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ALS PCS - PCP
ALS PCS Ver. 4.6.1 - PCP Medical and Auxiliary Directives
| Question | Answer |
|---|---|
| What is "PCP Assist IV"? | Authorization for a PCP to cannulate a peripheral IV at the request and under the direct supervision of an ACP. (Not authorized to administer) |
| What is "PCP Autonomous IV"? | Authorization for a PCP to independently cannulate an IV according to the Intravenous and Fluid Therapy Medical Directive - Auxiliary. |
| What is a "home medical technology" device? | a device prescribed by a member of a regulated health profession for the purposes of treating a medical condition. |
| What is a "novel medication"? | a self/care-giver administered medication prescribed by a member of a regulated health profession that is required to treat patients with generally rare and unusually complex chronic medical condition. |
| What is Normotension for adults? | SBP greater or equal to 100 mmHg |
| What is hypotension in adults? | SBP less than 90 mmHg |
| What rate is considered Bradycardic? | HR less than 50 BPM |
| What rate is considered Tachycardic? | HR greater than or equal to 100 BPM |
| What rate is considered Tachypneic? | RR greater than or equal to 28 breaths/min |
| What is the ideal pediatric RR and HR for 0-3 months old patient? | RR = 30-60, HR = 90-180 |
| What is the ideal pediatric RR and HR for 3-6 month old patient? | RR = 30-60, HR = 80-160 |
| What is the ideal pediatric RR and HR for a 6-12 month old Patient? | RR = 25-45, HR = 80-140 |
| What is the Ideal pediatric RR and HR for a 1-3 y.o.? | RR = 20-30, HR = 75-130 |
| What is the ideal RR and HR for a 6 y.o.? | RR = 16-24, HR = 70-110 |
| What is the ideal RR and HR for a 10 y.o.? | RR = 16-24, HR = 60-90 |
| What is considered pediatric normotension? | SBP greater than or equal to --> 90 mmHg + (2 x age in years) |
| What is considered pediatric hypotension? | SBP less than --> 70 + (2 x age in years) |
| How do you calculate pediatric weight? | (age x 2) + 10 |
| What blood glucose level is considered hypoglycemia in patients less than 2 years old? | BGL< 3.0 mmol/L |
| What blood glucose level is considered hypoglycemia in patients greater than or equal to 2 years old? | BGL , 4.0 mmol/L |
| What are the indications for the Medical Cardiac Arrest medical Directive? | Non-traumatic cardiac Arrest |
| What are the conditions and contraindications for Manual Defibrillation under the Medical Cardiac Arrest Directive? | Conditions --> Age greater than or equal to 30 days old; Altered LOA and monitor shows VF or pulseless VT Contraindications --> Rhythms other than VF or Pulseless VT |
| What are the conditions and contraindications for AED defibrillation under the Medical Cardiac arrest Directive? | Conditions --> Age is greater than or equal to 30 days; altered LOA and defibrillation is indicated Contraindications --> Non-shockable rhythm |
| What are the conditions and contraindications for Epinephrine administration under the medical Cardiac Arrest Medical Directive? | Conditions --> Altered LOA and anaphylaxis suspected as causative event. Contraindications --> Allergy or sensitivity to epinephrine |
| What are the conditions and contraindications for "Termination of Resuscitation under the medical cardiac arrest directive? | Conditions --> Age is greater than or equal to 18 years old; altered LOA; the arrest is not witnessed by EMS AND No ROSC AND no defibrillation delivered. Contraindications --> Arrest thought to be non-cardiac of origin |
| What are the conditions and contraindications for CPR under the Medical Cardiac Arrest Medical Directive? | Conditions --> Altered LOA; performed in 2 minute intervals Contraindications --> Obviously dead as per the BLS PCS; meets the conditions of the DO NOT RESUSCITATE (DNR) standard. |
| How is Manual Defibrillation administered in patients greater than or equal to 30 days but less than 8 years old? | Dose - 1 defibrillation; Initial dose - 2 J/kg; Subsequent Doses - 4 J/Kg; Dosing interval - 2 minutes; Max number of doses - 4 |
| How is Manual Defibrillation administered for a patent greater than or equal to 8 years of age? | Dose - 1 defibrillation; Initial and subsequent doses - As per BH/ manufacturer; Dosing interval - 2 minutes; Max number of doses - 4 |
| How is AED Defibrillation administred in patients greater than or equal to 30 days but less than 8 years old? | CONSIDER WITH OR WITHOUT Pediatric Attenuator Cable; Dose - 1 defibrillation; Max single dose - as per BH/ manufacturer dosing interval - 2 minutes Max number of doses- 4 |
| How is Manual Defibrillation administered for a patent greater than or equal to 8 years of age? | Dose - 1 defibrillation; Max single dose - As per BH / manufacturer; Dosing interval - 2 minutes Max number of doses - 4 |
| How is epinephrine administered under the medical cardiac arrest directive? | Route - IM; Concentration - 1mg/mL = 1:1000; Dose - 0.1 mg/kg; max dose single- 0.5 mg max # of doses - 1 |
| When is the mandatory patch point for a medical TOR? | Following the third analysis if applicable. |
