauma, blunt trauma, intubated neonatal and peds patients.
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C-spine can be removed if.... (4 reasons)
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Patient is not altered
Don't have spinal tenderness or tingling in the head or neck, or they're not less than 4 or having emotional or distracting pain. |
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What are the ALS interventions for adult respiratory emergencies?
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breathing treatment, Cpap, EPI
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What's the max number of times an adult patient can get a breathing treatment without base hospital contact?
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3 times
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What does an adult breathing treatment in SB count consist of?
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2.5 mg w/ atrovent .5mg up to 3 times
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How do I place a patient on CPAP? 4 steps
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1. obtain baseline o2 saturations at 0cms.
2. Instruct the patient to inhale through nose and exhale through mouth. 3. slowly titrate pressure in 3cm increments up to a max of 15cms. |
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Whats an important fact for patients once they're placed on cpap? It's the same rule that you use on a patient with a king airway.
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once it's placed it can't be removed.
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What's the dose of EPI on a patient with difficulty breathing in which the breathing treatments have failed?
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.3 MG (1:1,000 SC) may repeat once after 15 minutes
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What should you be aware of before giving epi?
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be aware if they have coronary artery disease or hypertension or over 40. you must then contact base.
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What's the dose for epi a patient in severe anaphylactic shock after the first two initial rounds SC?
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give EPI 0.1mg (1:10,000) slow ivp may repeat as needed up to .5mg
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For a suspected allergic reaction how much benadry (diphenhydramine) should you give? and how?
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25mg IV or 50mg IM
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On a patient with CHF, Acute Pulmonary adema what signs are you looking for?
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rales, occasional wheezes, JVD or edema.
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What drugs can you give for a patient in CHF without base station
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Nitro .4mg SL administer as long as signs of adequate tissue perfusion.
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When can you give lasix (furosemide) to a patient in CHF?
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with base station contact.
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What's the correct dose of Furosemide (2 parts)
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Furosemide 40mg-100mg IV or 2 times the daily dose to a max of 100mg.
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What treatment do you give to a patient with an airway obstruction on an adult patient
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If apneic attempt to ventilate or establish an advanced airway and or use magil forceps or perform needle cric.
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What are the S/SX of a patient in a non-traumatic-hypertensive crisis
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Altered, Headache, blurred vision, chest pain, dyspnea, pulmonary edema, abrupt elevation of diastolic pressure.
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What're contraindications for a Non-traumatic hypertensive crisis?
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Nitro
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What's your treatment for a non-traumatic hypertensive crisis? (2 things)
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Apply o2 and start a saline lock
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What's our als interventions for a patient in asymptomatic bradycardia? 2 parts.
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establish IV provide 300cc fluid bolus, may repeat once
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What's our treatment for symptomatic bradycardia?
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establish IV, Administer IV bolus 300cc (maintain iv rate at 300cc/hr)
Administer atropine 0.5mg IVP may repeat every 5 minutes up to a max of 3mg or 0.04mg/kg Consider TCP |
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What's the correct dose of atropine for a patient in symptomatic bradycardia? (with max)
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0.5mg IVP every 5 minutes up to a max of 3mg
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When should dopamine be considered?
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if a fluid bolus doesn't work at the patients b/p is still below 90 and signs of inadequate perfusion/shock exist.
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What're the 4 end points of procainamide?
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1. Arrhythmia is suppressed
2. Symptomatic hypotension 3. QRS widens by more than 50% 4. Max dose of 17mg/kg is given... |
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What's the correct dose of Procainamide?
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20mg/min IVP
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When should procainamide be used?
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V-tach or wide complex tachycardia (stable.....)
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What's treatment for a wide complex tachycardia?
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Procainamide, Lidocaine
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What's the correct dose of Lidocaine in stable V-tach?
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1mg/kg SLOW IVP, may repeat at 0.5mg/kg every 10 minutes until max is given
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What's the maintenance dose for a patient on Lidocaine after coming out of stable v-tach?
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2mg/min
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When should Magnesium be given in relation to rhythms?
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Torsades de pointe?
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What's the correct dose of Magnesium in regards to torsades de pointe?
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2gms in 100ml NS infuse over 5 minutes
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When should you perform a precordial thump?
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if you witness a patient go into v-tach?
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if right sided infarct, with signs of inadequate tissue perfusion what can you do?
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A fluid bolus 300ml NS and you may repeat once.
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What's the correct dose of NITRO for an MI prior to base station contact?
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3 doses of nitro 0.4mg SL may repeat once every 3 minutes as long as adequate tissue perfusion occurs.
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Can you give Nitro and Morphine at the same time in an AMI.
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yes
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What's the dose of Morphine Sulfate for an AMI?
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2mg IV, may repeat every 3 minutes to a total of 10mg.
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If in radio communication failure on an AMI patient can you give another 10mg or morphine in 2mg increments?
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yes!
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once you have an IV on a AMI patient where should you establish a second one?
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on the same side as the initial arm.
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On a "full arrest" a patient in VF/VT what should you shock your unconscious patient at?
