Brfr Protocol Notes

Front 1

A physician present at an emergency scene who wishes to alter these protocols or supervise the care of a patient, must provide:

Back 1

a valid Florida
Physician’s License and a current ACLS certification card. The physician must be informed that they are accepting full responsibility for the patient
and patient care. They must accompany the patient to the hospital and sign all medical reports. The receiving hospital should be notified prior to
relinquishing control to the physician on scene.

Front 2

If a patient refuses additional treatment or transport to a medical facility after the Paramedics have administered a medication, Paramedics must
remain with the patient for how long?

Back 2

30 min

Front 3

In the event of MCI, the paramedic may chose to turn patients over to other agencies and may elect to accompany any pt during transport.

T or F?

Back 3

True

Front 4

How long should the initial assessment take?

Back 4

less than 1 min

Front 5

Cardiac /Stroke patients with SaO2 readings equal to or greater than _____ should
not receive oxygen unless hypoxia, heart failure, or S.O.B. is noted

Back 5

94%

Front 6

When should you not use the autovent?

Back 6

do not use during CPR. Note: it can be used on non intubated pts

Front 7

What is normal ETCO2 reading?

Back 7

35- 45 mm/Hg

Front 8

Limit intubation to no more than __ attempts before securing the airway with a secondary device. Additional intubation attempts may be attempted at the
discretion on the EMS Captain. An attempt is considered when?

Back 8

3, the tube passes the incisors or when looking with the aid of a laryngoscope for greater than
10 seconds.

Front 9

Min weight for for King Airway?

Back 9

Greater than 12 Kg

Front 10

Weight for LMA?

Back 10

Less than 12 kg. EMS Captain

Front 11

Criteria for Cricothyrotomy ?

Back 11

surgical for adults, needle for pediatric under 12 yrs old or 50 kg

Front 12

Tx for esophageal food bolus obstruction?

Back 12

Glucagon 2mg IV push (preferred) or IM

Front 13

Sedation for pharmacological assisted intubation ?

Back 13

Etomidate 0.3 mg/kg IV, re-sedate with versed 2-5mg or Etomidate 0.3mg if hypotensive.

Front 14

List Succinylcholine complications.

Back 14

Bradycardia, hyperkalemia, massater spam not subsiding may indicate Malignant Hyperthermia

Front 15

Tx of bradycardia following Succinylcholine admin?

Back 15

1mg Atropine IV

Front 16

What are the 4 P's of pharmacology assisted intubation?

Back 16

Position, Pre-treat, Paralyze, Place

Front 17

Dose of Succinylcholine?

Adult and pedi

Back 17

1.5 mg/kg IV Adult - Pediatric 2 mg/kg IV

Front 18

Which drug should always be given prophylactically to pediatric patients prior to pharmacology assisted intubation?

Back 18

Atropine 0.02mg/kg IV

Front 19

Which drug should always be given prophylactically to patients with HX of asthma prior to pharmacology assisted intubation?

Back 19

Lidocaine 1.5mg/kg for adults and peds

Front 20

How long should you wait after administering a sedative before you push Succinylcholine?

Back 20

1 min

Front 21

Pediatric re-sedation dose?

Back 21

a) For patients who begin to gag, fight the tube or whose LOC increases, administer:
Midazolam 0.1 mg/kg IV slowly provided the patient is not hypotensive, may repeat as necessary.
b) For Hypotensive patients Etomidate 0.3 mg/kg IV. may be repeated as needed.

Front 22

For long transports (greater than 20min), re-paralyze with?

Back 22

Norcuron 0.1 mg/kg IV

Front 23

Name the 6 signs of a difficult intubation, as mentioned in the protocol.

Back 23

1. immobile neck
2. small mouth
3. bucked teeth
4. short thyromental distance
5. altered anatomy

Front 24

Per the protocol, what are the "main" antidotes used in Cardiac Arrest?

Back 24

1.Narcan
2. Glucagon- beta blocker- 2mg
3. Sodium Bicarb- Tricyclic
Antidepressants- 1meq/kg
4. Calcium Chloride- Calcium Chloride 1 gram IV/IO

Front 25

What are the joules sequence during V-Fib or Pulseless V-Tach?

