Emergency Medical Response Quiz
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Questions and Answers

What is the first action an EMT-Basic provider should take in response to a patient in ventricular fibrillation?

  • Attempt two IV accesses before considering EZ-IO
  • Defibrillate at 360 J immediately
  • Begin CPR for five minutes before any intervention
  • Administer Epinephrine 1:10,000 1 mg IV (correct)

    • When should a paramedic provider resume defibrillation at 360 J?

  • After every two (2) minutes of CPR (correct)
  • Only when the patient regains a pulse
  • After every 5 minutes of CPR
  • After assessing the patient's blood pressure

    • In the case of persistent or recurrent VF/VT, what should the paramedic provider prioritize?

  • Resume CPR and begin simultaneous therapy if there is a known treatable cause (correct)
  • Perform a rapid sequence intubation
  • Administer calcium gluconate immediately
  • Wait for advanced airway placement before administering medications

    • What is the dose of Epinephrine given by a paramedic provider for cardiac arrest?

    <p>1 mg IV every 3-5 minutes</p> Signup and view all the answers

    What consideration should be made if the cardiac arrest is due to beta blocker overdose?

    <p>Consider administering 3-5 mg of Epinephrine</p> Signup and view all the answers

    Which of the following is true regarding atropine's effectiveness in treating bradyarrhythmias?

    <p>Atropine may be ineffective for Second-degree Type II AVB.</p> Signup and view all the answers

    What is the recommended initial rate for transcutaneous pacing (TCP)?

    <p>60-80 bpm</p> Signup and view all the answers

    Which medication can be given at a dosage of 1-2 mg/kg IV/IO for bradycardia management?

    <p>Ketamine</p> Signup and view all the answers

    What is the maximum dose of Midazolam that can be administered if SBP is less than 100?

    <p>No dose should be administered</p> Signup and view all the answers

    What position should be preferred for a patient experiencing symptomatic bradycardia?

    <p>Modified Trendelenburg position</p> Signup and view all the answers

    What initial action should be taken if resuscitation should not be attempted?

    <p>Assess for evidence that resuscitation should not be attempted</p> Signup and view all the answers

    Which device should be used when available, as soon as possible during resuscitation?

    <p>LUCAS 2 device</p> Signup and view all the answers

    In adult resuscitation, what is the recommended dosage of Epinephrine for Advanced EMT Providers?

    <p>1 mg IV</p> Signup and view all the answers

    When performing chest compressions, what is the recommended use of patient therapy pads?

    <p>Apply them in line with the goal of consistent shocks</p> Signup and view all the answers

    What is the initial management for adult hypovolemia according to the guidelines?

    <p>Provide NS 10-20 mL/kg up to 1 L</p> Signup and view all the answers

    Which of the following should be monitored continuously during resuscitation?

    <p>EtCO2 and ECG</p> Signup and view all the answers

    For a patient experiencing anaphylaxis during cardiac arrest, what is the appropriate Epinephrine dosage to consider?

    <p>3-5 mg IV</p> Signup and view all the answers

    What position should a pregnant patient over 20 weeks gestation be placed in during resuscitation?

    <p>On her right side with a wedge cushion</p> Signup and view all the answers

    What is the correct first step in managing a newborn during resuscitation?

    <p>Dry and warm the newborn</p> Signup and view all the answers

    Which of the following indicates the need for suctioning in a newborn resuscitation scenario?

    <p>Apnea or gasping respirations</p> Signup and view all the answers

    When using power suction on a newborn, what is the maximum negative pressure that should not be exceeded?

    <p>100 mm Hg</p> Signup and view all the answers

    What is an essential action to stimulate a newborn to breathe during resuscitation?

    <p>Gentle tapping on the back</p> Signup and view all the answers

    What is the purpose of developing a treatment plan during newborn resuscitation?

    <p>To base actions on assessment findings and available resources</p> Signup and view all the answers

    In a hyperkalemic arrest, what is the primary treatment focus for all providers?

    <p>Reducing potassium levels</p> Signup and view all the answers

    Which medication is commonly considered in the management of hyperkalemic cardiac arrest?

    <p>Calcium gluconate</p> Signup and view all the answers

    What is a potential complication if hyperkalemic arrest is not promptly managed?

    <p>Reduced cardiac output</p> Signup and view all the answers

    Which of the following actions is NOT typically included in the management of a patient experiencing hyperkalemic arrest?

    <p>Using high-dose epinephrine</p> Signup and view all the answers

    Which clinical finding is most indicative of hyperkalemic arrest?