| When are we considering early transport in a medical cardiac arrest? | Pregnancy where gestation is greater than or equal 20 weeks; hypothermia, airway obstruction, suspected pulmonary embolus, medication overdose/toxicology, or other known reversible cause of arrest not addressed. |
| What are the indications for the Trauma Cardiac Arrest Medical Directive? | Cardiac arrest secondary to a severe blunt or penetrating trauma. |
| What are the conditions and contraindications for CPR under the Trauma Cardiac Arrest Medical Directive? | Conditions --> Altered LOA; performed in 2 minute intervals Contraindications --> obviously dead as per the BLS PCS; meet conditions for the DNR standard |
| What are the conditions and contraindications for Manual Defibrillation under the Trauma Cardiac Arrest Medical Directive? | Conditions --> Age greater than or equal to 30 days; Altered LOA; VF or pulseless VT Contraindications --> rhythms other than VF or Pulseless VT |
| What are the conditions and contraindications for AED defibrillations under the Trauma Cardiac Arrest Medical Directive? | Conditions --> Age greater than or equal to 30 days; Altered LOA; Defibrillation indicated Contraindications --> Non-shockable rhythm |
| what are the conditions for trauma "Termination of Resuscitation"? | Age greater than or equal to 16 years of age; Altered LOA; HR = 0; RR = 0; no palpable pulse AND no defibrillation delivered and Monitored HR at 0 or Monitored HR is greater than 0 but the closest ED is greater than or equal to 30 min. away |
| What are the contraindications for trauma "Termination of Resuscitation"? | Age less than 16 years old Defibrillation delivered Monitored HR > 0 and closest ED < 30 min transport time away. |
| How is Manual Defibrillation administered in a Trauma Cardiac Arrest in patients greater than or equal to 30 days but less than 8 years old? | Dose - 1 defibrillation; Initial dose - 2 J/kg; Dosing interval - N/A; Max number of doses - 1 |
| How is Manual Defibrillation administered in a Trauma Cardiac Arrest in patients greater than or equal to 8 years old? | Dose - 1 defibrillation; Initial dose - As per BH / manufacturer; Dosing interval - N/A Max number of doses - 1 |
| How is AED Defibrillation administered in a Trauma Cardiac Arrest in patients greater than or equal to 30 days but less than 8 years old? | CONSIDER WITH OR WITHOUT Pediatric Attenuator Cable; Dose - 1 defibrillation; Max single dose - as per BH/ manufacturer; dosing interval - N/A; Max number of doses- 1 |
| How is AED Defibrillation administered in a Trauma Cardiac Arrest in patients greater than or equal to 8 years old? | Dose - 1 defibrillation; Max single dose - as per BH/ manufacturer; dosing interval - N/A; Max number of doses- 1 |
| What are the indications for the Hypothermia Cardiac Arrest Medical Directive? | Cardiac arrest secondary to severe hypothermia |
| What are the indications for the Foreign Body Airway Obstruction Cardiac Arrest Medical Directive? | Cardiac Arrest secondary to an airway obstruction |
| How many analyses are we allowed in the FBAO directive? Clinical Considerations? | 1 analyses before we transport, unless the obstruction is removed then we initiate as a medical cardiac arrest. |
| How many analyses are we allowed in the Hypothermia Medical Directive? | 1 analyses before we transport. |
| What are the indications for the Neonatal Resuscitation Medical Directive? | Neonatal patient |
| What are the conditions and contraindications for the neonatal resuscitation medical directive? | Conditions --> Age less than 30 days Contraindications --> N/A |
| What are the targeted preductal SpO2 readings under the Neonatal Resuscitation Medical Directive? | 1 min - 60-65% 2min - 65-70% 3 min - 70-75% 4 min - 75-80% 5 min - 80-85% 10 min - 85-95% |
| What are the indications for the Return of Spontaneous Circulation (ROSC) Medical Directive? | Patient with ROSC after the resuscitation was initiated. |
| What are the treatment options for the ROSC medical directive? | 0.9% NaCl Fluid bolus if PCP Autonomous IV; Optimizing Ventilation and oxygenation; 12 Lead ECG acquisition and nterpretation |
| What are the conditions and contraindications for 0.9% NaCl Fluid Bolus under the ROSC Medical Directive? | Conditions --> Age is greater than or equal to 2 years old; SBP is hypotensive; chest auscultation is clear. Contraindications --> Fluid overload; SBP is greater than or equal to 90 mmHg. |
| How is ventilation and oxygenation managed under the ROSC Medical Directive? | Titrate oxygenation 94-98%; Avoid hyperventilation and target ETCO2 to 30-40 mmHg with continuous waveform capnography (if available) |
| How do we administer 0.9% NaCl fluid blous in a patient greater than or equal to 2 years but less than 12 years old under the ROSC medical directive? | Route - IV; infusion - 10 mL/Kg; Infusion Interval - Immediate; Reassess every - 100 mL; Max. volume - 1,000 ml |
