Term
| What is the trade name for Adenosine? |
|
Definition
|
|
Term
| What drug class does Adenosine belong to? |
|
Definition
|
|
Term
| What are 4 therapeutic actions of Adenosine? |
|
Definition
1). Slows conduction time through the AV node.
2). Interrupts the reentrant pathways through the AV and SA nodes.
3). Can restore NSR in patients with PSVT.
4). Can restore NSR in patients with PSVT including WPW syndrome. |
|
|
Term
| What are the pharmokinetics for Adenosine (Onset, Peak, 1/2-life)? |
|
Definition
Onset: immediate.
Peak: 20-30 Seconds.
1/2-life: Unknown. |
|
|
Term
| What are 5 contraindications for Adenosine? |
|
Definition
1.) Pre-existing 2nd or 3rd degree heart block.
2). Sinus node disease (sick-sinus syndrome or bradycardia)
3). Symptomatic Bradycardia.
4). A-Flutter and A-fib (Adenosine is ineffective for these conditions).
5). Known Hypersendsitivity to the drug. |
|
|
Term
| What are 3 common precautions for Adenosine? |
|
Definition
1). Caution in patients with asthma.
2). Dysrythmias, including AV blocks, are common at the time.
3). Cardioversion. |
|
|
Term
| What is the REMO Adult protocol indication for Adenosine? |
|
Definition
| Narrow complex tachycardia with stable, regular rhythm. 6 mg IV, then 12 mg IV, then an additional 12 mg once in 1-2 minutes. |
|
|
Term
| What is the REMO Pediatric protocol indication for Adenosine? |
|
Definition
| PHYSICIAN OPTION ONLY. For stable patient with narrow QRS complex tachycardia. 0.1 mg/kg (max 6mg); mayt repeat at 0.2 mg/kg (max dose of 12 mg). |
|
|
Term
| What is the Dosage regimen for Adenoside (adult)? |
|
Definition
IV direct in largest vein possible (AC, etc). Use med admin port closest to patient. Admin over 1-2 seconds and follow with a rapid 20 mL fluid blous to push the med into the patient.
repeat 12 mg doses follow same regimen. Wait 1-2 minutes between doses. |
|
|
Term
| What is the trade name for Amiodarone? |
|
Definition
|
|
Term
| What drug class does Amiodarone belong to? |
|
Definition
|
|
Term
| What the 6 therapeutic actions of Amiodarone? |
|
Definition
1). Acts directly on cardiac tissues.
2). Prolongs duration of action potential and refractory period without significantly affecting resting membrane potential.
3). Relaxes vasuclar smooth muscle
4). Decreases peripheral vascular resistance.
5). Increases coronary blood flow.
6). Blocks the effects of sympathetic stimulation. |
|
|
Term
| What are 4 contraindications for Amiodarone? |
|
Definition
1). Known hypersensitivity.
2). Presence of Cardiogenic shock
3). Severe sinus bradycardia
4). Advanced AV block |
|
|
Term
| What are 3 common precautions for Amiodarone? |
|
Definition
1). May produce vasodilation and hypotension.
2). May have negative inotropic effects.
3). May prolong the QT interval. |
|
|
Term
| What are the pharmokinetics for Amiodarone (Onset, Peak, 1/2-life)? |
|
Definition
Onset: unknown
Peak: Unknown
1/2-life: up to 40 days. |
|
|
Term
| What is the REMO Adult protocol indication for Amiodarone (VF Cardiac Arrest)? |
|
Definition
| 300 mg IV. Repeat 150 mg in 3-5 minutes. |
|
|
Term
| What is the REMO Adult protocol indication for Amiodarone (Wide Complex tachycardia with a pulse)? |
|
Definition
150 mg in 100ml normal saline infused over 10 minutes.
This is indicated for stable, unstable (2nd-line after cardioversion) and following rhythm coversion.
2nd dose available as PHYSICIAN OPTION (additional 150 in 100 over 10). |
|
|
Term
| What is the REMO Pediatric protocol indication for Amiodarone (VF Cardiac Arrest)? |
|
Definition
| 5 mg/kg (150 mg diluted into 100 ml, aka 1.5 mg/ml) via IV or IO. May repeat twice more if needed. |
|
|
Term
| What is the REMO Pediatric protocol indication for Amiodarone (Wide Complex tachycardia with a pulse)? |
|
Definition
| PHYSICIAN OPTION for a stable patient. 5 mg/kg (150 mg diluted into 100 ml, aka 1.5 mg/ml) via IV or IO. infused over 20 minutes. |
|
|
Term
| What are 4 non-REMO indications for Amiodarone? |
|
Definition
1.) Polymorphic VT
2). Use to control VT when cardioversion is unsuccessful.
3). As an adjunct to cardioversion to control SVT and PSVT.
4). Rate control in A-fib and A-flutter. |
|
|
Term
| What is the trade name for Albuterol? |
|
Definition
|
|
Term
| What drug class does Albuterol belong to? |
|
Definition
| Sympathomimetic Bronchodilator. |
|
|
Term
| What are 5 therapeutic actions of Albuterol? |
|
Definition
1). Relaxation of smooth muscle in bronchial tree.
2). Decreases airway resistance.
3). Facilitates mucous drainage.
4). Inhibits histamine release from MAST cells.
5). Reduced mucous secretions, capillary leaking, and mucousal edema caused by an allergic reponse in the lungs. |
|
|
Term
| What are the pharmokinetics for Albuterol (Onset, Peak, 1/2-life)? |
|
Definition
Onset: 5-15 minutes.
Peak: 1-1.5 hours.
1/2-life: < 3 hours. |
|
|
Term
| What are the 2 contraindications for Albuterol? |
|
Definition
1). Known hypersensitivity to the drug.
2). Tachydysrythmias. |
|
|
Term
| What are 2 common precautions for Albuterol? |
|
Definition
1). Blood pressure, pulse, and EKG should be monitored.
2). Use with caution in patients with known heart disease (due to B1 effects). |
|
|
Term
| What is the REMO Adult Albuterol protocol for anaphylaxis? |
|
Definition
| 2.5 mg in 3 ml (unit dose) via SVN or ET tube. Plus Atrovent 0.5 mg in 2.5 ml (unit dose) mixed together. May repeat to a total of 3 doses. Additional dose (Albuterol only) per PHYSICIAN OPTION. |
|
|
Term
| What is the REMO pediatric protocol for acute asthma? |
|
Definition
| 2.5 mg in 3ml (unit dose) + Atrovent 0.5 mg in 2.5 ml (unit dose) via SVN, repeat to a total of 3 doses. |
|
|
Term
| What is the REMO Pediatric Albuterol protocol for anaphylaxis? |
|
Definition
| 2.5 mg in 3 ml (unit dose) + Atrovent 0.5 mg in 2.5 ml (unit dose) mixed together via SVN. May repeat to a total of 3 doses. |
|
|
Term
| What is the REMO Adult protocol for acute asthma? |
|
Definition
| 2.5 mg in 3 ml (unit dose) via SVN or ET tube. Plus Atrovent 0.5 mg in 2.5 ml (unit dose) mixed together. May repeat to a total of 3 doses. Additional dose (Albuterol only) per PHYSICIAN OPTION. |
|
|
Term
| What is the total number of Albuterol administrations that can be administered by EMS prior to contacting medical control? |
|
Definition
|
|
Term
| What is the REMO Adult Albuterol protocol for Acute Pulmonary Edema? |
|
Definition
| 2.5 mg in 3 ml (unit dose) + Atrovent 0.5 mg in 2.5 ml (unit dose) mixed together via SVN if wheezes are present. Give 1 dose only. |
|
|
Term
| What is the REMO Adult Albuterol protocol for COPD exacerbation? |
|
Definition
| 2.5 mg in 3 ml (unit dose) + Atrovent 0.5 mg in 2.5 ml (unit dose) mixed together via SVN or ET tube. May repeat to a total of 3 doses. Additional dose (Albuterol only) per PHYSICIAN OPTION. |
|
|
Term
| What is the REMO Adult upper airway obstruction/stridor Albuterol protocol? |
|
Definition
| 2.5 mg in 3 ml (unit dose) + Atrovent 0.5 mg in 2.5 ml (unit dose) mixed together via SVN. Give 1 dose only. Additional dose (Albuterol only) available by PHYSICIAN OPTION. |
|
|
Term
| What is the REMO Adult crush injury Albuterol protocol? |
|
Definition
| PHYSICIAN OPTION ONLY: 2.5 mg in 3 ml (unit dose) via SVN. Do not combine with Atrovent. Repeat as needed. |
|
|
Term
| What is the REMO dosage for aspirin (in all conditions)? |
|
Definition
|
|
Term
| What are the two REMO indications for Aspirin in Adult Patients? |
|
Definition
1). Suspected Acute Coronary Syndrome
2). Acute Pulmonary Edema. |
|
|
Term
| What drug class does Atropine belong to? |
|
Definition
| Parasympatholytic (Anticholinergic). |
|
|
Term
| What are the pharmokinetics for Atropine (Onset, Peak, 1/2-life)? |
|
Definition
Onset: Immediate
Peak: 1-4 minutes.