Back 25

200, 300, 360 x 2min

Front 26

What is the dosage of Lidocaine and when should you use it according to the protocols?

Back 26

If patient is allergic to
Amiodarone, administer
Lidocaine 1.5 mg/kg .If
arrhythmia persists, may repeat
Lidocaine 0.75 mg/kg every 5
minutes. Max of 3 mg/kg
Lidocaine Requires a
Maintenance Infusion of
1 - 4 mg/min.

Front 27

What is the most common cause of death after initial resuscitation from sudden cardiac arrest?

Back 27

Brain injury ( reperfusion injury)

Front 28

What is the Criteria for Induced Hypothermia?

Back 28

1. ROSC not related to trauma or hemorrhage
2. Pt is not responsive to pain
3. Initial body temp > 93.2 F
4. Advanced airway in place
5. Induced Hypothermia ready hospital

Front 29

What are the contraindications for induced Hypothermia?

Back 29

1. Trauma
2. No advanced airway
3. known pregnancy

Front 30

What is the target ETCo2 during induced hypothermia?

Why?

Back 30

40mmHg

Patients develop metabolic alkalosis with cooling.

Front 31

What is the dosage of Cold Saline used during induced hypothermia?

Back 31

30ml/kg Max of 2 Liters

Front 32

What drugs are used to reduce shivering during induced Hypothermia and why is this important?

Back 32

Shivering is a physiological response to
the cold. Uncontrollable shivering can
generate significant heat that can slow
the Induced Hypothermia process.
Shivering also increases oxygen
consumption.

Etomidate (0.3mg/kg every 10min) and Norcuron (0.1mg/kg)
are administered to suppress shivering
and maximize oxygenation.

Front 33

What constitutes a "Cardiac Alert"?

Back 33

Patients with ST Elevation in 2 or more related leads or having a new onset of Left Bundle Branch
Block with chest discomfort.

Front 34

When can Morphine be administered during a cardiac event?

Back 34

If chest discomfort continues after the above treatment and the patient presents with STEMI, administer Morphine
2.5 mg IV which may be repeated as needed every 3-5 minutes provided the patient’s BP is > 90mm/Hg (Max 10
mg)

Front 35

What constitutes a malignant PVC?

Back 35

Greater than 6 per minute
Multifocal
Couplets
R on T

Front 36

Describe the tx for Stable V-Tach

Back 36

1- Consider Adenosine 6mg (for the diagnosis and treatment of stable undifferentiated wide-complex tachycardia when the
rhythm is regular and the QRS waveform is monomorphic)

4. Amiodarone 15mg in 100ml at 600 on pump

Front 37

What is the sequence of synchronized cardioversions for unstable V-Tach/SVT?

Back 37

100 joules, 200 joules, 300 joules, 360 joules, until rhythm is corrected 1 - 2 min

Front 38

Regardless of what new AHA standards state, protocol states that you shall not administer Atropine to 2nd degree type II or 3 degree AV block. T or F?

Back 38

True

Front 39

What drug can be given to an anxious PE pt after CPAP and Nitro have been applied?

Back 39

Morphine up to 10 mg (2.5mg)

Front 40

For extreme exacerbation of asthma, chronic bronchitis or emphysema consider?

Back 40

Magnesium Sulfate, 2 gm in 100 mL bag of D5W over
approximately 10 minutes (run 100 mL bag of D5W @ 600mL/hr)

For Patients in severe distress with minimal air movement consider Epinephrine 0.3 mg of 1:1,000
solution IM anytime in the sequence.

Front 41

What are the "ABCs" of an allergic reaction?

Back 41

Adrenaline, benedryl, corticosteroids

Front 42

For patients having moderate to severe attack not showing immediate
improvement after first nebulized treatment, administer what?

Back 42

Solu-Medrol, 125 mg IV

Front 43

If patient is possibly on beta blockers and fails to respond to Epinephrine:

Back 43

Administer Glucagon, 2 mg IV

Front 44

SEVERE ANAPHYLACTIC SHOCK - CHARACTERIZED BY:

Back 44

All the signs and symptoms of a severe allergic reaction plus cardiovascular collapse, where cardiac arrest is
imminent and blood pressure is unobtainable:

Front 45

Treat the patient the same as SEVERE ALLERGIC REACTIONS however use what?