| How do we administer 0.9% NaCl fluid blous in a patient greater than or equal to 2 years but less than 12 years old under the ROSC medical directive? | Route - IV; Infusion - 10 mL/Kg; Infusion Interval - Immediate; Reassess every - 250 mL; max. volume - 1, 000 mL |
| What are the indications for the Cardiac Ischemia Medical Directive? | Suspected Cardiac Ischemia |
| What are the treatment options considered under the Cardiac Ischemia Medical Directive? | ASA, Nitroglycerin, 12 Lead ECG acquisition and Interpretation |
| What are the conditions for ASA under the Cardiac Ischemia Medical Directive? | Age is greater than or equal to 18 years; Unaltered LOA; Able to chew and swallow |
| What are the contraindications for ASA under the Cardiac Ischemia Medical Directive? | Allergy or Sensitivity to ASA or NSAIDs; If asthmatic, no prior use of ASA; current or active bleeding; CVA or TBI in the past 24 hours |
| What are the conditions for Nitroglycerin under the Cardiac Ischemia Medical Directive? | Age greater than or equal to 18 years; Unaltered LOA; HR = 60-159 bpm; SBP = Normotensive Prior history of nitro use or IV access obtained |
| What are the contraindications for Nitroglycerin under the Cardiac Ischemia Medical Directive? | Allergy or Sensitivity to nitrates; PDE5 inhibitor use within last 48 hours; SBP drops by more than 1/3 of initial value of administration; 12-lead ECG compatible with Right MI |
| How is ASA administered under the Cardiac Ischemia Medical Directive? | Route - PO; Dose - 160-162 mg; Max. single dose - 162 mg; Max. Number of doses - 1; |
| How is Nitroglycerin administered in a Non-STEMI patient under the Cardiac Ischemia Medical Directive? | SBP is greater than or equal to 100 mmHg; Route - SL; Dose - 0.3mg or 0.4 mg; Max single Dose - 0.4mg; Dosing interval - 5 min; Max number of doses - 6 |
| How is nitroglycerin administered in a STEMI patient under the cardiac Ischemia Medical Directive? | SBP is greater than or equal to 100 mmHg; Route - SL; Dose - 0.3mg or 0.4 mg; Max single Dose - 0.4mg; Dosing interval - 5 min; Max number of doses - 3 |
| What are the indications for the Acute Cardiogenic Pulmonary Edema Medical Directive? | Moderate to severe respiratory distress; AND suspected acute cardiogenic pulmonary edema |
| What are the conditions for Nitroglycerin use in the ACPE Medical Directive? | Age is greater than or equal to 18 years old; HR = 60-159 bpm; SBP = normotensive; |
| What are the contraindications for nitroglycerin use in the ACPE Medical Directive? | Allergy or Sensitivity to nitrates; PDE5 inhibitor use within the last 48 hours; SBP drops by more than 1/3 of the initial value after nitro administration |
| How is Nitroglycerin administered under the ACPE medical directive for a patient with a blood pressure greater than or equal to 100 mmHg but less than 140 mmHg? | PCP IV or HX of USE NEEDED; Route - SL; Dose - 0.3mg or 0.4 mg; Max single Dose - 0.4mg; Dosing interval - 5 min; Max number of doses - 6 |
| How is Nitroglycerin administered under the ACPE medical directive for a patient with a blood pressure greater than or equal to 140 mmHg with NO PCP IV or Hx of use? | Route - SL; Dose - 0.3mg or 0.4 mg; Max single Dose - 0.4mg; Dosing interval - 5 min; Max number of doses - 6 |
| How is Nitroglycerin administered under the ACPE medical directive for a patient with a blood pressure greater than or equal to 140 mmHg WTH PCP IV or Hx of nitro use? | Route - SL; Dose - 0.6mg or 0.8 mg; Max single Dose - 0.8mg; Dosing interval - 5 min; Max number of doses - 6 |
| What are the indications for the Hypoglycemia Medical Directive? | Agitation; or Altered LOA; or Seizure; or Symptoms of Stroke |
| What are the treatment options under the Hypoglycemia Medical Directive? | Glucometry, dextrose, glucagon, oral glucose |
| What are the conditions and contraindications for Dextrose under the Hypoglycemia Medical Directive? | Conditions --> Age is greater than or equal to 2 years old; Altered LOA; Hypoglycemic Contraindications --> Allergy or sensitivity to dextrose |
| What are the conditions and contraindications for Glucagon under the Hypoglycemia Medical Directive? | Conditions --> Altered LOA; Hypoglycemic Contraindications --> Allergy or sensitivity to glucagon; pheochromacytoma |
| How is D10W (dextrose) administered under the Hypoglycemia Medical Directive? | Dose - 0.2g/Kg (2mL/Kg); Max single dose - 10 g (100mL); Dosing interval - 10 minutes; Max number of doses - 2 |
| How is D50W (dextrose) administered under the Hypoglycemia Medical Directive? | Dose - 0.5 g/Kg (1mL/Kg); Max single dose - 25 g (50 mL); Dosing Interval - 10 min; Max number of doses - 2 |
| How is glucagon administered under the Hypoglycemia Medical Directive for someone weighing less than 25 Kg? | Route - IM; Dose - 0.5mg; Max Single Dose - 0.5mg; Dosing interval - 20 min Max number of doses - 2 |
| How is glucagon administered under the Hypoglycemia Medical Directive for a patient weighing greater than or equal to 25 kg? | Route - IM; Dose - 1mg; Max single dose - 1mg; dosing interval - 20 minutes; Max number of doses - 2 |
