Primary Care Paramedic Medical Directives Version 3.2 ALS

The conditions for salbutamol are: AGE: N/A LOA: [blank_start]N/A[blank_end] HR: [blank_start]N/A[blank_end] RR: [blank_start]N/A[blank_end] SBP: N/A Other: [blank_start]N/A[blank_end]

The contraindications for salbutamol are: [blank_start]Allergy or sensitivity to salbutamol[blank_end]

The conditions for epinephrine under the bronchoconstriction directive are: AGE: N/A LOA: [blank_start]N/A[blank_end] HR: [blank_start]N/A[blank_end] RR: [blank_start]BVM ventilation required[blank_end] SBP: [blank_start]N/A[blank_end] Other: [blank_start]Hx of asthma[blank_end]

The contraindications for Epinephrine under the Bronchoconstriction Medical Directive are: [blank_start]Allergy or sensitivity to epinephrine[blank_end]

Under the Bronchoconstriction Medical Directive Consider Salbutamol: Weight: <[blank_start]25[blank_end] kg Route: MDI Dose: Up to [blank_start]600[blank_end] mcg ([blank_start]6[blank_end] puffs) Max. Single Dose: [blank_start]600[blank_end] mcg Dosing interval [blank_start]5[blank_end]-[blank_start]15[blank_end] min. PRN Max # of doses [blank_start]3[blank_end]

Under the Bronchoconstriction Medical Directive Consider epinephrine: Weight: [blank_start]N/A[blank_end] Route: [blank_start]IM[blank_end] Concentration: [blank_start]1:1,000[blank_end] Dose: [blank_start]0.01[blank_end]mg/kg Max. Single Dose: [blank_start]0.5[blank_end] mg Dosing interval : [blank_start]N/A[blank_end] Max # of doses: [blank_start]1[blank_end]

Under the Bronchoconstriction Clinical Considerations: [blank_start]Epinephrine[blank_end] should be the [blank_start]first[blank_end] drug administered if the patient is [blank_start]apneic[blank_end]. [blank_start]Salbutamol[blank_end] MDI may be administered subsequently using a [blank_start]BVM MDI adapter[blank_end].

Under the Bronchoconstriction Clinical Considerations: Nebulizations is contraindicated in patients with a known or suspected [blank_start]fever[blank_end] or in the setting of a declared [blank_start]febrile[blank_end] [blank_start]respiratory[blank_end] [blank_start]illness[blank_end] [blank_start]outbreak[blank_end] by the local [blank_start]medical officer[blank_end] of [blank_start]health[blank_end].

Under the Bronchoconstriction Clinical Considerations: When administering salbutamol MDI, the rate of administration should be:

Under the Bronchoconstriction Clinical Considerations: A [blank_start]spacer[blank_end] should be used when administering salbutamol [blank_start]MDI[blank_end].

Under the Bronchoconstriction Medical Directive Consider Salbutamol: Weight: <25 kg Route: [blank_start]NEB[blank_end]Dose: 2.5 mg Max. Single Dose: [blank_start]2.5 mg[blank_end] Dosing interval [blank_start]5-15[blank_end] min. PRN Max # of doses [blank_start]3[blank_end]

The indications for the Moderate to Severe Allergic Reaction Medical Directive: [blank_start]Exposure[blank_end] to a [blank_start]probable allergen[blank_end] AND [blank_start]Signs[blank_end] and/or symptoms of a [blank_start]moderate to severe[blank_end] allergic reaction ([blank_start]including anaphylaxis[blank_end])

Conditions for Epinephrine under the Moderate to Severe Allergic Reaction Medical Directive: AGE: [blank_start]N/A[blank_end] WEIGHT: N/A LOA: [blank_start]N/A[blank_end] HR: [blank_start]N/A[blank_end] RR: [blank_start]N/A[blank_end] SBP: N/A Other: For [blank_start]anaphylaxis only[blank_end]

The ONLY contraindication to giving a pediatric patient IM epinephrine without an autoinjector in the case of anaphylaxis according to the Moderate to Severe Allergic Reaction Medical Directive "contraindications" for Epinephrine is: "Allergy or sensitivity to epinephrine"

