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151 Cards in this Set

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Standing order or Medical Control ?
Fluid bolus in adult AFib HR>150, SBP<100 w/ signs of hypoperfusion
SO
Standing order or Medical Control ?
Cardioversion for adult unstable AFib
Trick question !
We don't cardiovert AFib
Standing order or Medical Control ?
Vasopressin in adult asystole
SO
Standing order or Medical Control ?
Sodium Bicarb in adult asystole
MC
Standing order or Medical Control ?
Glucagon in adult asystole
MC
Standing order or Medical Control ?
Fluid bolus in adult Atrial Fib HR>150 SBP<100 w/ signs hypoperfusion
SO
Standing order or Medical Control ?
Cardioversion for adult AFib, HR>150, SBP<100 w/ signs of hypoperfusion
Trick question-

We don't cardiovert AFib
Standing order or Medical Control ?
Vasopressin in adult asystole
SO
Standing order or Medical Control ?
Sodium Bicarb in adult asystole
MC
Standing order or Medical Control ?
Glucagon in adult asystole
MC
Standing order or Medical Control ?
Fluid bolus in adult Atrial Fib
HR>150, SBP<100, signs of hypoperfusion
SO
Standing order or Medical Control ?
Cardioversion for adult AFib, HR>150, SBP<100 w/ signs of hypoperfusion
SO
Standing order or Medical Control ?
Vasopressin in adult asystole
SO
Standing order or Medical Control ?
Sodium Bicarb in adult Asystole
MC
Standing order or Medical Control ?
Glucagon in adult Asystole
MC
Standing order or Medical Control ?
Fluid bolus in adult Atrial Fib
HR>150, SBP<100, signs of hypoperfusion
SO
Standing order or Medical Control ?
Cardioversion for adult AFib, HR>100, SBP<100 w/ signs of hypoperfusion
Trick question- We do not cardiovert AFib.
Dose of Diazepam for adult cardioversion
<70 kg 2.5 mg slow IVP
>70 kg 5.0 mg slow IVP
adult dose of Midazolam for cardioversion
0.5-2.5 mg slow IVP
adult dose of morphine for cardioversion
2-10 mg slow IVP
adult dose of fentanyl for cardioversion
1 mcg/kg to max 150 mcg slow IVP
What 2 sedatives for cardioversion may be given nasally?
morphine
fentanyl
adult dose diltiazem
(1st and 2nd)
2nd is ______ minutes after 1st
1st: 0.25 mg/kg
2nd: 0.35 mg/kg
15 minutes
Contraindications of Diltiazem
WPW
2nd/3rd degree HB
SSS
severe hypotension
cardiogenic shock
adult infusion rate diltiazem drip
10-15 mg/hr
Standing order or Medical Control ?
amiodorone in adult Afib
MC
Standing order or Medical Control ?
Metoprolol in adult AFib
MC
Energy level of adult cardioversion
200J > 300J > 360J
unstable atrial flutter
Standing order or Medical Control ?
TCP for symptomatic adult bradycardia
SO
Standing order or Medical Control ?
Atropine for adult sympomatic bradycardia
SO
Standing order or Medical Control ?
CaCl for adult symptomatic bradycardia
MC
The sedative that may be given nasally prior to TCP
fentanyl
Adult ROSC:
Epi infusion dose?
To mix, add ___ to ___
1 mcg to 10 mcg / minute
add 1 mg epinephrine to 250 cc NS
Standing order or Medical Control ?
Atropine in adult PEA arrest
MC
Standing order or Medical Control ?
Vasopressin in adult PEA arrest
SO
Cardiac arrest:
adult vasopressin dose
40 units IV or IO
in place of 1st or 2nd epi
Standing order or Medical Control ?
Glucagon in adult PEA
MC
Standing order or Medical Control ?
Sodium Bicarb
MC
Standing order or Medical Control ?
Adenosine in SVT, HR>150, SBP <100
SO
Cardioversion energy levels for unstable SVT
50J > 100J > 200J > 300J > 360J
Standing order or Medical Control ?
Amiodorone in SVT
MC
Amiodorone dose adult SVT
150 mg
1st defib in VF arrest = ___ joules
360
Standing order or Medical Control ?
250 cc fluid bolus for near-drowning victim w/ SBP <100
SO
Standing order or Medical Control ?
Tx of nerve agent exposure:
Albuterol for SOB
MC
Standing order or Medical Control ?
Tx of nerve agent exposure:
Midazolam for SZ's
MC
Adult nerve agent exposure:
Atropine dose w/ Med Control orders
and Route of administration
2 mg for mild sx
4 mg for moderate sx
6 mg for severe sx
IM only
Standing order or Medical Control ?
Morphine for severe non-traumatic ABD pain
MC