| What should we consider if patient responds to dextrose or glucagon? | Giving oral glucose or simple carbohydrates? |
| How is the dose determined for glucagon, age or weight? and what are the ranges? | Dosage is dependent on patient weight. Either less than 25 kg or greater than or equal to 25 Kg. |
| What are we to do if a patient refuses transportation to the hospital after a hypoglycemic event? | Attain a final set of vital signs, including glucometry, and then document. |
| What are the indications for the Bronchoconstriction Medical Directive? | Respiratory Distress; AND Suspected bronchoconstriction |
| What are the treatment options under the Bronchoconstriction Medical Directive? | Salbutamol and Epinephrine |
| What are the conditions and contraindications for Salbutamol under the Bronchoconstriction Medical Directive? | Conditions --> N/A Contraindications --> Allergy or sensitivity to Salbutamol |
| What are the conditions and contraindications for Epinephrine under the Bronchoconstriction Medical Directive? | Conditions --> RR - BVM ventilation required; Hx of asthma Contraindications --> Allergy or sensitivity to epinephrine |
| What are the two routes Salbutamol can be administered under the Bronchoconstriction Medical Directive? | MDI and NEB |
| How are dosages determined for salbutamol administration under the Bronchoconstriction Medical Directive, Age or Weight? what are the ranges? | Divided by weight, Less than 25 Kg, or greater than or equal to 25 Kg |
| How is Salbutamol administered under the Bronchoconstriction Medical Directive for a patient under 25Kg? | Route - MDI --> up to 600 mcg every 5-15 min to a max number of 3 times Route - NEB --> 2.5 mg every 5-15 minutes to a max number of 3 times. |
| How is Salbutamol administered under the Bronchoconstriction Medical Directive for a patient greater than or equal to 25 Kg? | Route - MDI --> up to 800 mcg every 5-15 min to a max number of 3 times Route - NEB --> 5 mg every 5-15 minutes to a max number of 3 times |
| How is Epinephrine administered under the Bronchoconstriction Medical Directive? | Route - IM; Concentration - 1 mg/mL = 1:1000; Max single dose - 0.5mg; Dosing interval - N/A; Max number of doses - 1 |
| What is the rate Salbutamol should be administered through MDI? | 100 mcg every 4 breaths. |
| What are the indications for the Moderate to Severe Allergic Reactions Medical Directive? | Exposure to a probable allergen; and Signs/symptoms of a moderate to severe allergic reaction (including anaphylaxis) |
| What are the treatment options under the Moderate to Severe Allergic Reaction Medical Directive? | Epinephrine and Diphenhydramine |
| What are the conditions and Contraindications for epinephrine under the Moderate to Severe Allergic reaction Medical Directive? | Conditions --> For anaphylaxis only Contraindications --> allergy or sensitivity to epinephrine |
| What are the conditions and contraindications for diphenhydramine under the Moderate to Severe Allergic Reaction Medical Directive? | Conditions --> Weight is greater than or equal to 25 Kg Contraindications --> Allergy or sensitivity to diphenhydramine |
| How is epinephrine administered under the Moderate to Severe Allergic Reactions Medical Directive? | Route - IM; Concentration - 1mg/mL = 1:1000; Dose - 0.01mg/Kg* ; Max single dose - 0.5 mg; Dosing interval - 5 minutes; max number of doses - 2; * round dose to the nearest 0.05mg |
| How are the doses for diphenhydramine determined under the Moderate to Severe Allergic Reaction Medical Directive, weight or range? what are the ranges? | Determined by weight, greater than or equal to 25 kg but less than 50 kg, or greater than or equal to 50 kg |
| How is diphenhydramine administered under the Moderate to Severe Allergic Reaction Medical Directive for a patient between 25 and 50 kg? | Route - IV or IM; Dose - 25 mg; Max Dose - 25 mg; Dosing interval - N/A; Max number of doses - 1 |
| How is diphenhydramine administered under the Moderate to Severe Allergic Reaction Medical Directive for a patient Greater than or equal to 50 Kg? | Route - IV or IM; Dose - 50 mg; Max single Dose - 50 mg; Dosing interval - N/A; Max number of doses - 1 |
| What are the indications for the Croup Medical Directive? | Severe Respiratory Distress; and Stridor at rest; And Current history of URTI; and Barking Cough or recent hx of a barking cough |
| What are the treatment options under the Croup Medical Directive? | Nebulized Epinephrine |
| What are the conditions and contraindications for epinephrine under the Croup Medical Directive? | Conditions --> Age is less than 8 years; HR is less than 200 bpm Contraindications --> Allergy or sensitivity to epinephrine |
| How is epinephrine administered under the Croup Medical Directive for a patient less than 1 years old and weighs less than 5kg | Route - NEB; Concentration - 1mg/1mL = 1:1000; Dose - 0.5mg; max single dose - 0.5; dosing interval - N/A; max number of doses - 1; * Minimum amount of liquid in NEB is 2.5 |
