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SNHD Paramedic Adult Protocols
Questions and correct Answers
Sexual Assault Transportation Destinations - ✅<13 y/o= Sunrise 13-18 y/o= Sunrise or UMC
18 y/o= UMC Waiting Room Criteria - ✅HR= 60-100 // RR= 10- SBP= 100-180 // DBP= 60- SPO02= >94% // AOX Received only 1 single dose of analgesia and or anti-emetic Does not require EKG monitoring Maintains a sitting position General Adult Trauma Assessment: GCS <8 - ✅- Ventilation Management BVM if SPO2 <
- No palpable pulse= IV, 1L NS
- Secondary Assessment
- Pain management General Adult Trauma Assessment: GCS >8 - ✅- Keep SPO2 >94%
- IV
- Secondary Assessment
- Pain management Treatment for suspected TBI - ✅Raise head of bed 30 degrees and maintain ETCO2 at 35 Adult abdominal/ flank pain, N/V - ✅12 lead EKG if age 35 or older Adult abdominal/ flank pain, N/V with signs of hypovolemia - ✅IV 500ml NS bolus; up to 2000ml Adult abdominal/ flank pain, N/V with nausea/ vomiting -
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✅Zofran 4mg ODT/IM/IV Droperidol 1.25mg IM/IV/IO Adult abdominal/ flank pain, N/V consider these 2 things.. - ✅ACS and chest pain Adult Allergic Reaction with no airway involvement - ✅- IV
- Benadryl 50mg IM/IV
- Reassess in 5 min Adult Allergic Reaction with airway involvement - ✅- Epi 1:1,000 0.5mg IM may repeat in 15 min up to max 1.5mg
- Albuterol 2.5mg SVN repeat as needed
- Ventilation management
- Cardiac monitor
- IV= 500-2000L NS
- Benadryl 50mg IM/IV Adult Allergic Reaction pt in shock - ✅- Epi 1:1,000 0.5mg IM may repeat in 15 min up to max 1.5mg
- Albuterol 2.5mg SVN as needed
- Cardiac monitor
- IV= 500-2000L NS
- Benadryl 50mg IM/IV
- Push dose epi 5-10mcg IV, may repeat in 2-5 min to maintain SBP > Adult Allergic Reaction Severities - ✅- Mild= involve skin rashes, itchy sensation, or hives with no respiratory involvement
- Moderate= skin disorders and may include some respiratory involvement like wheezing, yet pt still maintains good tidal volume
- Severe= skin disorders, respiratory difficulty and may include hypotension Adult AMS/ Syncope with BGL <60 - ✅- Oral glucose if pt is awake
- D10, 25g IV may repeat x1 in 5 min
- Glucagon 1mg IM for no IV access Adult AMS/ Syncope with BGL >60 - ✅- Cardiac monitor
- Consider NS 500-2000ml Adult AMS/ Syncope: unresponsive with respiratory depression and suspected narcotic OD -
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Adult Burns: Thermal Exposure - ✅- Stop the burning process with saline
- Ventilation management
- Cover with DRY sterile dressing
- IV
- NS 500-2000ml fluid bolus if signs of hypoperfusion or >10% BSA
- Cardiac monitor
- Pain management Adult Burns: Chemical/ Electrical Exposure - ✅- Cardiac monitor
- Eye involvement= flush 10-15 min
- IV
- NS 500-2000ml fluid bolus if signs of hypoperfusion or 10% BSA
- Pain management Burn Classifications - ✅1) superficial (1st degree)- epidermis/ red and painful
- partial thickness (2nd degree)- dermis & epidermis/ blistering
- full thickness (3rd degree)- subcutaneous layer and all layers above (don't irrigate it. Painless, charred or leathery skin Adult Burn: CO exposure - ✅- Treat with 100 O
- If primary event was inhalation of O2, transport to ER equipped with a hyperbaric chamber Adult Burn: BSA Chart - ✅- Head and arms= 9%
- Front torso= 18%
- Back= 18%
- Legs= 18%
- Groin= 1% Adult Burn: Transport Criteria - ✅2nd or 3rd degree burns >20% BSA 2nd or 3rd degree burns >10% BSA in pts under 10 y/o or over 50 y/o Adult Burn: Parkland Formula -
