Download Emergency Treatments: Adenosine, Albuterol, Atropine, Calcium Chloride, Lidocaine, Midazol and more Exams Computer Network Management and Protocols in PDF only on Docsity!
LA COUNTY PROTOCOLS FOR 2024 UPDATED
STUDY GUIDE.
What is 1200.2 - Base Contact? 1200.2 Base Contact required for all children when - less than or equal to 36 months old except those with no medical complaint or with isolated minor extremity injury, and critically ill pediatric patients who meet transport guidelines to a PMC, regardless of provider impression or field treatment rendered. 1200.2 Base contact criteria STILL apply if the patient is - refusing transport AMA, which includes parents or legal guardians who refuse transport of pediatric patient 1200.2 Base Contact Guidelines with the following provider impressions - 8 CCAARDSS and 4 BCPN for pads
- Childbirth
- Cardiac Arrest
- Anaphylaxis
- Agitated Delirium
- Respiratory Failure
- Dystonic Reaction
- Shock
- Stroke Pads
- BRUE
- Chest Pain
- Pregnancy/Labor
- Newborn 1200.2 Base Contact required for following provider impressions under the SPECIFIC CONDITIONS (10) - Specified Conditions is a Catastrophe
- Medical Device Malfunction
- Cardiac Dysrhythmia
3. ALOC
- Traumatic Injury
- Airway Obstruction
- Seizure
- Submersion
- Respiratory Distress
- Overdose/ Poisoning/ Ingestion
- Pregnancy Complication 1200.2 Base Contact Specified Condition of Airway Obstruction? (1) - 1) severe respiratory distress or respiratory arrest 1200.2 Base Contact Specified Condition of ALOC - persistent ALOC of unclear etiology 1200.2 Base Contact Specified Condition of Cardiac Dysrhythmia (3) - 1) fib w/ RVR
- Symptomatic bradycardia
- Wide complex tachycardia 1200.2 Base Contact Specified Condition of Medical Device Malfunction - ventricular assist device VAD malfunction 1200.2 Base Contact Specified Condition of OD/ Poisoning/ Ingestion - only if signing AMA 1200.2 Base Contact Specified Condition of Pregnancy Complication (1) - 1) only if
20 weeks gestation w/ vaginal bleeding 1200.2 Base Contact Specified Condition of Respiratory Distress of any etiology (2) -
- severe respiratory distress unresponsive to CPAP
- Unmanageable airway 1200.2 Base Contact Specified Condition of Seizure (2) - 1) pregnant patient
- Status epileptics 1200.2 Base Contact Specified Condition of Submersion (2) - 1) ALOC
- Decompression sickness 1200.2 Base Contact Specified Condition of Traumatic Injury (4) - 1) crush syndrome
1200.2 Base Contact required PRIOR to initiating the following treatments - TX PRIOR 7 ACCMIST
- Additional dosing of normal saline or meds after max dose per protocol
- Calcium chloride for patients with calcium channel blockers OD
- Cardio version of a patient with adequate perfusion, or awake with a narrow complex tachycardia, or any atrial fibrillation
- Midazolam for sedation of a patient with behavioral/psychiatric crisis
- Ion placement beyond indications
- Sodium biker for symptomatic bradycardia with suspected hyperkalemia or for dysrhythmia due to possible tricyclic antidepressant or other toxic OD
- TCP if HR > Adenosine Classification - Class V Antidysrhythmic Adenosine Prehospital Indications (2) - Cardiac Dysrhythmia: SVT - Narrow Complex: HR >= 150 adult, >=180 for child, >=220 for infants
- Perusing unresponsive to Valhalla.