    <p>Wide QRS complexes</p> Signup and view all the answers

    What is the oxygen therapy goal for patients experiencing acute coronary syndrome?

    <p>Maintain SaO₂ of ≥ 94%</p> Signup and view all the answers

    Which medication should be administered to a patient over 18 years old with no aspirin allergies?

    <p>324 mg of baby aspirin</p> Signup and view all the answers

    What is the first intervention for a patient in respiratory distress?

    <p>Provide oxygen at 10-15 LPM via non-rebreather mask</p> Signup and view all the answers

    In which scenario should a paramedic not administer nitroglycerin?

    <p>If the patient has taken erectile dysfunction medications within 24 hours</p> Signup and view all the answers

    When should a 12-lead ECG be obtained in the management of acute coronary syndrome?

    <p>If signs of inferior MI are present</p> Signup and view all the answers

    What is the maximum dosage of Fentanyl Citrate for persistent pain management after the initial dose?

    <p>300 mcg</p> Signup and view all the answers

    What is the preferred method of IV access prior to administering nitrates?

    <p>IV access via peripheral vein</p> Signup and view all the answers

    What should be done if ST segment elevation is identified during a patient's ECG?

    <p>Notify the receiving facility and consider a STEMI Alert</p> Signup and view all the answers

    What is a possible medication choice for significant anxiety in patients with acute coronary syndrome?

    <p>Midazolam 0.5-2 mg IV</p> Signup and view all the answers

    What is the initial management step when addressing a patient’s chest pain using the O-P-Q-R-S-T mnemonic?

    <p>Ask the patient to describe the pain</p> Signup and view all the answers

    What is the preferred action regarding IV access prior to administering nitrates?

    <p>Obtain IV access before administering nitrates if possible</p> Signup and view all the answers

    Which of the following treatments is recommended for a patient exhibiting significant bronchospasm/wheezing?

    <p>Albuterol 2.5 mg nebulized</p> Signup and view all the answers

    What is the maximum dose of furosemide administered IV to a patient not previously prescribed daily furosemide, assuming SBP >100 mmHg?

    <p>120 mg</p> Signup and view all the answers

    What should be monitored after applying CPAP therapy to a patient with SBP >100 mmHg?

    <p>Blood pressure for hypotension</p> Signup and view all the answers

    What is the purpose of administering ondansetron to a patient?

    <p>To manage nausea and vomiting</p> Signup and view all the answers

    For a patient with ST segment elevation and suspected MI, what is the recommended action regarding transport?

    <p>Notify and transport rapidly to a facility with a cardiac Cath lab</p> Signup and view all the answers

    What type of monitoring is essential during continuous treatment of patients experiencing heart issues?

    <p>Continuous ECG &amp; EtCO2 monitoring</p> Signup and view all the answers

    What is the initial dose and method of administration for nitroglycerin during symptom persistence with an SBP >100 mmHg?

    <p>0.4 mg SL every 5 minutes</p> Signup and view all the answers

    What is the recommended first step in initial scene and patient management for cardiac arrest?

    <p>Focused history and physical exam</p> Signup and view all the answers

    Which intervention should be performed if the patient is pregnant and over 20 weeks gestation?

    <p>Displace the uterus using a wedge-shaped cushion</p> Signup and view all the answers

    What should be done if a cardiac arrest is due to hypoglycemia?

    <p>Administer D10% IV fluids</p> Signup and view all the answers

    What is a key consideration for utilizing the LUCAS 2 device?

    <p>It must be used as soon as possible when available</p> Signup and view all the answers

    For an adult patient in cardiac arrest from hypovolemia, what is the suggested initial fluid administration?

    <p>NS 10-20 mL/kg up to 1 L</p> Signup and view all the answers

    What should be monitored continuously during a cardiac arrest resuscitation?

    <p>ECG and EtCO₂ levels</p> Signup and view all the answers

    What is the correct dose of Epinephrine for Advanced EMT Providers during cardiac arrest?

    <p>1 mg IV</p> Signup and view all the answers

    Which of the following conditions requires simultaneous therapy during resuscitation according to the management protocol?

    <p>Known treatable causes including hypoxia and hypovolemia</p> Signup and view all the answers

    What is the initial dose and administration method for Adenosine in an adult patient with tachycardia that does not respond to vagal maneuvers?

    <p>6 mg rapid IV push followed by a 10-20 mL NS flush</p> Signup and view all the answers

    Which medication is administered for chemical conversion of narrow complex PSVT if the SBP is greater than 100 mmHg?