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200 Joules
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In a patient in VF/VT when can you administer Lidocaine?
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After 2 cycles
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What's the dose of Lidocaine for a patient in Vfib/vtach?
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1.5mg/kg, may repeat at 0.75mg/kg every 5 minutes up to 3.0mg/kg
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How often should you administer epi in the full arrest setting?
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After each 2 minute cycle
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Should you obtain a BGL in a full arrest patient if possible?
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yes, and if needed administer dextrose.
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What's the dose of Narcan for suspected opitate overdose?
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2.0mg IV/IO/IM
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What's the maintenace dose of Lidocaine after conversion?
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2mg/min
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True or false, base station contact is required to terminate resuscitative efforts?
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TRUE!
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on a patient in PEA/Asystole what're your three main treatments?
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EPI 1mg, Fluid bolus 300ml N/S, Consider Atropine 1.0mg IV/IO ( may repeat up to three times if under 60)
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How many times can you give glucagon?
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once.
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What's the dose of Glucagon?
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1mg IM/SC/IN
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What's the dose of Dextrose?
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25grams
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What's the Dose of Midazolam for a seizure patient IM.
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5-10mg IM
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What's the Dose of Midazolam for a seizure patient IV/IO/IN?
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2.5mg-5.0mg (half the initial dose)
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What's the correct fluid bolus for an adult patient in shock?
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500ml may repeat once.
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What's the correct fluid bolus for an PEDS patient in shock?
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20ml/kg may repeat once for tachycardia, change in central peripheral pulses, altered level of consciousness
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What's the treatment for thermal burns?
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Stop the burning process, cover in dry steril dressing
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What's the treatment for chemical burns?
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Brush dry powder off, remove contaminated clothing and irrigate with copious amounts of water
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What's the treatment for tar burns?
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COOL with sterile water, but do not remove tar
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What's the treatment for electrical burns?
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remove from electrical source and cover with dry sterile dressing
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What's the correct fluid boluses for a patient who has sustained burns and is unstable.
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250ml Boluses may repeat to a maximum of 100ml
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If patient is stable and is a burn patient how much fluids should you give them?
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500ml/hour
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What's the correct dose of morphine sulfate for a burn patient via IV.
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5mg IVP every 5 minutes up to a max of 20,
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What's the correct dose of morphine for a burn patient via IM
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10mg IM
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What's the correct Criteria for determination of death at scene
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1. Decomposition
2. Rigor Mortis 3. Venous pooling (With cold extremities) 4. Decapitation 5. Incineration of the torso and or head 6. Massive crush injury, or penetrating injury with evisceration of the heart and or brain 7. gross dismemberment. |
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What can you withhold in regards to resuscitation for a valid dnr?
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1. perform chest compressions
2. Defib 3. ET intubation 4. Assisted ventilations 5. resuscitation drugs 6. absent vital signs |
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What's the correct dose of activated charcoal for an adult?
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50gms for adult
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What's the correct pediatric dose of Activated Charcoal?
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1gm/kg
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What's the correct dose of atropine in an organophosphate poisoning?
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2mg
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What's the correct treatment for a patient who OD'd on phenothiazine? WITH BASE STATION CONTACT or RCF failure
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Administer diphenhydramine 25mg IVP or 50mg IM for muscle spasms WITH BASE STATION CONTACT or RCF failure
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What's the correct treatment for a patient who OD'd on TCA's with base station contact or RCF?
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Sodium Bicarb 1 MEq/kg IVP for tachycardia, widening qrs or ventricular arrhythmias WITH BASE STATION CONTACT or RCF failure
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What's treatment for a calcium channel blocker OD? WITH BASE STATION CONTACT or RCF
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Administer calcium chloride 1gm if hypotension or bradycardic arrhythmias persist WITH BASE STATION CONTACT or RCF failure
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What's the best treatment for a beta blocker OD? (2 parts) WITH BASE STATION CONTACT or RCF failure
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administer glucagon 1mg IVP
repeat atropine in 2-4mg Increments until symptoms are controlled WITH BASE STATION CONTACT or RCF failure |
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In a patient with head exhaustion what's the correct fluid bolus for an adult?
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300cc's may repeat if bp is under 90
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In a patient with head exhaustion/heat stroke what's the correct fluid bolus for PEDS?
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20cc/kg until palpable pulses
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What's the pediatric dose of morphine via IV?
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0.1mg/kg not to exceed adult, also the max is 5mg.
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What's the pediatric dose of morphine via IM?
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0.2mg/kg not to exceed a total of 10mg IM.
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Can the IM dose of morphine for adults be repeated?
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yes
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What's our primary treatment for Cold related emergencies?
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IV, Morphine for pain relief, elevate extremity and wrap in dry sterile gauze and consider heating pads.
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what's the correct fluid bolus for cold emergencies?
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300cc's for adult
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In a cold emergency with documented VF or pulseless V-tach what can you defibrillate at?
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One time at 2j/kg (peds) or 200 Joules
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What's a part of the initial PEDS airway obstruction protocol?