Back 45

Epinephrine, 1:10,000 0.3 to 0.5 mg (3-5 mL) slow IV Instead of IM Epinephrine.

Front 46

Treat hypoglycemia with signs of stroke if BGL is less than what?

Back 46

50mg/dl

Front 47

Possible Reasons a Patient May Have
Altered Metal Status?

Back 47

AEIOUTIPS:
Alcohol or Acidosis
Epilepsy, Environmental or Electricity
Insulin
Overdose
Uremia
Trauma
Infection
Poisoning or Psychoses
Seizure, Stroke or Shock

Front 48

______________ is indicated for the
reversal of respiratory depression
from benzodiazepines
administered for sedation by
medical professionals. It is not for
use with “addicted patients” or
intentional overdoses.

Back 48

Romazicon 0.2mg Q 1min up to 1mg

Front 49

Medication names which
may cause a Dystonic
Reaction:

Back 49

Compazine
Phenergan
Thorazine
Haldol

Front 50

If symptoms of dystonic reactionpersist after 5 minutes of Benadryl administration:
Administer _____________

Back 50

Midazolam, 2.0-5.0 mg slow IV, IN, or IM

Front 51

Describe a dystonic reaction?

Back 51

A typical presentation of a dystonic reaction is a twisting of the head and neck
to one side from muscle spasm, a swelling and protrusion of the tongue, and
possibly the twisting and contortion of an arm.
This reaction is usually caused by medications such as Neuroleptics
(antipsychotics), antiemetics, and antidepressants.

Front 52

When can you give Midazolam during a stimulant overdose?

Back 52

If seizures are present or if the patient is extremely agitated or combative.
If patient has a significant tachycardia (150 or more) or chest pain due to stimulant overdose.

Front 53

What are some signs and symptoms of stimulant overdose

Back 53

-Agitation -Tachycardia -Chest Pain
-PVC’s -Hypertension
-Dilated Pupils -Hyperthermia

Front 54

Signs & Symptoms of Agitated Delirium

Back 54

• Bizarre and aggressive behavior
• Dilated pupils
• High body temperature
• Incoherent speech
• Inconsistent breathing patterns
• Fear and panic
• Profuse sweating
• Shivering
• Nakedness

Front 55

High _________ is a key finding in predicting a high risk of sudden death. Another key symptom to the onset of death
while experiencing agitated delirium is ______________. This is when the person has been very violent and vocal and
suddenly becomes quiet and docile.

Back 55

body temperature, “instant tranquility”

Front 56

What is the tx for agitated delirium?

Back 56

1- restraints if needed
2-O2 15LPM regardless of SPo2
3-Determine location of probes (DO NOT remove them)
4-BGL
------------ IF pt still combative
5- Turn down A/C and wet pt down for cooling
6-Sedate with versed
7- Ketamine 4mg/kg IM

Front 57

During agitated delirium, If temperature is > _____, mix ________________ with _______________and
infuse wide open. Repeat once if there is continued hyperthermia OR signs of hypotension

Back 57

102° F, 50 mEq ( 1 amp ) of Sodium Bicarbonate with 1 L of cool/cold (40° F) NaCl

Front 58

What do you do if pt starts hyper-salivating after Ketamine? administer Atropine 0.5 mg IV, IO, or IM)

Back 58

Administer Atropine 0.5 mg IV, IO, or IM

Front 59

What are Normal SpCO levels for
Nonsmokers and Current smokers

Back 59

Nonsmokers 0.83 ± 0.67
Current smokers 4.30 ± 2.55

Front 60

S & S of minor CO poisoning?

Back 60

headache- O2 observe

Front 61

S & S of medium CO poisoning?

Back 61

10-19 Dyspnea, headache Tx 100% Oxygen, ER
evaluation

Front 62

S&S of Severe CO poisoning?

Back 62

20-29. Headache, nausea,
dizziness
.100% Oxygen, ALS
transport, consider HBO. Any higher symptoms and consider air transport to HBO St. Mary's

Front 63

S & S and TX of moderate Cyanide Poisoning?