    <p>Diltiazem 0.25 mg/kg slow IV</p> Signup and view all the answers

    If an infant in tachycardia does not respond to vagal maneuvers, what is the maximum single dose of Adenosine that can be administered?

    <p>6 mg</p> Signup and view all the answers

    What is the initial energy dose for synchronized cardioversion in an unstable patient?

    <p>0.5 – 1 J/kg</p> Signup and view all the answers

    For patients requiring Amiodarone in situation of tachycardia, what is the maximum amount that can be infused over 10 minutes?

    <p>150 mg</p> Signup and view all the answers

    If a pediatric patient weighing less than 37 kg presents with symptoms unresponsive to vagal maneuvers and adenine, what is the recommended Amiodarone dose?

    <p>5 mg/kg in 100 mL D5W</p> Signup and view all the answers

    Which condition warrants immediate synchronized cardioversion?

    <p>Unstable patient showing shock</p> Signup and view all the answers

    What is the maximum administration frequency for Diltiazem if there is no response after the initial dose and the SBP remains over 100 mmHg?

    <p>Every 10 minutes</p> Signup and view all the answers

    If a patient is being administered Midazolam for sedation prior to cardioversion, what is the maximum total dose that can be given?

    <p>5 mg</p> Signup and view all the answers

    What is the definition of tachycardia in terms of heart rate for infants?

    <p>Greater than 220 bpm</p> Signup and view all the answers

    Study Notes

    Ventricular Fibrillation / Pulseless Ventricular Tachycardia

    • EMT-Basic Provider for adults should attempt IV access, then EZ-IO, and administer Epinephrine 1:10,000 1 mg IV.
    • Paramedic Provider for adults should defibrillate with 360 J and reassess rhythm.
    • If persistent VF/VT in adults, CPR and simultaneous therapy should be initiated if the arrest is from a treatable cause.
    • Epinephrine 1 mg IV should be repeated every 3-5 minutes for adults remaining pulseless.
    • Defibrillation should be performed at 360 J after every 2 minutes of CPR while in VF/pVT for adults.

    Pediatric Bradycardia (Symptomatic)

    • Initial Scene and Patient Management per system Core Principles
    • Focused history and physical exam
    • Develop and implement a treatment plan based on assessment findings, resources, and training
    • Atropine may be ineffective for certain bradycardias
    • Modified Trendelenburg position with appropriate airway management and potential spinal cord injury precautions
    • Patient warmth
    • Pediatric patient (60 mmHg, max 30 mcg/min)

    Acute Coronary Syndromes (ACS) - Acute Myocardial Infarction

    • Initial Scene and Patient Management per system Core Principles
    • Focused history and physical exam
    • Ask patient to describe the pain using the O-P-Q-R-S-T mnemonic
    • Determine if the patient has taken erectile dysfunction medications such as Viagra, Levitra, or Cialis within the last 24 hours
    • Develop and implement treatment plan based on assessment findings, resources, and training
    • Administer oxygen
    • 2-6 LPM via NC if no associated respiratory distress
    • 10-15 LPM via non-rebreather mask for respiratory distress
    • Oxygen therapy goal is to maintain SaO₂ of ≥ 94%