| How is epinephrine administered under the Croup Medical Directive for a patient less than 1 years old and weighs more than 5kg? | Route - NEB; Concentration - 1mg/1mL = 1:1000; Dose - 2.5 mg; max single dose - 2.5; dosing interval - N/A; max number of doses - 1; |
| How is epinephrine administered under the Croup Medical Directive for a patient greater than or equal to1 years old and less than 8 years old? | oute - NEB; Concentration - 1mg/1mL = 1:1000; Dose - 5mg; max single dose - 5mg; dosing interval - N/A; max number of doses - 1 |
| What are the indications for the Analgesia Directive? | Pain |
| What are the treatment options under the Analgesia Medical Directive? | Acetaminophen, Ibuprofen, and Ketorolac |
| What are the conditions for giving Acetaminophen under the Analgesia Medical Directive? | Age is greater than or equal to 12 years; Unaltered LOA; |
| What are the Contraindications for Acetaminophen under the Analgesia Medical Directive? | Acetaminophen use within 4 hours; Allergy or sensitivity to acetaminophen; Hx of liver disease; Active vomiting; Unable to tolerate oral meds.; suspected ischemic chest pain |
| What are the conditions for giving Ibuprofen under the Analgesia Medical Directive? | Age is greater than or equal to 12 years; unaltered LOA |
| What are the contraindications for giving Ibuprofen under the Analgesia Medical Directive? (missing unable to tolerate oral medication) | NSAID/Ibuprofen use in 6 hrs; Allergy to ASA/NSAIDS; Pt. on Anticoag. therapy; Current active bleed; Hx of peptic ulcer/ GI bleed; Pregnant; Asthmatic, no prior use of ASA/NSAIDS;CVA or TBI in 24 hrs; known renal impair.; active vomit, Susp. Isch. CP |
| What are the conditions for giving Ketorolac under the Analgesia Medical Directive? | Age is greater than or equal to 12 years; unaltered LOA; SBP = normotensive Restricted to those unable to tolerate oral medication |
| What are the contraindications for giving Ketorolac under the Analgesia Medical Directive? | NSAID/Ibuprofen use in 6 hrs; Allergy to ASA/NSAIDS; Pt. on Anticoag. therapy; Current active bleed; Hx of peptic ulcer/ GI bleed; Pregnant; If asthmatic, no prior use of ASA/NSAIDS; CVA or TBI in 24 hrs; known renal impair.; , Susp. Isch. CP |
| How is acetaminophen administered under the Analgesia Medical Directive for a more than or equal to 12 years old or younger than 18? | Route - PO; Dose - 500-650; Max Dose - 650 mg; Dosing interval - N/A; Max number of doses - 1 |
| How is acetaminophen administered under the Analgesia Medical Directive for greater than or equal to 18 years? | Route - PO; Dose - 960 - 1000mg; Max Dose - 1000 mg; Dosing interval - N/A; Max number of doses - 1 |
| How is ibuprofen administered under the Analgesia Medical Directive? | Route - PO; Dose - 400 mg; Max single dose - 400 mg; dosing interval - N/A; Max number of doses - 1 |
| how is Ketorolac administered under the Analgesia Medical Directive? | Route - IM/IV; Dose - 10-15mg; Max single dose - 15mg; Dosing interval - N/A; Max number of doses - 1 |
| What are the clinical considerations under the Analgesia Medical Directive? | Co-administer Ibuprofen and acetaminophen whenever possible; Suspected renal colic patients should be considered for ketorolac. |
| What are the indications for the Opioid Toxicity Medical Directive? | Altered LOC; AND Respiratory Depression; AND inability to adequately ventilate; AND Suspected opioid overdose. |
| What are the treatment options under the Opioid Toxicity Medical Directive? | Naloxone |
| What are the conditions and contraindications for administering naloxone under the Opioid Toxicity Medical Directive? | Conditions --> Age greater than or equal to 12 years; Altered LOA; RR s less than 10 breaths/min Contraindications --> Allergy or sensitivity to naloxone; uncorrected hypoglycemia |
| What are the Routes Naloxone can be administered? | Subcutaneous, intramuscular, Inhalation or IV |
| How is naloxone administered under the Opioid Toxicity Medical Directive? | Route - SC, IM, IV, or IN Dose - 0.8 mg Max single dose - 0.8 Dosing interval - 10 minutes Max number of doses - 3 |
| What are the indications for the Home Dialysis Emergency Disconnect Medical Directive? | Patient recieving home dialysis and connected to dialysis machine and requires transport to closest appropriate recieving facility: and Patient is unable to disconnect; and no available family or caregiver knowledgeable in dialysis disconnect |
| What are the conditions and contraindications for dialysis disconnect? | None |
| How do you disconnect a Home Dialysis patient in need of going to the hospital ? | Ensure both patient side and machine side of the connection is clamped before disconnecting and attaching end caps. |
| What are the indications for the Suspected Adrenal Crisis Medical Directive? | A patient with primary adrenal failure who is experiencing clinical signs of an adrenal crisis |
| What are the treatment options under the Suspected Adrenal Crisis Medical Directive? | Hydrocortisone? |