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✅4ml x kg x BSA %= total fluids in 24hrs Give 1/2 the first 8 hours, remainder over next 16 hours H's - ✅Hypovolemia- volume infusion Hypoxia- O2/ventilation, CPR Hydrogen Ion- Ventilation, CPR Hypo/er K- Calcium, glucose, bicarb, albuterol Hypothermia- warming T's - ✅Tension Pneumo- needle decompression Tamponade, cardiac- volume infusion Toxins- agent specific antidote Thrombosis, pulmonary- volume infusion Thrombosis, coronary- Emergent PCI Adult Chest Pain/ Suspected ACS: Non-diagnostic 12 lead EKG - ✅- EKG within 5 min of pt contact
- IV
- O2/ SPO2 >94%
- ASA 324mg PO
- NTG 0.4mg SL, may repeat in 5 min x
- Pain management
- Zoran 4mg ODT/IM/IV
- Droperidol 1.25mg IM/IV/IO Childbirth/ Labor: Normal Presentation - ✅- Puncture sac if not yet broken
- Deliver/ support head
- Suction mouth then nose
- Deliver upper shoulder then lower
- Delivery remainder of the baby
- Clamp/ cut cord
- Deliver placenta
- Attempt IV Childbirth/ Labor: Limb Presentation - ✅- Place pt in left lateral recumbent
- IV
- Transport
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Heat Stroke - ✅- High body temp >104, hot dry skin, hypotension, AMS, coma
- Airway as indicated
- AMS as indicated
- Active cooling
- IV 500-2000ml to effect SBP >
- Cardiac Monitor Heat Cramps - ✅Benign muscle cramping caused by dehydration and is not associated with an elevated temp Heat Exhaustion - ✅Consists of dehydration, salt depletion, dizziness, fever, AMS, HA, cramping, N/V. V/S usually consist of tachycardia, hypotension, elevated temp Heat Stroke - ✅Consist of dehydration, tachycardia, hypotension, temperature >104F (40C) and AMS Active Cooling Measures - ✅Cold packs Ice Fanning AC Adult Hyperkalemia - ✅- Cardiac monitor/ 12 lead EKG
- Albuterol 2.5mg in 3.0ml continuous SVN
- Calcium Chloride 1.0g slow IVP
- Bicarb 1.0 mEq/kg slow IVP What is contraindicated if a pt is taking Dig? - ✅Calcium Chloride Hyper-K is defined as a potassium level higher than what amount? - ✅5.5 mmol/L Potassium levels at what level will cause tall tented T waves? - ✅5.5-6.5 mmol/L Potassium levels at what level will cause a loss of P waves? - ✅6.5- 7.5 mmol/L Potassium levels at what level will cause widening QRS? -
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✅7.5-8.5 mmol/L Potassium levels at what level will continue to cause QRS widening approaching the sine wave? - ✅>8.5 mmol/L Adult Pregnancy: Exhibiting Seizures - ✅- Mag Sulfate 4.0g in 50cc over 10 min
- If refractory to Mag, give Versed 0.1mg/kg IN/IM/IV/IO may repeat in 5 min at 0.05mg/kg OR
- Diazepam 5mg IV; may repeat in 5 min; additional doses require orders Adult Pregnancy: Exhibiting Pre-Eclampsia - ✅- Mag Sulfate 2g in 50cc over 10 min
- Transport to appropriate facility What indicates pre-eclampsia? - ✅- Severe HA
- Vision changes
- RUQ pain In the setting of pregnancy, HTN is defined as what? - ✅- SBP >140 or DBP >
- Relative increase of 30 systolic and 20 diastolic from pts normal pre-pregnancy BP Adult OD/ Poisoning: Opiate OD - ✅- Airway
- IV
- Cardiac monitor
- Narcan 2mg IN/IM/IV may repeat to a max dose of 10mg
- Reassess and transport Adult OD/ Poisoning: Cyanide - ✅- Airway
- IV
- Cardiac monitor
- Hydroxocobalamin 5.0g IV over 15 min if available
- Reassess and transport Adult OD/ Poisoning: Dystonic Reaction -
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Acetaminophen S/S - ✅- Initial y normal or N/V
- Tachypnea and AMS may occur later
- Renal dysfunction
- Liver failure or cerebral edema may manifest Depressants S/S - ✅- Decreased HR
- Decreased BP
- Decreased temp
- Decreased RR Anticholinergics S/S - ✅- Increased HR
- Increased temp
- Dilated pupils
- AMS changes Insecticides S/S - ✅- May include S/S of organophasphate poisoning Solvents S/S - ✅- N/V