    Adult - Acute Coronary Syndromes (ACS) - Acute Myocardial Infarction

    • EMT-Basic Provider should apply a 12-lead ECG if trained and in presence of a Paramedic. They should also administer 324 mg baby aspirin PO if the patient is >18 years old and has no allergies to aspirin.
    • Do not administer aspirin if the patient has taken Warfarin (Coumadin) within 24 hours
    • Early notification & rapid transport to the appropriate facility with a functioning cardiac Cath Lab if the patient presentation and history are suggestive of MI.
    • Advanced EMT Provider should establish vascular access and fluid therapy per Resuscitation and Perfusion Core Principle. IV access prior to nitrates is preferred, if possible.
    • Paramedic Provider should administer nitroglycerin SL every 5 minutes, as long as symptoms persist and SBP >100 mmHg.
    • Do not administer nitroglycerin if the patient (male or female) has taken erectile dysfunction medications within 24 hours.
    • Obtain a 12-lead ECG (Right sided 12-Lead strongly recommended if Inferior MI)
    • If ST segment elevation is observed, early notification (STEMI Alert) and rapid transport to the appropriate facility with a functioning cardiac Cath Lab is indicated.
    • If possible, transmit the 12-lead to the receiving facility
    • When possible, obtain a 12-lead ECG prior to nitroglycerin therapy
    • Administer Normal Saline 250-1000 mL IV over 15 minutes to increase preload if signs of right-sided (Inferior, Posterior or Right Ventricular wall) MI's are present.
    • Administer Fentanyl Citrate 1 mcg/kg; repeat after 15 min if ineffective (300 mcg max) for persistent pain following nitroglycerin SL therapy if SBP remains >100 mmHg.
    • Administer Morphine Sulfate 2 - 20 mg (5 mg max increments) IV titrated to effect for persistent pain following nitroglycerin SL therapy if SBP remains >100 mmHg (IF STOCKED)
    • Administer Ondansetron 4 mg IV over 1-2 minutes (may dilute with 8 ml NS for ease of push) or IM undiluted; repeat dose X 1 in 10 minutes if ineffective for 8mg max.
    • Continuous ECG, and vitals monitoring
    • Administer Nitroglycerin IV (Tridil) 10-20 mcg/min increase by 5-10 mcg/min q 5 min till desired effect and SBP >100 mmHg.Max dose 200 mcg/min.Contact OLMC for higher dosing PRN.

    Pediatric ( < 37 kg) - Acute Coronary Syndromes (ACS) - Acute Myocardial Infarction

    • Initial Scene and Patient Management per system Core Principles
    • Focused history and physical exam
    • Develop and implement a treatment plan based on assessment findings, resources, and training
    • Administer oxygen 2-6 LPM via NC if no associated respiratory distress
    • 10-15 LPM via non-rebreather mask for respiratory distress
    • Oxygen therapy goal is to maintain SaO₂ of ≥ 94%

    Pediatric ( <= 10 kg) - Acute Coronary Syndromes (ACS) - Acute Myocardial Infarction

    • Initial Scene and Patient Management per system Core Principles
    • Focused history and physical exam
    • If possible, history should be obtained from a parent or caregiver
    • Develop and implement a treatment plan based on assessment findings, resources, and training
    • Administer oxygen
    • 2-6 LPM via NC if no associated respiratory distress
    • 10-15 LPM via non-rebreather mask for respiratory distress
    • Oxygen therapy goal is to maintain SaO₂ of ≥ 94%

    Cardiac Arrest Universal Management

    • Focused history and physical exam
    • Assess for evidence that resuscitation should not be attempted
    • Spinal motion restriction per algorithm (as indicated)
    • Develop and implement treatment plan based on assessment findings, resources, and training
    • Airway, ventilations, compression, and defibrillation per Resuscitation and Perfusion Core Principle
    • Patient warmth
    • Assess blood glucose level
    • Pregnancy >20 weeks gestation
    • If able, displace Place a wedge-shaped cushion or multiple pillows under patient's right hip
    • Apply AED and follow prompts
    • Utilize LUCAS 2 device when available as soon as possible
    • For manual defibrillators
    • Apply ECG electrodes during initial chest compressions if resuscitation attempts will take place
    • Apply patient therapy pads - in keeping in line with the goal of consistent shocks with minimal interruption of compressions
    • Adhesive hands free pads are recommended over traditional paddles

    Adult - Cardiac Arrest Universal Management

    • EMT-Basic Provider should administer Epinephrine 1:10,000 1 mg IV after attempting IV access, and then EZ-IO.
    • Advanced EMT Provider should administer Epinephrine 1:10,000 1 mg IV after attempting IV access, and then EZ-IO.
    • Paramedic Provider should administer Epinephrine 1 mg IV. If arrest is from a beta blocker overdose or anaphylaxis, consider 3-5 mg. Repeat every 3 - 5 minutes as long as the patient remains pulseless and initiate simultaneous therapy if arrest is from a known treatable cause 5 H's & 5 T's.
    • 5 H's & 5 T's:
    • Hypoxia - Oxygenation and Ventilation
    • Hypothermia - Warm
    • Hypovolemia - NS 10-20 mL/kg up to 1 L initially
    • Hypoglycemia - D10% 50-100 mL (5-10 Gm) IV, repeat PRN
    • Hyperkalemia see Hyperkalemic arrest
    • Tension (pneumothorax) - chest decompression
    • Tablet (OD) -
      • Calcium channel blocker - Calcium chloride 5-10 mL (500mg-1 Gm) May repeat in 10 minutes if no response is observed
      • Opioid - Naloxone 2 mg
    • Continuous ECG & EtCO2 monitoring

