Patient Care Maps

When to consider epinephrine for treatment of asthma

If an MDI or nebulizer is not tolerated or feasible

When to consider hydrocortisone for treatment of asthma

When time to medical care will be delayed or the patients symptoms do not improve

Dosage of Salbutamol in single use of MDI

100 mcg

Dosage of hydrocortisone for anaphylaxis, asthma, and AECOPD

5 mg/kg slow push over 1-2 min. Max dose 100 mg (all ages)

Three criteria tested for a LAMS score

Facial droop: absent = 0, present = 1

Arm drift: absent = 0, slow = 1, fast = 2

Grip strength: normal = 0, weak = 1, absent = 2

Most important information to obtain from stroke patient

Time of onset or last time seen normal

Checklist for stroke patients

Thrombolytic checklist

Two important exclusions to make in treatment of a seizing patient

Hypoglycemia and hypoxemia

Status Epilepticus as defined by Shared Health care maps

A seizure lasting longer than 5 minutes or that does not terminate with up to 2 doses of midazolam

Contraindications of midazolam

Hypersensitivity, respiratory depression

Midazolam is used with caution in what circumstances?

Hypotension, hypoperfusion, shock

Dosage of IN midazolam for seizures

adult: 5 mg, repeat once in 10 min if req

Dosage of IM midazolam for seizures

adult: 5 mg, repeat once in 15 min if req

Dosage of IV midazolam for seizures

0.05 - 0.1 mg/kg via slow push/1 min

max dose 5 mg q 5 min as req

IM dosage of epinephrine for anaphylaxis, and asthma

Adult: 0.5 mg q 10 min in anterolateral thigh

Epinephrine autoinjector dosages

6 years and older (orange injector): 0.3 mg

repeat once in 10 min if req in anterolateral thigh

Up to 6 years (green injector): 0.15 mg

repeat once in 10 min if req in anterolateral thigh

Perform an ECG on an ACS patient within what timeframe?

10 minutes of arrival

Checklist for known or suspected STEMI patients

TNK (fibrinolysis checklist)

5 medications in PCP scope for treatment of ACS/STEMI

Nitroglycerin

Fentanyl

Acetylsalicylic acid (ASA)

Enoxaparin (if advised)

Ticagralor (if advised)

Indications of nitroglycerin

Known or suspected ACS or ischemic cardiac chest pain

Acute cardiogenic pulmonary edema

Contraindication of nitroglycerin

Hypersensitivity

SBP of less than 90 mmHg

Use of ED meds within last 24 hrs

Increased ICP

Nitroglicerin is used with caution in what circumstances?

HR < 50 or >100

Right ventricular MI

Known or suspected hypovolemia

Cardiogenic shock

Aortic mitral stenosis, pericarditis, hypertrophic cardiomyopathy, left ventricualr outflow obstruction

Sublingual dosage for nitroglycerin

0.4 mg q 5 min as req

Topical/transdermal dosage for nitroglcerin

0.4 to 0.8 mg/hr

(replace pt's patch if on > 12 hrs)

PO dosage of acetylsalicylic acid

160 mg once

Advise patient to chew

Contraindications of ASA

Hypersensitivity

Known ASA-induced asthma

Active major bleeding

Should ASA be administered if the patient is on daily ASA or has already taken ASA as advised by 9-1-1

Yes

Indication for fentanyl

Analgesia for moderate to severe pain

Contraindications for fentanyl

Hypersensitivity

Decreased LOC

Hypoventilation or respiratory failure

Uncorrected hypotension/hypoperfusion/shock

Fentanyl is used with caution in the which circumstances? (7)

Compensated shock

Head injury

Opioid naive patients

Patients over 75

Drug or alcohol intoxication

Liver failure

Renal failure

IN dosage of fentanyl

Adults: 2 mcg/kg, max 100 mcg

may give additional 1 mcg/kg (max 50 mcg) after 10 min if no IV access.

IM dosage of fentanyl

Adult: 1 mcg/kg, max 100 mcg

repeat 0.5 to 1 mcg/kg (max 100mcg) q 60 min as required

IV dosage of fentanyl

Adult: 0.5 to 1 mcg/kg, max 100 mcg

May give additional 0.25 to 0.5 mcg/kg (max 50) after 5 min

Repeat 0.5 to 1 mcg/kg (max 100) q 30 min as required

Indications for ticagrelor

Known or suspected STEMI if Pt. is going directly to primary coronary intervention

Contraindications of ticagrelor

Hypersensitivity

Pt. may be candidate for fibrinolysis

Active major bleeding

Dosage of ticagralor

2 tablets (180 mg) as directed by Code-STEMI physician

Indications of enoxaparin

Known or suspected STEMI if Pt. is going directly to primary coronary intervention

Contraindications of enoxaparin

Hypersensitivity

Pt. may be a candidate for fibrinolysis

Active major bleeding

Heparin-induced-thrombocytopenia within 100 days

Dosage of enoxaparin

IV, under 75 yrs: 0.5 mg/kg slow push/60s, max dose 50 mg

SubQ, under 75: 1 mg/kg, max 100 mg

SubQ over 75: 0.75 mg/kg max 75 mg

Two treatments for AAA

Fluid resuscitation (if in shock)

Fentanyl

Dosage and considerations for fluid resuscitation of AAA patient

10 ml/kg, max 500ml per dose

Repeat as needed to cumulative volume of 2L

Reassess BP and chest after each dose

Target: SBP 80-90 or MAP 60-65

Consider smaller dose or slower admin for heart failure, dialysis, or Pt. over 75 years.

Discontinue if pulmonary edema develops

PCP treatment for SVT

Vagal maneuver

IV dosage of D10W

5 ml/kg, max dose 250ml via slow push/1 min

q 5 min as req

IV dosage of D50W

1 ml/kg, max dose 50ml via slow push/1 min q 5 min as req