Emergency Medical Procedures and Medications, Exams of Nursing

Download Emergency Medical Procedures and Medications and more Exams Nursing in PDF only on Docsity!

LA COUNTY PROTOCOLS QUESTIONS

AND ANSWERS 2024 UPDATE

GUARANTEE PASS

what is 1200.2 - SOLUTION Base Contact 1200.2 Base Contact required for all children when - SOLUTION 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 - SOLUTION 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 - SOLUTION 8 CCAARDSS and 4 BCPN for peds

1. Childbirth
2. Cardiac Arrest
3. Anaphylaxis
4. Agitated Delirium
5. Respiratory Failure
6. Dystonic Reaction
7. Shock
8. Stroke Peds

1. BRUE

2. Chest Pain
3. Pregnancy/Labor
4. Newborn 1200.2 Base Contact required for following provider impressions under the SPECIFIC CONDITIONS (10) - SOLUTION Specified Conditions is a MCATASSROPhe
5. Medical Device Malfunction
6. Cardiac Dysrhythmia
7. ALOC
8. Traumatic Injury
9. Airway Obstruction
10. Seizure
11. Submersion
12. Respiratory Distress
13. Overdose/ Poisoning/ Ingestion
14. Pregnancy Complication 1200.2 Base Contact Specified Condition of Airway Obstruction? (1) - SOLUTION 1) severe respiratory distress or respiratory arrest 1200.2 Base Contact Specified Condition of ALOC - SOLUTION persistent ALOC of unclear etiology

1200.2 Base Contact Specified Condition of Cardiac Dysrhythmia (3) - SOLUTION 1) afib w/ RVR

2. symptomatic bradycardia
3. wide complex tachycardia 1200.2 Base Contact Specified Condition of Medical Device Malfunction - SOLUTION ventricular assist device VAD malfunction 1200.2 Base Contact Specified Condition of OD/ Poisoning/ Ingestion - SOLUTION only if signing AMA 1200.2 Base Contact Specified Condition of Pregnancy Complication (1) - SOLUTION 1) only if >20 weeks gestation w/ vaginal bleeding 1200.2 Base Contact Specified Condition of Respiratory Distress of any etiology (2) - SOLUTION 1) severe respiratory distress unresponsive to CPAP
4. unmanageable airway 1200.2 Base Contact Specified Condition of Seizure (2) - SOLUTION 1) pregnant patient
5. status epilepticus 1200.2 Base Contact Specified Condition of Submersion (2) - SOLUTION
6. ALOC
7. decompression sickness 1200.2 Base Contact Specified Condition of Traumatic Injury (4) - SOLUTION 1) crush syndrome
8. eye problem, suspected penetrating globe injury
9. prolonged entrapment >30 minutes
10. trauma criteria or guidelines met

What is crush syndrome pathophysiology? - SOLUTION 1. As the compression occurs, cells in the immediate area are quickly damaged.

2. Within the next hour, the pressure continues to decrease circulation to the area. When this happens, the decrease in oxygen requires the cells needing to switch how they are able to function. This altered process is called anaerobic metabolism — which is metabolism without oxygen — and generates large amounts of lactic acid. With the decrease in oxygen, the cell walls have a harder time containing cell contents, which begin to leak through the walls because of the increasing wall permeability.
3. Cells continue to leak, and other cells begin to die. As this happens, their contents — which can include potassium, myoglobin, purines and other toxic substances — are dumped from the cells into the surrounding tissues. These contents cause major problems and can kill the patient.
4. These effects are normally isolated to the area involved; it may be a type of survival factor that allows the patient to remain stable and survive long periods of time. Rescuers often do not realize that the patient needs treatment before rescue.
5. Once freed and the weight is released, blood flow is returned and all the cell contents are now spread throughout the body. Without proper treatment, the effects of these contents are: Potassium — Potassium is normally kept in balance within the body. However, excess potassium leaking from the cells will disrupt the conductivity of the heart, causing arrhythmias or even cardiac arrest. Myoglobin — Myoglobin can be toxic to the renal tubular cells. Myoglobin can precipitate in the renal system (kidneys) and obstruct renal flow leading to failure or rhabdomyolysis [1]. Purines and other toxic substances — Can lead to respiratory distress and liver damage.
6. Depending on the amounts of toxins and chemica 1200.2 Base Contact is required CONCURRENTLY when the following treatments are initiated - SOLUTION TX CONCURRENT PACT
7. adenosine in pediatric patients