| What are the conditions for giving Hydrocortisone under the Suspected Adrenal Crisis Medical Directive? | EMS is presented with vial of hydrocortisone for said pt.; AND Age related (Hypoglycemia or tachycardia or hypotension);Or GI symptoms (Vomiting, diarrhea, abdo pain); or Syncope; Or Temp. Greater than or equal to 38C (or hx of fever); OR Altered LOA |
| What are the contraindications for giving Hydrocortisone under the Suspected Adrenal Crisis Medical Directive? | Allergy or sensitivity to hydrocortisone |
| How is Hydrocortisone administered under the Suspected Adrenal Crisis Medical Directive? | Route - IM Dose - 2mg/Kg (round to nearest 10mg) Max Single dose - 100mg Dosing interval - N/A Max number of doses - 1 |
| What are the indications for the Emergency Child Birth Medical Directive? | Pregnant patient experiencing labour; or Post-partum patient immediately following delivery |
| What are the treatments listed under the Emergency Childbirth Medical Directive? | Delivery; Umbilical Cord management; External Uterine Massage |
| What are the conditions and contraindications for Delivery under the Emergency Childbirth Medical Directive? | Conditions --> Age is in childbearing years; second stage labour and/or imminent birth contraindications --> N/A |
| What are the conditions and contraindications for Umbilical Cord Management under the Emergency Childbirth Medical Directive? | Conditions --> Age is of childbearing years; cord complications or neonatal or maternal resuscitation is required or due to transport considerations Contraindications --> N/A |
| What are the conditions and contraindications for External Uterine Massage under the Emergency Childbirth Medical Directive? | Conditions --> Age is of child bearing years; post-placental delivery Contraindications --> N/A |
| If patient is experiencing second stage labour/ imminent birth, what position should they placed in? | Supine on a firm surface with head and shoulders slightly elevated, legs flexed and abducted at the hips and knees, feet flat and perineum visible. |
| How is an uncomplicated delivery managed? | Deliver the head in a controlled fashion, allow for spontaneous head rotation (restitution), and deliver the neonate's shoulders and body. |
| How is a shoulder dystocia managed? | Attempt McRoberts Manoeuvre and apply suprapubic pressure (ALARM) |
| how is a breeched delivery managed? | Hands off the body until baby is born to the umbilicus, allow head to deliver spontaneously, or gently lift and hold neonate upwards and backwards. If head does not deliver, perform smellie-veit. |
| How is a nuchal or prolapsed cord managed? | cord is present, fetal part should be elevated to relieve pressure and place pt. in exaggerated simms position. If nuchal cord is present and loose, slip over the neonates head; if nucchal cord too tight, clamp and cut. otherwise clamp/cut when pulseless |
| What are we not doing is limb presents itself during labour and delivery? | Shoving the limb back in. |
| What are we encouraging the patient not to do is labour is not progressing? | Encourage them not to push. |
| What should you do once the placenta is delivered? | Inspect for wholeness, place in plastic bag from OBS kit with maternal patients name and time of delivery. |
| What are the indications under the Endotracheal and Tracheostomy Suctioning Medical Directive? | Patient with endotracheal or tracheostomy tube: and Airway obstruction or increased secretions. |
| What are the conditions and contraindications for suctioning under the Endotracheal and Tracheostomy Suctioning Medical Directive? | N/A |
| How is Suctioning administered for an Infant under the Endotracheal and Tracheostomy Suctioning Medical Directive? | Dose - suction at 60-100 mmHg Max single dose - N/A Dosing Interval -1 minute Max number of doses - 5 Max time suctioning per dose - 10 seconds |
| How is Suctioning administered for a Child under the Endotracheal and Tracheostomy Suctioning Medical Directive? | Dose - suction at 100-120 mmHg Max single dose - N/A Dosing Interval -1 minute Max number of doses - 5 Max time suctioning per dose - 10 seconds |
| How is Suctioning administered for an Adult under the Endotracheal and Tracheostomy Suctioning Medical Directive? | Dose - suction at 100-150 mmHg Max single dose - N/A Dosing Interval -1 minute Max number of doses - 5 Max time suctioning per dose - 10 seconds |
| What are some clinical considerations under the Endotracheal and Tracheostomy Suctioning and Medical Directive? | Pre-oxygenate with 100% oxygen; In an alert patient, have them cough to clear airway prior to suctioning |
| What are the indications for the Emergency Tracheostomy Tube Reinsertion Medical Directive? | Patient with existing tracheostomy where the inner and/or outer cannula(s) have been removed; And Resp. Distress: And Inability to Ventilate adequately: and No available family or caregiver knowledgeable in tracheostomy cannula replacement |
| What are the conditions and contraindications for Tach, tube reinsertion under the Emergency Tracheostomy Tube reinsertion Medical Directive? | Conditions --> N/A Contraindications --> Inability to landmark or visualize. |