1/2-life: 2-3 hours. |
|
|
Term
| What are 5 therapeutic actions for Atropine? |
|
Definition
1). Selectively blocks all muscarinic responses to acetylcholine.
2). Increases SA node discharge.
3). Enhances AV node conduction.
4). It is a potent bronchodilator.
5). Decreases gastric secretions. |
|
|
Term
| What are the contraindications for Atropine? |
|
Definition
| None in the emergency setting. |
|
|
Term
| What are 2 common precautions with Atropine? |
|
Definition
1). Doses of <0.5 mg may cause a paradoxical bradycardia. (tachycardia is the expected effect)
2). Hypertension may increase myocardial oxygen demand. |
|
|
Term
| What is the REMO Adult Atropine protocol for Asystole? |
|
Definition
| 1 mg IV; repeat every 3 minutes to a max dose of 0.04 mg/kg. |
|
|
Term
| What is the REMO Adult PEA Atropine protocol? |
|
Definition
| If HR < 60 BPM, give 1 mg IV; repeat every 3 minutes to a max dose of 0.04 mg/kg. |
|
|
Term
| What is the REMO Adult symptomatic bradycardia/heart blocks protocol for Atropine? |
|
Definition
| 0.5 mg IV; repeat every 3 minutes to a max dose of 0.04 mg/kg. |
|
|
Term
| What is the REMO Adult poisoning (organophosphate) protocol for Atropine? |
|
Definition
| 2-5 mg IV per dose until secretions dry. |
|
|
Term
| What is the REMO Pediatric symptomatic bradycardia protocol for Atropine? |
|
Definition
| 0.02 mg/kg (minimum dose 0.1 mg) via IV/IO/ET. May repeat once in 4 minutes to a max dose of 0.04 mg/kg. |
|
|
Term
| In pediatric patients with symptomatic bradycardia, when should you give Atropine before Epinephrine? |
|
Definition
| When the bradycardia is caused by increased vagal tone or primary AV block. |
|
|
Term
| What is the REMO Pediatric poisoning (organophosphate) protocol for Atropine? |
|
Definition
| 1 mg IV per dose every 3-5 minutes until secretions dry. |
|
|
Term
| Is Atrovent (Ipratropium Bromide) ever given without Albuterol? |
|
Definition
|
|
Term
| What drug class does Calcium Chloride belong to? |
|
Definition
|
|
Term
| What is the therapeutic action of Calcium Chloride? |
|
Definition
| It increases cardiac contractility and automaticity. |
|
|
Term
| What are the pharmokinetics for Calcium Chloride (Onset, Peak, 1/2-life)? |
|
Definition
Onset: immediate
Peak: immediate
1/2-life: unknown. |
|
|
Term
| What are the 3 contraindications for Calcium Chloride? |
|
Definition
1). V-Fib
2). Hypercalcemia
3). Possible Digitalis Toxicity. |
|
|
Term
| What is a common precaution for Calcium Chloride? |
|
Definition
| Patients taking digitalis. |
|
|
Term
| What is the REMO Adult poisoning (Calcium Channel Blocker OD) protocol for Calcium Chloride? |
|
Definition
| 1 Gram IV, then Glucagon 2mg IV. |
|
|
Term
| What is the REMO Adult poisoning (Beta Blocker OD) protocol for Calcium Chloride? |
|
Definition
| 1 Gram IV, right after Glucagon 2mg IV. |
|
|
Term
| What is the REMO Pediatric poisoning (Calcium Channel Blocker OD) protocol for Calcium Chloride? |
|
Definition
| 1 gram IV -OR- Glucagon 1 mg IV. |
|
|
Term
| What is the REMO Adult crush injury protocol for Calcium Chloride? |
|
Definition
| PHYSICIAN OPTION ONLY: If Hyperkalemia is suspected, give 1 gram IV over 5 minutes. Repeat in 10 minutes if no resolution. |
|
|
Term
| What is the trade name for Diazepam? |
|
Definition
|
|
Term
| What drug class does Diazepam (valium) belong to? |
|
Definition
| Sedative-Hypnotic, anticonvulsant, benzodiazepine, antianxiety. |
|
|
Term
| What are the 7 contraindications for Diazepam (Valium)? |
|
Definition
1). Hypersensitivity to the drug.
2). Shock
3). Coma
4). Acute Alcohol intoxication
5). Depressed Vital Signs
6). Obstetrical patients
7). Infant < 30 days old |
|
|
Term
| What are three common precautions with Diazepam (Valium)? |
|
Definition
1). Psychosis, depression, myasthnia gravis, impaired renal function.
2). Patient known to abuse drugs/addict.
3). Use EXTREME caution in elderly, very ill, or COPD patients. |
|
|
Term
| What are the pharmokinetics for Diazepam (Valium) when given IV (Onset, Peak, Duration)? |
|
Definition
Onset: 1-5 minutes
Peak: 15 minutes
Duration: 15 minutes to 1 hour. |
|
|
Term
| What are the pharmokinetics for Diazepam (Valium) when given IM (Onset, Peak, Duration)? |
|
Definition
Onset: 15-30 minutes
Peak: 30-45 mintues
Duration: 15 minutes to 1 hour. |
|
|
Term
| What are the pharmokinetics for Diazepam (Valium) when given RECTALLY (Onset, Peak, Duration)? |
|
Definition
Onset: rapid
Peak: 15-30 minutes
Duration: 15 minutes to 1 hour. |
|
|
Term
| What is the REMO Adult pain management protocol for Diazepam (Valium)? |
|
Definition
| PHYSICIAN OPTION ONLY 2-10 mg IV. |
|
|
Term
| What is the REMO Adult seizures protocol for Diazepam (Valium)? |
|
Definition
| 5 mg IV if patient continues to seize. If IV access cannot be obtained, give 10 mg Rectal (may use Diastat gel 10 mg as an alternative). PHYSCIAN OPTION: additional doses per need. |
|
|
Term
| What is the REMO Adult eclampsia protcol for Diazepam (Valium)? |
|
Definition
| 5 mg IV if patient is seizing. Alternatives (choose only ONE of the three): Magnesium 4g in 2 minutes IV, Midazolam (Versed) 5 mg IV/IM/intra-nasal. PHYSICIAN OPTION for additional Valium dose(s). |
|
|
Term
| What is the REMO Pediatric seizures protcol for Diazepam (Valium)? |
|
Definition
| 0.2 mg/kg IV or IO, max dose of 10mg. If IV access cannot be obtained, give 0.5 mg/kg rectal (can also use diastat gel) - max dose here of 10 mg. |
|
|
Term
| What is the trade name for Diltiazem? |
|
Definition
|
|
Term
| What drug class does Diltiazem (Cardizem) belong to? |
|
Definition
|
|
Term
| What are 8 therapeutic actions for Diltiazem (Cardizem)? |
|
Definition
1). Slow calcium channel blockers
2). Inhibits calcium ion influx
3). Dilates coronary arteries and arterioles
4). Inhibits coronary artery spasm
5). Slows SA and AV node conduction
6). Decreases total peripheral resistance.
