Vital Signs:

Respiration (normal ranges):

- adult 12-20 per/min

- children 15-30 per/min

- infants 25-50 per min

Pulse (normal ranges):

- adults 60-100 per/min

- children 80-120 per/min

- toddlers 90-150 per/min

- newborns 120-15- per min

Blood pressure (normal ranges):

- adults 100-140 systolic 60-90 diastolic

- children 80-110 systolic

- infants 60 systolic

O2 Intervention:

Nasal cannula 2-6 liters/min

Nonrebreather 10-15 liters/min

BVM 15-25 liters/min

Subcutaneous (SC) Injection:

45° angle on needle

24-26 gauge

½" - 1"

max volume= 1mL

Intramuscular (IM) Injection:

90° angle on needle

21 gauge

1½" - 2"

max volume (deltoid)= 1mL

max volume (thigh)= 3mL

max volume (gluteus)= 5mL

Capnography:

Ventilation vital sign

Hyperventilation etco2<35 (respiratory alkalosis- low CO2)

Hypoventilation etco2>45 (respiratory acidosis- high CO2)

Normal range: 35-45

Shark fin= bronchospasm

cpr range of etco2#---> 10-15

return of spontaneous circulation (rosc) etco2 > 13.5

Click here for capnography slideshow

Combitube contraindications:

1. gag reflex

2. esophageal disease

3. 4'<37f<6'

41f<5'

4. Caustic Ingestion/including thermal damage

COPD:

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ Albuterol 2.5mg

And/Or

Atrovent 1 unit dose

☐ Solumedrol 1mg-2mg/kg

Or

Decadron 1mg/kg

*if patient is not responding to treatment: sedate and intubate

Asthma:

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ Albuterol 2.5mg

And/Or

Atrovent 1 unit dose

☐ Solumedrol 1mg-2mg/kg

Or

Decadron 1mg/kg

* if not responding to Beta2 agonist then Epi 1:1000 0.3mg-0.5mg. SQ

* if patient is not responding to treatment:sedate and intubate

Chest Pain:

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ ASA 160mg-325mg

*** 12 lead as soon as patient condition allows ***

☐ Nitro 0.4mg

☐ Morphine 2mg-4mg (max of 10mg)

Pain Management:

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ Morphine 2mg-4mg (max of 10mg)

CHF:

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ If chest pain, then ASA 160mg-325mg

☐ Nitro 0.4mg

☐ CPAP

☐ Lasix 0.5mg-1mg/kg

☐ Morphine 2mg-4mg (max of 10mg)

* if patient doesn't respond to treatment: sedate and intubate

* 12 lead as soon as patient condition allows

Note: CPAP Contraindications: Respiratory arrest, Active gastrointestinal bleeding or vomiting, hypoventilation, Unable to follow verbal commands, s/s of pneumothorax or chest trauma, Inability to properly fit the CPAP mask, tracheostomy, inability to tolerate the mask, altered level of consciousness

Allergic Reactions (mild):

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ Benadryl 25mg-50mg IM/IV

Anaphylaxis (Moderate):

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ If wheezes then Albuterol 2.5mg and/or Atrovent 1unit dose

☐ Epi 1:1000 0.3mg-0.5mg. Sq/IM

☐ Benadryl 25mg-50mg IM/IV

☐ Solumedrol 1mg-2mg/kg or decadron 1mg/kg

Anaphylaxis (Severe- shock):

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ If wheezes then Albuterol 2.5mg and/or Atrovent 1unit dose

☐ Epi 0.3mg-0.5mg (1:1000) Sq/IM

☐ Benadryl 25mg-50mg IM/IV

☐ Solumedrol 1mg-2mg/kg or Decadron 1mg/kg

* if not responding to Epi SQ/IM, then Epi 0.1mg (1:10,000) IV

Hypoglycemia:

☐ BGL<60

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ If patient can talk and maintain own airway...

Oral glucose 15g- 45g

☐ If patient cannot talk and maintain own airway...

- Thiamine- 100mg (suspected alcoholics)

- D50 12.5g-25g IV/IO

If IV/IO access cannot be accessed, then Glucagon 0.5mg-1.0mg IM

Hyperglycemia:

☐ BGL>300

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ 500cc Fluid bolus

Hypovolemic Shock:

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ Systolic #:

100-130, then 250cc fluid

80-100, then 500cc fluid

<80, then 1000cc fluid

Coma of Unknown Origin:

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ Check BGL - fix hypo or hyper

☐ If CNS is down and resp down...

Narcan - 0.4mg increments up to 10mg

* 0.4 increments until resp rises and a gag reflex

Signs and symptoms of a narcotic overdose:

- CNS depression

- Respiratory depression

- pinpoint pupils

AEIOU -TIPS

Acronym for Altered Mental Status Causes

A- alcohol

E- epilepsy

I- insulin

O- opiates

U- uremia

T- trauma

I- infection

P- psychogenic

P- poison

S- shock/stroke

Stroke alert:

☐ Cincinatti Stroke Scale (facial droop, arm drift, and speech)

☐ BGL > 50 then treat for stroke (if under treat hypoglycemia)

☐ Onset < 5 hours

Deficit not likely due to head trauma

Seizures:

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ Ativan 2mg-4mg IV/IM (max 8mg)

or

Valium 5mg-10mg IV/IM/Rectal (max 30mg)

Stimulant Overdose:

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ Ativan 2mg-4mg IV/IM (max 8mg)

or

Valium 5mg-10mg IV/IM/Rectal (max 30mg)

Conscience Sedation:

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ Ativan 2mg-4mg IV/IM (max 8mg)

or

Valium 5mg-10mg IV/IM/Rectal (max 30mg)

☐ Etomidate 0.2mg-0.6mg/kg

Note: This is a specific order. Etomidate CANNOT be given before Ativan or Valium.

Cardiogenic Shock:

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ 500cc fluid bolus (If wet lung sounds then 250cc fluid bolus)

☐ If no response to bolus, then Dopamine 4mcg-10mcg/kg/minute

s/s of Cardiogenic shock

BP down

Pulse Rate up

Street method for Dopamine Drip

• • • • • • • 1. weight in lbs

              2. drop last digit

              3. subtract 10%

Note: this will result in starting dose of 5mcg/kg/min, you must have a 1600mcg/mL ratio bag for this to work

Nausea/Vomiting:

☐ If O₂ ≤ 94%, then administer O₂ intervention

☐ Zofran 4mg

or

Phenergan 12.5mg-25mg