(Protocol 3.1)
Standing order or Medical Control ?
Zofran for nausea, w/o use of analgesics
so
Standing order or Medical Control ?
Anaphylaxis: 2nd EpiPen
MC
Standing order or Medical Control ?
Anaphylaxis: Benadryl 50 mg IVP
SO
Standing order or Medical Control ?
Anaphylaxis: Albuterol
SO
Standing order or Medical Control ?
Narcan in Altered Mental Status
SO
Standing order or Medical Control ?
Thiamine in Altered Mental Status
SO
Adult Narcan dose
0.4 - 2.0 mg
Narcan: Routes of administration
IVP, IM, SC, Nasal via atomizer
Dose of Glucagon for adult AMS
1-2 mg IM or nasal
Can Glucagon be given via nasal route?
Yes
In AMS protocol, a pt. w/ adrenal insufficiency can receive ___ mg of ___ (med) by ___ (routes)
125 mg
Methylprednosone
IV, IM, IO
Standing order or Medical Control ?
Methylpredisone for AMS pt w/ adrenal insufficiency
SO
Standing order or Medical Control ?
additional D50 after first 25g
SO
In AMS, D50 is not a standing order when ___.
CVA is suspected
Standing order or Medical Control ?
Magnesium sulfate in severe respiratory distress
SO
adult dose of magnesium sulfate for severe SOB
2-4 g
adult dose of albuterol
2.5 - 3.0 mg
adult dose of ipatropium
500 mcg
Standing order or Medical Control ?
2nd dose of albuterol in adult SOB
MC
Standing order or Medical Control ?
Epi IM or IV for adult SOB
MC
Standing order or Medical Control ?
Lasix in CHF
MC
Standing order or Medical Control ?
1" Nitro paste for CHF in adult
SO
Per standing orders, how many NTG's max for CHF before Med Control
3
Dopamine dose in adult CHF
2 mcg/kg to 20 mcg/kg
Standing order or Medical Control ?
Tetracaine for eye injury
MC
Standing order or Medical Control ?
Use of Morgan lens for eye irrigation
MC
Standing order or Medical Control ?
NTG in hypertensive emergency
MC
Standing order or Medical Control ?
Furosemide in adult hypertensive emergency
MC
Standing order or Medical Control ?
Metoprolol for adult hypertensive emergency
MC
Adult dose of metoprolol
2.5 - 5.0 mg slow IVP
Standing order or Medical Control ?
Ativan for eclamptic SZ
SO
Standing order or Medical Control ?
Diazepam for eclamptic SZ
SO
Standing order or Medical Control ?
Magnesium sulfate for eclamptic SZ
MC
Standing order or Medical Control ?
Calcium chloride for eclamptic SZ
MC
Field delivery:
If cord is looped around baby's head: _____
If unable to do so: _____
Gently slip over baby's head
Clamp and cut the cord
During a breech delivery, avoid having the fetal face towards the
maternal symphasis
Breech delivery: If head does not deliver immediately:
Gloved hand in vagina, palm toward baby's face, form "V" either side of nose, hold vag wall away from infant's face until delivery. After 3 minutes, if no delivery, rapid trans to hosp, maintain "V" to infant nose
Standing order or Medical Control ?
If obvious narcotic OD, pt is seizing, use of narcan is ___
SO
What are the Standing Order controlled meds given to treat seizures ?
Lorazepam
Diazepam
Standing order or Medical Control ?
Dextrose for seizure if BG < 70
SO
Standing order or Medical Control ?
Glucagon for SZ, BG<70
SO
Standing order or Medical Control ?
Magnesium sulfate for SZ
MC
adult magnesium sulfate dose for SZ's related to eclampsia
1-4 g
The Standing Order meds that may be given to a pt w/ syncope of unknown origin are
Dextrose, thiamine, narcan, glucagon
Standing order or Medical Control ?
Activated charcoal for poisoning
MC
2 analgesics that may be given per standing order in adult pain mgt protocol, and their doses, are ___
morphine, 0.1 mg/kg max 10 mg
fentanyl, 1 mcg/kg, max 150 mcg
Acceptable routes of morphine administration
IV,IM,SC,IO
Acceptable routes of fentanyl administration
IV, nasal
Acceptable routes of ondansetron
IV, IM
Standing order or Medical Control ?
Removal (if necessary) of blocked tracheostomy tube
SO
Standing order or Medical Control ?
Re-intubation of tracheostomy patient with removed tube
SO if no other means of ventilating the pt are possible
Standing order or Medical Control ?
lidocaine prior to intubation of head-injured pt
SO
Dose of lidocaine given to head-injured pt prior to intubation
75-100 mg
Acceptable routes of lidocaine prior to intubation of head-injured pt
IV
Standing order or Medical Control ?
Midazolam to facilitate intubation
MC