7)Reduces arterial BP at rest.
8)May cause slight decrease in Heart Rate. |
|
|
Term
| What are 6 contraindications for Diltiazem (Cardizem)? |
|
Definition
1). Known hypersentsitivity to drug.
2). Sick Sinus Syndrome (unless Pacemkaker in place and functioning)
3). 2nd or 3rd Degree Heart block
4). Severe hypotension (systolic <90 or diastolic < 60)
5)Wide Complex tachycardias
6)WPW Syndrome. |
|
|
Term
| What are 5 common precautions for Diltiazem (Cardizem)? |
|
Definition
1). CHF
2). Conduction abnormalities
3). Renal or Hepatic Impairment.
4). Elderly patients
5). Nursing Mothers. |
|
|
Term
| What is the REMO Adult Narrow-Complex tachycardia protocol for Diltiazem (Cardizem)? |
|
Definition
| If STABLE, IRREGULAR rhythmn, give 0.25 mg /kg slow IV push. PHSICIAN OPTION: repeat at 0.35 mg/kg slow IV push. |
|
|
Term
| What is the REMO Adult Inter-Hospital Transport Infusion allowance for Diltiazem (Cardizem)? |
|
Definition
| 10-15 mg/hr infusion. MUST be on infusion pump, MUST be ordered and provided by the transferring physician. Discontinue if symptomatic bradycardia or hypotension occurs. |
|
|
Term
| What are the pharmokinetics for Diltiazem (Cardizem) (Onset, Peak, Duration)? |
|
Definition
Onset: 3 minutes
Peak: 7 minutes
Duration: 1-3 hours. |
|
|
Term
| What is the trade name for Diphenhydramine? |
|
Definition
|
|
Term
| What drug class does Diphenhydramine (Benadryl) belong to? |
|
Definition
|
|
Term
| What are 2 therapeutic effects of Diphenhydramine (Benadryl)? |
|
Definition
1). Blocks histamine receptors.
2). Has some sedative effects. |
|
|
Term
| What are the pharmokinetics for Adenosine (Onset, Peak, Duration)? |
|
Definition
Onset: Immediate
Peak: 1-4 hours
Duration: 4-7 hours. |
|
|
Term
| What are the 2 contraindications for Diphenhydramine (Benadryl)? |
|
Definition
1). Asthma
2). Nursing Mothers. |
|
|
Term
| What is a common precaution for Diphenhydramine (Benadryl)? |
|
Definition
|
|
Term
| What is the REMO Adult protocol for a dystonic reaction to Phenergan? |
|
Definition
| Diphenhydramine (Benadryl) 50 mg IV or IM. |
|
|
Term
| What is the REMO Adult anaphylaxis protocol for Diphenhydramine (Benadryl)? |
|
Definition
|
|
Term
| What is the REMO poison (overdose with dystonic reaction) protocol for Diphenhydramine (Benadryl)? |
|
Definition
|
|
Term
| What is the REMO Pediatric anaphylaxis protocol for Diphenhydramine (Benadryl)? |
|
Definition
| 1 mg/kg IV or IM, with a max dose of 25 mg. |
|
|
Term
| What is the REMO Pediatric overdose (dystonic reaction) protocol for Diphenhydramine (Benadryl)? |
|
Definition
|
|
Term
| What is the trade name for Dopamine? |
|
Definition
Intropin (in U.S)
Revimine (in Canada) |
|
|
Term
| What are 4 therapeutic actions for Dopamine? |
|
Definition
1.) Increases Cardiac Output
2.) Increases Cardiac Contractility
3.) Vasodilation of coronary, cerebral, and renal vessels.
4.)Peripheral VasoCONSTRICTION |
|
|
Term
| What drug class does Dopamine belong to? |
|
Definition
|
|
Term
| What are the pharmokinetics for Dopamine (Onset, Peak, 1/2-life)? |
|
Definition
Onset: <5 minutes.
Peak: < 10 minutes.
1/2-life: 2 minutes. |
|
|
Term
| What are two indications for Dopamine? |
|
Definition
1.) To increase end-organ perfusion in cardiogenic shock.
2.) To increase end-organ perfusion in hemodynamically significant hypotension. |
|
|
Term
| What are four contraindications for Dopamine? |
|
Definition
1.) Hypovolemic shock where complete fluid resus has not occurred.
2.) Pheochromocytona (adrenal gland tumor).
3.) Tachydysrhythmias.
4.) VF. |
|
|
Term
| What are two precautions with Dopamine? |
|
Definition
1.) Ventricular irratability.
2.) Inactivated by alkaline solutions. |
|
|
Term
| What is the REMO adult cardiogenic shock protocol indication for Dopamine? |
|
Definition
(following IV, EKG, and 250 ml fluid bolus).
If UNSTABLE, 5 ug/kg/min on standing orders.
PHYSICIAN OPTION: infusion at 5-20 ug/kg/min. |
|
|
Term
| What is the REMO Adult symptomatic bradycardia/heart blocks protocol indications for Dopamine? |
|
Definition
(in addition to Atropine)
Dopamine infusion at 5 ug/kg/min. |
|
|
Term
| What is the REMO Adult Anaphylaxis protocol indication for Dopamine? |
|
Definition
| PHYSICIAN OPTION ONLY: Dopamine infusion at 5-20 ug/kg/min. |
|
|
Term
| What is the REMO Adult Shock/Hypoperfusion protocol indication for Dopamine? |
|
Definition
(after 3-4 500ml Fluid bolus)
Consider Dopamine infusion at 5 ug/kg/min.
PHYSICIAN OPTION: Infusion at 5-20 ug/kg/m. |
|
|
Term
| What is the REMO Adult Traumatic hypoperfusion/hypovolemia protocol indication for Dopamine? |
|
Definition
| PHYSICIAN OPTION ONLY: Dopamine 5-20 ug/kg IV (note not an infusion). |
|
|
Term
| What drip set do you ALWAYS use for Dopamine infusions? |
|
Definition
|
|
Term
| What is the trade name for Epinephrine? |
|
Definition
|
|
Term
| What drug class does Epinephrine belong to? |
|
Definition
|
|
Term
| What are three therapeutic actions for Epinephrine? (in 1:1000 SQ dose) |
|
Definition
1.) Bronchodilation.
2.) Peripheral Vasoconstriction.
3.) Inhibits histamine release. |
|
|
Term
| What are the pharmokinetics of Epinephrine (1:1000 SQ dose)? |
|
Definition
Onset: 3-10 minutes.
Peak: 20 minutes.
Duration: 20-30 minutes.
1/2-life: N/A. |
|
|
Term
| What are two indications for Epinephrine (1:1000 SQ dose)? |
|
Definition
1.) Severe Bronchospasm.
2.) Anaphylaxis. |
|
|
Term
| What are five contraindications for Epinephrine (1:1000 SQ dose)? |
|
Definition
1.) Hypersensitivity to sympathomimetics.
2.) Underlying cardiovascular disease.
3.) Hypertension.
4.) Pregnancy.
5.) Tachydysrythmias. |
|
|
Term
| What are two precautions with Epinephrine (1:1000 SQ dose)? |
|
Definition
1.) Protect it from light.