2. cardioversion
3. push-dose epi
4. TCP transcutaneous pacing 1200.2 Base Contact required PRIOR to initiating the following treatments - SOLUTION TX PRIOR 7 ACCMIST
5. additional dosing of normal saline or meds after max dose per protocol
6. calcium chloride for patients with calcium channel blockers OD
7. cardioversion of a patient with adequate perfusion, or awake with a narrow complex tachycardia, or any atrial fibrillation
8. midazolam for sedation of a patient with behavorial/psychiatric crisis
9. io placement placement beyond indications
10. sodium bicarb for symptomatic bradycardia with suspected hyperkalemia or for dysrhythmia due to possible tricyclic antidepressant or other toxic OD
11. TCP if HR > Adenosine Classification - SOLUTION Class V Antidysrhythmic Adenosine Prehospital Indications (2) - SOLUTION Cardiac Dysrhythmia: SVT - Narrow Complex: HR >= 150 adult, >=180 for child, >=220 for infants
    1. Perfusing unresponsive to Valsalva.
    2. Poorly perfusing (if alert) Regular/Monomorphic Wide Complex Tachycardia with adequate perfusion. Adenosine Adult Dose - SOLUTION 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 - SOLUTION 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) - SOLUTION 1) slows conduction through the AV node

2. interrupts AV reentry pathways as well as conduction through the sinoatrial (SA) nodes Adenosine Interactions (2) - SOLUTION 1) potentiated by blocker of nucleoside transport (carbamazepine (Tegretol)
3. Antagonized by methylxanthines such as caffeine and theophyline Adenosine Pharmokinetics - SOLUTION onset immediate, duration < secs Yknow what im sayin NOW LESS THAN 10 Adenosine Contraindications (6) - SOLUTION 1) should not be used for sinus tachycardia, despite rate >
4. 2nd and 3rd degree heart block without pacemaker
5. sinus node disease (sick sinus syndrome)
6. Wolff-Parkinson-White (WPW) Syndrome or ECG consistent WPW
7. Atrial flutter or fibrillation
8. Heart transplant- base contact required, as noted "super-sensitivity" of transplanted heart to adenosine Adenosine Adverse Effects (10) - SOLUTION 1) blurred vision
9. bradycardia/ asystole
10. chest pain/ chest pressure

4. dyspnea
5. head pressure
6. hypotension
7. lightheadedness/ dizziness
8. metallic taste/ throat tightness
9. numbness/ tingling
10. palpitation Rhabdomyolysis what does it look like? what condition is it? pathophys? - SOLUTION dark urine, eg. coca cola pee muscle damage causes an increase in myogoblin 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 - SOLUTION agents interfere with the sodium (Na+) channel eg. Lidocaine Class II antidysrhythmics - SOLUTION agents are anti-sympathetic nervous system agents. Most agents in this class are beta blockers "-lol"s eg. Metropolol, Atenolol Class III antiarrhythmics - SOLUTION agents affect potassium (K+) efflux, aka potassium channel blockers eg. Amiodarone Class IV antiarrhythmics - SOLUTION IV agents affect calcium channels and the AV node calcium channel blockers

eg. Diltiazem Class V antidysrhythmics - SOLUTION agents work by other or unknown mechanisms eg. Adenosine Albuterol Classification - SOLUTION Sympathomimetic, B2 Receptor agonist, Bronchodilator, minor A agonist vasoconstrictor Albuterol Prehospital indications (4) - SOLUTION albuterol "carpet" CRPT

