EMS Protocol for Medical Complaints

Questions and Answers

What is the initial step when a patient's blood pressure remains less than 90 mmHg after fluid administration?

Administer premix dopamine (correct)

Initiate external pacing

Administer atropine sulfate

Transport the patient immediately

In the case of bradycardia resulting from Beta Blocker or Calcium Channel Blocker overdose, what is the maximum total dose for atropine sulfate?

5 mg

3 mg (correct)

2 mg

4 mg

When treating bradycardia due to organophosphate overdose, how often should atropine sulfate be administered?

As needed

Every 10 minutes

Every 2 minutes

Every 5 minutes (correct)

What is the preferred treatment for a patient with bradycardia and a high-grade Mobitz II or Third Degree Heart Block?

Use external pacing as the first treatment Signup and view all the answers

What should you do if a patient has a heart rate of 40 bpm or less but is otherwise stable?

Apply external pacemaker pads without turning the pacer on Signup and view all the answers

What is the first step in managing a patient with suspected alcohol intoxication?

Establish vascular access Signup and view all the answers

What potential EKG finding should you expect in patients with bradycardia?

Ventricular ectopy Signup and view all the answers

What should be done to treat a patient experiencing hypoglycemia due to alcohol intoxication?

Provide dextrose 50% (D50W) if indicated Signup and view all the answers

Which of the following is a treatment option for a patient with low blood pressure that has not improved after fluid administration?

Administer premix dopamine Signup and view all the answers

How should you handle a patient who is agitated and threatening due to alcohol withdrawal?

Follow the Agitated Patient protocol Signup and view all the answers

What is the starting dosage of premix dopamine to be administered for hypotension?

30 drops per minute Signup and view all the answers

What is recommended for a patient who may show signs of delirium tremens?

Transport them to the closest appropriate facility Signup and view all the answers

What procedure should be performed to ensure the patient remains stable during transport?

Continuous cardiac rhythm monitoring Signup and view all the answers

What is a serious risk when drugs and alcohol are consumed together?

Potential for a deadly combination Signup and view all the answers

What should be checked after establishing vascular access in an agitated patient?

Blood glucose levels Signup and view all the answers

In what situation does the Marchman Act come into play during patient management?

When a patient refuses treatment despite being a danger to themselves or others Signup and view all the answers

What initial step should be taken if a patient is suspected of experiencing metabolic acidosis with disrhythmias?

Give sodium bicarbonate at a dose of 1 mEq/kg IV/IO. Signup and view all the answers

In managing an agitated patient suspected of having excited delirium, what is the primary action if the patient's temperature is above 104°F?

Attempt to cool the patient down as quickly as possible. Signup and view all the answers

What is the maximum amount of morphine sulfate that can be administered to a patient experiencing agitation and pain?

20 mg Signup and view all the answers

What is the appropriate action if midazolam has not been given and the agitated patient is shivering?

Give midazolam (Versed) either IV/IO or IM/IntraNasal. Signup and view all the answers

Which of the following steps should be taken to manage a patient with suspected hyperthermia effectively?

Apply ice packs to the neck, axillae, and groin areas. Signup and view all the answers

What volume of cold normal saline should be bolused for a hyperthermic patient?

30 mL/kg IV/IO (maximum 2 liters). Signup and view all the answers

Which condition may indicate a metabolic acidosis in a patient's cardiac rhythm monitoring?

Wide QRS complexes and/or loss of P waves Signup and view all the answers

How should sedation be administered to an agitated patient before transferring to the Emergency Department?

Use midazolam (Versed) as a first-line sedative. Signup and view all the answers

Study Notes

Agitated Patient / Excited Delirium Syndrome

Treat signs of excited delirium, including fever (temperature reading of 104°F (40°C) or higher) or feeling hot to the touch
Attempt to cool the patient down:
- Remove clothing
- Move to a cooler environment
- Apply ice packs to neck, axillae, and groin areas
- Document baseline temperature before administering cold normal saline
Establish vascular access and administer cold (34°F) normal saline, 30 mL/kg IV/IO (maximum 2 Liters)
Administer midazolam (Versed), 5 mg IV/IO or 10 mg IM / IntraNasal if shivering
Administer morphine sulfate, 5 mg IV/IO/IM if agitated and/or in pain after midazolam (Versed) and systolic BP remains at 90 mmHg or greater

Alcohol Intoxication

Treat per Agitated Patient protocol if agitated and/or combative
Consider concurrent drug overdose
Consider transport to closest appropriate facility for further observation
Manage individuals with highly caffeinated alcoholic drinks appropriately
Consider other causes of shock, but do not delay transport

Bradycardia

Administer atropine sulfate, 1 mg IV every 2-3 minutes to a maximum of 3 mg for Beta Blocker or Calcium Channel Blocker excess / OD
Administer normal saline, 500 mL IV bolus if patient remains hypotensive
Administer atropine sulfate, 2 mg IVP every 5 minutes for Organophosphates Overdose until drying of the secretions (atropinization) occurs
Use external pacing for acute inferior wall myocardial infarction with high-grade Mobitz II or Third Degree Heart Block (complete heart block) and wide QRS complex
Apply external pacemaker pads without turning the pacer on for heart rate of 40 bpm or less, and observe for signs/symptoms suggesting instability

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Description

This quiz covers the protocols for Emergency Medical Services (EMS) providers to follow when treating patients with medical complaints, including administering oxygen and sodium bicarbonate.