1what are the indictions for hypoglycemia medical directives?
suspected hypoglycemia
2What are the conditions for dextrose ( hypoglycemia)?
≥ 2 years
LOA: altered
other: hypoglycemia
3what are the conditions for glucagon ( hypoglycemia)?
age: N/A OR ≥ 4 years ( IN)
LOA: altered
other: hypoglycemia
4what are the contraindications for dextrose (hypoglycemia)?
allergy/sensitivty
5what are the contraindications for glucagon (hypoglycemia)?
allergy or sensitivity
pheochromocytoma
6Dextrose 10%: what is the route, dose, max single dose, dosing interval, max # doses?
route: IV
dose: 0.2g/kg ( 2ml/kg)
max single: 25 g ( 250 ml)
dosing int: 10 min
max #: 2
7Dextrose 50%: what is the route, dose, max single dose, dosing interval, max # doses?
route: IV
dose: 0.5g/kg ( 1ml/kg)
max single: 25 g ( 50 ml)
dosing int: 10 min
max #: 2
8Glucagon < 25 kg: what is the route, dose, max single dose, dosing interval, max # ?
route: IM
dose: 0.5 mg
max single: 0.5 mg
dosing int: 20 min
max #: 2
9Glucagon ≥ 25 kg: what is the route, dose, max single dose, dosing interval, max # ?
route: IM
dose: 1 mg
max single: 1 mg
dosing int: 20 min
max #: 2
10INTRANASAL Glucagon: route, dose, max single dose, dosing interval, max # doses?
route: IN
dose; 3mg
max single: 3mg
dosing interval: 20 min
Max # : 2
11what are the age paramiter for treat and discharge
≥18 AND <65 years old;
12what are the indications for opioid toxicity and withdrawls?
suspected opioid toxicty
13what are the conditions for naloxene?
age: ≥ 24 hours
loa: altered
RR: < 10 breaths/min
other: inablity to adequately ventilate OR persistent need to assist ventilations
14what are the conditions for bureprhine/naloxone?
age: ≥ 16
LOA: unaltered
other: recived naloxone for current overdose AND acute withdrawal with COWS ≥ 8
15what are the contraindications for naloxone?
allergy/sensitivy
16what are the contraindications for buprenorphine/naloxone?
allergy/sensitivity
taken methadone in last 72 hours
17NALOXONE IV: dose, max single dose, dosing int, max # doses?
dose: up to 0.4 mg
max single: 0.4 mg
int: 5 min
max #: 3
18NALOXONE IM: dose, max single dose, dosing int, max # doses?
dose: up to 0.4 mg
max single: 0.4 mg
int: 5 min
max #: 3
19NALOXONE IN: dose, max single dose, dosing int, max # doses?
dose: 2-4 mg
max single: 2-4 mg
int: 5 min
max #: 3
20NALOXONE SC: dose, max single dose, dosing int, max # doses?
dose: 0.8 mg
max single: 0.8 mg
int: 5 min
max #: 3
21BUPRENORPHINE/NALOXONE: route, inital dose, subsequent dose(s), dosing int, max cumulative?
route: BUC/SL
subsequent dose: 8 mg
int: 10 min
max cumulative: 24 mg
22what are the indications for suspected adrenal crisis?
pt with primary adrenal failure who is experiencing signs of adrenal crisis
23what are the conditions for hydrocortisone ( adrenal crisis)?
Paramedics are presented with a vial of hydrocortisone for the identified patient AND
Age-related hypoglycemia (OR)
GI symptoms (vomiting, diarrhea, abdominal pain) (OR)
Syncope (OR)
Temperature ≥38C or suspected/history of fever (OR)
Altered level of awareness (OR)
Age-related tachycardia (OR)
Age-related hypotension
24what are contraindications for hydrocortisone (adrenal crisis)?
allergy/sensitivty
25HYDROCORTISONE: route, dose, max single dose, dosing int, max # doses?
route: IM/IV
dose: 2mg/kg
max single: 100 mg
int: N/A
max #: 1
26what are the indications for the analgesia medical directive?
pain
27what are the conditions for acetominophen?
age: ≥ 12 years
LOA: unaltered
28what are the contraindications for ibuprofen?
age: ≥ 12 years
LOA: unaltered
29what are the conditions for ketorolac?
age: ≥ 12 years
LOA: unaltered
30what are the 6 contraindications for acetaminophen?
Allergy or sensitivity to acetaminophen
Acetaminophen use within previous 4 hours
Hx of liver disease
Active vomiting
Unable to tolerate oral medication
Suspected ischemic chest pain
31What are the 12 contraindications to ibuprofen?