1. Cardiac Dysrhythmia: suspected hyperkalemia causing bradycardia
2. Traumatic Injury: suspected hyperkalemia in the setting of crush injury or potential for development of crush syndrome (administer prior to release of crushed tissue)
3. Respiratory Distress: bronchospasm caused by acute asthma, bronchitis, bronchiolitis, COPD, drug overdose, near drowning, pulmonary edema, and/or toxic gas inhalation.
4. Pulmonary Edema/CHF: persistent wheezing despite CPAP Albuterol Adult Dose (3) - SOLUTION 1) Cardiac Dysrhythmia/Crush - Suspected hyperkalemia 5mg (6mL) via neb, repeat continuously until hospital arrival
5. Crush at risk for Crush Syndrome- 5minutes prior to extrication: 5mg/6mL via neb X
6. Respiratory Distress (including pulmonary edema/CHF with wheezing) 5mg (6mL) via neb May repeat x2 prn for wheezing Albuterol Pediatric Dose (3) - SOLUTION 1) Crush - Suspected hyperkalemia 6mL (2.5mg/3mL) via neb

2. Crush- at risk for crush syndrome 5 minutes prior to extrication: 5mg/6mL via neb repeat immediately x
3. Respiratory Distress < 1 year of age 2.5mg/3mLvia neb ≥ 1 year of age 6mL (2.5mg/3mL) via neb Albuterol Mechanism of Action - SOLUTION 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- activity with mild effect on heart rate. Albuterol Pharmacokinetics (2) - SOLUTION 1) onset- 5-15min inhaled
4. duration- 3-6 hours for bronchial smooth muscle relaxation, 3-4 hours for hyperkalemia shifting potassium intracellular, albuterol 5153634 Albuterol contraindications - SOLUTION allergies, sensitivty Albuterol interactions (2) - SOLUTION 1) caution with patients being treated with MAO inhibitors or TCA
5. Beta blocking agents and Albuterol may each inhibit the effects of the other, monitor closely Albuterol Adverse Effects (4) - SOLUTION 1) anxiety/ tremors
6. hypertension
7. hypokalemia
8. palpitations/ tachycardia Amiodarone classification - SOLUTION antidysrhythmic potassium channel blocker Amiodarone dosage adult - SOLUTION adult 300mg followed one time in 3-5 min 150mg max 450mg

Amiodarone dosage peds - SOLUTION 5mg/kg max of 300mg IVIO Amiodarone indications - SOLUTION cardiac arrest- pulseless VTACH, VFIB after defib 2x Amiodarone MOA - SOLUTION inhibits adrenergic stimulation to the heart, prolongs action potential and delays repolaratization; decreases AV node and Sinus node function Amiodarone contraindications - SOLUTION none Aspirin Classification - SOLUTION Antiplatelet NSAID Aspirin Adult Dose - SOLUTION 325mg chewable PO Aspirin Pediatric Dose - SOLUTION not recommended for children Aspirin MOA - SOLUTION inhibits platelet aggregation, inhibits synthesis of prostaglandins. Can be used as antipyretic and analgesic Aspirin Contraindications - SOLUTION active GI ulcers Atropine classification - SOLUTION Anticholinergic Atropine Indications - SOLUTION SLUDGEM- organophosphate poisning/nerve agent exposure, symptomatic bradycardia Atropine Adult dose (2) - SOLUTION 1) organophosphate poisoning- 2mg may repeat every 5min until asymptomatic

2. symptomatic bradycardia- 0.5mg may repeat every 3-5minutes max dose of 3mg Atropine pediatric dose - SOLUTION 1) organophosphate poisoning- 0.05mg/kg IVIM, prn every 5 min max dose of 5mg
3. symptomatic bradycardia- 0.02mg/kg may repeat once in 5 min