Except in the "Emergent Airway Protocol" where it becomes a Standing Order
Midazolam dose to facilitate intubation
2.5 - 5.0 mg
Acceptable routes to give midazolam
IV, nasal
procedures for tx of open pneumothorax
occlusive dressing sealing 3 sides
monitor closely for signs of tension pneumo
the 2 treatments for tension pneumo
release occclusive dressing then reseal
needle chest decompression
Lidocaine after IO: Dose and Standing Order or Med Control?
20 mg Lidocaine then wait 30 sec then 10cc normal saline
Standing Order
Vasopressin: In cardiac arrest, when is it given, dose, how many times?
40 units IV/IO in place of 1st or 2nd epinephrine
Given once.
To qualify for "Cessation of Resuscitation", pt must have been in ___ or ___ for at least ___ minutes during resuscitation efforts
asystole or PEA
20 minutes
Cessation of resuscitation does not apply to pregnant pts.
True or false
true
In the "emergent airway" protocol, Versed can be administered without Medical Control True/False
True
In the "emergent airway" protocol, a needle cricothyrotomy can be used without Medical Control True/False
true
The lowest GCS a pt can score is ___, the highest score is ___.
3, 15
The dose of Glucagon for suspected beta-blocker or calcium channel blocker toxicity ranges from ___ to ___ mg
1.0 - 5.0 mg
Valsalva manuevers can be used without Medical Control for unstable SVT.
true
True or false: Diltiazem is useful in the treatment of WPW
False, it is strongly contraindicated.
Metoprolol can be used in a pt who is receiving calcium channel blockers via IV infusion. True / False
False
Diltiazem may be used in Atrial Flutter per Standing Orders True / False
True
A diltiazem bolus should be pushed slowly, over ____ minutes
2 minutes
What is the sequence of energy levels for cardioversion of atrial flutter?
50J > 100J > 200J > 300J > 360J
What are 4 sedative drugs that can be given prior to TCP ?
morphine, midazolam, diazepam, fentanyl
Treatment of suspected calcium channel blocker toxicity would include what med at what dose?
Calcium chloride 10%, 2-4 mg/kg
max 1 g
over 5 minutes
Calcium chloride is a standing order for treatment of calcium channel blocker toxicity True/False
False, MC only
NTG spray is to be used only after contacting Medical Control.
True / False
False
In ACS, the dose of ASA is ___ to ___ mg
162 - 325 mg
When counting total NTG that can be administered prior to contacting Medical Control, only NTG administered by EMS is counted. True / False
False

You should also count the NTG's taken by the patient prior to your arrival.
Fentanyl can be given as a Standing Order in ACS. True / False
True
Fentanyl can be administered via the nasal route. True / False
True
In the ROSC protocol, if the resuscitation was the result of VF or VT, administer (med name)___ at (dose) ___slowly then set up an infusion at ___
mg per minute
amiodorone
150 mg in 10 cc over 8-10 minutes
then infusion at 1 mg/minute
PVC's should be treated with a bolus of lidocaine followed by a lidocaine infusion. True / False
false
Follow all adenosine IV pushes with ___.
20 ml normal saline bolus and elevate the extremity where bolus was given.
The dose of amiodorone in a VF arrest is ____.
300 mg
Medical Control options for ventricular tachycardia with pulses includes adenosine. True / False
true
What is the initial and subsequent doses of lidocaine in ventricular tachycardia? What is the maximum?
1 - 1.5 mg/kg IV/IO then 0.5-0.75 mg/kg IV/IO q 3-5 minutes.
Max = 3 mg/kg
Standing order or Medical Control ?
Lidocaine for ventricular tachycardia
MC
Standing order or Medical Control ?
Lidocaine in VF arrest
MC
In the VT protocol, Med Control may order ______ for Torsades de Pointes
Magnesium sulfate
An amiodorone infusion per medical Control would run at ___mg/minute.
1 mg/minute
CPAP may be used on unconcious patients. True / false
false
CPAP is useful in patients who are unable to follow commands.
True / False
False
NTG given sublingually is given at what dose?
_____ mg, which is equal to _____ grains.
0.4 mg
1/150 grains
Nitropaste can be used per Standing Order
True / False
True
The length of nitro paste is ____ and it is placed where?
1 inch
anterior chest wall
Tetracaine is useful in facilitating nasal intubations. True / false
False
Lasix is administered via Standing Orders in severe cases of CHF. True / false
false
Placenta previa usually manifests in the _____ trimester of gestation.
3rd
Common signs of placenta previa include painless bright red vaginal bleeding. True/False
true
True or false. Glucagon may be administered via the nasal route.
true
What medications are allowed to be given via Standing Orders in the Acute Pain Management protocol ?
morphine
fentanyl