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REMO Paramedic Protocol meds
"Cookbook" approach to meds and treatments 2007
173
Medical
Professional
01/14/2008
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Term
You are treating an adult patient with suspected ACS. Besides oxygen, what two medications are you allowed to give on standing orders?
 Definition
1.) Aspirin 324 mg
2.) Nitroglycerin 0.4 mg per dose, q5min, max of 3 doses before contacting medical control.
Term
You are treating an adult patient with suspected ACS. You elect to give Nitroglycerin. How many doses can you give before establishing IV access?
 Definition
1 dose.
Term
You are treating an adult patient with suspected ACS. You elect to give nitroglycerin. What is the minimum systolic BP at which you can give nitro?
 Definition
120 mHg systolic.
Term
You are treating an adult patient with suspected ACS. You elect to give a dose of nitroglycerin and the patient's BP drops below 100 mmHg. What should you do?
 Definition
Give 250 cc IV bolus.
Term
You are treating an adult patient with suspected ACS. What three medications are avaialble as physician option?
 Definition
1.) Repeat Nitro (q5min).
2.) Lopressor 5 mg, may repeat q5min to a max of 3 doses.
3.) Morphine 0.05-0.1 mg.kg slow IV push.
Term
Lopressor is one of the physician option medications in treating suspected ACS. What 2 (vital sign) precautions are associated with this drug?
 Definition

1.) Systolic BP must be greater than 120, 2.) HR must be greater than 80.

 
Term
Is Lopressor administered via slow IV push?
 Definition
Yes.
Term
You are treating an adult patient with suspected ACS. What are the parameters for determining STEMI-CONFIRMED?
 Definition
1/2mm or more elevation in 2 or more contiguous leads, -or- machine interpretation reads "Acute MI".
Term
You are treating an adult patient with suspected ACS and note the patient is STEMI-CONFIRMED. What three things do you do now?
 Definition
1.) Notify a REMO physician ASAP.
2.) Do not delay transport.
3.) Follow STEMI-CONFIRMED protocol.
Term
You are treating an adult patient with STEMI-CONFIRMED. What two medications are you allowed to administer on standing orders (beyond O2, ASA, and Nitro)?
 Definition
1.) Morphine 0.05-0.1 mg/kg
2.) Lopressor 5 mg slow IV.
Term
Morphine is one of the medications you can give on standing orders for STEMI-CONFIRMED. What two conditions must be met to adminsiter morphine?
 Definition

1.) Systolic BP > 120

2.) SEVERE chest pain.

(note how SBP is same as for Nitro) 
Term
Lopressor is one of the medications you can give on standing orders for STEMI-CONFIRMED. What two conditions must be met to adminsiter Lopressor?
 Definition

1.) Systolic BP > 120

2.) Pulse > 80

(note how systolic BP limit is the same for Nitro, Morphine, and Lopressor).

Term
How many doses of Lopressor can you give on standing orders for STEMI-CONFIRMED?
 Definition
single dose only while contacting a REMO physician.
Term
Lopressor can be administered on standing orders for STEMI-CONFIRMED. What is one contraindication for Lopressor in this stituation?
 Definition
Hold admin for pulmonary edema. Contact medical control.
Term

You are treating an adult patient with STEMI-CONFIRMED. What two medications are available as physician option?

(Additional doses of standard meds) 

 Definition

1.) Additional Nitro q5m (no max dose)

2.) Additinal lopressor slow IV, IF HR > 80 and SBP >120 to a total of 3 doses.
Term
You are treating an adult patient in cardiogenic shock. Besides oxygen, what treatments (2 meds and a fluid dose) can you administer on standing orders? (presume patient is unstable)?
 Definition

1.) ASA 324 mg

2.)Dopamine 5 ug/kg/min (if patient is unstable)

2.) 250ml NS bolus 

Term
You are treating an adult patient in cardiogenic shock. You have administered 250ml NS and checkd lung sounds. They are clear. What can you do now?
 Definition
Administer another 250ml NS bolus.
Term
What constitues an "unstable" adult cardiogenic shock patient?
 Definition
Systolic BP <90 and/or decreased LOC.
Term

You are treating an adult patient in cardiogenic shock. What two things are available as physician options?