- Poorly perusing (if alert) Regular/Monomorphic Wide Complex Tachycardia with adequate perfusion. Adenosine Adult Dose - 6 or 12mg rapid IVP (per protocol), within 1-3 seconds, followed by a rapid flush of 10mL of NS If no conversion after 1-2 minutes, may repeat 12mg rapid IVP followed by rapid flush of 10mL of NS. Adenosine Pediatric Dose - 0.1mg/kg rapid IVP, maximum 6mg, followed by a rapid followed by a rapid flush 10mL NS. If no conversion after 1-2 minutes, may repeat one time 0.2mg/kg followed by a rapid flush of 10mL NS, max of 12mg. Adenosine MOA (2) - 1) slows conduction through the AV node
- Interrupts AV reentry pathways as well as conduction through the senatorial (SA) nodes Adenosine Interactions (2) - 1) potentiated by blocker of nucleoside transport (carbamazepine (Tigerton)
- Antagonized by methylxanthines such as caffeine and theophylline
Adenosine Pharm kinetics - onset immediate, duration <10 sacs Know what imp saying NOW LESS THAN 10 Adenosine Contraindications (6) - 1) should not be used for sinus tachycardia, despite rate >
- 2nd and 3rd degree heart block without pacemaker
- Sinus node disease (sick sinus syndrome)
- Wolff-Parkinson-White (WPW) Syndrome or ECG consistent WPW
- Atrial flutter or fibrillation
- Heart transplant- base contact required, as noted "super-sensitivity" of transplanted heart to adenosine Adenosine Adverse Effects (10) - 1) blurred vision
- Bradycardia/ systole
- Chest pain/ chest pressure
- Dyspnea
- Head pressure
- Hypotension
- Lightheadedness/ dizziness
- Metallic taste/ throat tightness
- Numbness/ tingling
- Palpitation Rhabdomyolysis What does it look like? What condition is it? Pathophys? - Dark urine, egg. Coca cola pee Muscle damage causes an increase in myoglobin levels. When it passes the kidneys in abundance, it causes tubular obstruction, which leads to a buildup of toxins in the kidneys which results in renal failure. Rhabdomyolysis can also lead to hyperkalemia with potassium leaking into cardiovascular system, which then can lead to arrhythmias. Class I antidysrhythmics - agents interfere with the sodium (Na+) channel Egg. Lidocaine Class II antidysrhythmics - agents are anti-sympathetic nervous system agents. Most agents in this class are beta blockers "-lolls Egg. Metropolis, Atenolol
Albuterol Mechanism of Action - selective beta-2 adrenergic agonist that causes relaxation of smooth muscles in the bronchial tree decreasing the airway resistance, facilitating mucous drainage and increasing vital capacity shifts potassium intracellular. Has mild beta-1 activity with mild effect on heart rate. Albuterol Pharmacokinetics (2) - 1) onset- 5-15min inhaled
- duration- 3-6 hours for bronchial smooth muscle relaxation, 3-4 hours for hyperkalemia shifting potassium intracellular, albuterol 5153634 Albuterol contraindications - allergies, sensitivity Albuterol interactions (2) - 1) caution with patients being treated with MAO inhibitors or TCA
- Beta blocking agents and Albuterol may each inhibit the effects of the other, monitor closely Albuterol Adverse Effects (4) - 1) anxiety/ tremors
- Hypertension
- Hypokalemia
- Palpitations/ tachycardia Amiodarone classification - antidysrhythmic Potassium channel blocker Amiodarone dosage adult - adult 300mg followed one time in 3-5 min 150mg max 450mg Amiodarone dosage pads - 5mg/kg max of 300mg IVIO Amiodarone indications - cardiac arrest- pulseless VTACH, VFIB after defy 2x Amiodarone MOA - inhibits adrenergic stimulation to the heart, prolongs action potential and delays repolarization; decreases AV node and Sinus node function Amiodarone contraindications - none Aspirin Classification - Antiplatelet NSAID Aspirin Adult Dose - 325mg chewable PO Aspirin Pediatric Dose - not recommended for children Aspirin MOA - inhibits platelet aggregation, inhibits synthesis of prostaglandins. Can be used as antipyretic and analgesic
Aspirin Contraindications - active GI ulcers Atropine classification - Anticholinergic Atropine Indications - SLUDGEM- organophosphate poisoning/nerve agent exposure, symptomatic bradycardia Atropine Adult dose (2) - 1) organophosphate poisoning- 2mg may repeat every 5min until asymptomatic