2.) BP, pulse, and EKG must be constantly monitored. |
|
|
Term
| What is the REMO Adult anaphylaxis protocol indication for Epinephrine (1:1000 dose)? |
|
Definition
| 0.5 mg SQ if hypotension and/or resp distress w/airway swelling, hoarseness, stridor or wheezing. |
|
|
Term
| What is the REMO Pediatric Cardiac Arrest (all types) protocol indication for Epineprhine (1:1000 dose)? |
|
Definition
| if IV unavailable but pt is tubed, 0.1 mg/kg via ET, repeat every 3-5 minutes. |
|
|
Term
| What is the REMO Pediatric Bradycardia protocol indication for Epinephrine (1:1000 dose)? |
|
Definition
| If IV unavailable but pt is tubed, give 0.1 mg/kg via ET, repeat every 3-5 minutes. |
|
|
Term
| What is the REMO Pediatric Acute Asthma procotol indication for Epinephrine (1:1000 dose)? |
|
Definition
0.01 mg/kg SQ, max dose 0.5 mg if pt in severe distress.
PHYSICIAN OPTION: 0.3 mg mixed with 3ml NS via nebulizer. |
|
|
Term
| What is the REMO Pediatric Anaphylaxis protocol indication for Epineprhine (1:1000 dose)? |
|
Definition
| 0.01 mg/kg SQ. max dose 0.5 mg. |
|
|
Term
| What if a patient or EMT has administered an Epi-pen prior to your arrival? |
|
Definition
| You must contact medical control prior to administering any Epinephrine via SQ route. |
|
|
Term
| What is the REMO Pediatric Stridor protocol indication for Epinephrine (1:1000 dose)? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.3 mg mixed with 3 ml NS, via nebulizer. |
|
|
Term
| What is the REMO Adult Acute Asthma protocol indication for Epineprhine (1:1000 dose)? |
|
Definition
0.3 to 0.5 mg SQ, if in severe distress.
PHYSICIAN OPTION ONLY: 0.5 mg mixed with 3ml NS via nebulizer. |
|
|
Term
| What is the REMO Adult Upper Respiratory obstruction/stridor protocol indication for Epinephrine (1:1000 dose)? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.5 mg mixed with 3 ml NS, via nebulizer. |
|
|
Term
| What are 5 therapeutic actions for Epinephrine (1:10,000 dose)? |
|
Definition
1.) Increases heart rate.
2.) Increases automaticity of cardiac cells.
3.) Increases cardiac contractility.
4.) Peripheral vasoconstriction.
5.) Bronchodilation. |
|
|
Term
| What are the pharmokinetics for Epinephrine (1:10,000 dose)? |
|
Definition
(IV or IO)
Onset < 2 minutes.
Peak: < 5 minutes.
Duration: 5-10 minutes.
1/2-life: N/A. |
|
|
Term
| What are three indications for Epinephrine (1:10,000 dose)? |
|
Definition
1.) Cardiac Arrest.
2.) Severe Bronchospasm.
3.) Anaphylaxis. |
|
|
Term
| Are there any contraindications for Epineprhine (1:10,000 dose) in the setting of cardiac arrest, severe bronchospasm, or anaphylaxis? |
|
Definition
|
|
Term
| What are two precautions for Epinephrine (1:10,000 dose)? |
|
Definition
1.) Protect it from light.
2.) It may be deactivated by alkaline solutions such as soduim bicarbonate. |
|
|
Term
| What is the REMO Adult cardiac arrest (all types) protocol indication for Epineprhine (1:10,000 dose)? |
|
Definition
|
|
Term
| What is the REMO Adult Anaphylaxis protocol for Epineprhine (1:10,000 dose)? |
|
Definition
0.5 mg via ET if intubated.
PHYSICIAN OPTION ONLY: 5 ug/m (1 mg in 250 ml NS). |
|
|
Term
| What is the REMO Pediatric cardiac arrest (all types) indication for Epinephrine (1:10,000 dose)? |
|
Definition
| 0.01 mg/kg IV or IO, repeat every 3-5 minutes. |
|
|
Term
| What is the REMO Pediatric bradycardia protocol indication for Epinephrine (1:10,000 dose)? |
|
Definition
| 0.01 mg/kg IV or IO, repeat every 3-5 minutes. |
|
|
Term
| In pediatric patients where you think bradycardia is due to increased vagal tone or primary AV block should you give Epinephrine or Atropine first? |
|
Definition
|
|
Term
| What is the REMO Pediatric Anaphylaxis protocol indication for Epineprhine (1:10,000 dose)? |
|
Definition
PHYSICIAN OPTION ONLY:
(for cardiovascular collapse)
0.01 mg/kg IV, IO, or ET to a max dose of 0.5 mg. |
|
|
Term
| What is the REMO Adult Acute asthma protcol indication for Epinephrine (1:10,000 dose)? |
|
Definition
0.5 mg via ET tube if intubated.
PHYSICIAN OPTION ONLY: 0.5 mg IV if imminent respiratory arrest. |
|
|
Term
| When should Epineprhine be used in acute asthma? |
|
Definition
| When the patient's tidal volume is so small that nebulized meds cannot work. |
|
|
Term
| What is the trade name for Etomidate? |
|
Definition
|
|
Term
| What drug class does Etomidate belong to? |
|
Definition
|
|
Term
| What are 3 therapeutic actions of Etomidate? |
|
Definition
1.) Ultra short acting non-barbituate hypnotic.
2.) Produces rapid induction of anesthesia with minimal cardio/respiratory effects.
3.) Does not cause histamine release. |
|
|
Term
| What are the pharmacokinteics of Etomidate? |
|
Definition
Onset: 10-20 seconds.
Peak: 1 minute.
Duration: 3-5 minutes.
1/2-life: 30-74 minutes. |
|
|
Term
| What is an indication for Etomidate? |
|
Definition
| To induce sedation for endotracheal intubation. |
|
|
Term
| What are 2 contraindications for Etomidate? |
|
Definition
1.) Known hypersensitivity.
2.) Safety in children <10 y/o not established. |
|
|
Term
| What are 3 precautions with Etomidate? |
|
Definition
1.) Marked hypotension.
2.) Severe Asthma.
3.) Severe Cardiovascular disease. |
|
|
Term
| What is the REMO Adult procedural sedation protocol indication for Etomidate? |
|
Definition
0.1 mg/kg IV for brief procedures.
NOT for disentanglement or management of suspected fractures without Medical Control. |
|
|
Term
| What is the REMO Adult Medication Facilitated Intubation protocol indication for Etomidate? |
|
Definition
0.3 mg/kg rapid IV push during setup.
Maintain with 0.15 mg/kg every 5-10 minutes. |
|
|
Term
| What is the trade name for Furosemide? |
|
Definition
Lasix (USA).
Apo-Furosemide, Novo-semide, Uritrol (Canada). |
|
|
Term
| What drug class does Furosemide belong to? |
|
Definition
|
|
Term
| What are 3 therapeutic effects of Furosemide? |
|
Definition
1.) Inhibits resorption of NaCl.
2.) Promotes prompt diuresis.
3.) Vasodilation. |
|
|
Term
| What are the pharmacokinetics of Furosemide? |
|
Definition
Onset: vasodilation 5-10m, diuresis 5-30 m.
Peak: vaso 30m, Diur 20-60m.
Duration: v <2hr, d 6 hr.
1/2-life (both) 30 m. |
|
|
Term
| What is an indication for Furosemide? |
|
Definition
| To treat CHF and acute Pulmonary Edema. |
|
|
Term
| What are 4 contraindications for Furosemide? |
|
Definition
1.) Known hypersensitivity.
2.) Pregnancy.
3.) Fluid and electrolyte depletion.
4.) Hepatic Coma. |
|
|
Term
| What are 4 precautions for Furosemide? |
|
Definition
1.) Infants and the elderly.
