129-145
ALS treatment for envenomation injuries (S-129)
• IV
• Treat per Pain Management Protocol (S-141)
The two meds given for VF/pulseless VT
Amiodarone 300 mg IV/IO, MR 150 mg q3-5 min (max 450 mg)
Lidocaine 1.5 mg/kg IV/IO, MR at 0.5 mg/kg IV/IO q5 min to max 3 mg/kg
BLS Treatment For Inadequate Air Exchange (S-121)
Airway maneuvers (AHA)
• Abdominal thrusts
• Use chest thrusts in obese or pregnant patients
The class for EPI push dose
Sympathomimetic: Catecholamine (both alpha and beta effects)
The powerhouse of the cell.
What is the Mitochondria?
BLS treatment for Heat exhaustion and Heat stroke (S-130)
Heat exhaustion
• Cool gradually
• Fan and sponge with tepid water
• Avoid shivering
• If conscious, give small amounts of fluids
Heat stroke
• Rapid cooling
• Spray with cool water and fan
• Avoid shivering
• Apply ice packs to carotid, inguinal, and axillary regions
The medication given for Unstable Bradycardia with dosage and repeat times
Atropine 1 mg IV/IO, MR q3-5 min to max 3 mg
ALS treatment for symptomatic hypoglycemia and symptomatic hyperglycemia (S-123)
Symptomatic hypoglycemia with altered LOC or unresponsive to oral glucose agents
• Dextrose 25 gm IV if BS <60 mg/dL Ⓐ
• If patient remains symptomatic and BS remains <60 mg/dL, MR Ⓐ
• If no IV, glucagon 1 mL IM if BS <60 mg/dL Ⓐ
Symptomatic hyperglycemia with diabetic history
• 500 mL fluid bolus IV/IO if BS >350 mg/dL or reads “high”, if no rales MR x1
Indications for EPI push dose
(S-126)
(S-127)
(S-127 ROSC) (S-163)
(S-138) (S-168)
(S-143) (S-177)
(S-122) (S-162)
The alternative name for the Citric Acid Cycle
What is the Kreb's Cycle?
Suspected non-cardiac origin treatment for Respiratory Distress (S-136)
Suspected non-cardiac origin
• Albuterol/Levalbuterol 6 mL via nebulizer, MR Ⓐ
• Ipratropium bromide 2.5 mL 0.02% via nebulizer added to first dose of albuterol/levalbuterol
• CPAP 5-10 cmH2O
The rhythms that are an indication for cardioversion
AFIB/Flutter
SVT
VTACH
ALS protocol/treatment for: Suspected anaphylaxis reaction
Suspected anaphylaxis reaction
• Respiratory: throat tightness, hoarse voice, wheezing/stridor, cough, SOB
• Cardiovascular: fainting, dizziness, tachycardia, low BP
• GI: nausea, vomiting, abdominal cramping
• Tissues: angioedema of eyelids, lips, tongue, face
Anaphylaxis treatment
• Epinephrine 1:1,000 (1 mg/mL) 0.5 mg IM, MR x2 q5 min Ⓐ then
• Diphenhydramine 50 mg IV/IM
If respiratory involvement1
• Albuterol/Levalbuterol 6 mL via nebulizer, MR Ⓐ
• Ipratropium bromide 2.5 mL 0.02% via nebulizer added to first dose of albuterol/levalbuterol
Push Dose Epi Mixing Instructions
Push-dose epinephrine mixing instructions
1. Remove 1 mL normal saline (NS) from the 10 mL NS syringe
2. Add 1 mL of epinephrine 1:10,000 (0.1 mg/mL) to 9 mL NS syringe
The mixture now has 10 mL of epinephrine at 0.01 mg/mL (10 mcg/mL) concentration.
This is a conversion from one cell type to another.