Back 63

• Soot in nose/ mouth/ oropharynx, headache, nausea
3) Administer 100% oxygen via tight fitting NRM
4) Monitor SA02 and SpCO (refer to CO protocol if necessary)
5) Monitor and record ECG
6) Reassess frequently

Front 64

S & S of moderate Cyanide Poisoning?

Back 64

• Soot in nose/ mouth/ oropharynx, Confusion, Altered Mental Status, Dilated Pupils, Vomiting, Dyspnea, Chest tightness

Front 65

S & S and TX of severe Cyanide Poisoning?

Back 65

• Tachycardia, hyper/hypotension, Seizures, Coma,
Cardiovascular collapse, Cardiac arrest
1) Administer 100% oxygen via tight fitting NRM
2) Ventilate as needed according to rate and effort
3) Monitor SA02 and SpCO (refer to CO protocol if necessary)
4) Monitor and record ECG
5) Collect blood sample using the supplied blood tubes
6) Establish IV/IO of NaCl TKO
7) If hypotensive, administer 500ml bolus of NaCl
8) If available administer Cyanokit® over 15 minutes
*Add 100 mL of 0.9% sodium chloride to each vial
9) Pediatric Dose: 70 mg/kg over 15 minutes
10) Reassess frequently

Front 66

Tx and S&S of Organophosphate Poisoning

Back 66

1. use SCBA if necessary
2. Call Haz-mat
3. Atropine 2mg every 5min until secretions dry
(Decon)

Front 67

Signs of Malignant Hyperthermia

Back 67

Signs of Malignant Hyperthermia
• Increasing EtCO2
• Trunk or total body rigidity
• Masseter spasm or trismus
•Tachycardia/tachypnea
• Increased temperature (may be a late sign)

Front 68

The drug ___________ is the definitive
treatment for Malignant Hyperthermia.
Contact the receiving hospital as soon as
possible to allow them time to procure the
drug.

Back 68

Dantrolene

Front 69

Tx for Malignant Hyperthermia

Back 69

1. Obtain Hx and meds given
2. Monitor ETCo2 and hyperventilate as necessary
3. If Temp >105, remove clothing, IV cool saline, stop cooling <100.4, control shivering with Midazolam and Norcuron
4-If brady: Atropine 1mg adlt, 0.02 mgkg IV ped
5- Hyperkalemia : Calcium Chloride and Sodium Bicarb

Front 70

Whats the dose of Atropine for an adult in bradycardia exhibiting signs of malignant hyperthermia

Back 70

1mg IV

Front 71

Situations in which restraints are clinically justified include:

Back 71

Harmful to self or others, as evidenced by hitting, hair pulling, striking at or biting at
personnel, self-mutilation. Threatens placements and/or patency of necessary therapeutic lines/tubes, interfering with necessary medical treatment,
and appropriate alternative measures have been attempted

Front 72

What can you use as a form of chemical restraint?

Back 72

Patients who are continually aggressive and combative may be sedated using:
Midazolam 2.0 – 5.0 mg(max 5 mg) IN OR IM, repeat as necessary every 3 minutes.
EMS Captain Only – Consider administering Ketamine 4 mg/kg IM
(If patient experiences hypersalivation after Ketamine, administer Atropine 0.5 mg IV, IO, or IM)

Front 73

When to decompress a tension pheumpthorax

Back 73

If signs of a tension pneumothorax are present, and the patient presents with two (2) or more of the following:
• Loss of radial pulse
• Decreasing level of consciousness
• Severe respiratory distress

Front 74

What ETCO2 level should be maintained with a head injured (NOT herniating) pt?

Back 74

35-40 mmHg (approximately one breath every 6
seconds - 10 breaths/minute)

Front 75

BP should be maintained to what with a head injury pt?

Back 75

110 - 120 systolic

Front 76

S&S and TX for Herniation Syndrome

Back 76

1) Perform tracheal intubation and correct for any hypoxia and hypotension (systolic BP <
110 mmHg)
2) Hyperventilate any unresponsive (GCS < 9) head injured patient that presents with
either:
a) Unequal (or bilateral) dilated and non-reactive pupil (s)
b) Extensor (decerebrate) posturing upon painful stimuli

Front 77

What is the target ETCO2 for Herniation Syndrome?

Back 77

25 mmHg. If ongoing exams reveal that signs of herniation have been
resolved with hyperventilation, discontinue hyperventilation unless
signs return.