Atropine MOA - SOLUTION Competes with acetycholine 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) - SOLUTION 1) glaucoma

2. tachycardia
3. hyperthyroidism Calcium Chloride classification - SOLUTION electrolye Calcium Chloride Indications (4) - SOLUTION 1) Cardiac Arrest- non traumatic (suspected hyperkalemia, patients with renal failure)
4. Cardiac Dysrhythmia- suspected hyperkalemia causing bradycardia
5. OD/Poison- calcium channel blocker toxicity
6. traumatic injury- suspected hyperkalemia in setting o crush injury or potential for development of crush syndrome Calcium Chloride Adult Dose (3) - SOLUTION 1) Cardiac Arrest- 1gm IVP/IO
7. Cardiac Dysrhythmia- 1gm SLOW IV/IO push
8. OD/Poisoning-1g SIVP over 60 seconds Calcium Chloride Pediatric dose (2) - SOLUTION 1) crush- 20mg/kg SIVP IO repeat x1 for persistent ECG
9. OD/Poisoning- 20mg/kg SIVP over 60 seconds Aspirin Pharmacokinetics - SOLUTION Onset: 5-30 minutes I sprint a 530

Atropine Pharmacokinetics peak effect for both IV and IM Duration (3) - SOLUTION Peak effect: 2-4 minutes IV/IO Peak effect: 20-30 minutes IM Duration 4 hours smelling pine 24-2030-4hours Calcium Chloride Pharmacokinetics - SOLUTION Onset and peak immediate, duration varies I SEE THEM NOW VARIES Calcium Chloride Contraindications (2) - SOLUTION 1) Hypercalcemia

2. Vfib Calcium Chloride Adverse Effects (4) - SOLUTION 1) cardiac arrest
3. hypotension or hypertension
4. pain on injjection site
5. tingling Calcium Chloride interactions - SOLUTION causes digoxin toxicity if given to patients with digoxin Atropine consideration - SOLUTION 2nd degree type II and 3rd degree heart blocks will not improve with atropine Dextrose classification - SOLUTION carbohydrate Dextrose indication - SOLUTION hypoglycemia, blood glucose level <60mg/dL Dextrose Adult dose - SOLUTION D10 in water, 125mL reassess and if pt still symptomatic repeat 125mL for total of 250mL

Dextrose Pediatric dose - SOLUTION 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 - SOLUTION form of glucose used by the body to create energy Dextrose: Pharmacokinetics - SOLUTION onset <1min peak effect dependent on degree of hypoglycemia D rose less than 1 year but depends on hypoglycemia Dextrose consideration - SOLUTION confirm IV line prior to admin of this drug due to extravasation causing necrosis Diphenhydramine classification - SOLUTION Antihistamine Diphenhydramine MOA - SOLUTION Histamine H1 receptor antagonist of effector cells in respiratory tract, blood vessels and GI smooth muscle. Possesses anticholinergic properties. Diphenhydramine Indications (2) - SOLUTION 1) allergic reaction-itching hives

2. dystonic reaction Diphenhydramine Adult dose - SOLUTION 50mg IVP, IM may repeat once in 15 minutes max dose of 100mg Diphenhydramine pediatric dose - SOLUTION 1mg/kg SIVP, or IM one time thats it. Diphenhydramine Pharmacokinetics - SOLUTION onset is 15-30 minutes, duration <10min Die Abel everything contributed nothing but 10 goats

Diphenhydramine Contraindications - SOLUTION Acute asthma attack because they dry the secretion in upper and lower respiratory tracts Diphenhydramine interactions - SOLUTION increases CNS depression when used with alcohol and other CNS depressants or MAOIs Epinephrine Classification - SOLUTION Sympathomimetic, adrenergic Epinephrine indications (6) - SOLUTION 6 SCAARS

