Massachusetts Paramedic Adult Protocols Version 10.01 Effective 3/1/12

Front 1

Standing order or Medical Control ?
Fluid bolus in adult AFib HR>150, SBP<100 w/ signs of hypoperfusion

Back 1

SO

Front 2

Standing order or Medical Control ?
Cardioversion for adult unstable AFib

Back 2

Trick question !
We don't cardiovert AFib

Front 3

Standing order or Medical Control ?
Vasopressin in adult asystole

Back 3

SO

Front 4

Standing order or Medical Control ?
Sodium Bicarb in adult asystole

Back 4

MC

Front 5

Standing order or Medical Control ?
Glucagon in adult asystole

Back 5

MC

Front 6

Standing order or Medical Control ?
Fluid bolus in adult Atrial Fib HR>150 SBP<100 w/ signs hypoperfusion

Back 6

SO

Front 7

Standing order or Medical Control ?
Cardioversion for adult AFib, HR>150, SBP<100 w/ signs of hypoperfusion

Back 7

Trick question-

We don't cardiovert AFib

Front 8

Standing order or Medical Control ?
Vasopressin in adult asystole

Back 8

SO

Front 9

Standing order or Medical Control ?
Sodium Bicarb in adult asystole

Back 9

MC

Front 10

Standing order or Medical Control ?
Glucagon in adult asystole

Back 10

MC

Front 11

Standing order or Medical Control ?
Fluid bolus in adult Atrial Fib
HR>150, SBP<100, signs of hypoperfusion

Back 11

SO

Front 12

Standing order or Medical Control ?
Cardioversion for adult AFib, HR>150, SBP<100 w/ signs of hypoperfusion

Back 12

SO

Front 13

Standing order or Medical Control ?
Vasopressin in adult asystole

Back 13

SO

Front 14

Standing order or Medical Control ?
Sodium Bicarb in adult Asystole

Back 14

MC

Front 15

Standing order or Medical Control ?
Glucagon in adult Asystole

Back 15

MC

Front 16

Standing order or Medical Control ?
Fluid bolus in adult Atrial Fib
HR>150, SBP<100, signs of hypoperfusion

Back 16

SO

Front 17

Standing order or Medical Control ?
Cardioversion for adult AFib, HR>100, SBP<100 w/ signs of hypoperfusion

Back 17

Trick question- We do not cardiovert AFib.

Front 18

Dose of Diazepam for adult cardioversion

Back 18

<70 kg 2.5 mg slow IVP
>70 kg 5.0 mg slow IVP

Front 19

adult dose of Midazolam for cardioversion

Back 19

0.5-2.5 mg slow IVP

Front 20

adult dose of morphine for cardioversion

Back 20

2-10 mg slow IVP

Front 21

adult dose of fentanyl for cardioversion

Back 21

1 mcg/kg to max 150 mcg slow IVP

Front 22

What 2 sedatives for cardioversion may be given nasally?