Front 78

True or False? Do NOT manipulate joint injuries in an attempt to regain absent pulses. Splint as found and transport

Back 78

True

Front 79

Tx for eye inuries

Back 79

1. remove lenses
2. teracaine if not penetrating
3. 2000mls
• Flush Alkalines for a minimum of 20 minutes
• Flush Acids for a minimum of 10 minutes
• Flush unknown chemicals for a minimum of 20 minutes
NEVER apply pressure

Front 80

Second or Third Degree burns equal to or greater than ____ BSA meets Trauma
Alert criteria

Back 80

15%

Front 81

Partial thickness burns, cover area with ___ sterile sheet. Superficial burns, cover with ______.

Back 81

dry, wet

Front 82

SWAT Medics may administer ________ for pts displaying signs of hypovolemia secondary to blood loss.

Back 82

Hextend 500ml. May be repeated once.

Front 83

Which types of fluids should be used for heat related emergencies, such as heat exhaustion?

Back 83

Normal Saline

Front 84

If the patient has S/S of dehydration and hyperthermia >_______ that is not caused by infection, administer a 500mL fluid
bolus of_______________and reassess. Avoid causing the patient to shiver.

Back 84

105°, cooled Normal Saline

Front 85

Do not use cold water or place cold packs in the mid-axillary or groin regions as this can induce shivering and raise core
temperatures. True or False?

Back 85

True

Front 86

Rough handling of hypothermic patients, including rough intubation attempts, may
_____________. However, this only becomes a significant risk with profound hypothermia
(core temp. < ____degrees F.) Therefore, DO NOT withhold any potentially life saving
treatments.

Back 86

precipitate V-Fib, 86

Front 87

What is the tx for Marine Stings?

Back 87

1. Remove the tentacles or residue by flushing the area with sea-water or 0.9% NaCl.
2.4) Apply a neutralizing agent to the affected area. Do not rub or massage the skin.
5) Apply a warm pack to the affected area (do not place directly on skin, use a sea water or
0.9% NaCl moistened bandage between the warm pack and the skin
7) Inform the patient that other S/S such as dizziness, hypotension, or allergic reaction may
occur and need immediate medical attention. After 30-minutes of solution application,
shaving the affected area or utilizing tape may remove any remaining residue

Front 88

When treating marine stings, be sure never to wash off infected area with _______. Also, do not use ____ packs.

Back 88

Do not use fresh water or apply cold packs/ice to the affected areas

Use Normal Saline or sea water and heat packs.

Front 89

Name the 6 venomous snakes that reside in FL.

Back 89

There are 45 species of snakes in Florida, with only 6 being venomous. The
Dusky, Pygmy, and Eastern Diamondback are the 3 rattlesnakes found in
Florida. The Coral, Copperhead, and Cottonmouth are the other 3 poisonous
snakes that reside in Florida.

Front 90

Which fluid is to be used for drownings?

Back 90

LR

Front 91

When obtaining a Hx from a dive accident pt, which are some questions you need to ask?

Back 91

• Type of equipment used
• The depth of the dive(s)
• The number of dives
• The amount of time spent on the bottom
• Any complications regarding the dive
• When the symptoms first occurred
If possible, bring the patient’s Dive Log and/or Computer to ER.

Front 92

Place the dive accident patient in a _____ position

Back 92

supine

Front 93

Consider placing the pregnant in labor
patient on the
stretcher _______
to facilitate delivery of
the baby. This will
allow more room for
the paramedic to
work, as well as
giving the patient
privacy when arriving
at the hospital.

Back 93

backwards

Front 94

What are some possible complications associated with antepartum/third trimester bleeding? What are their S&S?

Back 94

Abruptio placenta-tearing pain, shock, may or may not see bleeding
• Placenta previa-no pain other than labor, bleeding present
• Uterine rupture-usually during labor or from trauma, bleeding and shock

Front 95

What are the S&S of pre-eclampsia?

Back 95

hypertension, generalized edema and protein in
the urine, usually in the last trimester of pregnancy. Headache and altered mental status are
seen later as the process worsens.

Front 96

Which type of fluid is used for pregnant pts?

