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Paramedic Protocol 2017- PREMATURE VENTRICULAR CONTRACTIONS - PVCs in bradycardia or heart blocks?***
- PVCs should not be suppressed in bradycardic rhythms***
- (Could not find in 2017 protocols)
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Paramedic Protocol 2017- (CVA) AND ACUTE STROKE- Apply oxygen if pulse ox is less than what %? pg 29
94%
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Paramedic Protocol 2017- (CVA) AND ACUTE STROKE- Who may be a candidate for fibrinolytic therapy? pg 29
Acute stroke with one or more abnormal CPSS findings and last known normal at or within four (4) hours (observed by a valid historian)
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Paramedic Protocol 2017- (CVA) AND ACUTE STROKE- What position should you transport a stroke patient?*** pg 29
Semi-Fowlers position with no more than 30 degrees head elevation***
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Paramedic Protocol 2017- PEDIATRIC PULSELESS ARREST/ENTRY ALGORHITHM - Should you allow the family to remain present during resuscitation?***pg 32
Consider allowing the family to remain present during resuscitation. Studies show that family members who were present believe their presence was beneficial to the patient. Studies also suggest that family members present during resuscitations have less anxiety and depression and more constructive grieving behavior.***
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Paramedic Protocol 2017- PEDIATRIC PULSELESS ARREST/ENTRY ALGORHITHM - What are the most common causes of cardiac arrest in children? pg 32
respiratory failure and hypotension
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Paramedic Protocol 2017- How should you deliver low energy shocks during Cardioversion? pg 22
Low energy shocks should always be delivered as synchronized shocks. Low energy unsynchronized shocks (defibrillation) are likely to induce VF. If cardioversion is needed and it is not possible to synchronize a shock, use unsynchronized shocks (defibrillation) at defibrillation doses.
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Paramedic Protocol 2017- PEDIATRIC VF/PULSELESS VT- What is the Joule setting for the initial and subsequent shocks? pg 34
2 J/KG then 4 J/KG
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Paramedic Protocol 2017- PEDIATRIC VF/PULSELESS VT-The pause in chest compressions to check the rhythm and pulse should not exceed how many seconds?***pg 35
10 seconds***
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Paramedic Protocol 2017- PEDIATRIC VF/PULSELESS VT- What should you do for a cardiac arrest patient in VF/VT who has a body temperature of <30oC (<86oF)?***pg 35
A single defibrillation attempt is appropriate. If the patient fails to respond to the initial defibrillation attempt, defer subsequent attempts and drug therapy until the core temperature rises above 30oC (86oF).***
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Paramedic Protocol 2017- PEDIATRIC VF/PULSELESS VT- What are the priorites during cardiac arrest? Pg 35
high-quality CPR and early defibrillation. Insertion of advanced airway and drug administration are of secondary importance
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Paramedic Protocol 2017- PEDIATRIC ASYSTOLE- What medication and dose is given for asystole? pg 36
EPINEPHRINE 0.01 MG/KG IV/IO
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Paramedic Protocol 2017- PEDIATRIC ASYSTOLE- May you administer Epinephrine through an ET tube? pg 36
IF IV/IO UNAVAILABLE ET ADMINISTRATION MAY BE CONSIDERED WITH DOSE OF 0.1 MG/KG
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Paramedic Protocol 2017- PEDIATRIC TACHYCARDIA - What is the Joules setting for Synchronized Cardioversion? pg 38
0.5-1J/KG; IF NOT EFFECTIVE INCREASE TO 2 J/KG
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Paramedic Protocol 2017- PEDIATRIC TACHYCARDIA - What is the ket to proper treatment? pg 39
is to differentiate whether the tachycardia is the primary cause of the patient’s symptoms, or if the tachycardia is a compensatory response to a separate medical issue.
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Paramedic Protocol 2017- PEDIATRIC TACHYCARDIA -What are common causes of sinus tachycardia? pg 39
- hypovolemia
- fever
- metabolic stress
- injury
- pain
- anxiety
- toxins
- and anemia
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Paramedic Protocol 2017- PEDIATRIC TACHYCARDIA - What are the Key questions to answer? pg 39
- Are there serious signs and symptoms?
- Are the signs and symptoms related to the patient’s fast heart rate
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Paramedic Protocol 2017- PEDIATRIC BRADYCARDIA - What are the most common pre-arrest rhythms in children? pg 41
Bradyarrhythmias and are often associated with hypoxia, hypotension and acidosis.