- Symptomatic bradycardia- 0.5mg may repeat every 3-5minutes max dose of 3mg Atropine pediatric dose - 1) organophosphate poisoning- 0.05mg/kg IVIM, prn every 5 min max dose of 5mg
- Symptomatic bradycardia- 0.02mg/kg may repeat once in 5 min Atropine MOA - Competes with acetylcholine at muscarinic receptor sites as an agonist (blocks action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, And the CNS) Increases cardiac output, dries secretions, antagonizes histamine and serotonin, increases SA node firing, increases conduction through AV node Atropine contraindications (3) - 1) glaucoma
- Tachycardia
- Hyperthyroidism Calcium Chloride classification - electrolyte Calcium Chloride Indications (4) - 1) Cardiac Arrest- non traumatic (suspected hyperkalemia, patients with renal failure)
- Cardiac Dysrhythmia- suspected hyperkalemia causing bradycardia
- OD/Poison- calcium channel blocker toxicity
- Traumatic injury- suspected hyperkalemia in setting o crush injury or potential for development of crush syndrome Calcium Chloride Adult Dose (3) - 1) Cardiac Arrest- 1gm IVP/IO
- Cardiac Dysrhythmia- 1gm SLOW IV/IO push
- OD/Poisoning-1g SIVP over 60 seconds
Dextrose MOA - form of glucose used by the body to create energy Dextrose: Pharmacokinetics - onset <1min Peak effect dependent on degree of hypoglycemia D rose less than 1 year but depends on hypoglycemia Dextrose consideration - confirm IV line prior to admin of this drug due to extravasation causing necrosis Diphenhydramine classification - Antihistamine Diphenhydramine MOA - Histamine H1 receptor antagonist of effector cells in respiratory tract, blood vessels and GI smooth muscle. Possesses anticholinergic properties. Diphenhydramine Indications (2) - 1) allergic reaction-itching hives
- Dystonic reaction Diphenhydramine Adult dose - 50mg IVP, IM may repeat once in 15 minutes max dose of 100mg Diphenhydramine pediatric dose - 1mg/kg SIVP, or IM one time that’s it. Diphenhydramine Pharmacokinetics - onset is 15-30 minutes, duration <10min Die Abel everything contributed nothing but 10 goats Diphenhydramine Contraindications - Acute asthma attack Because they dry the secretion in upper and lower respiratory tracts Diphenhydramine interactions - increases CNS depression when used with alcohol and other CNS depressants or MAOIs Epinephrine Classification - Sympathomimetic, adrenergic Epinephrine indications (6) - 6 SCAARS
- Shock
- stridor/croup
- Cardiac arrest
- Anaphylaxis
- Airway swelling
- Respiratory distress Epinephrine Adult dose (6) - 1) anaphylaxis- 0.5mg(1mg/mL) IM in the lateral thigh, may repeat every 10min x2 prn, max total 3 doses
- Cardiac arrest- 1mg (0.1mg/mL) 10mL IVIO every 3-5min
- Non-traumatic shock- push dose epinephrine- mix 9mL NS with 1mL epic 0.1mg/mL (IV formulation) in a 10mL syringe. Administer push dose epic 1mL IVIO every 1-5minutes as needed to maintain SBP >90mmHg
- Respiratory distress/bronchospasm- 0.5mg/mL (1mg/mL) IM in the lateral thigh
- Airway obstruction-stridor 5mg via neb (1mg/mL) repeat x1 in 10min prn
- Airway obstruction- airway swelling 0.5mg IM (1mg/mL) repeat every 10min prn x2, max of three doses Epinephrine pediatric dose - literally all 6 is 0.01mg/kg only difference is all cardiac epic is 1:10,000 so concentration will be 0.1mg/mL vs. everything else which is 1:1000 or 1mg/mL Epinephrine MOA - naturally occurring catecholamine, works on Beta 1, Beta 2, and alpha 1 receptors. Beta 1 increases Isotropy, Chronotropy, and Dromotropy. Beta 2 causes bronchial smooth muscle relaxation and vasodilation and alpha 1 vasoconstricts. Isotropy - force of contraction Intrinsic rates of the conduction system - -SA node: 60-100 times/min -AV node: 40-60 times/min -Bundle of His, Purkinje fibers: 20-40 times/min Chronotropy - heart rate Dromotropy - conduction velocity Epinephrine Pharmacokinetics (2 onset and duration <2 increments of 5 - 1) onset <2min IV, 1-3min IM
- Duration is 5-10min IV, 20-30min IM Epic 213 5 increments 5-10-20- Epic Interactions - can be partially deactivated by highly alkaline solutions such as sodium biker Epic considerations - giving injection of IM formulation and dose which is 1:1000 can cause severe hypertension and possible cerebral hemorrhage. SO DONT **** IT UP! REMEMBER- GO EASYYY IN THE IVVVVV!