(additional dose of a med and a fluid) 

 Definition

1.) Dopamine infusion 5-20 ug/kg/m

2.) Additional Normal Saline.
Term
You are treating an adult patient with a wide-complex tachycardia (w/pulse). What consitutes "unstable" in this situation?
 Definition
HR > 150 with symptoms of chest pain, dyspnea, AMS, pulmonary edema, ischemia, infarction or hypotension (BP < 90).
Term
You are treating an adult patient with a wide-complex tachycardia (w/pulse). The patient is unstable. What are your treatment options on standing orders?
 Definition
1.) Consider sedation
2.) Synchronized cardioversion.
Term
You are treating an adult patient with a wide-complex tachycardia (w/pulse). The patient is unstable and you elect to cardiovert. At what power level do you begin?
 Definition
100J or the equivalent biphasic setting.
Term
How many times can you cardiovert an unstable adult patient with wide-complex tachycardia?
 Definition
Three.
Term
You have successfully cardioverted a patient with unstable wide-complex tachycardia. What medication/dose can you administer now on standing orders?
 Definition
Amiodarone 150 mg in 100 ml NS over 10 minutes.
Term
You are running in 100 ml of fluid in 10 minutes using a 10-drop dripset. How many drips per minute do you need?
 Definition
100, or approximately 17 drips in 10 seconds.
Term
You are running in 100 ml of fluid in 10 minutes using a 15-drop dripset. How many drips per minute do you need?
 Definition
150, or 25 drops in 10 seconds.
Term
You are treating an adult patient with a wide-complex tachycardia (w/pulse). The patient is stable. What medication can you administer on standing orders?
 Definition
Amiodarone 150 mg in 100 ml NS over 10 minutes.
Term
You are treating an adult patient with a wide-complex tachycardia (w/pulse). What are 4 physician options for this condition?
 Definition

1.) Synchronized or unsynchronized cardioversion. 2.) Lidocane 1.5 mg/kg IV. 3.) Repeat Amiodarone (same regimen) 4.) Magnesium 2 gm IV over 20 minutes if STABLE, over 2 minutes if UNSTABLE.

"S.L.A.M-2"
Term
You are treating an adult patient with a narrow-complex tachycardia. What consitutes an "unstable" patient in this situation?
 Definition
HR > 150 with symptoms of chest pain, dyspnea, AMS, pulmonary edema, ischemia, infarction or hypotension (BP < 90).
Term
Is there any difference between the criteria for an "unstable" patient in narrow and wide-complex tachycardia?
 Definition
No.
Term
You are treating an adult patient with a narrow-complex tachycardia. The patient is unstable. The rhythm is regular. Can you cardiovert on standing orders?
 Definition
No.
Term
You are treating an adult patient with a narrow-complex tachycardia. The patient is unstable. The rhythm is regular. What medication can you administer on standing orders?
 Definition
Adenosine 6 mg rapid IV push while contacting medical control.
Term
You are treating an adult patient with a narrow-complex tachycardia. The patient is unstable. The rhythm is irregular. Can you cardiovert on standing orders?
 Definition
Yes.
Term
You are treating an adult patient with a narrow-complex tachycardia. The patient is stable. The rhythm is regular. What medication can you give on standing orders?
 Definition
Adenosine 6 mg , then 12 mg in 1-2 min, then an additional 12 mg in another 1-2 minutes if needed.
Term
You are treating an adult patient with a narrow-complex tachycardia. The patient is stable. The rhythm is irregular. What medication can you give on standing orders?
 Definition
Cardizem (Diltiazem) 0.25 mg/kg slow IV.
Term
You are treating an adult patient with a narrow-complex tachycardia. Should you first try vagal maneuvers?
 Definition
Yes.
Term
You are treating an adult patient with a narrow-complex tachycardia. The patient is stable. The rhythm is irregular and you elect to cardiovert. At what power level do you start?
 Definition

100 joules or equivalent biphasic setting.

(note how cardioversion starting point is always 100). 
Term
You are treating an adult patient with a narrow-complex tachycardia. What 4 treatments are available as physician option?
 Definition

1.) Additional cardizem 0.25 mg/kg slow IV. 2. )Lopressor 5 mg slow IV. 3.) Amiodarone, 150 in 100 over 10 4.) Synchronized cardioversion.

