Standing Orders 2024 Updates

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Questions and Answers

What must be done before initiating blood products during interfacility transport?

Administer at least 100 mL prior to departure

Confirm with a registered nurse or physician (correct)

Ensure no allergies are present

Start the infusion at the receiving facility

What should be considered if a patient's transport needs exceed the capabilities of the ALS interfacility unit?

Transport the patient without additional resources

Reassess the patient's condition before transport

Consider the need for additional specialty transport resources (correct)

Delay transport until capabilities are met

What was removed from the protocol regarding blood infusions before transport?

The need to start the infusion for at least 15 minutes (correct)

The verification of blood units by hospital staff

The restriction on blood product types that can be transported

The requirement for documentation of patient allergy

What does the new addition titled 'Shock Index' include?

Age adjusted values for both adults and pediatrics Signup and view all the answers

Where was the allergy reference moved in the updated protocol?

Higher in the protocol for better visibility Signup and view all the answers

What is the new upper limit for systolic blood pressure in the ALS to BLS release?

180 mmHg Signup and view all the answers

In pediatric seizures, what is the maximum dose of midazolam to be administered?

5 mg total Signup and view all the answers

What should be done if signs of fluid overload develop in pediatric shock?

Discontinue fluid bolus Signup and view all the answers

What is the revised maximum dose for Epinephrine in pediatric allergic reactions?

0.5 mg Signup and view all the answers

Which of the following is a new guideline for pediatric bradycardia?

Ensure adequate oxygenation and ventilation Signup and view all the answers

What is the updated intercostal space for needle decompression in pediatric patients?

4th intercostal space Signup and view all the answers

What action was removed regarding pediatric CPR in patients with cardiac arrest from submersion injury?

Contact Medical Control Signup and view all the answers

In the updated guidelines, what term is now used regarding optional junctional tourniquet?

Optional Signup and view all the answers

What is the updated maximum dose for Norepinephrine during post-resuscitation care?

50 mcg/min Signup and view all the answers

Which medication has had its dosing guidelines changed for pediatric patients?

Droperidol Signup and view all the answers

What is the range for the Tylenol PO dose according to the new protocol?

975-1000 mg Signup and view all the answers

In the updated protocol, which condition was moved from an absolute contraindication to a relative contraindication for airway management?

Myasthenia gravis Signup and view all the answers

What was the change made to the dose of Toradol for adult patients?

Increased to 15 mg Signup and view all the answers

Which of the following changes was made regarding pediatric and adult airway management?

Language added to initiate hemodynamic resuscitation before DFI Signup and view all the answers

What modification was made regarding Benadryl administration for patient restraint?

Fixed dosage of 50 mg established without range Signup and view all the answers

What significant change was added concerning mandatory ALS equipment?

Addition of cuffed ET tubes if available Signup and view all the answers

What was the change made to the fluid bolus for Sepsis in 2024?

Increased to 1000 ml Signup and view all the answers

What is the updated upper range for Norepinephrine administration after 2024?

50 mcg/min Signup and view all the answers

In the management of Acute Coronary Syndromes, what was the new systolic blood pressure limit set in 2024?

Less than 120 mmHg Signup and view all the answers

What was the significant change in the treatment of Hemodynamically Compromising Bradycardia?

Increased Atropine dose to 1 mg Signup and view all the answers

What was added to the General Adult Cardiac Arrest Bundle of Care in 2024?

Ketamine administration for sedation Signup and view all the answers

What significant change was made regarding the duration of resuscitative efforts?

Changed from 30 minutes to 20 minutes Signup and view all the answers

What is the new terminology introduced for CPAP/BiPAP in the document?

Non-Invasive Mechanical Ventilation Signup and view all the answers

What age was specified for patients in the newly titled 'Pediatric and Adult Traumatic Cardiac Arrest' protocol?

At least 5 years of age Signup and view all the answers

What new guideline was added for pediatric patients regarding needle decompression?

Updated needle decompression guidelines Signup and view all the answers

What was the change made to the dose of Epinephrine?

Increased from 0.3-0.5 mg to just 0.5 mg Signup and view all the answers

Which medication's dose was clarified to a maximum of 24 mg?

Buprenorphine Signup and view all the answers

What is the new protocol added for Non-Invasive Mechanical Ventilation?

It provides a follow-up for BiPAP usage. Signup and view all the answers

What change was made regarding the Midazolam dosage?

