Download Emergency Treatments for Pediatric Patients: Adenosine, Atropine, Calcium, Dextrose 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 peds
- Childbirth
- Cardiac Arrest
- Anaphylaxis
- Agitated Delirium
- Respiratory Failure
- Dystonic Reaction
- Shock
- Stroke Peds
- BRUE
- Chest Pain
- Pregnancy/Labor
- Newborn 1200.2 Base Contact required for following provider impressions under the SPECIFIC CONDITIONS (10) - Specified Conditions is a MCATASSROPhe
- Medical Device Malfunction
- Cardiac Dysrhythmia
- 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) afib 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 > weeks gestation w/ vaginal bleeding 1200.2 Base Contact Specified Condition of Respiratory Distress of any etiology (2) - 1) severe respiratory distress unresponsive to CPAP
- unmanageable airway 1200.2 Base Contact Specified Condition of Seizure (2) - 1) pregnant patient
- status epilepticus
1200.2 Base Contact is required CONCURRENTLY when the following treatments are initiated - TX CONCURRENT PACT
- adenosine in pediatric patients
- cardioversion
- push-dose epi
- TCP transcutaneous pacing 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
- cardioversion of a patient with adequate perfusion, or awake with a narrow complex tachycardia, or any atrial fibrillation
- midazolam for sedation of a patient with behavorial/psychiatric crisis
- io placement placement beyond indications
- sodium bicarb 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
- Perfusing unresponsive to Valsalva.
- Poorly perfusing (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 sinoatrial (SA) nodes Adenosine Interactions (2) - 1) potentiated by blocker of nucleoside transport (carbamazepine (Tegretol)
- Antagonized by methylxanthines such as caffeine and theophyline Adenosine Pharmokinetics - onset immediate, duration <10 secs Yknow what im sayin 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/ asystole
- 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?
- Pulmonary Edema/CHF: persistent wheezing despite CPAP Albuterol Adult Dose (3) - 1) Cardiac Dysrhythmia/Crush - Suspected hyperkalemia 5mg (6mL) via neb, repeat continuously until hospital arrival
- Crush at risk for Crush Syndrome- 5minutes prior to extrication: 5mg/6mL via neb X
- Respiratory Distress (including pulmonary edema/CHF with wheezing) 5mg (6mL) via neb May repeat x2 prn for wheezing Albuterol Pediatric Dose (3) - 1) Crush - Suspected hyperkalemia 6mL (2.5mg/3mL) via neb
- Crush- at risk for crush syndrome 5 minutes prior to extrication: 5mg/6mL via neb repeat immediately x
- Respiratory Distress < 1 year of age 2.5mg/3mLvia neb ≥ 1 year of age 6mL (2.5mg/3mL) via neb 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 capacitiy shifts potassium intracelllular. 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, sensitivty 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 peds - 5mg/kg max of 300mg IVIO Amiodarone indications - cardiac arrest- pulseless VTACH, VFIB after defib 2x Amiodarone MOA - inhibits adrenergic stimulation to the heart, prolongs action potential and delays repolaratization; 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 poisning/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 acetycholine at muscarinic receptor sites as an agonist (blocks action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands,
I SEE THEM NOW VARIES
Calcium Chloride Contraindications (2) - 1) Hypercalcemia
- Vfib Calcium Chloride Adverse Effects (4) - 1) cardiac arrest
- hypotension or hypertension
- pain on injjection site
- tingling Calcium Chloride interactions - causes digoxin toxicity if given to patients with digoxin Atropine consideration - 2nd degree type II and 3rd degree heart blocks will not improve with atropine Dextrose classification - carbohydrate Dextrose indication - hypoglycemia, blood glucose level <60mg/dL Dextrose Adult dose - D10 in water, 125mL reassess and if pt still symptomatic repeat 125mL for total of 250mL Dextrose Pediatric dose - 1) <24kg: D10 in water, 5mL/kg IV in 1mL/kg increment dose reassess for clinical improvement after every 1mL/kg 2)>24kg: D10, 125mL IVPB and reassess continue if needed max dose of 5mL/kg 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 thats 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 epi 0.1mg/mL (IV formulation) in a 10mL syringe. Administer push dose epi 1mL IVIO every 1- 5minutes as needed to maintain SBP >90mmHg
Fentanyl Adult dose - 50mcg (1mL) SIVP or IMIN repeat every 5min prn, max dose prior to base contact is 150mcg Fentanyl Pediatric dose - 1mcg/kg (50mcg/mL) SIVP or IM or 1.5mcg/kg IN repeat in 5min prn x1 max of 2 doses prior to base contact Fentanyl MOA - Narcotic agonist-analgesic of opiate receptors. Inhibits ascending pain pathways, has respiratory depression and sedation but increases pain threshold Fentanyl Pharmacokinetics - onset- immediate peak in 3-5minutes duration is 30-60minutes dont use fentanyl for mama,kuku, papa 353060 Fentanyl Interactions - alcohol and other CNS depressants potentiate its effect Fentanyl Contraindications - SBP<90mmHg Head Trauma Fentanyl considerations - CNS depression naloxone can be used for reversal if needed Glucagon classification - hormone (pancreatic) Glucagon indications - hypoglycemia <60mg/dL and venous access cannot be established Glucagon other common indications - clearance of impacted esophageal foreign body through smooth muscle relaxation Tx of beta blocker OD and adjunctive Tx of calcium channel blocker OD Glucagon Adult dose - 1mg(1mL) IM, may repeat in x1 in 20 min prn Glucagon Pediatric dose <1year of age - 0.5mL (1mg/mL) IM may repeat once in 20 min Glucagon Pediatric dose >1 year of age - same as adult dose 1mg IM 20min prn