"L.A.C.S."
Term
You are treating an adult patient with symptomatic bradycardia. What two medications are you allowed to administer on standing orders?
 Definition
1.) Atropine, 0.5 mg IV q3min to a max dose of 0.04 mg/kg.
2.) Dopamine infusion 5 ug/kg.min.
Term
You are treating an adult patient with symptomatic bradycardia. What constitutes a "symptomatic" presentation?
 Definition
Symptomatic presentation includes chest pain, dyspnea, AMS, pulmonary edema, ischemia, infarction or hypotension (BP <90mmHg).
Term
You are treating an adult patient with symptomatic bradycardia. Besides medication, what treatment options are you allowed under standing orders?
 Definition
Transcutaneous pacing.
Term
You are treating an adult patient with symptomatic bradycardia. You elect to use TCP and procedural sedation. What medication and dose is ideal for this treatment?
 Definition
Midazolam (Versed) 0.05.g/kg IV, IM, or IN.
Term
You are treating an adult patient with symptomatic bradycardia. You are using TCP and have sedated the patient. How often can you readminister Versed?
 Definition
q5m as needed if SBP > 100.
Term
You are treating an adult patient with symptomatic bradycardia. You elect to give atropine. What is an important dosing consideration with atropine?
 Definition
Be sure to give at least 0.5 mg; doses less than this amount can cause paradoxical slowing of heart rate.
Term
You are treating an adult patient with symptomatic bradycardia. The patient is hypothermic. Should you give atropine?
 Definition
No. Atropine is to be avoided in hypothermic bradycardias. Call med control.
Term
You are treating an adult patient with symptomatic bradycardia. You elect to give atropine. For what two rhythms is this drug likely NOT to be effective?
 Definition
2nd-degree type II (Mobitz type II) and new 3rd-degree block with wide QRS complexes. These patients can have paradoxical slowing so keep catecholamines handy.
Term
You are treating an adult patient with symptomatic bradycardia. What are two medications available as physician option (and in what doses)?
 Definition

1.) Dopamine infusion 5-20 ug/kg/m

2.) Epinephrine infusion 1 ug/min
Term
You are treating an adult patient with nausea and vomiting. Besides ABCs, O2, and medications what are two other treatment options?
 Definition
1.) 250 ml fluid bolus.
2.) Cardiac Monitor (consider 12-lead).
Term
You are treating an adult patient with nausea and vomiting. What medication can you give on standing orders?
 Definition
Ondansetron (Zofran) 4 mg IV or IM. May repeat once in 10 minutes.
Term
You are treating an adult patient with nausea and vomiting. What are two medications available as physician option (it's NOT additional Zofran)?
 Definition

1.) Midazolam (Versed) 0.05 mg/kg IV, IM, or IN. 2.) Diphenhydramine (Benadryl) 12.5-25 mv IV for motion sickness.

("V.D.") 
Term
You are treating an adult patient for pain management. What two medications are available on standing orders?
 Definition
1.) Morphine 0.05 mg/kg IV or IM, may repeat ONCE with a total dose not to exceed 10 mg.
2.) Zofran 4 mg IV or IM, if patient becomes nauseous.
Term
You are treating an adult patient for pain management. What are the four contraindications for standing orders drug admin?
 Definition

1.) AMS

2.) Hypoventillation

3.) SBP <120 (same as for Cardiac)