Glucagon MOA - normally produced in pancreas which cause breakdown of glycogen stored in liver to glucose and inhibits the synthesis of glycogen from glucose Lidocaine classification - local anesthetic Lidocaine indications - patients responsive to pain that have IO access Lidocaine Adult dose - 40mg SIOP over 2 minutes prn once of 20mg Lidocaine pediatric dose don’t you lie to me, it’s not 1mg/kg - 0.5mg/kg (20mg/mL) SIOP over 2 minutes prn once at half the initial dose Lidocaine MOA - inhibits sodium ion channels, stabilizing neuronal cell membranes causing a nerve conduction blockage Lidocaine pharmacokinetics (3) lie 5 increments - 1) onset is 2min
- Peak in 3-5min
- Duration is 10-20min Midazolam classification - Sedative, benzodiazepine Midazolam indications - agitated delirium, behavioral, psychiatric, and cardiac- prior to TX of TCP or cardio version, seizure- active Midazolam Adult dose - ACS 525 552 10-6- Midazolam pediatric dose - 0.1mg/kg (5mg/mL) IMINIV A-continuously, C-2 doses max after 2 min, S- 2 doses max after 2 min Midazolam MOA - binds to receptors at several sites within the CNS, potentiates GABA receptor system which produces anxiolytic, anti-convulsing, muscle relaxant, and amnesic effects Midazolam pharmacokinetics - onset 3-5min IV, 15-20 min IM, 6-14min IN Duration 1-6hours IVIM Midazolam contraindications (3) - 1) acute alcohol intoxication with AMS
- Respiratory depression
- Shock Midazolam interactions - risk of respiratory or CNS depression, increases when used with diphenhydramine, fentanyl, morphine, or other opiate or sedative medications
Morphine Classification - opiate analgesic Morphine indications - pain management Morphine adult dose - 4mg slow IVIOP, repeat every 5min prn, max dose prior to base 12mg Morphine pediatric dose - 0.1mg/kg SIVPIO repeat once in 5min max 2 doses prior to Base contact Morphine MOA - Narcotic Agonist, analgesic of opiate receptors; inhibits ascending pain pathways, thus altering response to pain Morphine pharmacokinetics - onset is immediate IV, 15-30min IM, duration is 2- 7hours MORE NOW, IM 153027 Morphine contraindications - hypotension sap<90mmHg or poor perfusion Allergy Morphine interactions - CNS depressants Morphine considerations - Narran can be used to reverse CNS depression Naloxone Classification - Opiate antagonist Naloxone indications - suspected narcotic OD w/ AMS and apnea Naloxone adult dose - 2-4mg IN 0.8-2mg IV 2mg IM Max 8mg on all routes titrate to adequate respiratory rate and tidal volume Naloxone Pediatric dose - 0.1mg/kg IMINIV dose, max dose 8mg on all routes titrate to effect Naloxone MOA - competes for and displaces narcotic molecules in opiate receptors in the brain. Reverses CNS depression until the Naloxone wears off, where it needs to be read ministered Naloxone Pharmacokinetics - onset is <2min IV, 2-10min IM, duration 20-120min Nar cant TUH TWOOOO 2210, 20120 Nitroglycerin Classification - Nitrate Vasodilator Nitroglycerin indications - Chest pain suspected cardiac Chest pain stem
