Pa ALS Protocol Review II

Diphenhydramine can be administered without medical command orders in the case of moderate allergic reactions. This is because diphenhydramine is an antihistamine medication that can help alleviate symptoms such as itching, swelling, and rash caused by allergies. In moderate allergic reactions, the symptoms are not life-threatening or severe enough to require immediate medical intervention. However, for severe dystonic reactions, status asthmaticus, and schizophrenic episodes, medical command orders are necessary as these conditions may require specific treatments or interventions that should be overseen by a healthcare professional.

Anisocoria is the condition where the pupils of the eyes are of unequal size. While an ischemic stroke can cause various symptoms such as facial droop, slurred speech, and arm drift, anisocoria is not typically associated with an ischemic stroke. Therefore, the presence of anisocoria would be least likely to increase suspicion for an ischemic stroke.

No, the ALS provider cannot release this patient without contacting medical command. Although the patient's blood sugar level has increased and they appear conscious, alert, and oriented, it is important to consider the underlying condition of type I diabetes and the potential for further complications. The patient's altered mental status and low blood sugar level indicate a need for medical evaluation and monitoring. It is necessary to consult with medical command to ensure appropriate care and to discuss the patient's refusal of transport.

In this scenario, the patient is hypotensive, meaning their blood pressure is low. A bolus of normal saline solution is administered to increase the blood pressure. The target systolic blood pressure associated with this intervention is > 90 mmHg, meaning it should be higher than 90 mmHg. This is because a systolic blood pressure below 90 mmHg is considered low and may indicate inadequate perfusion to vital organs. Therefore, the goal is to raise the blood pressure to a level above 90 mmHg to improve organ perfusion and prevent further complications.

Flumazenil is not an approved ALS drug for the treatment of benzodiazepine overdose. Flumazenil is actually a medication used to reverse the effects of benzodiazepines and is commonly used in emergency situations to treat benzodiazepine overdose. ALS (Amyotrophic Lateral Sclerosis) is a neurodegenerative disease and Flumazenil is not indicated for its treatment. Therefore, the statement is false.

Lidocaine is not a pharmaceutical treatment for narrow complex tachycardias per PA protocol. Lidocaine is primarily used for the treatment of ventricular arrhythmias, such as ventricular tachycardia and ventricular fibrillation, rather than narrow complex tachycardias. Diltiazem, Verapamil, and Procainamide are commonly used pharmaceutical treatments for narrow complex tachycardias as per PA protocol.

An initial fluid bolus of 500-cc is recommended for a tachycardic, hyperpyretic adult patient with a history of urinary tract infections and complaining of dysuria. This bolus helps to address the patient's increased heart rate and high fever, while also providing hydration. The 500-cc volume is appropriate as it is a moderate amount that can help alleviate symptoms without overwhelming the patient's system.

The patient is presenting with chest pain and very high blood pressure, which may indicate an acute coronary syndrome. The appropriate treatment for this condition includes NTG administration to relieve chest pain and lower blood pressure. However, the option of an initial spray of NTG followed by three additional sprays as long as the systolic blood pressure remains above 100 mmHg is inappropriate. In this situation, the patient's blood pressure is already very high, and further NTG administration may cause a significant drop in blood pressure, leading to hypotension and potential cardiovascular collapse. Therefore, this treatment option should be avoided.

Epinephrine is not an appropriate pediatric dosing/route for epiglottitis. Epiglottitis is a serious condition that can cause severe airway obstruction. In this situation, the preferred treatment is immediate intubation or tracheostomy, rather than using a nebulizer. Epinephrine may be used in other respiratory emergencies, such as croup, but it is not appropriate for epiglottitis.

The correct answer is to contact medical command. This is the appropriate step to take when encountering a stable, but irregular, narrow complex tachycardia in a patient. Contacting medical command allows for further guidance and direction from a higher medical authority, ensuring the best course of action is taken for the patient's condition. It is important to consult with medical command in order to provide the most appropriate and effective care for the patient.