4.) Other traumatic injuries
Term
You are treating an adult patient for pain management. What two presentations are eligible for standing orders medication?
 Definition
1.) Severe burns without hemoduynamic compromise.
2.) Isolated extremity injuries or dislocations with severe pain.
Term
You are treating an adult patient for pain management. Should shoulder injuries or suspected hip fractures be treated as isolated extremity injuries in terms of standing order meds?
 Definition
Yes.
Term
You are treating an adult patient for pain management. Can the standing orders pain meds be combined with the procedural sedation protocol?
 Definition
NO unless a REMO physician is consulted.
Term
You are treating an adult patient for pain management. What 4 medications are available as physician option?
 Definition
1.) Fentanyl 0.5-1.0 ug/kg slow IV, IM, or IN.
2.) Addtional morpine IV or IM
3.) Additional Zofran IV or IM
4.) Midazolam (Versed) 0.05mg/kg IV,IM, IN.
Term
You are treating an adult patient for pain management. There is concern over the patient's hemodynamic stability. Which medication is the best choice for this patient?
 Definition
Fentanyl. It may only be used after a consultation with a REMO physician on a recorded line.
Term
You are treating an adult patient in need of medicinal restraint. What medications are you allowed to administer on standing orders?
 Definition
NONE. You must contact medical control for all medicinal restraint cases.
Term
You are treating an adult patient in need of medicinal restraint. The patient is below age 70. What two medications can you administer via Physician option?
 Definition
1.) Haldol 5 mg
2.) Versed 2 mg
should be admin together IV or IM.
Term
You are treating an adult patient in need of medicinal restraint. The patient is above age 70. What one medication can you administer via Physician option?
 Definition
Haldol 5 mg IV or IM.
Term
You are treating an adult patient in need of medicinal restraint. Aside from the "5 and 2 mixed" setup what other methods of these meds are available as physician option?
 Definition
1.) Versed 2-5 mg IV, IM, or IN. 2.) Additional Haldol.
Term
For procedural sedation, what two medications are avaialable on standing orders?
 Definition
1.) Etomidate 0.1 mg/kg
2.) Versed 0.05 mg/kg
Term
Of the medications available on standing orders for procedural sedation, which one is ideal for brief procedures such as cardioversion?
 Definition
Etomidate 0.1 mg/kg IV.
Term
If you want to use Etomidate for post-intubation sedation what must the patient's BP be LESS THAN?
 Definition
< 100 SBP.
Term
Of the medications available on standing orders for procedural sedation which one is better for longer procedures such as TCP or post-intubation?
 Definition
Versed 0.05 mg/kg IV, IM, or IN.
Term
How often can you repeat Versed admin and what SBP must the patient have?
 Definition
Can repeat q5m if SBP > 100.
Term
What are 5 medications available as physician option for procedural sedation?
 Definition
1.) Etomidate 0.3 mg/kg for intubation ONLY
2.) Morphine IV or IM
3.) Fentanyl IV, IM, or IN
4.) Versed 2-5 mg IV, IM, or IN
5.) Zofran 4 mg IV or IM if nauseous
Term
What is the difference in Etomidate dosage for procedural sedation and intubation?
 Definition
0.1 mg/kg for sedation, 0.3 mg/kg for intubation. Intubation dose is BY PHYSCIAN ORDER ONLY.
Term
You are treating an adult patient for anaphylaxis. What four medications are avaialable on standing orders?
 Definition
1.) Duo-neb (total of 3) for wheezing.
2.)Benadryl 50 mg IV or IM
3.) Epinephrine 1:1000 0.5 mg IM
4.) Solu-medrol 125 mg IV.
Term
You are treating an adult patient for anaphylaxis. What three medications are available as physician option?
 Definition
1.) Additional Albuterol (only) dose
2.) Dopamine infusion 5-20 ug/kg/min
3.) Epineprhine infusion 1mg in 250 ml at 5 ug/min.
Term
You are treating an adult patient for anaphylaxis. An epi-pen was administered prior to your arrival. What must you do prior to administering any more epi?
 Definition
Contact medical control.
Term
You are treating an adult patient for anaphylaxis. An Epi-pen was administered PTA and now the patient wants to RMA. What needs to be done?
 Definition
Need to contact medical control before allowing a patient to RMA.
Term
You are treating an adult patient for a diabetic emergency. How many times can you administer D50 on standing orders?
 Definition
Twice. Redose if hypoglycemia recurs during transport.
Term
You are treating an adult patient for a diabetic emergency. BGL is > 400. What do you administer on standing orders?
 Definition
250 ml NS bolus.
Term
You are treating an adult patient for a diabetic emergency. What are two things available as physician option?
 Definition

1.) additional NS if patient is hypoglycemic.