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provide 5 back thrusts and 5 chest thrusts, administer oxygen, provide 2 ventilations, check pulse every 2 minutes
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at what age can you consider needle cric?
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2 years or older
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ALS interventions for the PEDS airway obstruction
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laryngoscope and remove visable foreign body, if apneic and able to ventilate consider intubation.
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What's the peds dose for atrovent for less than a year old?
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.25mg
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What's the dose of atrovent for peds patients 1year to 14 years old? (same as adult)
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0.5mg
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For a pediatric patient in allergic reaction what's the correct dose for epi?
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0.01mg/kg (SC 1:1000) not to exceed adult dose of .3mg
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What's the pediatric dose of diphenhydramine?
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1-2mg/kg not to exceed 25mg IV or 50mg IM
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for a pediatric patient in anaphylactic shock with no palpable radial pulse and depressed LOC what's the correct dose of epi?
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0.01mg/kg (1:10,000) Iv/IO no more than 0.01mg per dose may repeat to a max of 0.5mg
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What's the correct dose epi for peds cardiac arrest ages 1-8 years?
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0.01mg/kg IV
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What's the correct dose epi for peds cardiac arrest ages 9-14 years?
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same as adult
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What's the correct defibrillation for a pediatric patient in vfib/vtach
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2j/kg then shock at 4j/kg if it continues and continue at that joule setting
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What's the correct dose of Lidocaine for a pediatric patient in VFIB/Vtach?
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1.0mg/kg IV (may repeat at 0.5mg/kg every 5 minutes up to 3mg/kg)
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PEA/Asystole for a kid 9-14 years old what should you do?
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treat them like an adult EPi, atropine etc.
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PEDS-seizures what's the correct dose of Midazolam IM?
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0.2mg/kg IM/IN with max IM/IN dose of 10mg (not to exceed adult)
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PEDS-seizures what's the correct dose of Midazolam IV?
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0.1 mg/kg IV with a max dose 2.5-5mg not to exceed adult dose.
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What's the pediatric dose of Dextrose?
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D25% (half of D25) when they're less than 25kg
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What's the correct fluid bolus for a patient under OB emergencies?
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500ml, with maintaining IV rate at 150ml/hr
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If hypertension/eclampsia exists
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limit fluid intake, prepare to give Mag sulfate
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What's the correct dose of Mag sulfate for a patient who is eclamptic?
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4gms diluted with 20ml NS over 3-4 minutes
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IF a baby is delivered uncomplicated, with breathing under 20 what should you do?
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provide stimultation
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IF a newborn baby's HR is under 100 what should you do?
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ventilate for 30 seconds then reassess and repeat if needed.
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if HR is under 60 what should you do? (on a newborn)
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began chest compressions at 120/times a minute
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At what rate should you be ventilating a newborn?
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40-60 a minute.
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Where should you get a sugar check on a pediatric patient? and what's your treatment? (3 parts)
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on the heel, if it's under 40 give D25 consider fluid bolus 10ml/kg
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What's the dose of Verapamil?
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5mg SLOW IVP over 3 minutes, may repeat in 15 minutes at 10mg slow IVP over 3 minutes.
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A stemi Base station should be considered as the destination of choice if all of the following criteria are met.
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1. Machine interpretation of field 12 lead ECG, verified by paramedics and approve by a Base Station Physician.
2.Total transport time to the Base Station SRC is thirty minutes or less, Base hospital can override this. 3. Stemi Base Station contact is mandatory for all patients identified as possible Stemi. |
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4 Exceptions to sending the patient to a stemi facility
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1. unmanageable airway, cardiac condition or cardiac arrest
2. patients with malignant vfib, vtach, mobitz 2 and 3rd degree heart blocks should be considered going elsewhere. 3. Contraindication to thrombolytic 4. patients with hemodynamic instability as exhibited by bp under 90 systolic or inadequate tissue perfusion. |
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If a patient is under 9 what is required prior to leaving?
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You must make base station contact. In the absence of a parent they must be transported to a facility
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You have a patient who needs a Size 3 King airway how tall are they?
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4-5 Feet and it'll be yellow
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You have a patient who needs a Size 4 King airway how tall are they?
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5-6 Feet and it'll be red
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You have a patient who needs a Size 5 King airway how tall are they?
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6 feet and over and it'll be purple
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What should you inflate a yellow King airway to?
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60ml it's size 3
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What should you inflate a red King airway to?
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80ml it's a size 4
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What should you inflate a purpl King airway to?
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90ml it's a size 5
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What is the Peds King airway based of of?
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Height or Weight
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What size is green?
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2 for 35-45 inches
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What color is the 2.5 king airway?
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Orange (41-51) inches.
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What classifies as an intubation attempt?
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When the tube passes the gum line.
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What is the maximum # of intubation attempts you can make on an adult?
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3
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How many peds intubation can you attempt prior to base station contact?
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2. Only consider Needle Cric if they're over 2 years old
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What gauge needle cric should you use for patients over 50kg?
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14-16 G
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What gauge needle cric needle should you use for patients less than 50kg?
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18G
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