- Cough
- AMS Stimulants S/S - ✅- Increased HR
- Increased temp
- Dilated pupils
- Seizures
- Possible violence TCA S/S - ✅- Decreased mental status
- Dysrhythmias
- Seizures
- Hypotension
- Coma/ Death Adult Pain Management: Ketamine - ✅Ketamine 0.2mg/kg IM/IN/ IV/ IO No repeat dose
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Adult Pain Management: Morphine - ✅Morphine 0.1mg/kg IM/IV; max single dose 10mg
- May repeat dose in 10 min after the first until pain relieved or respiratory depression occurs Adult Pain Management: Fentanyl - ✅Fentanyl 1.0 msg/kg IN/IM/IV; max single dose 100mcg
- May repeat dose after 10 min Adult Pain Management: Hydromorphone - ✅Hydromorphone 0.01mg/kg IM/IV; max single dose 1.0mg
- May repeat dose after 10 min Adult Pulmonary Edema/ CHF: Hypotensive SBP <100mmHg - ✅- Airway
- Keep O2 >94% // ETCO
- Consider CPAP
- 12 lead EKG
- BP reassessment
- Signs of cariogenic shock??
- Dopamine 5-20mcg/kg/min; titrate to SBP >100mmHg Adult Pulmonary Edema/ CHF: Normotensive SBP >100mmHg - ✅- Airway
- Keep O2 >94% // ETCO
- Consider CPAP
- 12 lead EKG
- BP reassessment
- NTG 0.4mg SL; may repeat in 5 min as long as HR >60 and SBP >100mmHg Adult Pulmonary Edema/ CHF: Hypertensive DBP >100mmHg - ✅- Airway
- Keep O2 >94% // ETCO
- Consider CPAP
- 12 lead EKG
- BP reassessment
- NTG 1.6mg SL; may repeat in 5 min for DBP >100mmHg What effects will Dopamine have when administered at 2-10mcg/kg/min? - ✅- Increases myocardial contractility and HR
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- Diazepam 5.0mg IM/IN/IV/IO Actively seizing and not>20 weeks pregnant or <6 weeks postpartum and BGL <60 - ✅- D10 25g IV; may repeat x1 in 5 min
- Glucagon 1.0mg IM for no IV access IF PERSISTENT/RECURRENT SEIZURE
- Glucose retest
- Ventilation Management
- IV
- Cardiac monitor
- Midazolam 0.1mg IM/IN/IV/IO up to max 5.0mg OR
- Diazepam 5.0mg IM/IN/IV/IO Status Epilepticus Seizure - ✅Two or more seizures successively without an intervening lucid period, or a seizure lasting over 5 minutes Grand Mal Seizure - ✅Associated with loss of consciousness, incontinence, and oral trauma Focal Seizure - ✅Affect only part of the body and are not usually associated with a loss of consciousness Adult Shock: Non-Trauma, Non-cardiogenic - ✅- Keep SPO2 >94%
- IV/ cardiac monitor/ ETCO -NS bolus 1000ml; may repeat x1 with no rales on lung exam
- Push dose Epi 1:10,000 5-10mcg IV may repeat in 2-5 min to maintain SBP > OR
- Dopamine 5-20mcg/kg/min; titrate to SBP >
- Obtain capnography waveform Adult Shock: Cardiogenic - ✅- Keep SPO2 >94%
- IV/ cardiac monitor/ ETCO
- NS bolus 500ml; if no rales on lung exam, may repeat x
- Push dose Epi 1:10,000 5-10mcg IV may repeat in 2-5 min to maintain SBP > OR
- Dopamine 5-20mcg/kg/min; titrate to SBP >
- Obtain capnography waveform What are some causes of hypovolemic shock? -
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✅Hemorrhage, trauma, GI bleeding, ruptured aortic aneurysm, or pregnancy related bleeding What are some causes of cardiogenic shock? - ✅Heart failure, MI, cardiomyopathy, myocardial contusion, toxins What are some causes of distributive shock? - ✅Sepsis, anaphylaxis, neurogenic, toxins What are some causes of obstructive shock? - ✅Pericardial tamponade, pulmonary embolus, tension pneumo What are some causes of adrenal insufficiency? - ✅- Addisons disease
- Congenital Adrenal Hyperplasia
- Long term administration of steroids Adult Smoke Inhalation - ✅- O2 100% NRB
- Ventilation management
- Cardiac monitor
- IV/ NS bolus 500ml up to max 2000ml for hypoperfusion IF CARDIAC ARREST OF PROFOUND AMS....