2.) Additional d50 in patient is hypoglycemic.
Term
You are treating an adult patient for a suspected narcotic overdose. The patient is intubated. Can you administer narcan to an intubated patient without physician order?
 Definition
NO. You must get a physician order to admin narcan on an intubated narcotic overdose patient.
Term
You are treating an adult patient for a suspected narcotic (opiate) overdose. Presuming that the patient is NOT intubated, what can you administer on standing orders?
 Definition
Naolxone (Narcan) 0.4-2 mg IV, IM, or IN.
Term
You are treating an adult patient for a suspected overdose. A 12-lead shows a tachycardia or bradycardia with a widened QRS interval. What type of OD do you suspect?
 Definition
TCA.
Term
You are treating an adult patient for a suspected TCA overdose. What medication should you give on standing orders?
 Definition
Sodium Bicarbonate 1Meq/Kg IV until QRS complex narrows below 100msec.
Term
You are treating an adult patient for a suspected overdose. There is uncrontrolled cotnractions of the face and tongue. What OD do you suspect and what do you give on standing orders?
 Definition
Dystonic reaction. Give Benadryl 50 mg IV or IM.
Term
You are treating an adult patient for a suspected sympathomimetic (cocaine/amphetamines) overdose. What medication should you give? Do you need medical control to give this?
 Definition
Midazolam (Versed) 0.05 mg/kg IV, IM, IN. YES you need physician control to administrate this medication.
Term
You are treating an adult patient for a suspected Organophosphate poisoning. What medication should you give (on standing orders)?
 Definition
Atropine 2-5 Mg IV per dose. Continue until secretions dry.
Term
You are treating an adult patient for a suspected Calcium channel blocker overdose. What two medications should you give on standing orders?
 Definition
Calcium Chloride 1 gram IV, Glucagon 2 mg IV.
Term
You are treating an adult patient for a suspected beta blocker overdose. What two medications should you give on standing orders?
 Definition
Glucagon 2 mg IV, Calcium Chloride 1 gram IV.
Term
Do you give Calcium Chloride first or second for an adult Calcium Chloride OD?
 Definition
Give Calcium Chloride (1 gram IV) first, then 2 mg Glucagon IV.
Term
You are an adult patient who is unconscious/unresoponsive without suspected trauma. What protocol should you consider following first?
 Definition
Overdose/Toxic exposure.
Term
You are treating an adult patient for a suspected narcotic overdose. Should you give narcan BEFORE checking BGL?
 Definition
YES.
Term
You are treating an adult patient for seizures. What two medications are you allowed to administer on standing orders?
 Definition
1.) Diazepam (Valium) 5 mg IV,
2.) Versed 5 mg IM or IN.
Term
You are treating an adult patient for seizures. You cannot obtain IV access. What medication should you use per standing orders?
 Definition
Versed 5 mg IM or IN.
Term
You are treating an adult patient for seizures. What three medications are available as Physician Option?
 Definition
1.) Magnesium 4 grams IV over 2 minutes if patient is pregnant.
2.) Additional Valium 5mg IV.
3.) Additional Versed 2-5 IV, IM, or IN.
Term
Are the medications listed in the Seizures protocol only to be administered for Grand-Mal (tonic-clonic) seizures only?
 Definition
YES.
Term
You are treating an adult patient for seizures. The patient is a pregnant female with a BP of >140/90 and sever headache, confusion, hyper-reflexia and seizures. What protocol do you refer to?
 Definition
Eclampsia protocol.
Term
Besides up to 3 500ml NS bolus, what medication can you give for adult shock/hypoperfusion on standing orders?
 Definition
Dopamine 5ug/kg/m.
Term
What are three physician options for the treatment of shock/hypoperfusion in the adult patient?
 Definition
1.) Additional NS bolus.
2.) Dopamine infusion 5-20 ug/kg/m
3.) Epinephrine 2-10 ug/m.
Term
What are 8 potential causes of shock/hypoperfusion (other than trauma)?
 Definition
Anaphylaxis, Toxic Ingestion, Cardiac Rhythm disturbances, MI, sepsis, ruptured AAA, ectopic pregnancy.
Term
In treating an adult patient afflicted by a stroke, what is the most important piece of information you should obtain?
 Definition
Exact time patient was in last usual state of health and/or seen without symptoms.
Term
For stroke patients, what is the "golden period" of time between symptom onset and arrival at a stroke center?
 Definition
2 hours.
Term
What is the first thing you should check in the suspected stroke patient?
 Definition
BGL.
Term
For a stroke patient, at what BP levels should you contact medical control?
 Definition
SBP > 220 or DBP > 120.
Term
Are there any medications you can administer on standing orders for a stroke patient?
 Definition
NO.
Term
What are two medications available as Physician Option for stroke patients?
 Definition
1.) Lopressor 5 mg slow IV push.
2.) Nitroglycerin Paste 1-2" TD.
Term
What are the components of the APGAR scale and what number ranges do they use?
 Definition
Appearance, Pulse, Grimace (flick soles of feet) Activity (muscle tone) Respirations. They are scored 0-2.
Term
What is the clinical picture for pre-eclampsia?
 Definition
BP > 140/90 in a pregnant or recently-pregnant female, with severe headache, confusion, and/or hyper-reflexia.
Term
What is hyper-reflexia?
 Definition
Hyperreflexia is defined as overactive or overresponsive reflexes. Examples of this can include twitching or spastic tendencies as well as the lessening or loss of control of other parts.
Term
What is the difference between pre-eclampisa and eclampsia?
 Definition
eclampsia is pre-eclampsia plus seizures.
Term
You are treating a Pregnant female patient for seizures. What medication can you give on standing orders?
 Definition
Magnesium 4 grams over 2 minutes IV.
Term
What four medications are available as physician option for the treatment of eclampsia?
 Definition