    Pediatric (< 37 kg) - Cardiac Arrest Universal Management

    • Focused history and physical exam (if possible, history should be obtained from a parent or caregiver)
    • Assess for evidence that resuscitation should not be attempted
    • Spinal motion restriction per algorithm (as indicated)
    • Develop and implement treatment plan based on assessment findings, resources, and training
    • Airway, ventilations, compression, and defibrillation per Resuscitation and Perfusion Core Principle
    • Patient warmth
    • Assess blood glucose level
    • Displacement - If able, place a wedge-shaped cushion or multiple pillows under the patient’s right hip
    • Apply AED and follow prompts
    • Utilize LUCAS 2 device when available as soon as possible
    • For manual defibrillators
    • Apply ECG electrodes during initial chest compressions if resuscitation attempts will take place.
    • Apply patient therapy pads - in keeping in line with the goal of consistent shocks with minimal interruption of compressions.
    • Adhesive hands-free pads are recommended over traditional paddles.

    Ventricular Tachycardia or Wide-Complex of Unknown Type (with pulses)

    • Initial Scene and Patient Management per system Core Principles
    • Focused history and physical exam
    • Develop and implement a treatment plan based on assessment findings, resources, and training

    Adult - Ventricular Tachycardia or Wide-Complex of Unknown Type (with pulses)

    • EMT-Basic Provider - follow the core principle of vascular access and fluid therapy.
    • Advanced EMT Provider - follow the core principle of vascular access and fluid therapy.
    • Paramedic Provider - follow the core principle of vascular access and fluid therapy.

    Pediatric (< 37 kg) - Ventricular Tachycardia or Wide-Complex of Unknown Type (with pulses)

    • EMT-Basic Provider - follow the core principle of vascular access and fluid therapy.
    • Advanced EMT Provider - follow the core principle of vascular access and fluid therapy.
    • Paramedic Provider - follow the core principle of vascular access and fluid therapy.

    Hemodynamically stable Monomorphic - Ventricular Tachycardia or Wide-Complex of Unknown Type (with pulses)

    • Obtain a 12-lead ECG if time and patient condition permit.
    • Only if regular and monomorphic rhythm
    • Administer Adenosine 6 mg rapid IV push followed by a rapid 10 mL flush of NS.
    • Following 1-2 minutes with no conversion, administer a second dose of Adenosine 12 mg.
    • Administer Amiodarone 150 mg in 100 mL to D5W or NS IV infusion over 10 minutes. May repeat the same dose and method every 10 minutes to a MAX of 450 mg.
    • If conversion occurs, administer Amiodarone 1 mg/min (set pump to 33 mL/hr) to prepare a mix of 450 mg in 250 mL D5W.

    Hemodynamically UNSTABLE - Ventricular Tachycardia or Wide-Complex of Unknown Type (with pulses)

    • If patient condition permits, administer Magnesium Sulfate 50% 1-2 Gm (2-4 mL of 50% solution) mix in 10 mL D5W slow IV push at 1 Gm/min, if SBP >100 mmHg. May repeat the same dose every 5 minutes until a maximum of 4 grams is reached.
    • Large doses (i.e., up to 8-10 Gm) of magnesium may be required to suppress arrhythmia. Contact OLMC for further magnesium therapy
    • Administer Midazolam (Do NOT administer if SBP < 100)
    • 2-10 mg (2.5 mg max increments) IV (preferred)
    • OR
    • 2.5–5 mg MADD (5 mg IM)
    • OR
    • Ketamine 1-2 mg/kg IV/IO

    Pediatric ( < 37 kg) - Hemodynamically stable Monomorphic - Ventricular Tachycardia or Wide-Complex of Unknown Type (with pulses)

    • Obtain a 12-lead ECG if time and patient condition permits.
    • Only if regular and monomorphic rhythm
    • Administer Adenosine 0.1 mg/kg (max dose 6 mg) rapid IV push followed by a rapid 5 mL flush of NS.
    • Following 1-2 minutes with no conversion, administer a second dose of Adenosine 0.2 mg/kg (max dose 12 mg).
    • Administer Amiodarone 5 mg/kg in 100 mL D5W or NS IV infusion over 20 minutes in 250 mL D5W.