2.) Hepatic cirrhosis.
3.) Cardiogenic shock associated with MI.
4.) Pts on Digitalis or Potassium-depleting steroids. |
|
|
Term
| What is the REMO Adult Actue Pulmonary Edema protocol indication for Furosemide? |
|
Definition
40 mg IV over 2-3 minutes, if peripheral edema is present.
PHYSICIAN OPTION ONLY: additional Furosemide (no specific dose indicated). |
|
|
Term
| What is the trade name for Glucagon? |
|
Definition
|
|
Term
| What drug class does Glucagon belong to? |
|
Definition
| Hormone (antihypoglycemic agent). |
|
|
Term
| What are 5 therapeutic actions for Glucagon? |
|
Definition
1.) Causes breakdown of glycogen to glucose.
2.) Inhibits glycogen synthesis.
3.) Elevates blood glucose levels.
4.) Increases cardiac conduction force.
5.) Increases heart rate. |
|
|
Term
| What are the pharmacokinetics of Glucagon? |
|
Definition
Onset 5-20 m.
Peak: <30 m.
Duration: 1-1.5 hr.
1/2-life 3-10 m. |
|
|
Term
| What are 2 indications for Glucagon? |
|
Definition
1.) Increase BGL where no IV access is available.
2.) Reverse the effects of Beta-Blocker OD. |
|
|
Term
| What is a contraindication for Glucagon? |
|
Definition
|
|
Term
| What are 3 precautions for Glucagon? |
|
Definition
1.) Only works if sufficient glycogen in lever.
2.) Use w/caution in cardiovascular or renal disease.
3.) Draw BGL before admin. |
|
|
Term
| What is the REMO Adult diabetic emergency protocol indication for Glucagon? |
|
Definition
| 1 mg IM or SQ if no IV access. |
|
|
Term
| What is the REMO Adult Calcium Channel Blocker/Beta Blocker OD protocol indication for Glucagon? |
|
Definition
| 2 mg IV, along with 1 gram Calcium Chloride. |
|
|
Term
| What is the REMO Pediatric Diabetic emergency protocol indication for Glucagon? |
|
Definition
|
|
Term
| What is the REMO Pediatric Beta Blocker OD protocol indication for Glucagon? |
|
Definition
| PHYSICIAN OPTION ONLY: 1 mg IV. |
|
|
Term
| What is the REMO Pediatric Calcium Channel Blocker OD protocol indication for Glucagon? |
|
Definition
| PHYSICIAN OPTION ONLY: 1 mg IV -OR- 1 g Calcium Chloride IV. |
|
|
Term
| What is the trade name for Haloperidol? |
|
Definition
Haldol (USA)
Peridol (Canada) |
|
|
Term
| What drug class does Haloperidol belong to? |
|
Definition
|
|
Term
| What are 4 therapeutic actions for Haloperidol? |
|
Definition
1.) Blocks dopamine receptors in the brain responsible for mood/behavior.
2.) Has antiemetic properties.
3.) Produces weak anticholinergic effects.
4.) Produces transient orthostatic hypotension. |
|
|
Term
| What are the pharmacokinetics for Haloperidol? |
|
Definition
Onset: 30-45m.
Peak: 10-20m.
Duration: N/A.
1/2-life: 3-35 hr. |
|
|
Term
| What is an indication for Haloperidol? |
|
Definition
| To manage acute psychotic disorders. |
|
|
Term
| What are 2 contraindications for Haloperidol? |
|
Definition
1.) Pts with parkinson's seizure disorders, coma, alcoholism, severe mental depression.
2.) Should not be administered in presence of other sedatives. |
|
|
Term
| What are 4 precautions for Haloperidol? |
|
Definition
1.) Elderly or debilitated patients.
2.) Pts with urinary retention or severe cardiovascular disorders.
3.) Pts receiveing anticonvulsant, anticoagulant, or lithium therapy.
4.)"Black Box" warning - possible QT prolongation. |
|
|
Term
| What is the REMO Adult patient restraint protocol indication for Haloperidol for patients less than age 70? |
|
Definition
| PHYSICIAN OPTION ONLY: 5 mg mixed with 2 mg Midazolam (Versed) IM. Also additional Haloperidol. |
|
|
Term
| What is the REMO Adult patient restraint protocol indication for Haloperidol for patients older than age 70? |
|
Definition
| PHYSICIAN OPTION ONLY: 5 mg IM. Also, additional Haloperidol (dose not given). |
|
|
Term
| What is the trade name for Lidocaine? |
|
Definition
Xylocaine (USA)
Xylocard (Canada) |
|
|
Term
| What drug class does Lidocaine belong to? |
|
Definition
|
|
Term
| What is the therapeutic action of Lidocaine? |
|
Definition
| Antidysrhythmic (class 1b) suppresses automaticity in His-purkinje system. Also elevates electrical stimulation threshold for ventricular dysrhythmias AND lowers threshold for defib and cardioversion. |
|
|
Term
| What are the pharmacokinteics of Lidocaine? (IV) |
|
Definition
Onset: < 3m
Peak: 2-7m
Duration: 8-20m
1/2-life: 1.5-2 hr. |
|
|
Term
| What is the indication for Lidocaine? |
|
Definition
| To convert ventricular dysrhythmias (VF, VT) in cardiac arrest to a sinus rhythym. |
|
|
Term
| What are 2 contraindications for Lidocaine? |
|
Definition
1.) High-degree heart blocks.
2.) PVCs in conjunction with bradycardia. |
|
|
Term
| What are 4 precautions with Lidocaine? |
|
Definition
1.) Dosage should not exceed 300mg/hr.
2.) Monitor for CNS toxicity.
3.) Dosage should be reduced by 50% in patients > 70 y/o or with liver disease.
4.)In cardiac arrest use only bolus therapy. |
|
|
Term
| What is the REMO Adult VF/Pulseless VT protocol indication for Lidocaine? |
|
Definition
| 1.5 mg/kg IV. Repeat ONCE in 3 minutes to a max dose of 3.0 mg/kg. |
|
|
Term
| What is the REMO Adult VF/pulseless VT protocol indication for a return of pulses for Lidocaine? |
|
Definition
If you have only given 1.5 mg/kg of Lidocaine you can give the other 1.5 mg/kg to a max dose of 3.0 mg/kg.
PHYSICIAN OPTION: Lidocaine infusion (no dose given). |
|
|
Term
| What is the REMO Adult Wide Complex Tachycardia (w/pulse) protocol indication for Lidocaine? |
|
Definition
| PHYSICIAN OPTION ONLY:1.5 mg/kg IV. |
|
|
Term
| What is the REMO Pediatric VF/pulseless VT protocol indication for Lidocaine? |
|
Definition
| 1 mg/kg IV, IO, or ET. May repeat twice as needed. |
|
|
Term
| What is the REMO Pediatric (wide complex, stable patient) protocol indication for Lidocaine? |
|
Definition
| PHYSICIAN OPTION ONLY: 1 mg/kg IV. |
|
|
Term
| What is the REMO Adult MFI protocol indication for Lidocaine? |
|
Definition
As part of pre-treatment:
1.5 mg/kg to a max dose of 100mg if increased ICP is suspected. |
|
|
Term
| What is the typical REMO concentration of Lidocaine for infusion? |
|
Definition
| 200mg in 100ml NS = 2mg/ml. |
|
|
Term
| What drug class does Magnesium belong to? |
|
Definition
|
|
Term
| What are 3 therapeutic actions for Magnesium? |
|
Definition
1.) Physiologic Ca channel blocker and blocks neuromuscular transmission.
2.) CNS depressant and also a depressant of smooth, skeletal, and cardiac muscle function.