1.) Additional Magnesium infusion or bolus. 2.) Lopressor 5 mg slow every 5m, max 3 doses. 3.) Versed 2-5 mg IV, IM, IN. 4.) Valium 5 mg IV.

"V.L.V.M." 
Term
What time frame denotes pre-term labor?
 Definition
24-37 weeks.
Term
You are treating a patient for pre-term labor. Are there any medications you can administer on standing orders?
 Definition
NO. Just 1-2 500ml NS bolus.
Term
What medication is available as Physician Option for pre-term labor?
 Definition
Magnesium 2 grams in 100ml over 20 minutes.
Term
In treating adult acute asthma, what clinical condition necessitates the use of IM epinephrine?
 Definition
Severe Distress.
Term
For acute asthma (on standing orders), should epineprhine be given SQ or IM?
 Definition
IM.
Term
What four medications are available on standing orders for acute asthma?
 Definition

1.) Duo-neb

2.) Solu-Medrol 125 mg

3.) 0.3-0.5mg 1:1000 Epi IM

4.) Magnesium 50 mg/kg IV (2 in 100ml over 10m)
Term
On standing orders you can give Magnesium 50 mg/kg IV for actue asthma. What is the mix and rate of infusion?
 Definition
2 grams in 100ml NS run in over 10 minutes.
Term

You are treating a patient with actute asthma. What three medications are available as physician option?

(two routes of one med, one additonal dose of another)

 Definition
1.) Epi 1:1000 0.5 mg mixed with 3 ml NS via nebulizer. 2.) Epi 1:10,000 IV IF IMMINENT RESPIRATORY ARREST 3.) Additional Albuterol unit dose via SVN.
Term
"All that wheezes is not asthma". Name 4 other potential causes of wheezes.
 Definition
1.) Allergic reaction
2.) Airway obstruction
3.) Pulmonary Edema
4.) COPD exacerbation
Term
What is the total number of Albuterol doses that can be given by prehospital providers to acute asthma patients before contacting medical control?
 Definition
Three.
Term
You are treating a patient with Acute Pulmonary Edema. Can you give a Dou-neb treatment on standing orders?
 Definition
Yes, but only one and only if wheezes are present.
Term
Besides a Dou-neb, what two medications are available on standing orders to treat actue pulmonary edema?
 Definition
1.) Nitro
2.) Lasix.
Term
How often can you give Nitro (SL) to a patient with actue pulmonary edema?
 Definition
0.4 mg (1 spray) every 2-5 minutes IF the patient's BP is > 100.
Term
You are treating a patient with actue pulmonary edema and cannot give nitro SL. What is the TD dosage for Nitro (on standing orders)?
 Definition
1-2" of Nitro paste.
Term
In treating a patient with actue pulmonary edema, what physical finding must be present for the admin of lasix and what is the dosage (on standing orders)?
 Definition
Patient must have peripheral edema.
Dosage is 40mg IV over 2-3 minutes.
Term
Should you administer Lasix slowly? Why?
 Definition
Yes, risk of tinnitus. Admin over 2-3 minutes.
Term
You are treating a patient with actue pulmonary edema. Can you administer Nitro before establishing vascular access?
 Definition
Yes, 1 dose only.
Term
What are two physician options for the treatment of acute pulmonary edema?
 Definition
1.) Additional Lasix (generally double the dose)
2.) Morphine 0.05 mg/kg IV.
Term
What are two medications available on standing orders for the treatment of COPD exacerbation?
 Definition
1.) Duo-neb (max 3 doses)
2.) Solu-Medrol (Methylprednisolone) 125 mg IV.
Term
What are three physician options for the treatment if COPD exacerbation (two meds and a treatment)?
 Definition