    Pediatric ( < 37 kg) - Hemodynamically UNSTABLE - Ventricular Tachycardia or Wide-Complex of Unknown Type (with pulses)

    • If patient condition permits, administer Midazolam 0.05-0.5 mg/kg per dose (max total of 5 mg) IV, IM or MADD titrated to effect with SBP >70 + (age in years x 2) mmHg or peripheral pulses if needed for sedation prior to cardioversion of the conscious patient (if time and patient condition allows)
    • OR
    • Administer Ketamine 0.5–1 mg/kg IV/IO

    Synchronized Cardioversion

    • Indicated immediately in the unstable patient
    • Initial energy dose is 0.5-1 J/kg
    • If no response and tachydysrhythmia persists, double the energy dose to 2 J/kg
    • Repeat as needed at 2 J/kg while establishing OLMC

    Synchronized Cardioversion - Adult

    • Indicated for unstable (i.e., shock, serious signs or symptoms) patients.
    • Wide regular, (mono V-Tach), synch 100 J
    • If no response, increase energy to 100 J, 200 J, 300 J, 360 J, as needed.
    • Remember, if unable to synchronize quickly, move to unsynchronized.

    Unsynchronized Cardioversion - Adult (Defibrillation)

    • Wide irregular, poly (V-Fib, Torsades) 360 J. Perform 2 minutes of CPR, repeat defibrillation/CPR sequencing.

    Hyperkalemic Arrest (Presumed)

    • See “Cardiac Arrest Universal Management” Guideline

    Newborn Resuscitation

    • Initial Scene and Patient Management per system Core Principles
    • See APGAR Score table below
    • Dry, Warm, Position, Suction (bulb syringe) mouth, then nose, Stimulate to breathe. If power suction is used, negative pressure must be regulated to not exceed 100 mm Hg.
    • Develop and implement treatment plan based on assessment findings, resources, and training.
    • Apnea, slow or gasping respirations
    • Heart rate

    Congestive Heart Failure / Pulmonary Edema

    • Initial Scene and Patient Management per system Core Principles
    • Focused history and physical exam
    • Determine if the patient (male or female) has taken erectile dysfunction medications such as Viagra, Levitra or Cialis within the last 24 hours
    • Develop and implement treatment plan based on assessment findings, resources, and training

    Adult - Congestive Heart Failure / Pulmonary Edema

    • EMT-Basic Provider
    • If patient presentation and history suggestive of MI, early notification and rapid transport to the appropriate facility with a functioning cardiac Cath-Lab
    • Administer albuterol 2.5 mg nebulized only for patient with significant bronchospasm/wheezing
    • Advanced EMT Provider
    • Advanced airway, vascular access and fluid therapy per Resuscitation and Perfusion Core Principle
    • IV access prior to nitrates is preferred, if possible
    • Limit fluid bolus to 250–500 mL NS
    • Paramedic Provider
    • Obtain 12-lead ECG
    • If ST segment elevation, new or presumedly new LBBB and history suggestive of MI, early notification and rapid transport to the appropriate facility with a functioning cardiac Cath lab
    • When possible, obtain 12-lead prior to nitroglycerin therapy
    • Administer nitroglycerin 0.4 mg every 5 minutes SL as long as symptoms persist and SBP > 100 mmHg
    • Administer Nitroglycerin IV (Tridil) 10–20 mcg/min increase by 5–10 mcg/min q 5 min till desired effect and SBP >100 mmHg.Max dose 200 mcg/min.Contact OLMC for higher dosing PRN.
    • Administer albuterol 2.5 mg mixed with Atrovent 0.5 mg nebulized only for patient with significant bronchospasm/wheezing.
    • Administer Ondansetron 4 mg IV over 1–2 minutes (may dilute with 8 mL NS for ease of push) or IM undiluted; repeat dose X 1 in 10 minutes if ineffective for 8mg max
    • Administer Furosemide 40 mg IV for patient not prescribed daily furosemide if SBP >100 mmHg or IV two (2) times patient's oral daily dose up to maximum of 120 mg if SBP >100 mmHg
    • Administer NOREpinephrine 2–4 mcg/min (or 0.01–2.0 mcg/kg/min) IV/IO infusion increase increments of 1 mcg/min every 3–5 minutes to targeted MAP of >60 mmHg, max 30 mcg/min
    • Administer CPAP 5–10 cm $H_2O$ PEEP if SBP >100 mmHg. Monitor for hypotension.
    • OR
    • Administer BL (BiLevel) initial 10–12/5 cm $H_2O$ (not to exceed 20/10 cm $H_2O$ without OLMC)
    • Continuous ECG & EtCO2 monitoring