Under the Moderate to Severe Allergic Reaction Medical Directive Consider epinephrine: Weight: [blank_start]N/A[blank_end] Route: IM Concentration: 1/[blank_start]1000[blank_end] Dose: 0.01mg/kg Max. Single Dose: [blank_start]0.5[blank_end] mg Dosing interval: N/A Max # of doses: [blank_start]1[blank_end]

According to the formula for approximate pediatric weight (kg) calculation, a 4 year old child should weigh [blank_start]18[blank_end] kg. Using this weight, the proper dose of IM epinephrine for this child according to the Moderate to Severe Allergic Reaction Medical Directive for anaphylaxis would be [blank_start]0.18[blank_end] mg which may be rounded to the nearest [blank_start]0.05[blank_end] mg, making the proper dose [blank_start]0.2[blank_end] mg. According to the Epinephrine 1:1000 IM Dosing Chart on page 24, the dose of epinephrine that would be given to a 4 year old child who weighs 18kg is actually [blank_start]0.15[blank_end] mg. However, according to the same chart, a child weighing 28 kg should receive a dose of [blank_start]0.3[blank_end] mg.

The two drugs administered under the Moderate to Severe Allergic Reaction Medical Directive are:

Conditions for Diphenhydramine under the Moderate to Severe Allergic Reaction Medical Directive: AGE: [blank_start]N/A[blank_end] WEIGHT: ≥[blank_start]25[blank_end]kg LOA: [blank_start]N/A[blank_end] HR: N/A RR: N/A SBP: N/A Other: N/A

Under the Moderate to Severe Allergic Reaction Medical Directive Consider diphenhydramine (if certified and authorized): Weight: ≥[blank_start]25[blank_end] kg to <[blank_start]50[blank_end] kg Route: [blank_start]IV[blank_end] or IM Dose: [blank_start]25[blank_end] mg Max. Single Dose: [blank_start]25[blank_end] mg Dosing interval: [blank_start]N/A[blank_end] Max # of doses: [blank_start]1[blank_end]

Under the Moderate to Severe Allergic Reaction Medical Directive Consider diphenhydramine (if certified and [blank_start]authorized[blank_end]): Weight: ≥[blank_start]50[blank_end] kg Route: [blank_start]IV[blank_end] or IM Dose: [blank_start]50[blank_end] mg Max. Single Dose: [blank_start]50[blank_end] mg Dosing interval: [blank_start]N/A[blank_end] Max # of doses: [blank_start]1[blank_end]

Patch to BHP for authorization to use pediatric auto injector for patients <[blank_start]10[blank_end]kg

Epinephrine should be the first drug administered in anaphylaxis.

Under the Croup Medical Directive, the indications are: [blank_start]Severe[blank_end] r[blank_start]espiratory[blank_end] [blank_start]distress[blank_end] AND [blank_start]Stridor[blank_end] [blank_start]at[blank_end] r[blank_start]est[blank_end] AND [blank_start]Current[blank_end] history of [blank_start]URTI[blank_end] AND B[blank_start]arking[blank_end] [blank_start]cough[blank_end] OR [blank_start]recent[blank_end] history of [blank_start]barking[blank_end] cough

Conditions for Epinephrine under the Croup Medical Directive: AGE: [blank_start]<8[blank_end] LOA: [blank_start]N/A[blank_end] HR: [blank_start]<200[blank_end]/min RR: [blank_start]N/A[blank_end] SBP: N/A Other: N/A

Number of contraindications listed under the Croup Medical Directive for Epinephrine:

You are giving epinephrine to a 6 month old under the croup medical directive. Her weight is 17.7lbs or approximately [blank_start]8[blank_end]kg. The correct dose is [blank_start]2.5[blank_end][blank_start]mg[blank_end] of 1:1,000 concentration epinephrine. You can give [blank_start]1[blank_end] dose and the dosing interval is [blank_start]N/A[blank_end]. The route you use is [blank_start]NEB[blank_end].

You are giving epinephrine to a 3 month old under the croup medical directive. Her weight is 8.8lbs or approximately [blank_start]4[blank_end]kg. The correct dose is [blank_start]0.5[blank_end][blank_start]mg[blank_end] of 1:1,000 concentration epinephrine. You can give [blank_start]1[blank_end] dose(s) and the dosing interval is [blank_start]N/A[blank_end]. The route you use is [blank_start]NEB[blank_end].