1. Shock
2. stridor/croup
3. cardiac arrest
4. anaphylaxis
5. airway swelling
6. Respiratory distress Epinephrine Adult dose (6) - SOLUTION 1) anaphylaxis- 0.5mg(1mg/mL) IM in the lateral thigh, may repeat every 10min x2 prn, max total 3 doses
7. cardiac arrest- 1mg (0.1mg/mL) 10mL IVIO every 3-5min
8. 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
9. respiratory distress/bronchospasm- 0.5mg/mL (1mg/mL) IM in the lateral thigh
10. airway obstruction-stridor 5mg via neb (1mg/mL) repeat x1 in 10min prn
11. airway obstruction- airway swelling 0.5mg IM (1mg/mL) repeat every 10min prn x2, max of three doses

Epinephrine pediatric dose - SOLUTION literally all 6 is 0.01mg/kg only difference is all cardiac epi is 1:10,000 so concentration will be 0.1mg/mL vs everything else which is 1:1000 or 1mg/mL Epinephrine MOA - SOLUTION naturally occuring catecholamine, works on Beta 1, Beta 2, and alpha 1 receptors. Beta 1 increases Inotropy, Chronotropy, and Dromotropy. Beta 2 causes bronchial smooth muscle relaxation and vasodilation and alpha 1 vasoconstricts. Inotropy - SOLUTION force of contraction Intrinsic rates of the conduction system - SOLUTION -SA node: 60- times/min -AV node: 40-60 times/min -Bundle of His, Purkinje fibers: 20-40 times/min Chronotropy - SOLUTION heart rate Dromotropy - SOLUTION conduction velocity Epinephrine Pharmacokinetics (2 onset and duration <2 increments of 5 - SOLUTION 1) onset <2min IV, 1-3min IM

2. duration is 5-10min IV, 20-30min IM epi 213 5 increments 5-10-20- Epi Interactions - SOLUTION can be partially deactivated by highly akaline solutions such as sodium bicarb Epi considerations - SOLUTION giving injection of IM formulation and dose which is 1:1000 can cause severe hypertension and possible cerebral hemmorhage. SO DONT **** IT UP! REMEMBER- GO EASYYY IN THE IVVVVV! Fentanyl classification - SOLUTION synthetic opioid, analgesic Fentanyl indications - SOLUTION pain management

Fentanyl Adult dose - SOLUTION 50mcg (1mL) SIVP or IMIN repeat every 5min prn, max dose prior to base contact is 150mcg Fentanyl Pediatric dose - SOLUTION 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 - SOLUTION Narcotic agonist-analgesic of opiate receptors. Inhibits ascending pain pathways, has respiratory depression and sedation but increases pain threshold Fentanyl Pharmacokinetics - SOLUTION onset- immediate peak in 3-5minutes duration is 30-60minutes dont use fentanyl for mama,kuku, papa 353060 Fentanyl Interactions - SOLUTION alcohol and other CNS depressants potentiate its effect Fentanyl Contraindications - SOLUTION SBP<90mmHg Head Trauma Fentanyl considerations - SOLUTION CNS depression naloxone can be used for reversal if needed Glucagon classification - SOLUTION hormone (pancreatic) Glucagon indications - SOLUTION hypoglycemia <60mg/dL and venous access cannot be established Glucagon other common indications - SOLUTION 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 - SOLUTION 1mg(1mL) IM, may repeat in x1 in 20 min prn Glucagon Pediatric dose <1year of age - SOLUTION 0.5mL (1mg/mL) IM may repeat once in 20 min Glucagon Pediatric dose >1 year of age - SOLUTION same as adult dose 1mg IM 20min prn Glucagon MOA - SOLUTION normally produced in pancreas which cause breakdown of glycogen stored in liver to glucose and inhibits the synthesis of glycogen from glucose Lidocaine classification - SOLUTION local anesthetic Lidocaine indications - SOLUTION patients responsive to pain that have IO access Lidocaine Adult dose - SOLUTION 40mg SIOP over 2 minutes prn once of 20mg Lidocaine pediatric dose dont you lie to me, its not 1mg/kg - SOLUTION 0.5mg/kg (20mg/mL) SIOP over 2 minutes prn once at half the initial dose Lidocaine MOA - SOLUTION inhibits sodium ion channels, stabilizing neuronal cell membranes causing a nerve conduction blockage Lidocaine pharmacokinetics (3) lie 5 increments - SOLUTION 1) onset is 2min