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 dont you lie to me, its 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, cardiac- prior to tx of TCP or cardioversion, 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 anxiolyti, anti convulsant, 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
NarcanT TUH TUH TUH TWOOOO 2210, 20120 Nitroglycerin Classification - Nitrate Vasodilator Nitroglycerin indications - Chest pain suspected cardiac Chest pain stemi PE/CHF Nitroglycerin Adult dose - Chest Pain STEMI- 0.4mg SL prn, repeat every 5 min prn x total 3 doses, hold is SBP <100mmHg or pt has taken Sex enhancing drug PE/CHF 0.4mg BP> 0.8mg BP> 1.2mg BP> repeat every 3-5minutes prnx2 for persistent dyspnea hold if SBP <100mmHg Nitro MOA - causes systemic venous dilation which decreases preload. Nitrate enters vascular smooth muscle and is converted to nitric oxide leading to vasodilation. Improves coronary collateral circulation, lowersBP, increases heart rate. Nitro contraindications - sexually enhancing drugs within last 48 hours hypotension SBP< suspected cardiac tamponade Beck's triad for cardiac tamponade. - Hypotension, distant heart sounds, and JVD Nitro Considerations - caution in giving this to patients with intracranial hemorrhage or stroke patients as the vasodilation will increase intercranial pressure Ondansetron classification - Antiemetic ondansetron indication - nausea and vomiting prior to giving morphine and fentanyl to prevent nausea ondansetron adult dose - 4mg ODTIVIM ondansetron pediatric dose - 4mg ODT only for 4 years of age or older ondansetron MOA - 5-HT3 antagonist seratonin Decrease vagal stimulation
Central acting antiemetic ondansetron pharmacokinetics - onset is 1-5min duration 4-6hours Dancing queen courting six ondansetron contraindications - pregnancy, regardless of gestational age ondansetron interactions - amiodarone and other Qt prolonging drugs (prolonging QT interval may produce Torsades) Pralidoxime chloride classification - cholinesterase reactivator 2PAM chloride indications - Organophosphate, or nerve agent exposure Pralidoxime chloride adult dose - Given in conjunction with atropine as a DuoDote 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 Broselow tape receives adult dose 1 duodote up to orange-green which is 26-33 which will be 2 duodotes Pralidoxime chloride MOA - cholinesterase reactivator, 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 carbamate insecticide Sevin, inorganic phosphates, organophosphates with no antichholinesterase Sodium Bicarb classification - electrolyte/ alkalinizing agent
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 ITS A TRAUMA , STROKE, OR CARDIAC JUST GO! Diabetic Hypoglycemia Tx protocol - <60mg/dL oral glucose paste 15gm PO or D 125mL IV and reassess if pt continues to symptomatic, repeat 125mL for a total of 250mL If unable to obtain venous access, give Glucagon 1mg IM, may repeat 20 min prn Contact base for persistent hypoglycemia for repeat dose of D10 250mL IV Hyperglycemia Tx protocol - If >200mg/dL and <400 with related symptoms CONTACT BASE for order of NS 1L IV rapid infusion If >400 or reading is HIGH or for poor perfusion give NS 1L rapid infusion reasses after each 250mL increment for evidence of volume overload If theres Nausea and Vomiting 4mg Ondansetron ODT,IVIOIM prn once in 15 minutes Fever Sepsis Tx - Honestly just check sugar level always. safe bet. For suspected sepsis with any one of the following , tactile fever, tachycardia, or poor perfusion NS 1L IVIO rapid infusion, reassess after each 250mL increment for evidence of volume overload Trauma Criteria - 1) SBP<90, or less than 70 in infants less than one year
- Respiratory rate greater than 29 bpm or less than 10 bpm. In infants less than 20bpm <1 year og age or requiring ventilatory support
- Cardiopulmonary Arrest with penetrating torso trauma unless based upon the paramedics thorough assessment is found apneic, pulseless, asystolic, and without pupillary reflexes upon arrival of EMS personnel at the scene
- all penetrations to head, neck, torso, and extremities proximal to the elbow of knee
- blunt head injury associated with a suspected skull fx, ALOC (GCS less than or equal to 14), seizures, unequal pupils, or focal neurological deficits 6 ) injury to the spinal column associated with acute sensory or motor deficit
- blunt injury to chest with flail chest
- diffuse abdominal tenderness
- suspected pelvic fx (excluding isolated hip fx from a ground level fall)
- extremity with a) neurological/vascular compromise and/or crushed, degloved or mangled extremity b) amputation proximal to the wrist or ankle c) fx of two or more proximal (humerus/femur) long-bones d) bleeding not controlled by direct pressure requiring the usage of a hemmorhage 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 inv