Back 22

morphine
fentanyl

Front 23

adult dose diltiazem
(1st and 2nd)
2nd is ______ minutes after 1st

Back 23

1st: 0.25 mg/kg
2nd: 0.35 mg/kg
15 minutes

Front 24

Contraindications of Diltiazem

Back 24

WPW
2nd/3rd degree HB
SSS
severe hypotension
cardiogenic shock

Front 25

adult infusion rate diltiazem drip

Back 25

10-15 mg/hr

Front 26

Standing order or Medical Control ?
amiodorone in adult Afib

Back 26

MC

Front 27

Standing order or Medical Control ?
Metoprolol in adult AFib

Back 27

MC

Front 28

Energy level of adult cardioversion

Back 28

200J > 300J > 360J

Front 29

unstable atrial flutter

Front 30

Standing order or Medical Control ?
TCP for symptomatic adult bradycardia

Back 30

SO

Front 31

Standing order or Medical Control ?
Atropine for adult sympomatic bradycardia

Back 31

SO

Front 32

Standing order or Medical Control ?
CaCl for adult symptomatic bradycardia

Back 32

MC

Front 33

The sedative that may be given nasally prior to TCP

Back 33

fentanyl

Front 34

Adult ROSC:
Epi infusion dose?
To mix, add ___ to ___

Back 34

1 mcg to 10 mcg / minute
add 1 mg epinephrine to 250 cc NS

Front 35

Standing order or Medical Control ?
Atropine in adult PEA arrest

Back 35

MC

Front 36

Standing order or Medical Control ?
Vasopressin in adult PEA arrest

Back 36

SO

Front 37

Cardiac arrest:
adult vasopressin dose

Back 37

40 units IV or IO
in place of 1st or 2nd epi

Front 38

Standing order or Medical Control ?
Glucagon in adult PEA

Back 38

MC

Front 39

Standing order or Medical Control ?
Sodium Bicarb

Back 39

MC

Front 40

Standing order or Medical Control ?
Adenosine in SVT, HR>150, SBP <100

Back 40

SO

Front 41

Cardioversion energy levels for unstable SVT

Back 41

50J > 100J > 200J > 300J > 360J

Front 42

Standing order or Medical Control ?
Amiodorone in SVT

Back 42

MC

Front 43

Amiodorone dose adult SVT

Back 43

150 mg

Front 44

1st defib in VF arrest = ___ joules

Back 44

360

Front 45

Standing order or Medical Control ?
250 cc fluid bolus for near-drowning victim w/ SBP <100

Back 45

SO

Front 46

Standing order or Medical Control ?
Tx of nerve agent exposure:
Albuterol for SOB

Back 46

MC

Front 47

Standing order or Medical Control ?
Tx of nerve agent exposure:
Midazolam for SZ's

Back 47

MC

Front 48

Adult nerve agent exposure:
Atropine dose w/ Med Control orders
and Route of administration

Back 48

2 mg for mild sx
4 mg for moderate sx
6 mg for severe sx
IM only

Front 49

Standing order or Medical Control ?
Morphine for severe non-traumatic ABD pain

Back 49

MC

(Protocol 3.1)

Front 50

Standing order or Medical Control ?
Zofran for nausea, w/o use of analgesics

Back 50

so

Front 51

Standing order or Medical Control ?
Anaphylaxis: 2nd EpiPen

Back 51

MC

Front 52

Standing order or Medical Control ?
Anaphylaxis: Benadryl 50 mg IVP

Back 52

SO

Front 53

Standing order or Medical Control ?
Anaphylaxis: Albuterol

Back 53

SO

Front 54

Standing order or Medical Control ?
Narcan in Altered Mental Status

Back 54

SO

Front 55

Standing order or Medical Control ?
Thiamine in Altered Mental Status

Back 55

SO

Front 56

Adult Narcan dose

Back 56

0.4 - 2.0 mg

Front 57

Narcan: Routes of administration

Back 57

IVP, IM, SC, Nasal via atomizer

Front 58

Dose of Glucagon for adult AMS

Back 58

1-2 mg IM or nasal

Front 59

Can Glucagon be given via nasal route?

Back 59

Yes

Front 60

In AMS protocol, a pt. w/ adrenal insufficiency can receive ___ mg of ___ (med) by ___ (routes)

Back 60

125 mg
Methylprednosone
IV, IM, IO

Front 61

Standing order or Medical Control ?
Methylpredisone for AMS pt w/ adrenal insufficiency

Back 61

SO

Front 62

Standing order or Medical Control ?
additional D50 after first 25g

Back 62

SO

Front 63

In AMS, D50 is not a standing order when ___.

Back 63

CVA is suspected

Front 64

Standing order or Medical Control ?
Magnesium sulfate in severe respiratory distress