| What are the max number of attempts for Emergency tracheostomy tube reinsertion? | 2 attempts. |
| What are the auxiliary directives for PCP's? | Intravenous and Fluid Therapy; Cardiogenic Shock; Continuous Positive Airway Pressure (CPAP); Supraglottic Airway; Nausea/Vomiting; Electronic Control Device Probe Removal; Minor Abrasions; Minor Allergic Reaction; Musculoskeletal Pain; Headache |
| What are the indications for IV and Fluid Therapy medical directive? | Actual or potential need for intravenous medication or fluid therapy |
| What are the conditions and contraindications for IV Cannulation under the Intravenous and Fluid Therapy Medical Directive? | Conditions --> Age greater than or equal to 2 years Contraindications --> Suspected fracture proximal to the access sight |
| What are the conditions and contraindications for IV Cannulation under the Intravenous and Fluid Therapy Medical Directive? | Conditions --> Age is greater than or equal to 2; SBP is hypotensive Contraindications --> Fluid overload, SBP is greater than or equal to 90. |
| When s the mandatory patch point under the Intravenous and Fluid Therapy Medical Directive? | Patch to BHP to administer IV NaCl bolus to a patient whose age is greater than or equal to 2 years but younger than 12 years with suspected DKA. |
| How is 0.9% NaCl maintenance infusion administered to a patient between 2 and 12 years of age under the intravenous and Fluid Therapy Medical Directive? | Route - IV Infusion - 15 ml/hr Infusion interval - N/A Reassess every - N/A Max Volume - N/A |
| How is 0.9% NaCl maintenance infusion administered to a patient greater than or equal to 12 years of age under the intravenous and Fluid Therapy Medical Directive? | Route - IV Infusion - 30-60 ml/hr Infusion interval - N/A Reassess every - N/A Max Volume - N/A |
| How is 0.9% NaCl fluid bolus administered to a patient greater than or equal to 2 years but younger than 12 years of age under the intravenous and Fluid Therapy Medical Directive? | Route - IV Infusion - 20 mL/Kg Infusion interval - N/A Reassess every - 100mL Max Volume - 2,000 mL |
| How is 0.9% NaCl maintenance infusion administered to a patient greater than or equal to 12 years of age under the intravenous and Fluid Therapy Medical Directive? | Route - IV Infusion - 20 mL/Kg Infusion interval - N/A Reassess every - 250 mL Max Volume - 2,000mL |
| What should be considered in patients under the age of 12 under the Intravenous and Fluid Therapy Medical Directive? | Microdrips and/or volume control administration |
| What are the indications for the Cardiogenic Shock Medical Directive? | STEMI - positive 12-lead ECG; And Cardiogenic Shock |
| What are the treatment options under the Cardiogenic Shock Medical Directive? | 0.9% NaCl Fluid Bolus |
| What are the conditions and contraindications for 0.9% NaCl Fluid bolus under the Cardiogenic Shock Directive? | Conditions --> Age is greater than or equal to 18 years; SBP s hypotensive; chest auscultation is clear. Contraindications --> Fluid Overload; SBP greater than or equal to 90. |
| How is 0.9% NaCl Fluid bolus administered under the Cardiogenic Shock Directive? | Route - IV Infusion - 10 mL/ Kg Infusion Interval - N/A Reassess every - 250 mL Max volume - 1,000 mL |
| What are the indications for the Continuous Positive Airway Pressure Directive? | Severe Respiratory Distress; and Signs and/or symptoms of acute pulmonary edema or COPD |
| What are the conditions for CPAP? | Age is greater than or equal to 18 years; RR = tachypnea; SBP = normotension SpO2 is less than 90% or there is evidence of accessory muscle use. |
| What are the contraindications for CPAP? | Asthma exacerbation; suspected pneumothorax; unprotected or unstable airway; major trauma or burns to the head or torso; tracheostomy; inability to sit up right; unable to cooperate. |
| How is CPAP administered? | Initial setting - 5 cm H20 titration increment - 2.5 cm Titration interval - 5 minutes Max setting - 15 cm H20 |
| How do we administer increase FiO2 if available under the CPAP Directive? | Initial FiO2 - 50-100% FiO2 increment - SpO2 less than 92% despite treatment and/or 10cm H20 pressure or equivalent Max FiO2 - 100% |
| What are the indications for the supraglottic Airway Medical Directive? | Need for ventilatory assistance or airway control?; and Other airway management is ineffective? |
| What are the conditions for a supraglottic airway? | Patient must be in cardiac arrest |
| What are the contraindications for a supraglottic airway? | Active vomiting; Inability to clear the airway; Airway edema; Stridor; Caustic Ingestion |
| What are the maximum number of attempts for a supraglottic arway? | 2 attempts |
| What is the primary way to determine if a supraglottic airway s properly placed? | ETCO2 (waveform capnography) |
| What is the secondary way to confirm is a supraglottic airway is in place? | ETCO2 (Waveform capnography) Auscultation; Chest rise. |
| What are the indications for the Nausea/Vomiting Medical Directive? | Nausea or vomiting |
| What are the treatment options under the Nausea/Vomiting Medical Directive? | Dimenhydrinate |