3.) Has anticonvulsant properties. |
|
|
Term
| What are the pharmicokinteics of Magnesium? |
|
Definition
Onset: immediate (IV), 1 hr IM
Peak: N/A
Duration: 30m
1/2-life: N/A |
|
|
Term
| What are 4 indications for Magnesium? |
|
Definition
1.) to reverse refractory VF and pulseless VT.
2.) To reverse torsades.
3.) Prophylaxis during AMI.
4.) Manage seizures due to eclampsia. |
|
|
Term
| What are 5 contrainidications for Magnesium? |
|
Definition
1.) Heart blocks
2.) Recent MI
3.) Shock
4.) Persistent hypertension
5.) hypocalcemia. |
|
|
Term
| What are 3 precautions with Magnesium? |
|
Definition
1.) Impaired renal function.
2.) Digitalized patients.
3.) concomitant use of other CNS depressants or neuromuscular blocking agents. |
|
|
Term
| What is the typical REMO concentration for Magnesium infusions? |
|
Definition
| 2gm in 100 ml NS (20mg/ml) using a macro drip set. |
|
|
Term
| What is the typical REMO Magnesium infusion rate? |
|
Definition
| 5 ml/min over 20 min. 10 drop = 50 drops/m, 15 drop = 75 drops/m. |
|
|
Term
| What is the REMO VF/pulseless VT protocol indication for VT (suspected hypomagnesmic or torsades)? |
|
Definition
|
|
Term
| What is the REMO protcol indication for wide-complex tachycardia with a pulse for Magnesium? |
|
Definition
| PHYSICIAN OPTION ONLY: 2 gm over 20 minutes for STABLE patient, 2 gm over 2 minutes if UNSTABLE patient. |
|
|
Term
| What is the REMO Adult seizure protocol indication (if patient is pregnant) for Magnesium? |
|
Definition
| PHYSICIAN OPTION ONLY: 4 grams IV over 2 minutes. |
|
|
Term
| What is the REMO Eclampsia protocol for Magnesium? |
|
Definition
If pt is seizing: 4 Grams IV over 2 minutes.
PHYSICIAN OPTION ONLY: 1-2 grams per hour (infusion) IV. |
|
|
Term
| What are the classifications for pre-eclampsia and eclampsia? |
|
Definition
| pre-eclampsia is BP > 140/90 in a pregnant (or recently given birth) pt with severe headache, confusion, or hyper-reflexia. Eclampsia is above + seizures. |
|
|
Term
| What is the REMO Adult pre-term labor (24-37 weeks) protocol indication for Magnesium? |
|
Definition
| PHYSICIAN OPTION ONLY: 4 grams IV over 20 minutes. |
|
|
Term
| What is the REMO Adult Acute Asthma protocol indication for Magnesium? |
|
Definition
| 2 grams IV in 50 ml NS over 10 minutes. |
|
|
Term
| What is the REMO Adult COPD Exacerbation protocol indication for Magnesium? |
|
Definition
| PHYSICIAN OPTION ONLY: 2 grams IV in 50 ml NS over 20 minutes. |
|
|
Term
| What is the trade name for Methylprednisolone? |
|
Definition
| Solu-Medrol or A-MethaPred. |
|
|
Term
| What drug class does Solu-Medrol belong to? |
|
Definition
|
|
Term
| What are 2 therapeutic actions of Solu-Medrol? |
|
Definition
1. )Anti-inflammatory.
2.) Suppresses immune response (especially in allergic reactions). |
|
|
Term
| What are the pharmacokinetics of Solu-Medrol? |
|
Definition
Onset: rapid.
Peak: 4-8 days
Duration 1-5 weeks
1/2-life 3.5 hrs. |
|
|
Term
| What are 2 indications for Solu-Medrol? |
|
Definition
1.) To reduce inflammation caused by severe anaphylaxis and asthma/COPD.
2.) To treat urticaria (skin wheals). |
|
|
Term
| Are there any contraindications to the use of Solu-Medrol in the emergency setting? |
|
Definition
|
|
Term
| What are two precautions for Solu-Medrol? |
|
Definition
1.) must be mixed and used quickly.
2.) onset of action may be 2-6 hrs and therefore not therapeutic in effect during critical hour. |
|
|
Term
| What is the REMO Adult anaphylaxis protocol indication for Solu-Medrol? |
|
Definition
|
|
Term
| What is the REMO Pediatric Acute Asthma protocol indication for Solu-Medrol? |
|
Definition
| PHYSICIAN OPTION ONLY: 1 mg/kg IV. |
|
|
Term
| What is the REMO Pediatric Anaphylaxis protocol indication for Solu-Medrol? |
|
Definition
| PHYSICIAN OPTION ONLY: 1 mg/kg IV. |
|
|
Term
| What is the REMO Pediatric Stridor protocol indication for Solu-Medrol? |
|
Definition
| PHYSICIAN OPTION ONLY: 1 mg/kg IV. |
|
|
Term
| What is the REMO Adult Acute Asthma protocol indication for Solu-Medrol? |
|
Definition
|
|
Term
| What is the REMO Adult COPD Exacerbation protocol indication for Solu-Medrol? |
|
Definition
|
|
Term
| What is the REMO Adult upper respiratory obstruction/stridor protocol indication for Solu-Medrol? |
|
Definition
|
|
Term
| What is the trade name for Metoprolol? |
|
Definition
|
|
Term
| What drug class does Lopressor belong to? |
|
Definition
|
|
Term
| What are five contraindications for Lopressor? |
|
Definition
1.) Severe bradycardia (60bpm or less)
2.) Systolic BP < 100
3.) Severe LV failure
4.) Hypoperfusion
5.) 2nd or 3rd degree heart block |
|
|
Term
| What are 4 common precautions for Lopressor? |
|
Definition
1.) concurrent admin with IV Ca channel blockers can cause severe hypotension.
2.) Avoid in bronchospastic diseases, cardiac failure, or abnormalities in cardiac conduction.
3.) Monitor cariac and pulmonary status
4.) May cause myocardial depression. |
|
|
Term
| What are three indications for Lopressor? |
|
Definition
1.) Hypertension
2.) Angina Pectoris
3.) MI |
|
|
Term
| What is the REMO Adult ACS protocol indication for Lopressor? |
|
Definition
| 5 mg slow IV, provided HR > 60 and BP > 100. Can repeat every 5 minutes to a total of 3 doses. |
|
|
Term
| What is the REMO Adult Narrow-complex tachycardia protocol indication for Lopressor? |
|
Definition
| PHYSICIAN OPTION ONLY: 5 mg IV. |
|
|
Term
| What is the REMO Adult Suspected Stroke protocol indication for Lopressor? |
|
Definition
| PHYSICIAN OPTION ONLY: 5 mg slow IV push. |
|
|
Term
| What is the REMO Adult eclampsia protocol indication for Lopressor? |
|
Definition
| PHYSICIAN OPTION ONLY: 5 mg slow IV every 5 minutes to a max of 3 doses. |
|
|
Term
| What is the trade name for Midazolam? |
|
Definition
|
|
Term
| What drug class does Versed belong to? |
|
Definition
|
|
Term
| What are two therapeutic actions for Versed? |
|
Definition
1.) Sedative.
2.) Hypnotic. |
|
|
Term
| What are the pharmacokinetics for Versed? |
|
Definition
Onset: 3-5m (IV) 15m (IM)
Peak: 20-60 m
Duration: <2hr (IV), 1-6hr (IM)
1/2-life: 1-4 hr. |
|
|
Term
| What is a common indication for Versed? |
|
Definition
| To induce sedation and amnesia prior to a painful procedure. |
|
|
Term
| What are three contraindications for Versed? |
|
Definition
1.) Hypersensitivity
2.) Narrow-angle glaucoma.
3.) Shock. |
|
|
Term
| What are two precautions with Versed? |
|
Definition
1.) must dilute with NS or D5W.