    Pediatric ( < 37 kg) - Congestive Heart Failure / Pulmonary Edema

    • Initial Scene and Patient Management per system Core Principles
    • Focused history and physical exam
    • If possible, history should be obtained from a parent or caregiver
    • Develop and implement a treatment plan based on assessment findings, resources, and training
    • Administer oxygen 2-6 LPM via NC if no associated respiratory distress
    • 10-15 LPM via non-rebreather mask for respiratory distress
    • Oxygen therapy goal is to maintain SaO₂ of ≥ 94%

    Cardiac Arrest Universal Management (Pediatric)

    • Initial Scene and Patient Management
    • Focused history and physical exam
    • Assess for evidence that resuscitation should not be attempted
    • Spinal motion restriction per algorithm (as indicated)
    • Develop and implement treatment plan based on assessment findings, resources, and training
    • Airway, ventilations, compression, and defibrillation per Resuscitation and Perfusion Core Principle
    • Patient warmth
    • Assess blood glucose level
    • Pregnancy >20 weeks gestation
    • If able, displace Place a wedge-shaped cushion or multiple pillows under patient's right hip
    • Apply AED and follow prompts
    • Utilize LUCAS 2 device when available as soon as possible
    • For manual defibrillators
    • Apply ECG electrodes during initial chest compressions if resuscitation attempts will take place.
    • Apply patient therapy pads - in keeping in line with the goal of consistent shocks with minimal interruption of compressions.
    • Adhesive hands-free pads are recommended over traditional paddles.

    Adult - Cardiac Arrest Universal Management

    • EMT-Basic Provider - N/A
    • Advanced EMT Provider
    • Advanced airway, vascular access and fluid therapy per Resuscitation and Perfusion Core Principle
    • One IV attempt then EZ-IO
    • Epinephrine 1:10,000 1 mg IV
    • Paramedic Provider
    • Administer Epinephrine 1 mg IV
    • Consider 3-5 mg if arrest is from beta blocker overdose or anaphylaxis.
    • Repeat every 3 - 5 minutes as long as patient remains pulseless.
    • Begin simultaneous therapy if arrest is from known treatable cause 5 H's & 5 T's.
    • Hypoxia - Oxygenation and Ventilation
    • Hypothermia - Warm
    • Hypovolemia - NS 10-20 mL/kg up to 1 L initially
    • Hypoglycemia - D10% 50-100 mL (5-10 Gm) IV, repeat PRN
    • Hyperkalemia see Hyperkalemic arrest
    • Tension (pneumothorax) - chest decompression
    • Tablet (OD) -
      • Calcium channel blocker - Calcium chloride 5-10 mL (500mg-1 Gm) May repeat in 10 minutes if no response is observed
      • Opioid - Naloxone 2 mg
    • Continuous ECG & EtCO₂ monitoring

    Pediatric ( < 37 kg) - Cardiac Arrest Universal Management

    • EMT-Basic Provider - N/A
    • Advanced EMT Provider - N/A
    • Paramedic Provider - N/A

    Tachycardia - Narrow Complex (with pulses)

    • Initial Scene and Patient Management per system Core Principles
    • Focused history and physical exam
    • Develop and implement a treatment plan based on assessment findings, resources, and training

    Adult - Tachycardia - Narrow Complex (with pulses)

    • EMT-Basic Provider - N/A
    • Advanced EMT Provider - N/A
    • Paramedic Provider - N/A
    • Core Principle: Vascular access and fluid therapy per Resuscitation and Perfusion

    Pediatric ( < 37 kg) - Tachycardia - Narrow Complex (with pulses)

    • EMT-Basic Provider - N/A
    • Advanced EMT Provider - N/A
    • Paramedic Provider - N/A
    • Core Principle: Vascular access and fluid therapy per Resuscitation and Perfusion

    Hemodynamically stable Monomorphic - Tachycardia - Narrow Complex (with pulses)

    • Obtain a 12-lead ECG if time and patient condition permits
    • Only if regular and monomorphic rhythm
    • Attempt vagal maneuvers
    • If no response to vagal maneuvers, administer:
      • Adenosine 6 mg rapid IV push followed by a rapid 10-20 mL NS flush
      • Following 1-2 minutes with no conversion, administer:
        • Second dose of Adenosine 12 mg rapid IV push followed by a rapid 10-20 mL NS flush
      • Amiodarone 150 mg in 100 mL D5W or NS IV/IO infuse over 10 minutes. May repeat the same dose and method every 10 minutes to a maximum of 450 mg.