Back 64

SO

Front 65

adult dose of magnesium sulfate for severe SOB

Back 65

2-4 g

Front 66

adult dose of albuterol

Back 66

2.5 - 3.0 mg

Front 67

adult dose of ipatropium

Back 67

500 mcg

Front 68

Standing order or Medical Control ?
2nd dose of albuterol in adult SOB

Back 68

MC

Front 69

Standing order or Medical Control ?
Epi IM or IV for adult SOB

Back 69

MC

Front 70

Standing order or Medical Control ?
Lasix in CHF

Back 70

MC

Front 71

Standing order or Medical Control ?
1" Nitro paste for CHF in adult

Back 71

SO

Front 72

Per standing orders, how many NTG's max for CHF before Med Control

Back 72

3

Front 73

Dopamine dose in adult CHF

Back 73

2 mcg/kg to 20 mcg/kg

Front 74

Standing order or Medical Control ?
Tetracaine for eye injury

Back 74

MC

Front 75

Standing order or Medical Control ?
Use of Morgan lens for eye irrigation

Back 75

MC

Front 76

Standing order or Medical Control ?
NTG in hypertensive emergency

Back 76

MC

Front 77

Standing order or Medical Control ?
Furosemide in adult hypertensive emergency

Back 77

MC

Front 78

Standing order or Medical Control ?
Metoprolol for adult hypertensive emergency

Back 78

MC

Front 79

Adult dose of metoprolol

Back 79

2.5 - 5.0 mg slow IVP

Front 80

Standing order or Medical Control ?
Ativan for eclamptic SZ

Back 80

SO

Front 81

Standing order or Medical Control ?
Diazepam for eclamptic SZ

Back 81

SO

Front 82

Standing order or Medical Control ?
Magnesium sulfate for eclamptic SZ

Back 82

MC

Front 83

Standing order or Medical Control ?
Calcium chloride for eclamptic SZ

Back 83

MC

Front 84

Field delivery:
If cord is looped around baby's head: _____
If unable to do so: _____

Back 84

Gently slip over baby's head
Clamp and cut the cord

Front 85

During a breech delivery, avoid having the fetal face towards the

Back 85

maternal symphasis

Front 86

Breech delivery: If head does not deliver immediately:

Back 86

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

Front 87

Standing order or Medical Control ?
If obvious narcotic OD, pt is seizing, use of narcan is ___

Back 87

SO

Front 88

What are the Standing Order controlled meds given to treat seizures ?

Back 88

Lorazepam
Diazepam

Front 89

Standing order or Medical Control ?
Dextrose for seizure if BG < 70

Back 89

SO

Front 90

Standing order or Medical Control ?
Glucagon for SZ, BG<70

Back 90

SO

Front 91

Standing order or Medical Control ?
Magnesium sulfate for SZ

Back 91

MC

Front 92

adult magnesium sulfate dose for SZ's related to eclampsia

Back 92

1-4 g

Front 93

The Standing Order meds that may be given to a pt w/ syncope of unknown origin are

Back 93

Dextrose, thiamine, narcan, glucagon

Front 94

Standing order or Medical Control ?
Activated charcoal for poisoning

Back 94

MC

Front 95

2 analgesics that may be given per standing order in adult pain mgt protocol, and their doses, are ___

Back 95

morphine, 0.1 mg/kg max 10 mg
fentanyl, 1 mcg/kg, max 150 mcg

Front 96

Acceptable routes of morphine administration

Back 96

IV,IM,SC,IO

Front 97

Acceptable routes of fentanyl administration

Back 97

IV, nasal

Front 98

Acceptable routes of ondansetron

Back 98

IV, IM

Front 99

Standing order or Medical Control ?
Removal (if necessary) of blocked tracheostomy tube

Back 99

SO

Front 100

Standing order or Medical Control ?
Re-intubation of tracheostomy patient with removed tube

Back 100

SO if no other means of ventilating the pt are possible

Front 101

Standing order or Medical Control ?
lidocaine prior to intubation of head-injured pt

Back 101

SO

Front 102

Dose of lidocaine given to head-injured pt prior to intubation

Back 102

75-100 mg

Front 103

Acceptable routes of lidocaine prior to intubation of head-injured pt

Back 103

IV

Front 104

Standing order or Medical Control ?
Midazolam to facilitate intubation

Back 104

MC

Except in the "Emergent Airway Protocol" where it becomes a Standing Order

Front 105

Midazolam dose to facilitate intubation

Back 105

2.5 - 5.0 mg

Front 106

Acceptable routes to give midazolam

Back 106

IV, nasal

Front 107

procedures for tx of open pneumothorax

Back 107

occlusive dressing sealing 3 sides
monitor closely for signs of tension pneumo

Front 108

the 2 treatments for tension pneumo

Back 108

release occclusive dressing then reseal
needle chest decompression

Front 109

Lidocaine after IO: Dose and Standing Order or Med Control?

Back 109

20 mg Lidocaine then wait 30 sec then 10cc normal saline
Standing Order

Front 110

Vasopressin: In cardiac arrest, when is it given, dose, how many times?

Back 110

40 units IV/IO in place of 1st or 2nd epinephrine
Given once.

Front 111

To qualify for "Cessation of Resuscitation", pt must have been in ___ or ___ for at least ___ minutes during resuscitation efforts

Back 111

asystole or PEA
20 minutes

Front 112

Cessation of resuscitation does not apply to pregnant pts.
True or false

Back 112

true

Front 113

In the "emergent airway" protocol, Versed can be administered without Medical Control True/False

Back 113

True

Front 114

In the "emergent airway" protocol, a needle cricothyrotomy can be used without Medical Control True/False

Back 114

true

Front 115

The lowest GCS a pt can score is ___, the highest score is ___.