Back 96

LR

Front 97

What is the tx for Eclampsia? What is the theory behind giving Midazolam?

Back 97

Administer Magnesium Sulfate Bolus 4 Grams over 10 minutes....
Midazolam 2.0-5.0 mg slow IV, IN, or IM may be used to supplement
Magnesium Sulfate (See Seizure Protocol). However, it’s use is controversial
because it is felt that the depressant effect on the mother and fetus may
outweigh the potential benefit and , therefore, Midazolam should be used with
great caution and only in those with prolonged status seizures.

Front 98

History of Pregnancy should include (but not limited to):

Back 98

a) Possibility of Multiple Births f) Number of Previous Births
b) Expected Date of Delivery g) Show of Blood
c) Gush/Color of Water h) Frequency, Duration and Strength of Contractions
d) Any Narcotic use in last 4 Hours i) Need to Move Bowels
e) Number of Previous Pregnancies j) Assess for Crowning if Necessary

Front 99

What do you do if the umbilical cord is wrapped tightly around the newborn’s neck?

Back 99

Slip it over the shoulder. If this can not be performed,
clamp the cord in two places and cut between the clamps

Front 100

Upon delivery of the newborn’s head, bulb suction the ____, then
_______.

Back 100

mouth, each nostril

Front 101

What should be done the newborn is apneic or with gasping respirations, or the heart rate falls
below 100 beats per minute?

Back 101

1..use Positive Pressure Ventilation

If the heart rate is less than 60, perform chest compressions
at a rate of 120 per minute. The ratio of compressions to
ventilations in the newborn is 3:1. Chest compressions should
be discontinued when a spontaneous heart rate of 60 or
greater is reached

Front 102

When appropriate, cut the umbilical cord. Apply two clamps, one __
inches and one__ inches from the newborn.

Back 102

3, 4

Front 103

What should be done if the newborn’s head is not delivered within 3 minutes of the body

Back 103

a) Elevate the mother’s hips
b) With gloved fingers, form a “V” and attempt to push the vaginal wall away from the newborns mouth
and nose and administer 100% Oxygen at the earliest possible time
c) NEVER ATTEMPT TO PULL THE BABY OUT!
d) Transport immediately to the closest Obstetrics Hospital with the mother’s hips elevated and baby’s
airway maintained while enroute
e) Notify the hospital as soon as possible

Front 104

What should be done in the case of a Single Limb presentation during labor ?Transport
Immediately! Do Not Stimulate the Limb

Back 104

Transport
Immediately! Do Not Stimulate the Limb

Front 105

What should be done for a prolapse cord?

Back 105

1) Refer to General Assessment and Initial Patient Management Protocols
2) Place the mother in an exaggerated trendelenberg or knee/chest position
3) Verify a pulse in the umbilical cord. If no pulse is present, with a gloved hand, push the baby up into the
uterus and away from the vagina and the compressed cord until a pulse returns in the cord
4) Wrap the exposed cord in a moist sterile dressing

Front 106

What should be done if no pulse is felt on a prolapse cord?

Back 106

If no pulse is present, with a gloved hand, push the baby up into the
uterus and away from the vagina and the compressed cord until a pulse returns in the cord

Front 107

Pedi Quick Combo are for pts less than __Kg.

Back 107

15

Front 108

Durring a pedi code, administer Epinephrine endotracheally at ___ times the IV dose. Dilute meds with NS to a total of____ mL

Back 108

ten, 3-5

Front 109

What is the fluid bolus for a pedi for hypovolemia?

Back 109

20ml/Kg

Front 110

What is the initial shock for a pedi in v-fib?

Back 110

2 joules/ kg then 4 joules/kg

Front 111

True or False. Lidocaine Maintenance
Infusions are not required
for PEDS.

Back 111

True

Front 112

How do you contact poison control ?

Back 112

1-800-222-1222

Front 113

How and when do you administer Amiordarone to a pedi during POST RESUSCITATIVE CARE?

Back 113

Administer Amiodarone 5 mg / kg in 100 mL bag of D5W at 300 mL / hour (over 20 minutes), if:
a) Resuscitation from V-Fib or Pulseless V Tach was completed without antiarrhythmic administration
b) Patient’s ECG exhibits frequent coupled PVCs or runs of V-Tach

Front 114

What are the SVT rates for infants and children?