| What are the conditions and contraindications for Dimenhydrinate under the Nausea/ Vomiting Medical Directive? | Conditions --> Weight is greater than or equal to 25 Kg; Unaltered LOA Contraindications --> Allergy or sensitivity to dimenhydrinate or other antihistamines or anticholinergics or tricyclic anti-depressants |
| How is Dimenhydrinate administered under the Nausea/Vomiting Directive for a patient between 25 and 50 Kg? | Route - Iv or IM Dose - 25 mg Max single dose - 25 mg Dosing interval - N/A Mac number of doses - 1 |
| How is Dimenhydrinate administered under the nausea/Vomiting Directive for a patient greater than or equal to 50 Kg? | Route - IV or IM Dose - 50 mg Max single dose - 50 mg dosing interval - N/A Max number of doses - 1 |
| What needs to be done if Dimenhydrinate is being administered through an IV? | Dilute dimenhydrinate (Concentration of 50mg/1L) 1:9 with Normal Saline or sterile water. |
| What are the indications for the Electronic Control Probe Removal Medical Directive? | Electronic Control Device probes embedded in patient |
| What are the conditions and contraindications for the Probe Removal under the Electronic Control Device Probe Removal Medical Directive? | Conditions --> Age is greater than or equal to 18 years old; unaltered LOA Contraindications --> Probe embedded above the clavicles, in the nipple(s), or in the genital area. |
| What are some clinical considerations under the Electronic Control Device Probe Removal Medical Directive? | Police may require preservation of the probe(s) for evidence; Directive s for ECD removal only and does not consitute as treating and release (normal principals of patient assessment and care apply). |
| What are the indications for the Minor Abrasions Medical Directive - Special Event? | Minor abrasions; AND Special Event (preplanned gathering with potentially large numbers and approval of special event medical directives) |
| What are the conditions and contraindications for a topical antibiotic under the minor abrasions medical directive? | Conditions --> Unaltered LOA Contraindications --> Allergy or sensitivity to any of the components of the topical antibiotic. |
| What are the indications for the Minor Allergic Reaction Medical Directive - Special Event? | Signs consistent with a minor allergic reaction; and Special Event (preplanned gathering with potentially large numbers and approval of special event medical directives) |
| What are the conditions for diphenhydramine under the Minor Allergic Reaction Medical Directive - Special Event? | Age is greater than or equal to 18 years; Unaltered LOA; HR = Within Normal limits (WNL) RR = WNL SBP = normotension |
| What are the contraindications for diphenhydramine under the Minor Allergic Reaction Medical Directive - Special Event? | Allergy or sensitivity to diphenhydramine; Antihistamine or sedative use within last 4 hours; signs or symptoms of moderate to severe allergic reaction Signs or symptoms of intoxications; Wheezing |
| How is diphenhydramine administered under the Minor Allergic Reactions Medical Directive - Special Event? | Route- PO Dose - 50 mg Max single dose - 50 mg Dosing interval - N/A Max number of doses - 1 |
| What are the indications for the Musculoskeletal Pain Medical Directive - Special Event? | Minor musculoskeletal pain; and Special event (preplanned gathering with potentially large numbers and approval of special event medical directives) |
| What are the conditions and contraindications for Acetaminophen under the Musculoskeletal Pain Medical Directive - Special Event? | Conditions --> age is greater than or equal to 18 years; unaltered LOA Contraindications --> Acetaminophen use within the last 4 hours; allergy or sensitivity to acetaminophen, signs or symptoms of intoxication |
| How is acetaminophen administered under the Musculoskeletal Medical Directive - Special Event? | Route - PO Dose - 325 - 650 mg Max single dose - 650 mg Dosing interval - N/A max number of doses - 1 |
| What are the indications for the Headache Medical Directive - Special Event? | uncomplicated headache conforming to the patient's usual pattern ;AND Special event (preplanned gathering with potentially large numbers and approval of special event medical directives) |
| What are the conditions and contraindications for Acetaminophen under the Headache Medical Directive - Special Event? | Conditions --> age is greater than or equal to 18 years; unaltered LOA Contraindications --> Acetaminophen use within the last 4 hours; allergy or sensitivity to acetaminophen, signs or symptoms of intoxication |
| How is acetaminophen administered under the Headache Medical Directive - Special Event? | Route - PO Dose - 325 - 650 mg Max single dose - 650 mg Dosing interval - N/A max number of doses - 1 |
| What is a Special Event Directive? | A preplanned gathering with potentially large numbers of people and the Special Event Medical Directives have been pre-authorized for use by the Medical Director. |
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