Metaplasia
ALS treatment for Shock (S-138)
- Monitor/EKG
• IV/IO Ⓐ
• Capnography PRN
Non-traumatic, hypovolemic shock*
• 500 mL fluid bolus IV/IO, MR to maintain SBP >90 mmHg Ⓐ SBP <90 mmHg after second fluid bolus
• Push-dose epinephrine 1:100,000 (0.01 mg/mL) 1 mL IV/IO, MR q3 min, titrate to SBP ≥90 mmHg
Distributive shock†
• 500 mL fluid bolus IV/IO, MR to maintain SBP >90 mmHg Ⓐ SBP <90 mmHg after second fluid bolus
• Push-dose epinephrine 1:100,000 (0.01 mg/mL) 1 mL IV/IO, MR q3 min, titrate to SBP ≥90 mmHg
Unstable Criteria (S-127)
SBP ˂90 mmHg and exhibiting any of the following signs/symptoms of inadequate perfusion, e.g.,
• Altered mental status (decreased LOC, confusion, agitation)
• Pallor
• Diaphoresis
• Significant chest pain of suspected cardiac origin
• Severe dyspnea
BLS treatment (S-124)
• Move patient to safe environment
• Break contact with causative agent
• Ensure patent airway, O2, and/or ventilate PRN
• O2 saturation PRN
• Treat other life-threatening injuries
• Carboxyhemoglobin monitor PRN, if available
Thermal burns
• For burns <10% BSA, stop burning with nonchilled water or saline
• For burns >10% BSA, cover with dry dressing and keep patient warm
• Do not allow patient to become hypothermic
Toxic inhalation (e.g., CO exposure, smoke, gas)
• Move patient to safe environment
• 100% O2 via mask
• Consider transport to facility with hyperbaric chamber for suspected CO poisoning, particularly in unconscious or pregnant patients
Chemical burns
• Brush off dry chemicals
• Flush with copious amounts of water
Tar burns
• Do not remove tar
• Cool with water, then transport
Epi Push Dose PACS
Packaging
Administration
Cautions and Considerations
Special Info
The parts of the lower airway
Trachea
Bronchial tree
bronchials
alveoli
lungs
Explain BEFAST and FASTED
B = Balance: Unsteadiness, ataxia
E = Eyes: Blurred/double or loss of vision
F = Face: Unilateral face droop
A = Arms and/or legs: Unilateral weakness exhibited by a drift or drop
S = Speech: Slurred, inability to find words, absent
T = Time: Accurate Last Known Well time
F = Facial palsy
A = Arm weakness
S = Speech changes
T = Time
E = Eye deviation
D = Denial/Neglect
The protocol for Supraventricular Tachycardia for a stable(symptomatic) patient
Stable (symptomatic)
• If SBP <90 mmHg and rales not present, 250 mL fluid bolus IV/IO, MR Ⓐ
• VSM
• Adenosine 6 mg rapid IV/IO followed by 20 mL NS rapid IV/IO
• Adenosine 12 mg rapid IV/IO followed by 20 mL NS rapid IV/IO, MR x1
ALS Treatment section of (S-126)
Monitor/EKG
• IV Ⓐ
• Obtain 12-lead EKG
• Repeat 12-lead EKG after arrhythmia conversion or any change in patient condition2
• If STEMI suspected, immediately notify BH, transmit 12- lead EKG to appropriate STEMI receiving center and transport3
• Report LBBB, RBBB or poor-quality EKG
• Aspirin 324 mg chewable PO4,5 Ⓐ
If SBP >100 mmHg
• NTG1 0.4 mg SL, MR q3-5 min Ⓐ
• Treat pain per Pain Management Protocol (S-141)
Discomfort/pain of suspected cardiac origin with associated shock
• 250 mL fluid bolus IV/IO with no rales, MR to maintain SBP >90 mmHg Ⓐ If BP refractory to second fluid bolus
• Push-dose epinephrine 1:100,000 (0.01 mg/mL) 1 mL IV/IO, MR q3 min, titrate to SBP ≥90 mmHg
Name as many protocols that utilize normal saline as a fluid bolus (+10 points for each correct verbatim statement)
(S-120) (S-122) (S-123) (S-124) (S-126) (S-127) (S-130) (S-133) (S-138) (S-139) (S-142) (S-143) (S-144)
The function of the sympathetic nervous system
The sympathetic nervous system (SNS) is a network of nerves that prepares the body for physical activity, stress, and danger. "Fight or Flight" response.