2. peak in 3-5min
3. duration is 10-20min Midazolam classification - SOLUTION Sedative, benzodiazepine Midazolam indications - SOLUTION agitated delirium, behavioral, psychiatric, cardiac- prior to tx of TCP or cardioversion, seizure- active

Midazolam Adult dose - SOLUTION ACS 525 552 10-6- Midazolam pediatric dose - SOLUTION 0.1mg/kg (5mg/mL) IMINIV A- continuously, C-2 doses max after 2 min, S- 2 doses max after 2 min Midazolam MOA - SOLUTION 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 - SOLUTION onset 3-5min IV, 15-20 min IM, 6-14min IN duration 1-6hours IVIM Midazolam contraindications (3) - SOLUTION 1) acute alcohol intoxication with AMS

2. respiratory depression
3. shock Midazolam interactions - SOLUTION risk of respiratory or CNS depression, increases when used with diphenhydramine, fentanyl, morphine, or other opiate or sedative medications Morphine Classification - SOLUTION opiate analgesic Morphine indications - SOLUTION pain management Morphine adult dose - SOLUTION 4mg slow IVIOP, repeat every 5min prn, max dose prior to base 12mg Morphine pediatric dose - SOLUTION 0.1mg/kg SIVPIO repeat once in 5min max 2 doses prior to Base contact Morphine MOA - SOLUTION Narcotic Agonist, analgesic of opiate receptors; inhibits ascending pain pathways, thus altering response to pain Morphine pharmacokinetics - SOLUTION onset is immediate IV, 15-30min IM, duration is 2-7hours

MORE NOW, IM 153027

Morphine contraindications - SOLUTION hypotension sbp<90mmHg or poor perfusion allergy Morphine interactions - SOLUTION CNS depressants Morphine considerations - SOLUTION Narcan can be used to reverse CNS depression Naloxone Classification - SOLUTION Opiate antagonist Naloxone indications - SOLUTION suspected narcotic OD w/ AMS and apnea Naloxone adult dose - SOLUTION 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 - SOLUTION 0.1mg/kg IMINIV dose, max dose 8mg on all routes titrate to effect Naloxone MOA - SOLUTION competes for and dispalces narcotic molecules in opiate receptors in the brain. Reverses CNS depression until the Naloxone wears off, where it needs to be readministered Naloxone Pharmacokinetics - SOLUTION onset is <2min IV, 2-10min IM, duration 20-120min NarcanT TUH TUH TUH TWOOOO 2210, 20120 Nitroglycerin Classification - SOLUTION Nitrate Vasodilator Nitroglycerin indications - SOLUTION Chest pain suspected cardiac Chest pain stemi

PE/CHF

Nitroglycerin Adult dose - SOLUTION Chest Pain STEMI- 0.4mg SL prn, repeat every 5 min prn x2 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 - SOLUTION 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 - SOLUTION sexually enhancing drugs within last 48 hours hypotension SBP< suspected cardiac tamponade Beck's triad for cardiac tamponade. - SOLUTION Hypotension, distant heart sounds, and JVD Nitro Considerations - SOLUTION caution in giving this to patients with intracranial hemorrhage or stroke patients as the vasodilation will increase intercranial pressure Ondansetron classification - SOLUTION Antiemetic ondansetron indication - SOLUTION nausea and vomiting prior to giving morphine and fentanyl to prevent nausea ondansetron adult dose - SOLUTION 4mg ODTIVIM