The largest single dose of epinephrine in the PCP medical directives v3.2 is in the [blank_start]croup[blank_end] directive. A Primary Care Paramedic can give [blank_start]5mg[blank_end] of 1:1000 epinephrine to a patient who meets the conditions and is ≥[blank_start]1[blank_end] year(s) old.

Match the assessment findings with their point vales according to the Westley Croup Score chart on page 30. Altered level of consciousness is worth [blank_start]5[blank_end] point(s). Audible inspiratory stridor with a stethoscope is worth [blank_start]1[blank_end] point(s). Severely Decreased Air Entry is worth [blank_start]2[blank_end] point(s). Cyanosis with agitation is worth [blank_start]4[blank_end] point(s) The highest score possible is [blank_start]17[blank_end] point(s) The lowest score possible is [blank_start]0[blank_end] point(s) Moderate croup is considered a score of [blank_start]4-7[blank_end] points Severe croup is a score of [blank_start]>7[blank_end] points

Croup is generally the result of a:

Croup is a(n) [blank_start]upper[blank_end] [blank_start]respiratory[blank_end] [blank_start]infection[blank_end].

Croup tends to occur in children aged [blank_start]6[blank_end] months to [blank_start]3[blank_end] years and is most prevalent at the age of [blank_start]2[blank_end] years.

Generally speaking, patients with [blank_start]moderate[blank_end] to [blank_start]severe[blank_end] croup should be considered for therapy as per the medical directive.

You are following the croup medical directive for a patient whose stridor is audible without a stethoscope, has no retraction, has somewhat decreased air entry, cyanosis only when agitated and a GCS of 13 (this child is normally GCS 15). According the Westley Croup score, what score does this patient receive?

You are following the croup medical directive for a patient whose stridor is audible with a stethoscope, has severe retraction, has severely decreased air entry, no cyanosis and a GCS of 15. According the Westley Croup score, what score does this patient receive?

Your croup patient has a Westley Croup Score of 7. According to ALS, they would be considered to have:

Indications for Continuous Positive Airway Pressure (CPAP) Medical Directive - Auxiliary: S[blank_start]evere[blank_end] [blank_start]respiratory[blank_end] [blank_start]distress[blank_end] AND [blank_start]Signs[blank_end] and/or [blank_start]symptoms[blank_end] of [blank_start]acute[blank_end] [blank_start]pulmonary[blank_end] [blank_start]edema[blank_end] OR [blank_start]COPD[blank_end]

Conditions for Continuous Positive Airway Pressure (CPAP) Medical Directive - Auxiliary AGE: ≥[blank_start]18[blank_end] years LOA: [blank_start]N/A[blank_end] HR: [blank_start]N/A[blank_end] RR: [blank_start]Tachypnea[blank_end] SBP: [blank_start]Normotension[blank_end] Other: [blank_start]SpO2[blank_end] <[blank_start]90[blank_end]% or [blank_start]accessory muscle use[blank_end]

Contraindications for CPAP Asthma [blank_start]exacerbation[blank_end] Suspected [blank_start]pneumothorax[blank_end] Unprotected or unstable [blank_start]airway[blank_end] Major [blank_start]trauma or burns[blank_end] to the [blank_start]head or torso[blank_end] [blank_start]Trache[blank_end]ostomy Inability to [blank_start]sit upright[blank_end] Unable to [blank_start]cooperate[blank_end]

Consider CPAP: Initial setting [blank_start]5[blank_end] cm H2O or equivalent flow rate of device as per BH direction. [blank_start]Titration[blank_end] [blank_start]increment[blank_end] [blank_start]2.5[blank_end] cm H2O or equivalent flow rate of device as per BH direction. [blank_start]Titration[blank_end] [blank_start]interval[blank_end] [blank_start]5[blank_end] [blank_start]min[blank_end]. Max. [blank_start]setting[blank_end] [blank_start]15[blank_end] cm H2O or equivalent flow rate of device as per BH direction

Under the treatment section of the Continuous Positive Airway Pressure Medical Directive: Consider increasing FiO2 (if available): Initial FiO2: [blank_start]50[blank_end]-[blank_start]100[blank_end]% FiO2 increment (if available on device) SpO2 [blank_start]<92%[blank_end] despite treatment and/or [blank_start]10[blank_end] cm H2O pressure or equivalent flow rate of device as per BH direction. Max FiO2: [blank_start]100%[blank_end]