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Paramedic Protocol 2017- PEDIATRIC BRADYCARDIA - What medication is indicated for persistent symptomatic bradycardia not responding to oxygenation and ventilation? pg 41
Epinephrine 0.1 – 1 mcg/kg/min IV drip with Base Hospital Order
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Paramedic Protocol 2017- PEDIATRIC BRADYCARDIA - What medication is indicated as first medication intervention for bradycardia secondary to increased vagal tone, cholinergic drug toxicity (eg, organophosphates), or AV block? pg 41
ATROPINE FIRST 0.02 MG/KG (MINIMUM DOSE 0.1 MG) MAY REPEAT TO MAXIMUM TOTAL DOSE OF 1 MG.
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Paramedic Protocol 2017- PEDIATRIC SHOCK/HYPOPERFUSION - What is the primary treatment for hypovolemic shock? pg 43
Fluid resuscitation
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Paramedic Protocol 2017- PEDIATRIC SHOCK/HYPOPERFUSION - Is Correlation of blood pressure and fluid deficit accurate? pg 43
No, child may have fluid deficits in excess of 50-100 ml/kg before hypotension presents.
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Paramedic Protocol 2017- PEDIATRIC SHOCK/HYPOPERFUSION - What rate should Fluid resuscitation for hypovolemic shock begin? pg 43
with a rapid infusion of 20 ml/kg of NS. Only 25% of the fluid administered is expected to stay in the intravascular space, the other 75% will be in the extravascular space. It will take approximately 3 mL of IV solution to replace 1 mL lost.
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Paramedic Protocol 2017- PEDIATRIC SHOCK/HYPOPERFUSION - How much fluid can be given without making base station contact? pg 43
Fluid boluses may be repeated in 20 mL/kg increments up to 60 mL/kg.
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Paramedic Protocol 2017- PEDIATRIC SHOCK/HYPOPERFUSION - What is the Fluid resuscitation rate for suspected cardiogenic shock pg 43
10 mL/kg NS over 10 minutes
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Paramedic Protocol 2017- PEDIATRIC SHOCK/HYPOPERFUSION - When should you Suspect cardiogenic shock? pg 43
when there are signs of pulmonary or venous congestion (dyspnea, distended neck veins, hepatomegaly)
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Paramedic Protocol 2017- NEONATAL RESUSCITATION -What is the age range to be considered Neonate? pg 45
all premature infants who are reported to be over 20 weeks gestation or less than 28 days old.
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Paramedic Protocol 2017- NEONATAL RESUSCITATION - What is the most common cause of bradycardia and cardiac arrest in neonates? pg 45
Hypoxia
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Paramedic Protocol 2017- NEONATAL RESUSCITATION - What is the primary measure of adequate ventilation in Neonates? pg 45
prompt improvement in heart rate.
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Paramedic Protocol 2017- NEONATAL RESUSCITATION - What is the recommended ratio for compressions to ventilations?***
3:1 with 90 compressions and 30 breaths to achieve 120 events per minute***
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Paramedic Protocol 2017- NEONATAL RESUSCITATION - Is Narcan recommended as part of the initial resuscitation for newborns with respiratory depression? pg 45
No
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Paramedic Protocol 2017- NEONATAL RESUSCITATION - Should blood sugar analysis be performed on newborns? pg 46
Yes, heelstick. If <40mg/dL administer 5ml/kg D10 IV.
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Paramedic Protocol 2017- PEDIATRIC POST RESUSCITATION CARE - What is the transcutaneous oxygen saturation level that should be maintained? pg 48
at least 94%
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Paramedic Protocol 2017- PEDIATRIC POST RESUSCITATION CARE - Why should you not provide excessive ventilation or hyperventilation? pg 48
Hyperventilation may impair neurologic outcome by adversely affecting cardiac output and cerebral perfusion
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Paramedic Protocol 2017- PEDIATRIC POST RESUSCITATION CARE - What are the Signs of impending cranial hemorrhage? pg 48
- Dilated pupil(s) not responsive to light
- Bradycardia
- Hypertension
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Paramedic Protocol 2017- What is a BRUE? pg 49
- Brief Resolved Unexplained Event
- an event that is frightening to the observer (may think infant has died)
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Paramedic Protocol 2017- What are the signs and symptoms of a BRUE? pg 49
- Apnea (central or obstructive)
- Color Change (cyanosis, pallor, erythema)
- Marked change in muscle tone (limpness)
- Choking or gagging
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