Both IM and IV doses increased Signup and view all the answers

What additional consideration was added under the Opioid Overdose section?

Consider tiered dosing of 0.4 mg per dose Signup and view all the answers

In the management of Pulmonary Edema due to Congestive Heart Failure, what was added?

For systems using BiPAP Signup and view all the answers

What dose change was made to Droperidol for nausea/vomiting refractory to Zofran?

Added as a new option at 1.25 mg Signup and view all the answers

Study Notes

Standing Orders - 2024 Changes

Non-Invasive Mechanical Ventilation (NIMV): BiPAP added after CPAP, moving ALS Priority I to be before II and III. Removed (Pilot) and changed to (Optional).
Opioid Overdose: Added tiered dosing (0.4 mg per dose) and authorized total ALS dose of up to 6 mg. Total ALS doses for Buprenophine are authorized for all agencies.
Midazolam: Increased IM dose to 10 mg and IV dose to 5 mg, with a total of 3 doses allowed. Clearer wording for magnesium sulfate administration.
Epinephrine: Increased dose to 0.5 mg IM. Removed dose range for Benadryl, now 50 mg.
Norepinephrine: Increased dose from 10-40 mcg/min to 10-50 mcg/min, titrating by 10 mcg every 5 minutes to maintain MAP greater than 65.
Other Changes: Protocol reformatted, and language extended for multiple items in the updated standing orders.

Sepsis

POC Lactate Meters: Removed.
Fluid Bolus: Changed from 30 ml/kg to 1000 ml. After 1000 ml bolus add Norepinephrine.
Norepinephrine: Increased upper range to 50 mcg/min.
Systolic BP: Decreased from less than 150 to less than 120.

Acute Coronary Syndromes (ACS)

Systolic BP: Decreased from less than 150 to less than 120.

Hemodynamically Compromising Bradycardia

Atropine: Increased from 0.5 mg to 1mg.
Ketamine: Added 0.25mg/kg for pain from pacing.

General Adult Cardiac Arrest Bundle of Care

Ketamine: Added for neurologic responsiveness and/or consciousness.

Traumatic Cardiac Arrest

Resuscitative Efforts: Changed from 30 to no less than 20 minutes.

Termination of Resuscitative Efforts & Telemetric Pronouncement of Death

Resuscitative Efforts: Changed from 30 to no less than 20 minutes.

Pediatric and Adult Pain Management

Tylenol (Acetaminophen): PO dose changed from 1000 mg to 975-1000 mg.
Pediatric Dose of Tylenol: 15 mg/kg to adult maximum dose.
Toradol: Dose changed to 15 mg for all adult doses.
Fentanyl: Changed adult max dose to 400 mcg.
Pregnancy: Added as a contraindication for Toradol.

Other Updated Standing Orders

Interfacility Management of Previously Initiated Continuous IV Fusions: Clarified language on ALS interfacility transport needs, if capacity exceeded.
Blood Products (Interfacility): Removed "Blood infusions must be started at the sending facility for at least 15 minutes and at least 50 mL must be infused before transport can begin," and wording changed to require verification by nurse/physician. -Paramedics confirming with a nurse or physician before initiating blood product transport.
Mandatory ALS Equipment Inventory: Added ET tubes and Droperidol to the list.
Protocol Reformatting: Protocol formatting changed for several items such as medications and dosing protocol.
Protocols: Protocols were reformatted and updated in several categories.

Pediatric Standing Orders

Pediatric Shock and Hypotension: Discontinue fluid bolus if fluid overload develops.
Pediatric Tachycardia: Changed maximum atropine dose to 1 mg.
Pediatric CPR: Removed redundant bullet point.
Pediatric and Adult Trauma, Adult Blood Administration, Pediatric Blood Administration: Added guidelines and/or wording changes.
Patient Restraints: Additional information added for specific pediatric and adult procedures.
Airway Management: Added language about hemodynamic resuscitation.
Extreme Agitation: Atropine dose changed to 0.5 mg IV and Midazolam dose to 5 mg IM. Additional protocol notes included as well.

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Description

This quiz covers the recent changes to standing orders in 2024, focusing on updates regarding Non-Invasive Mechanical Ventilation, opioid dosing, and protocol adjustments for emergency care. Test your knowledge on the new guidelines regarding dosing and treatment protocols.