Back 114

INFANTS GREATER THAN 220 BPM
CHILDREN GREATER THAN 180 BPM

Front 115

Describe the process of synchronized cardioversion for peds.

Back 115

Perform synchronized cardioversion: 0.5 to 1 joule/kg. If rhythm is not corrected increase to 2 joules/kg
(If rhythm fails to convert, continue to cardiovert at 2 joules/kg every 1 – 2 minutes)

Front 116

How do you perform a vagal maneuver for an infant and a child?

Back 116

Infants and young
children:
Apply ice in a latex glove
over the forehead, eyes, and
bridge of the nose.
(Do Not use a cold pack).
Children:
Have the patient blow
into an occluded straw.

Front 117

What is the pacemaker set at when pacing a pedi?

Back 117

100bpm for Third Degree (complete heart block) or patient with congenital
heart disease not responding to oxygenation, CPR, and Epinephrine

Front 118

What is the first thing you should do when confronted with a pediatric whose HR is below 60 and symptomatic?

Back 118

Ensure adequate oxygenation and ventilation via BVM for 1 minute and reassess patient

4) If oxygenation and ventilation do not increase the heart rate above 60 bpm- perform CPR.
After 1 minute of CPR- reassess the patient. Continue CPR until the heart rate is sustained at greater
than 60 bpm with adequate perfusion
5) Administer Epinephrine 1:10,000 0.01 mg/kg IV/IO. Repeat every 3-5 minutes as required
6) Administer Atropine 0.02 mg/kg if the patient is GREATER than 1 year old
Min. Dose: 0.1 mg
Max. Dose: 0.5 mg Child and 1 mg Adolescent

Front 119

What is the MINIMUM age requirement for the administration of Atropine in a pediatric?

Back 119

1 year old

Front 120

Consider _________
administration after BLS
CPR and before
Epinephrine if vagal
stimulation is suspected
(e.g. post intubation or
suctioning) or the patient
has______________ on the ECG
monitor.

Back 120

Atropine, Second Degree Type I
(Wenckebach)

Front 121

What are some common facts about febrile seizures?

Back 121

• Usually ages 6 months to
3 years
• Temp. > 103 degrees F
• Generally subside as the
patient is air cooled prior to
medication administration

Front 122

What is the tx of asthma in a pediatric

Back 122

1.Administer Proventil and Atrovent together via nebulizer
2.If no response to first nebulizer treatment, administer Proventil 2.5 mg/3mL
3. For patients initially presenting with respiratory failure and requiring IV access:
Administer Solu-Medrol 2 mg/kg (Max. 125 mg) IV

Front 123

For Pediatric Patients in severe distress with minimal air movement, consider Epinephrine _________________ anytime in the treatment sequence.

Back 123

1:1,000 0.01 mg/kg
IM (Max. 0.3 mg)

Front 124

Tx for CROUP/Epiglottitis

Back 124

DO NOT MAKE ANY ATTEMPT TO VISUALIZE THE PATIENT’S AIRWAY
1. Comfort pt
2. humidified O2
3.If respiratory failure or airway obstruction occurs provide ventilations via two person BVM. DO NOT attempt intubation

Front 125

What are S&S of CROUP?

Back 125

Most Common. Slow onset (2-3 days). Cold Symptoms low grade fever 100 - 101F. SEAL BARK COUGH

Front 126

What are S&S of SPASMODIC CROUP?

Back 126

Common. Sudden onset - mostly in the middle of the night. No preceding symptoms. SEAL Bark Cough. Inspiratory stridor with any agitation of the patient.

Front 127

What are S&S of EPIGLOTTITIS

Back 127

Sudden onset, High Fever (102 - 104) sore throat Drooling, pain on swallowing.

Front 128

Tx for Hypoglycemia in pediatrics greater than 1 month and less than 1 month old.

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D25 2-4 mL/kg for pediatrics (greater than 1 month old)
D12.5 5-10 mL/kg for newborns (less than 1 month old)

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What is the dose of Glucagon for a pedi less 20kg? Greater than 20kg?

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0.5 mg (1/2 unit) for pediatrics < 20 kg
1.0 mg (1 unit) for pediatrics > 20 kg