- Hydroxocobalamin 5.0g IV over 15 min
- Transport to UMC Trauma Adult STEMI - ✅- 12 lead EKG within 5 min of pt contact
- IV
- Keep SPO2 >94%
- ASA 324mg PO
- NTG/ 0.4mg SL may repeat in 5 min x
- Pain management
- Consider anti-emetic for N/V Zofran 4mg ODT/IM/ IV OR Droperidol 1.25mg IM/IV/IO Adult Stroke: RACE= 1-4 - ✅- BGL
- Document last known normal and a witness with phone number
- Perform and document RACE score
- BGL 60-400 rapid transport to approved stroke center
- Tele
- IV/ cardiac monitor/ 12 lead EKG
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- Consider sedation; Etomidate 0.15mg/kg IV Adult Stable Tachycardia: Normal mental status, palpable radial pulse Wide Complex >0.12 sec Torsades - ✅- Cardiac monitor/ 12 lead
- IV
- Mag Sulfate 2gm IV in 50cc NS over 10 min
- Defib @ 200, 300, 360
- Consider sedation; Etomidate 0.15mg/kg IV Adult Unstable Tachycardia: Mental staus changes and no palpable pulse Narrow Complex <0.11 sec - ✅- Cardiac monitor
- IV
- Adenosine 12mg rapid IVP
- Synchronized cardioversion; consider sedation Etomidate 0.15mg/kg IV
- Repeat cardioversion and assess need for sedation
- Transport Adult Unstable Tachycardia: Mental staus changes and no palpable pulse Torsades - ✅- Cardiac monitor
- IV
- Defib; consider sedation Etomidate 0.15mg/kg IV
- Mag Sulfate 2gm IV in 50cc in 10 min
- Repeat defib and assess need for sedation Adult Unstable Tachycardia: Mental staus changes and no palpable pulse Monomorphic VT - ✅- Cardiac monitor
- IV
- Synchronized cardioversion @ 100; consider sedation Etomidate 0.15mg/kg IV
- Amiodarone 150mg in 50cc over 10 min
- Repeat cardioversion or defib if VT not resolved; assess need for repeat sedation Adult Target Temperature Management/ Post Resuscitation
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ROSC with pt unresponsive to voice or pain - ✅- 12 lead EKG
- Cardiac monitor
- SPO2/ ETCO
- IV
- Neuro exam
- Expose; ice packs to axilla and groin
- Cold NS 250ml/hr up to 1L
- Maintain ETCO2 at approx 40mmHg
- Dopamine 5-20mcg/kg/min PRN titrate SBP >
- Transport to approved hypothermia Center What are the approved hypothermia centers in SNV? - ✅Centennial Hills Desert Springs Mtn. View St. Rose Campuses Spring Valley Summerlin Sunrise Valley UMC What are the criteria for hypothermia resuscitation? - ✅- >18 y/o
- Temp S/P ROSC >34C (93F)
- No purposeful response to voice/ pain
- BGL >
- Sustained ETCO2 waveform in place
- Cardiac arrest not due to trauma
- Not pregnant Adult Ventilation Management - ✅- Basic airway maneuvers
- Jaw thrust/ head tilt chin lift
- NPA/ OPA as needed
- Suction as needed
- Consider C-spine
- Consider AMS/ Syncope
- O2 // BVM as needed
- Consider sedation Etomidate 0.3mg/kg IV OR Ketamine 2mg/kg IV or 4mg/kg IM How do you maintain sedation according to the ventilation management protocol? - ✅- Midazolam 0.1mg/kg IV/IN/IM;