2.) Respiratory depression is more common than with other benzos. |
|
|
Term
| What is the REMO Adult Nausea/vomiting protocol indication for Versed? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.05 mg/kg IV or IM. |
|
|
Term
| What is the REMO Adult pain management protocol indication for Versed? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.05 mg/kg IV, IM, or nasal. |
|
|
Term
| What is the REMO patient restraint protocol for Versed? (patient age < 70) |
|
Definition
| PHYSICIAN OPTION ONLY: 2 mg mixed with 5 mg Haldol IM. |
|
|
Term
| What is the REMO Adult procedural sedation protocol indication for Versed? |
|
Definition
0.05 mg/kg IV for TCP or post-intubation (may repeat every 5m if BP >100).
PHYSICIAN OPTION ONLY: IV, IM, or nasal (dose not specified). |
|
|
Term
| What is the REMO Sypathomimetic (e.g., cocaine or amphetimies) OD protocol indication for Versed? |
|
Definition
| PHYSICIAN OPTION ONLY: .05 mg/kg IV or IM. |
|
|
Term
| What is the REMO Adult seizure management protocol indication for Versed? |
|
Definition
If vascular access cannot be obtained, 5 MG IM or nasal.
PHYSICIAN OPTION ONLY: Additional 2-5 mg IV, IM, or nasal. |
|
|
Term
| What is the REMO Adult eclampsia protocol indication for Versed (if patient is seizing)? |
|
Definition
5 mg IV, IM, or nasal.
PHYSICIAN OPTION ONLY: 2-5 mg IV. |
|
|
Term
| What is the REMO Pediatric sypathomimetic (cocaine or amphetamines) OD protocol indication for Versed? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.1 mg/kg IV or IM. |
|
|
Term
| What is the REMO Pediatric procedural sedation protocol indication for Versed? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.05 mg/kg IV or IM. |
|
|
Term
| What is the REMO pediatric seizure management protocol for Versed? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.1 mg/kg IV, IM, or IO. |
|
|
Term
| What is the REMO Adult crush injuries protocol indication for Versed? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.05 mg/kg IV or IM. |
|
|
Term
| What is the REMO MFI protocol indication for Versed? |
|
Definition
(to administer continual sedation)
0.03-0.05 mg.kg IV every 15m if hemodynamically stable. |
|
|
Term
| What drug class does Morphine belong to? |
|
Definition
|
|
Term
| What are 3 therapeutic actions for Morphine? |
|
Definition
1.) CNS depressant.
2.) Causes peripheral vasodilation.
3.) Decreases sensitivity to pain. |
|
|
Term
| What are the pharmacokinetics for Morphine? |
|
Definition
Onset: Immediate (IV), 15-30m (IM)
Peak: 20m (IV), 30-60m (IM)
Duration: 2-7hr (IV), >2-7 hr (IM)
1/2-life: N/A. |
|
|
Term
| What are two common indications for Morphine? |
|
Definition
1.) Relief of moderate to severe pain.
2.) Reduce venous return in AMI and actue pulmonary edema. |
|
|
Term
| What are 4 contraindications for Morphine? |
|
Definition
1.) Head injury
2.) Volume depletion
3.) Undiagnosed abdominal pain
4.) Hypersensitivity |
|
|
Term
| What are 3 precautions for Morphine? |
|
Definition
1.) Respiratory depression (keep Narcan handy).
2.) Hypotension.
3.) Nausea. |
|
|
Term
| What is the REMO Adult ACS protocol indication for Morphine? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.5-1.0 mg/kg slow IV push. |
|
|
Term
| What is the REMO Adult pain management protocol indication for Morphine? |
|
Definition
0.05 mg/kg IV or IM, can repeat ONCE to a total dose not to exceed 10 Mg.
PHYSICIAN OPTION ONLY: additional Morphine by IV or IM. |
|
|
Term
| In which two conditions can you give Morphine on standing orders? |
|
Definition
1.) Severe burns w/o hemodynamic compromise.
2.) Suspected isolated extremity fractures with extreme pain.
MUST CALL FOR ORDERS ON ALL OTHER USES. |
|
|
Term
| What is the REMO Adult Procedural Sedation protocol indication for Morphine? |
|
Definition
| PHYSICIAN OPTION ONLY: Morphine IV or IM (no dose given). |
|
|
Term
| What is the REMO pediatric pain management protocol indication for Morphine? |
|
Definition
0.05 mg/kg, may be repeated once after 5 minutes to a total dose not to exceed 0.1 mg/kg. This is for burns and fractures - call for everything else.
PHYSICIAN OPTION ONLY: additional morphine IV or IM (dose not given). |
|
|
Term
| What is the REMO Pediatric procedural sedation protocol indication for Morphine? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.05 mg/kg IV or IM. |
|
|
Term
| What is the REMO Adult Acute Pulmonary Edema protocol indication for Morphine? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.05 mg/kg IV. |
|
|
Term
| What is the REMO burn management protocol indication for Morphine? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.05-0.1 mg/kg IV. |
|
|
Term
| What is the REMO Adult Crush Injury Management protocol indication for Morphine? |
|
Definition
| PHYSICIAN OPTION ONLY: 0.05 mg/kg IV or IM. |
|
|
Term
| What is the trade name for Naloxone? |
|
Definition
|
|
Term
| What drug class does Narcan belong to? |
|
Definition
|
|
Term
| What is the therapeutic effect of Narcan? |
|
Definition
| It reverses the effects of narcotics. |
|
|
Term
| What are the pharmacokinetics of Narcan? |
|
Definition
Onset: <2m (IV), 2-10m (IM, ET)
Peak: <2m (IV), 2-10m (IM,ET)
Duration: 20m-2hr
1/2-life: 60-90m. |
|
|
Term
| What are 9 narcotics that cand be treated for OD by Narcan? |
|
Definition
1.) Morphine 2.) Dilaudid 3.)Fentanyl
4.) Demerol 5.) Paregoric 6.) Methadone
7.) Heroin 8.) Percodan 9.) Tylox |
|
|
Term
| What are 4 synthetic analgesic overdoses that can be treated with Narcan? |
|
Definition
1.) Nubain 2.) Stadol
3.) Talwin 4.) Darvon |
|
|
Term
| What is a contraindication for Narcan? |
|
Definition
| Hypersensitivity to the drug. |
|
|
Term
| What are 3 precautions for Narcan? |
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Definition
1.) may cause withdrawal effects in addicts.
2.) Short-acting; should be augmented every 5 minutes.
3.) Not to be used as part of a "coma cocktail". |
|
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Term
| What is the REMO Adult symptomatic opiate overdose protocol indication for Narcan? |
|
Definition
| 0.2-2.0 mg IV, IM or nasal. |
|
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Term
| What is the REMO Pediatric Symptomatic Opiate overdose protocol indication for Narcan? |
|
Definition
| 0.1 mg/kg IM or nasal. MAX DOSE 2mg. |
|
|
Term
| What class does Nitroglycerin belong to? |
|
Definition
|
|
Term
| What are 4 therapeutic actions for Nitroglycerin? |
|
Definition
1.) Smooth-muscle relaxant
2.) Reduces cardiac workload
3.) Dilates Coronary arteries
4.) Dilates systemic arteries |
|
|
Term
| What are the pharmacokitetics for Nitroglycerin? |
|
Definition
Onset: 1-3m (SL) 30m (TD)
Peak: 5-10m
Duration: 20-30m (SL) 3-6hr (TD)
1/2-life: 1-4 min. |
|
|
Term
| What are 2 indications for Nitroglycerin? |
|
Definition
1.) Angina Pectoris
2.) Chest pain associated with MI. |
|
|
Term
| What are 2 contraindications for Nitroglycerin? |
|
Definition
1.) Children < 12yo
2.) Hypotension |
|
|
Term
| What are 4 precautions for Nitroglycerin? |
|
Definition
1.) Constantly monitor BP
2.) Syncope
3.) Drug must be protected from light
4.) Expires quickly once bottle is opened. |
|
|
Term
| What is the REMO Adult ACS protocol indication for Nitrocglycerin (SL)? |
|
Definition
0.4mg per dose, up to 3 doses, 5 minutes apart if systolic BP is > 100.