ondansetron pediatric dose - SOLUTION 4mg ODT only for 4 years of age or older ondansetron MOA - SOLUTION 5-HT3 antagonist seratonin Decrease vagal stimulation Central acting antiemetic ondansetron pharmacokinetics - SOLUTION onset is 1-5min duration 4-6hours Dancing queen courting six ondansetron contraindications - SOLUTION pregnancy, regardless of gestational age ondansetron interactions - SOLUTION amiodarone and other Qt prolonging drugs (prolonging QT interval may produce Torsades) Pralidoxime chloride classification - SOLUTION cholinesterase reactivator 2PAM chloride indications - SOLUTION Organophosphate, or nerve agent exposure Pralidoxime chloride adult dose - SOLUTION 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 x1 Moderate Exposure DuoDoteTM IM x2, one after another Severe Exposure DuoDoteTM IM x3, one after another Pralidoxime chloride pediatric dose - SOLUTION 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 - SOLUTION 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 - SOLUTION onset is 2-3min peak effect 5-15min duration is 2-3hours 2PAM 23-515-23hours 2PAM chloride contraindications - SOLUTION poisonings with carbamate insecticide Sevin, inorganic phosphates, organophosphates with no antichholinesterase Sodium Bicarb classification - SOLUTION electrolyte/ alkalinizing agent Sodium Bicarb indications (4) - SOLUTION 1) cardiac arrest: suspected hyperkalemia

2. cardiac dys: SB suspected hyperkalemia causing bradycardia
3. OD: suspected TCA with ECG changes
4. Traumatic injury: suspected hyperkalemia with crush injury or potential for development of crush syndrome Sodium Bicarb adult dose - SOLUTION 50mEq SIVIOP but for crush injury you can repeat once for persistent ECG abnormalities Sodium Bicarb Pediatric Dose - SOLUTION 1mEq/kg SIVP for crush injury repeat once for persistent ECG abnormalities Sodium Bicarb MOA - SOLUTION increases blood and urinary pH by releasing a bicarbonate ion, which in turn neutralizes hydrogen ion concentrations

Sodium Bicarb Pharmacokinetics - SOLUTION onset is <15min, duration 1- 2 hours Sodium bicarb, had my 7th grade had salty snacks for 15 minutes when i was 12 Sodium Bicarb contraindications (3) - SOLUTION 1) pulmonary edema

2. hypernatremia
3. hypocalcemia Sodium Bicarb interactions (2) - SOLUTION 1) precipitates to form calcium carbonate (chalk) when used with calcium chloride or calcium gluconate.
4. can reduce potency of epi, flush line after admin Sodium Bicarb Consideration - SOLUTION multiple doses maybe needed in TCA overdose when indicated Call run - SOLUTION Hi my name is Melvin and paramedic intern, it okay if i treat you? check pulses, and skin signs if bad O2 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 ITS A TRAUMA , STROKE, OR CARDIAC JUST GO!

Diabetic Hypoglycemia Tx protocol - SOLUTION <60mg/dL oral glucose paste 15gm PO or D10 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 - SOLUTION 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 - SOLUTION 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 - SOLUTION 1) SBP<90, or less than 70 in infants less than one year

2. Respiratory rate greater than 29 bpm or less than 10 bpm. In infants less than 20bpm <1 year og age or requiring ventilatory support
3. 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
4. all penetrations to head, neck, torso, and extremities proximal to the elbow of knee

5. 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
6. blunt injury to chest with flail chest
7. diffuse abdominal tenderness
8. suspected pelvic fx (excluding isolated hip fx from a ground level fall)
9. 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
10. 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
11. passenger space intrusion of greater than 12 inches into an occupied passenger space
12. ejected from vehicle (partial or complete)
13. auto versus pedestrian/bicyclist/motorcyclist thrown, run over, or with significant (greater than 20mph) impact