1.) Addtional Alubterol unit dose via SVN.

2.) Magnesium 2g in 100ml NS over 10 minutes.

3.) CPAP.

Term
You are treating a patient with upper airway obstruction/stridor. When can you use the Magill Foceps to remove a stuck item?
 Definition
After the patient becomes unconscious.
Term
What two medications are available on standing orders for the treatment of upper airway obstruction/stridor?
 Definition
1.) Duo-Neb (1 dose)
2.) Solu-Medrol 125 mg IV.
Term
What two medications are available as physician option for the treatment of upper aiway obstruction/stridor?
 Definition
1.) Additional Albuterol dose via SVN.
2.) Epi 1:1000 0.5 mg mixed in 3 ml NS via SVN.
Term
In the Adult trauma patient, what vital signs qualify a patient as "unstable"?
 Definition
BP < 90
Pulse <50 or > 120
GCS < 13.
Resp rate <10 or >29.
Term
In burn patients, what % BSA is the cutoff for moist and dry sterile dressings?
 Definition
10% (< wet, > dry).
Term
For a patient with burns to the eyes, how many drops of tetracaine (0.5%) should be administered per eye (on standing orders)?
 Definition
2.
Term
For treating a burn patient, what amount of NS should you run in on standing orders?
 Definition
250ml.
Term
For a burn patient, what other protocol should you refer to?
 Definition
Pain management.
Term

What three physician options are available for the treatment of a burn patient?

(2 meds and 1 fluid) 

