2017 Nyc Remac - Gop Als - Drug Administration

Front 1

True or False

ET drug administration is no longer the standard of care within this region.

Back 1

True

Front 2

True or False

ET drug administration continues to be an option for pediatric patients.

Back 2

True

Front 3

Name two situations in which IO access can be attempted in an adult with failed IV access.

Back 3

(1) cardiac arrest

(2) decompensated shock

Front 4

In cases of adults in cardiac arrest or decompensated shock in which IV access is unobtainable after no more than ____ attempts, IO access should be attempted.

Back 4

two

Front 5

IO access should be attempted via...

Back 5

...an approved extremity approach.

Front 6

If establishing an IO in a conscious adult or pediatric patient, administer _____ of _____ Lidocaine via IO port, slowly, up to a max of _____ prior to any other administration.

Back 6

0.5 mg/kg

2% presevative-free

50 mg

Front 7

Administer initial dose of Lidocaine via IO port over ____ (seconds/minutes).

Back 7

2-3 minutes

Front 8

What is the initial IO dose of Lidocaine?

Back 8

0.5 mg/kg

Front 9

What is the maximum initial dose of IO Lidocaine?

Back 9

50 mg

Front 10

Why must 2% preservative-free Lidocaine be infused so slowly?

Back 10

to prevent it from being sent directly into the central circulation

Front 11

For continued discomfort or pain due to infusion, repeat IO Lidocaine at a dose of _____ slowly over _____ (seconds/minutes).

Back 11

0.25 mg/kg

30 seconds

Front 12

What is the repeat dose of IO Lidocaine?

Back 12

0.25 mg/kg

Front 13

What is the maximum repeat dose of IO Lidocaine?

Back 13

25 mg

Front 14

The maximum initial and repeat doses of IO Lidocaine are ____ and ____.

Back 14

50 mg

25 mg

Front 15

Medication intended to remain in the _____, such as a local anesthetic, must be administered very slowly until the desired anesthetic effect is achieved.

Back 15

medullary space

Front 16

In the absence of IV access, the following six meds are approved for atomized IN:

Back 16

(1) Glucagon

(2) Fentanyl

(3) Ketamine

(4) Midazolam

(5) Lorazepam

(6) Naloxone

"Good Friends Kiss My Lovely Nose"

Front 17

Contraindication(s) for IN administration

Back 17

epistaxis

Front 18

The pharmacology table refers to ______ patients under _____.

Back 18

adult

40 kg

Front 19

The pharmacology table refers to patients beginning at the age of ____ (and over) who weigh under ____.

Back 19

15

40kg

Front 20

40 kg is roughly ____ lbs.

Back 20

88 lbs

Front 21

List the five drugs on the Pharmacology table.

Back 21

(1) Amiodarone

(2) Atropine Sulfate

(3) Epinephrine

(4) Furosemide (Lasix)

(5) Sodium Bicarbonate

"Anorexics Are Emaciated For Sure"

Front 22

dose of Amio for adult patients under 40 kg or 88 lbs

Back 22

5 mg/kg

Front 23

dose of Atropine for adult patients under 40 kg or 88 lbs

Back 23

0.02 mg/kg

(minimum dose 0.1 mg)

Front 24

What is the minimum dose of atropine, per the Pharmocology Table?

Back 24

0.1 mg

Front 25

dose of Epi for adult patients under 40 kg or 88 lbs

Back 25

0.01 mg/kg/dose

Front 26

dose of Furosemide for adult patients under 40 kg or 88 lbs

Back 26

1 mg/kg/dose

Front 27

dose of Sodium Bicarb for adult patients under 40 kg or 88 lbs

Back 27

1 mEq/kg/dose

Front 28

Per the Pharm Table, the dose of Epi 1:1,000 should not exceed ____ IM.

Back 28

0.3 mg

Front 29

Per the Pharm Table, dosing should not exceed...

Back 29

...dose from appropriate adult protocol.

Front 30

Aspirin should not be administered to...

Back 30

...patients with known hypersensitivity to it.

Front 31

_______ are not a contraindication to aspirin.

Back 31

Gastrointestinal complaints

Front 32

Ondansetron has been associated with ______, possibly resulting in ______.

Back 32

prolonged QT

torsades

Front 33

Ondansetron should be used with caution in patients with ______ and ______.

Back 33

(1) Hx cardiac disease

(2) meds that prolong QT

Front 34

Ondansetron should not be administered to patients with...

Back 34

...a history of familial QT prolongation.

Front 35

Diphenhydramine has _____-like action.

Back 35

atropine

Front 36

Diphenydramine must be used with caution in patients with a history of any of the following four conditions.

Back 36

(1) Increased intraocular pressure

(2) Hyperthyroidism

(3) Cardiovascular disease

(4) Hypotension

"I Have Cardiac History"

Front 37

_____ may be used interchangeably with _____ for IV and IO infusion.

Back 37

0.9% NS

RL

Front 38

Diltiazem should be used with caution in patients with a history of any of the following five conditions:

Back 38

(1) Liver disease

(2) Kidney disease

(3) CHF

(4) AV conduction abnormalities

(5) Hypotension

"Let's Keep Cardizem At Half"

Front 39

When Diltiazem must be used with caution...

Back 39

...alert medical control of the condition and cut the dose in half.

Front 40

Nitroglycerine shall not be administered to patients who have used _____ within the past _____ hours.

Back 40

erectile dysfunction meds

72 hours

Front 41

True or False

IO access via the sternum is considered acceptable in the NYC region.

Back 41

False.

It is considered unacceptable.

Front 42

True or False

Drug administration via the IO route will utilize doses identical to those used for IV administration.

Back 42

True.

Front 43

True or False

Paramedics may only access PICC lines with prior permission of medical control.

Back 43

False.

Paramedics may, under Standing Order, consider using PICC lines for Cardiac Arrest and unstable patients in which IV access is UTO.

Front 44

True or False

PICC lines in the neck or chest can be accessed under standing orders.

Back 44

False.

Only upper extremity PICC lines may be accessed under standing orders.

Front 45

True or False

PICC lines in the neck or chest may be accessed under standing orders.

Back 45

False.

Only upper extremity PICC lines may be accessed under standing orders.

Front 46

If a central line that is not in the upper extremities is encountered, which the Paramedic feels could be used for patient care, the Paramedic...

Back 46

...must contact OLMC for approval on a case by case basis.

Front 47

True or False

Dialysis catheters or shunts shall not be accessed in the out-of-hospital environment.

Back 47

True

Front 48

Catheter ports requiring breaking of skin by a needle are often called...

Back 48

..."Hickman Ports" or "Port-A-Caths".

Front 49

True or False

Catheter ports requiring breaking of skin by a needle may be used prehospitally.

Back 49

False.

Hickman Ports, Port-A-Caths, etc., shall not be used prehospitally.

Front 50

True or False

Paramedics may use the patient's own needles or equipment to access pre-existing ports.

Back 50

False.

Front 51

True or False.

Paramedics may troubleshoot or attempt to clear central lines.

Back 51

False.

It is beyond the EMS Scope of Practice to troubleshoot, maintain, remove, re-insert, or otherwise manipulate central lines.

Front 52

Any central line that cannot be easily flushed with _____cc of sterile normal saline, should be considered NOT functional.

Back 52

10

Front 53

All vasopressor infusions must be administered via ____G or larger IV, or an IO, via an IV flow regulating device.

Back 53

18G

Front 54

Give three examples of an IV flow regulating device.

Back 54

(1) adjustable flow regulator

(2) rate control extension set

(3) infusion pump