Allergy or sensitivity to ASA or NSAIDs
NSAID use within previous 6 hours
Patient on anticoagulation therapy
Current active bleeding
Hx of peptic ulcer disease or GI bleed
Pregnant
Asthmatic, no prior use
CVA or TBI in the previous 24 hours
Known renal impairment
Active vomiting
Unable to tolerate oral medication
Suspected ischemic chest pain
32what are the 10 contraindications for ketorolac?
Allergy or sensitivity to ASA or NSAIDs
NSAID use within previous 6 hours
Patient on anticoagulation therapy
Current active bleeding Hx of peptic ulcer disease or GI bleed
Pregnant
asthmatic, no prior use
CVA or TBI in the previous 24 hours
Known renal impairment
Suspected ischemic chest pain
33ACETOMINIPHEN (≥ 12 years to < 18 years): route, dose, max single dose, dosing int, max # doses?
route: PO
dose: 500-650 mg
max single dose: 650 mg
int: n/a
max #: 1
34ACETOMINIPHEN (≥ 18 years): route, dose, max single dose, dosing int, max # doses?
route: PO
dose: 960-1000 mg
max single dose: 1000 mg
int: n/a
max #: 1
35IBUPROFEN: route, dose, max single, dosing int, max # doses?
route: PO
dose: 400 mg
max single: 400 mg
dosing int: n/a
max # : 1
36KETOROLAC: route, dose, max single dose, dosing int, max # doses?
route: IM/IV
dose: 10-15 mg
max single: 15 mg
dosing int: n/a
max #: 1
37what are the indications for nausea/vomiting medical directive?
nausea OR vomiting
38what are the conditions for odansetron?
Weight ≥ 25 kg
LOA:Unaltered
39what are the conditions for dimenhyDRINATE (gravol)?
Weight ≥ 25 kg
LOA:Unaltered
40what are the contraindications for odansetron?
allergy/sensitivity
prolonged QT syndrome
apomorphone use
41what are the contraindications for dimenhyDRINATE (gravol)?
allergy/sensitivity
overdose on antinhistamines OR anticholinergics OR tricyclic antidepressants
co admin with diphenhydramine
42ONDANSETRON: route, dose, max single, dosing int, max # doses?
Route PO / IV* / IM*
Dose: 4 mg
max single: 4 mg
int: n/a
max # : 1
43dimenhyDRINATE (≥25 kg to <50 kg ): route, max single dose, dosing int, max # doses, max cumulitive dose?
route: IV/IM
dose: 25 mg
max single: 25 mg
int: n/a
max # : 1
cumulative: n/a
44dimenhyDRINATE (≥50 kg ): route, max single dose, dosing int, max # doses, max cumulitive dose?
route: IV/IM
dose: 25 OR 50 mg
max single: 50 mg
int: 30 min
max # : 2
cumulative: 50 mg
45If ondansetron is unavailable, assess the risks and benefits to pts ______ for dimenhyDRINATE?
≥ 65 years
46what are the indications for home dialysis emergency disconct?
Patient receiving home dialysis (hemo or peritoneal) and connected to dialysis machine and requires transport to the closest appropriate receiving facility; (AND)
Patient is unable to disconnect;
(AND )
There is no family member or caregiver who is available and knowledgeable in dialysis disconnect.
47What are the conditions and contraindications for home dialysis emergency disconnect?
none
48what are the indications for lateral patellar dislocations?
patient with suspected lateral patellar dislocations
49what are the conditions for a patellar reduction?
age: ≥10 years to ≤50 years
loa: Unaltered
50what are the contraindications for a patellar reduction?
High velocity trauma
Direct knee trauma
51What are the steps to a patellar reduction?
1. pt lying/sitting
2. Gently extend knee while lifting up on patella
3. Simultaneously with 2, have partner apply medial pressure to push the patella inwards
52what are the max patellar reduction attemps?
2
53what are the considerations for seizure treat and discharge?
pt ≥18 AND <65 years old
history of epilepsy
pt is taking anticonvulsants as prescribed
only had one seizure in past 24 hours
seizure pattern same as past ones
pt returned to normal LOC
vitals within normal ranges
AND
seizure is not result fo hypoglycemia + alcohol + substance abuse + withdrwal
pt did not recive midazolam
pt did not injure themselfs
no fever/ilness present
pt not pregnant
54What are the additional criteria to seizure treat and discharge?
responsible adult next 4 hours
pt + substitute decision-makers' questions were answered
pt must follow up with family doctor
clear instructions to call 911
pt has acess to recall 911
consent + discharge