 Definition
1.) Morphine IV or IM. 2.) Fentanyl 0.5-1.0 ug/kg slow IV, IM or IN. 3.) Additional fluids.
Term
When considering the total area of a burn, should you include 1st degree burns too?
 Definition
No.
Term
Your patient has burns associated with trauma. What should be your destination hospital?
 Definition
The closest trauma center.
Term
What six conditions should warrant transport to a burn center?
 Definition
1.) >10% BSA partial thickness burns
2.) Burns to face, neck, hands, genitals or major joints
3.) 3rd-degree burns
4.) Electrical burns/lighting strikes
5.) Chemical Burns
6.) Inhalation burns (only if intubated)
Term
Where are two adult burn centers?
 Definition
1.) Westchester Medical Center
2.) SUNY Upstate, Syracuse
Term
Where is a childrens' (only) burn center?
 Definition
Shriner's Hospital, Boston MA.
Term
Where are three facilities with hyperbaric chambers?
 Definition
1.) Westchester Medical Center
2.) SUNY Upstate, Syracuse
3.) Jacobi Medical Center, the Bronx
Term
Is penetrating chest trauma a contraindication for MAST?
 Definition
Yes.
Term
In chest trauma, what two conditions must be present to warrant needle decompression?
 Definition
1.) S/Sx consistent with tension pneumo
2.) Hemodynamic compromise
Term
In the chest trauma patient, what constitues "hemodynamic compromise"?
 Definition
Hypotension, narrowed pulse pressure and tachycardia.
Term
Can you give pain medications to the chest trauma patient on standing orders?
 Definition
No.
Term
What pain medication is avaialble for the chest trauma patient as physician option?
 Definition
Fentanyl 0.5-1.0 ug/kg IV, IM, or IN.
Term
Your patient is in apparent traumatic cardiac arrest and has chest trauma. Should you consider needle decompression?
 Definition
Yes, bilaterally.
Term
You are treating a patient with crush injuries. How many IV sites should you secure?
 Definition
Two.
Term
For the crush injury patient, how much NS can you run in under standing orders?
 Definition
1 L, preferrably warmed.
Term
What condition(s) must occur to the crush injury patient to warrant consideration of Sodium Bicarb?
 Definition
1 complete extremity crushed for more than 2 hours -OR- 2 extremities crushed for 1 hour.
Term
For the crush injury patient that meets the requirements, when should you give Sodium Bicarb?
 Definition
1.) IV bolus
2.) Infusion
3.) IV Bolus 1 minute prior to extrication.
Term
What is the IV bolus dosage of Sodium Bicarb for crush injury patients?
 Definition
50 mEq IV. This is also the dosage for 1-minute to extrication.
Term
What is the IV infusion dosage and rate for Sodium Bicarb infusion for the crush injury patient?
 Definition
50 mEq in 1L NS, run in at 1.5 liters per hour.
Term
If hyperkalemia is suspected in the crush injury patient, what two medications are available as physician option?
 Definition
1.) Calcium Chloride 1 gm over 5m, repeat in 10m if no resolution.
2.) Albuterol 1 unit dose via SVN.
Term
If hyperkalemia is NOT suspected in the crush injury patient, what 3 medications are available as physician option?
 Definition
1.) Versed 0.05 mg/kg IV, IM, IN
2.) Morphine 0.05 mg/kg IV or IM
3.) Fentanyl 0.5-0.1 ug/kg IV, IM, IN.
Term
What EKG changes would you expect to see in a patient with hyperkalemia?
 Definition
Peaked, pointy T waves. The T waves will probably have a symmetric base and overall shape (like a TeePee). You may also see widened QRS complexes.
Term
When running in Sodium Bicarbonate, can you use the same IV site for other medications?
 Definition
NO. Use a dedicated side for Sodium Bicarb.
Term
You have just extricated a crush injury. Should you elevate the extremity?
 Definition
No, apply cold therapy and immobolize it.
Term
What is the BP "cutoff" to differentiate between compensated and decompensated shock?
 Definition
SBP of 90.
Term
What is the NS regimen for treating compensated shock/hypovolemia on standing orders?
 Definition
1 L, then 500ml/hr.
Term
What is the NS regimen for treating decompensated shock/hypovolemia on standing orders?
 Definition
Additional access, 2L, then 500 ml/hr.
Term
What are two physician options for the treatment of shock/hypovolemia?
 Definition
1.) additional NS
2.) Dopamine 5-20 ug/kg IV
Term
For the trauma patient, what is the BP requirement for MAST (no suspected pelvic fx)?
 Definition
Systolic BP <50.
Term
What is the BP indication for MAST in the patient with suspected pelvic fx?
 Definition
BP < 90.
Term
What is the tidal volume setting for trasport ventilators?
 Definition
5-7 ml/kg.
Term
For ETI, how many "strikes" do you get?
 Definition
One provider can make two attempts, then one more attempt by a different provider.
Term
For incident rehab, what vital signs indicate the need for a 15-minute rest and rehydrate?
 Definition
SBP >150 or DBP >100
Resps > 24
Pulse > 110
Temp > 100.6
Term
You are rehabbing a firefighter. After 15 minutes his vitals are still out of scope. What now?
 Definition
Rest & Rehydrate for another 15m while determining if futher treatment is needed.
Term
You are rehabbing a firefighter and his vitals are out of scope for > 30 minutes. What needs to be done now?
 Definition
Transport to the hospital should be initiated.
Term
What conditions will disqualify a firefighter from rejoining the scene?
 Definition
Irregular pulse, CP, SOB, or AMS. Follow appropriate ALS protocols.
Term
You are managing a suspected CO exposure. There are more than 5 patients. What should you do?
 Definition
Request a physician to the scene.
Term
Should all symptomatic patients be transported in a suspected CO exposure?
 Definition
Yes.
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