PHYSICIAN OPTION ONLY: Repeat 0.4mg doses every 5 minutes. |
|
|
Term
| What is the REMO Adult ACS protocol indication for Nitroglcerin (TD)? |
|
Definition
| 1-2" if resolution of chest pain and systolic BP >100. |
|
|
Term
| If giving Nitroglycerin and patient's BP goes below 100, what amount of NS do you give? |
|
Definition
|
|
Term
| How many doses of Nitroglycerin can you administer before establishing IV access? |
|
Definition
|
|
Term
| What is the TOTAL number of Nitroglycerin doses that can be administered by EMS before medical contact must be established? |
|
Definition
|
|
Term
| What is the REMO Adult Suspected Stroke protocol indication for Nitroglycerin? |
|
Definition
| PHYSICIAN OPTION ONLY: 1-2" of NTG paste TD. |
|
|
Term
| What is the REMO Adult Acute Pulmonary Edema Protocol Indication for Nitroglycerin? |
|
Definition
0.4mg, every 2-5 minutes, if patient's BP is > 100.
If no SL route avaialable can give 1-2" of NTG paste TD. |
|
|
Term
| What is the typical REMO indication for a saline bolus in Cardiac arrest (PEA, VF, etc)? |
|
Definition
|
|
Term
| What is the REMO Adult cardiogenic shock protocol indication for normal saline? |
|
Definition
250ml bolus, recheck lung sounds and repeat if unchanged.
PHYSICIAN OPTION ONLY: Additional NS. |
|
|
Term
| What is the REMO Adult nausea/vomiting protocol indication for normal saline? |
|
Definition
|
|
Term
| What is the REMO Adult Anaphylaxis protocol indication for Normal Saline? |
|
Definition
|
|
Term
| What is the REMO Adult Diabetic emergency (hyperglycemia) protocol indication for Normal Saline? |
|
Definition
250ml bolus.
PHYSICIAN OPTION ONLY: Additional NS. |
|
|
Term
| What is the REMO Adult shock/hypoperfusion protocol indication for Normal Saline? |
|
Definition
500ml bolus, recheck lung sounds, repeat if unchanged. Can repeat to a total of 1.5L
PHYSICIAN OPTION ONLY:Additional NS. |
|
|
Term
| What is the REMO Adult pre-term labor protocol indication for Normal Saline? |
|
Definition
| 500ml Bolus. May repeat one time. |
|
|
Term
| What is the REMO Pediatric Cardiac arrest (Asystole and PEA) protocol indication for Normal Saline? |
|
Definition
| 20 ml/kg rapid IV or IO Bolus. |
|
|
Term
| What is the REMO Pediatric Tachycardia protocol indication for Normal Saline? |
|
Definition
| 20ml/kg bolus, may repeat once. |
|
|
Term
| What are the two most common causes of Pediatric (sinus) Tachycardia? |
|
Definition
|
|
Term
| What is the REMO Pediatric Anaphylaxis protocol indication for Normal Saline? |
|
Definition
|
|
Term
| What is the REMO Pediatric hyperglycemic (BGL>400) + signs of dehydration protocol indication for Normal Saline? (pt age < 1y/o) |
|
Definition
|
|
Term
| What is the REMO Pediatric hyperglycemic (BGL>400) + signs of dehydration protocol indication for Normal Saline? (pt age > 1y/o) |
|
Definition
|
|
Term
| What is the REMO Pediatric hypoperfusion protocol indication for Normal Saline? |
|
Definition
|
|
Term
| What is the REMO Adult crush injuries protocol indication for Normal Saline? |
|
Definition
| 1L initial bolus, additional (preferrably wamed) 500ml as needed for perfusion. |
|
|
Term
| What is the REMO Traumatic hypovolemia/hypoperfusion protocol indication for Normal Saline (Compensated shock)? |
|
Definition
1L, then 500ml/hr.
PHYSICIAN OPTION ONLY: Additional NS. |
|
|
Term
| What is the REMO Traumatic hypovolemia/hypoperfusion protocol indication for Normal Saline (Decompensated shock)? |
|
Definition
2L, then 500ml/hr.
PHYSICIAN OPTION ONLY: Additional NS. |
|
|
Term
| What is the REMO clinical definition for compensated shock? |
|
Definition
| significant mechanism of injury, AND tachypnea, tachycardia, pallor, or restlessness AND Systolic BP >90. |
|
|
Term
| What is the REMO clinical definition for decompensated shock? |
|
Definition
| Clinical picture of shock AND systolic BP < 90. |
|
|
Term
| What is the REMO Pediatric Traumatic hypovolemia/hypoperfusion protocol indication for Normal Saline? |
|
Definition
|
|
Term
| What drug class does Sodium Bicarbonate belong to? |
|
Definition
|
|
Term
| What are two therapeutic actions for Sodium Bicarbonate? |
|
Definition
1.) Combines with excessive acids to form a volatile acid.
2). Increases pH. |
|
|
Term
| What are the pharmacokinetics for Sodium Bicarbonate? |
|
Definition
Onset: < 15m
Peak: N/A
Duration: 1-2hr.
1/2-life: N/A. |
|
|
Term
| What are three indications for Sodium Bicarbonate? |
|
Definition
1.) Correct severe acidosis refractory to hyperventilation.
2.) Known Hyperkalemia.
3.) Alalinize the urine to enhance excretion of TCA and barbituate drug overdose. |
|
|
Term
| What is a contraindication for Sodium Bicarbonate? |
|
Definition
|
|
Term
| What are four precautions for Sodium Bicarbonate? |
|
Definition
1.) Correct dosage essential to avoid overcompensation of pH
2.) Can deactivate catecholamines
3.) Can precipitate with calcium
4.) Delivers large sodium load. |
|
|
Term
| What is a REMO Adult Cardiac Arrest protocol indication for Sodium Bicarbonate (for Asystole and PEA)? |
|
Definition
| PHYSICIAN OPTION ONLY: 1MeQ/kg IV. |
|
|
Term
| What is the REMO Adult Cardiac Arrest protocol indication for Sodium Bicarbonate (VF/VT)? |
|
Definition
| Consider 1 Meq/kg for patients with renal failure or syspected hyperkalemia. |
|
|
Term
| What is the REMO Adult TCA OD Protocol indication for Sodium Bicarbonate? |
|
Definition
| 1MeQ/kg IV until QRS complex narrows. |
|
|
Term
| What is the REMO Pediatric Cardiac Arrest protocol indication for Sodium Bicarbonate (Asystole and PEA)? |
|
Definition
| PHYSICIAN OPTION ONLY: 1MeQ/kg IV. |
|
|
Term
| What is the REMO Adult crush injury protocol indication for Sodium Bicarbonate? (complete extremity crushed for more than 2 hr or 2 extremities crushed for > 1hr) |
|
Definition
-50mEQ IV.
-infusion (50MeQ in 1L NS, run at 1.5L.hr)
-one minute prior to extrication: 50MeQ IV. |
|
|
Term
| What is one thing to remember about running in Sodium bicarb in a crush injury patient? |
|
Definition
| Use a dedicated IV for the Bicarb and a second one for all other medications. |
|
|
Term
| If a patient has burns to the eyes should you delay irrigation for the application of tetracaine? |
|
Definition
|
|
Term
| What is the REMO Adult (eye) burns protocol indication for Tetracaine? |
|
Definition
2 drops to affected eye prior to irrigation.
Insert morgan lens under eyelid of affected eye. |
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