Back 115

3, 15

Front 116

The dose of Glucagon for suspected beta-blocker or calcium channel blocker toxicity ranges from ___ to ___ mg

Back 116

1.0 - 5.0 mg

Front 117

Valsalva manuevers can be used without Medical Control for unstable SVT.

Back 117

true

Front 118

True or false: Diltiazem is useful in the treatment of WPW

Back 118

False, it is strongly contraindicated.

Front 119

Metoprolol can be used in a pt who is receiving calcium channel blockers via IV infusion. True / False

Back 119

False

Front 120

Diltiazem may be used in Atrial Flutter per Standing Orders True / False

Back 120

True

Front 121

A diltiazem bolus should be pushed slowly, over ____ minutes

Back 121

2 minutes

Front 122

What is the sequence of energy levels for cardioversion of atrial flutter?

Back 122

50J > 100J > 200J > 300J > 360J

Front 123

What are 4 sedative drugs that can be given prior to TCP ?

Back 123

morphine, midazolam, diazepam, fentanyl

Front 124

Treatment of suspected calcium channel blocker toxicity would include what med at what dose?

Back 124

Calcium chloride 10%, 2-4 mg/kg
max 1 g
over 5 minutes

Front 125

Calcium chloride is a standing order for treatment of calcium channel blocker toxicity True/False

Back 125

False, MC only

Front 126

NTG spray is to be used only after contacting Medical Control.
True / False

Back 126

False

Front 127

In ACS, the dose of ASA is ___ to ___ mg

Back 127

162 - 325 mg

Front 128

When counting total NTG that can be administered prior to contacting Medical Control, only NTG administered by EMS is counted. True / False

Back 128

False

You should also count the NTG's taken by the patient prior to your arrival.

Front 129

Fentanyl can be given as a Standing Order in ACS. True / False

Back 129

True

Front 130

Fentanyl can be administered via the nasal route. True / False

Back 130

True

Front 131

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

Back 131

amiodorone
150 mg in 10 cc over 8-10 minutes
then infusion at 1 mg/minute

Front 132

PVC's should be treated with a bolus of lidocaine followed by a lidocaine infusion. True / False

Back 132

false

Front 133

Follow all adenosine IV pushes with ___.

Back 133

20 ml normal saline bolus and elevate the extremity where bolus was given.

Front 134

The dose of amiodorone in a VF arrest is ____.

Back 134

300 mg

Front 135

Medical Control options for ventricular tachycardia with pulses includes adenosine. True / False

Back 135

true

Front 136

What is the initial and subsequent doses of lidocaine in ventricular tachycardia? What is the maximum?

Back 136

1 - 1.5 mg/kg IV/IO then 0.5-0.75 mg/kg IV/IO q 3-5 minutes.
Max = 3 mg/kg

Front 137

Standing order or Medical Control ?
Lidocaine for ventricular tachycardia

Back 137

MC

Front 138

Standing order or Medical Control ?
Lidocaine in VF arrest

Back 138

MC

Front 139

In the VT protocol, Med Control may order ______ for Torsades de Pointes

Back 139

Magnesium sulfate

Front 140

An amiodorone infusion per medical Control would run at ___mg/minute.

Back 140

1 mg/minute

Front 141

CPAP may be used on unconcious patients. True / false

Back 141

false

Front 142

CPAP is useful in patients who are unable to follow commands.
True / False

Back 142

False

Front 143

NTG given sublingually is given at what dose?
_____ mg, which is equal to _____ grains.

Back 143

0.4 mg
1/150 grains

Front 144

Nitropaste can be used per Standing Order
True / False

Back 144

True

Front 145

The length of nitro paste is ____ and it is placed where?

Back 145

1 inch
anterior chest wall

Front 146

Tetracaine is useful in facilitating nasal intubations. True / false

Back 146

False

Front 147

Lasix is administered via Standing Orders in severe cases of CHF. True / false

Back 147

false

Front 148

Placenta previa usually manifests in the _____ trimester of gestation.

Back 148

3rd

Front 149

Common signs of placenta previa include painless bright red vaginal bleeding. True/False

Back 149

true

Front 150

True or false. Glucagon may be administered via the nasal route.

Back 150

true

Front 151

What medications are allowed to be given via Standing Orders in the Acute Pain Management protocol ?

Back 151

morphine
fentanyl