Ondansetron interactions - amiodarone and other Qtr. prolonging drugs (prolonging QT interval may produce Torsade’s) Pralidoxime chloride classification - cholinesterase deactivator 2PAM chloride indications - Organophosphate, or nerve agent exposure Pralidoxime chloride adult dose - Given in conjunction with atropine as a Duo Dote injection - Atropine 2.1mg and Pralidoxime Chloride 600mg (2PAMCl). Medications delivered sequentially by one syringe into 2 different areas of the muscle. Mild Exposure DuoDoteTM IM x Moderate Exposure DuoDoteTM IM x2, one after another Severe Exposure DuoDoteTM IM x3, one after another Pralidoxime chloride pediatric dose - patients longer than the length of Brose low tape receives adult dose 1 duo dote up to orange-green which is 26-33 which will be 2 duo dotes Pralidoxime chloride MOA - cholinesterase deactivator, by displacing the enzyme from its receptor sites. The enzyme then can then resume its job of breaking down acetylcholine 2PAM Jordan 515 chloride pharmacokinetics - onset is 2-3min Peak effect 5-15min Duration is 2-3hours 2PAM 23-515-23hours 2PAM chloride contraindications - poisonings with carbonate insecticide seven, inorganic phosphates, organophosphates with no anticholinesterase Sodium Biker classification - electrolyte/ alkalinizing agent Sodium Biker indications (4) - 1) cardiac arrest: suspected hyperkalemia
- Cardiac dyes: SB suspected hyperkalemia causing bradycardia
- OD: suspected TCA with ECG changes
- Traumatic injury: suspected hyperkalemia with crush injury or potential for development of crush syndrome Sodium Biker adult dose - 50mEq SIVIOP But for crush injury you can repeat once for persistent ECG abnormalities
Sodium Biker Pediatric Dose - 1mEq/kg SIVP For crush injury repeat once for persistent ECG abnormalities Sodium Biker MOA - increases blood and urinary pH by releasing a bicarbonate ion, which in turn neutralizes hydrogen ion concentrations Sodium Biker Pharmacokinetics - onset is <15min, duration 1-2 hours Sodium biker, had my 7th grade had salty snacks for 15 minutes when I was 12 Sodium Biker contraindications (3) - 1) pulmonary edema
- Hypernatremia
- Hypocalcaemia Sodium Biker interactions (2) - 1) precipitates to form calcium carbonate (chalk) when used with calcium chloride or calcium glucometer.
- Can reduce potency of epic, flush line after admin Sodium Biker Consideration - multiple doses maybe needed in TCA overdose when indicated Call run - Hi my name is Melvin and paramedic intern, it okay if I treat you? Check pulses, and skin signs If bad O What is your name? How old are you? What city are we in right now? Tell me the year it is right now? To teammate: Can I get the patient's blood pressure, pulse ox, and 12 lead, also take the patients sugar level too please Any pain? Yes? Then OPQRST No. Then go to SAMPLE IV access REMEMBER IF IT’S A TRAUMA, STROKE, OR CARDIAC JUST GO! Diabetic Hypoglycemia TX protocol - <60mg/ld. oral glucose paste 15gm PO or D 125mL IV and reassess if pt. continues to symptomatic, repeat 125mL for a total of 250mL
D) bleeding not controlled by direct pressure requiring the usage of a hemorrhage control tourniquet or hemostatic agent
- Falls: a) Adult patients from heights greater than 15 feet b) Pediatric patients from heights greater than 10 feet, or greater than 3 times the height of the child
- Passenger space intrusion of greater than 12 inches into an occupied passenger space
- ejected from vehicle (partial or complete)
- Auto versus pedestrian/bicyclist/motorcyclist thrown, run over, or with significant (greater than 20mph) impact
- Unenclosed transport crash with significant (greater than 20 mph impact)
- Major/ Critical Burn a) Patients 15 years of age or older with 2nd partial thickness burns and 3rd degree burns in