    Hemodynamically UNSTABLE - Tachycardia - Narrow Complex (with pulses)

    • If patient condition permits, administer Magnesium Sulfate 50% 1-2 Gm (2-4 mL of 50% solution) mix in 10 mL D5W slow IV push at 1 Gm/min, if SBP >100 mmHg. May repeat the same dose every 5 minutes until a maximum of 4 grams is reached.
    • Large doses (i.e., up to 8-10 Gm) of magnesium may be required to suppress arrhythmia. Contact OLMC for further magnesium therapy.
    • Administer Midazolam (Do NOT administer if SBP < 100)
    • 2-10 mg (2.5 mg max increments) IV (preferred)
    • OR
    • 2.5–5 mg MADD (5 mg IM)
    • OR
    • Ketamine 1-2 mg/kg IV/IO

    Adenosine fails to convert (SVT, or Atrial Fibrillation with Rapid Ventricular Response)

    • Administer Diltiazem 0.25 mg/kg (max 1st dose of 25 mg) slow IV over 2 minutes, with SBP >100 mmHg, for chemical conversion of narrow and rapid (>150 bpm) PSVT
    • No response observed after 15 minutes, and SBP >100 mmHg:
    • Administer Diltiazem 0.35 mg/kg (max 2nd dose of 35 mg) slow IV over 2-5 minutes
    • Contact OLMC for further push doses.

    CONSIDER - Tachycardia - Narrow Complex (with pulses)

    • Administer Diltiazem 10–15 mg/hr infusion for successful conversion with diltiazem. To mix add 125 mg (25 mL) to 100 mL D5W (125 mL total volume) to yield 1 mg/mL.
    • If pt condition permits, perform before cardioversion
    • Administer Midazolam (Do NOT administer if SBP < 100)
      • 2-10 mg (2.5 mg max increments) IV (preferred)
      • OR
      • 2.5–5 mg MADD (5 mg IM)

    Pediatric ( < 37 kg) - Hemodynamically stable Monomorphic - Tachycardia - Narrow Complex (with pulses)

    • Attempt vagal maneuvers
    • Cold compresses to the face, blowing through straw if able to follow commands
    • If no response to vagal maneuvers, administer:
    • Adenosine 0.1 mg/kg (max single dose 6 mg) rapid IV push followed by 5 mL flush of NS
    • Following 1-2 minutes with no conversion:
    • Second dose of Adenosine 0.2 mg/kg (max dose 12 mg) rapid IV push followed by a rapid 5-10 mL NS flush
    • With associated signs & symptoms unresponsive to vagal maneuvers and Adenosine:
    • Amiodarone 5 mg/kg in 100 mL D5W or NS IV infusion over 20 minutes in 250 mL D5W

    Pediatric ( < 37 kg) - Hemodynamically UNSTABLE - Tachycardia - Narrow Complex (with pulses)

    • If pt condition permits, perform before cardioversion:
    • Administer Midazolam 0.1-0.2 mg/kg per dose (max total of 5 mg) IV, IM, or MADD titrated to effect with SBP >70 + (age in years x 2) mmHg or peripheral pulses if needed for sedation prior to cardioversion of the conscious patient (if time and patient condition allows)
    • OR
    • Administer Ketamine 0.5-1 mg/kg IV/IO

    Synchronized Cardioversion - Pediatric ( <37 kg)

    • Indicated immediately in the unstable patient
    • Initial energy dose is 0.5 – 1 J/kg
    • If no response and tachydysrhythmia persists, double energy dose to 2 J/kg
    • Repeat as needed at 2 J/kg while establishing OLMC

    Synchronized Cardioversion - Adult

    • Indicated for unstable (i.e., shock, serious signs or symptoms) patients.
    • Narrow regular (A-flutter & SVT): 50 – 100 J
    • Narrow irregular (A-fib): 120 – 200 J
    • If no response, increase energy to 100 J, 200 J, 300 J, 360 J, as needed.

    Unsynchronized Cardioversion (Defibrillation) - Adult

    • Wide irregular, poly (V-Fib, Torsades) 360 J. Perform 2 minutes of CPR, repeat defibrillation/CPR sequencing.

    Obtain a 12-lead ECG if time and patient condition permits.

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    Test your knowledge on essential actions and medications for treating ventricular fibrillation in emergency situations. This quiz will cover key topics such as defibrillation protocols, drug dosages, and considerations for cardiac arrest due to specific causes. Perfect for EMT-Basic and paramedic providers looking to enhance their skills.

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