Paramedic Cheat Sheet - ALS
Paramedic Cheat Sheet
As a paramedic, your job is to render advanced medical care to a patient in order to stabilize them enough to get them to a hospital. This means you can do everything that you could do as an EMT but also do even more. You have to remember that not everyone is a medical professional so go off of what you are given in regards to signs,symptoms, and vitals. Also keep up with the EMT cheat sheet as well as being a paramedic you also need to know the material in there as well.
Assessment
As a paramedic you are able to dive deeper into what’s going on with a patient by looking at things like an ECG so you can better diagnose them. It creates avenues that you can now do more for the patient depending on the diagnosis. The first thing you should do is start off with the basic assessment skills outlined in the EMT cheat sheet.
Cardiac
When there is any kind of event that may involve the heart as a paramedic you have the ability to use a 12 lead ECG. In RP, how you would do this is by in /me asking what does the pts (patient’s) ECG look like or what is their heart rhythm or something to that nature.
When someone is in cardiac arrest there are only 2 heart rhythms that you can shock and that it will do something. That is Ventricular Tachycardia and Ventricular Fibrillation or Vtach and Vfib, that is when the heart’s electrical impulses are messed up and shocking them would reset the heart.
When a person is flat line or asystole the only thing that will bring them back is CPR and medications which will be outlined in the Pharmacology section. You must continue CPR if a person goes into asystole, if they remain in asystole after 2 pulse checks then call a time of death.
Stroke/Seizures
When someone is having a stroke the best way to tell is by using a stroke scale which consists of 3 tests and if the patient fails any 2 of the 3 tests then they are most likely having a stroke.
- Ask the patient to smile if there is any kind of facial droop to one side that’s an indication of a stroke.
- Ask the patient to hold both hands out in front of them and if one starts to drift down then that’s a sign of a stroke
- Another sign is any kind of slurred speed or if the patient is mute and not normally
The best way to handle these is to monitor their blood pressure and treat as you see it.
For an individual having a seizure more than likely when you get on scene it will be post seizure so they will most likely be out of it and not all together. It is at this point you highly recommend they go to the hospital. It is important to obtain if they have any history of seizures or if they take any meds for it.
If a person is actively having a seizure give versed 5-10mg IV or in the muscle.
Hyper/Hypo Glycemic Shock
>250 Hyper <60 Hypo
As a Paramedic, to mitigate a hypoglycemic emergency, you can use oral glucose. But, if the patient is unconscious or altered and not alert and oriented, you can give this solution called D10 which comes in a 250mL bag, and is a solution of carbohydrates that increase the blood sugar rapidly. At first, you should give 100mLs and the patient should wake up or become alert and oriented. After a patient has come out of their Hypoglycemic state, check their vitals once more and ask them if they would like to go to the hospital, if they are alert and oriented; they do not have to go. For Hyperglycemia, the way to help is to dilute by Saline given IV.
Mass-Casualty Incidents (MCI):
A Mass-Casualty Incident, or MCI, is a scene with multiple patients and not enough resources or personnel to provide one-on-one patient care. A MCI will be declared by the first arriving unit at the scene of the incident after they conduct a basic survey of the scene; specifically looking at how many patients are on-scene and what is a rough idea of injuries. This information will then be relayed to Fire Control who in turn will notify responding units. Once additional units arrive on-scene, they will conduct a further sweep and examine patient injuries. When patient injuries are determined, the patients will then be given a colour code (Reference the Colour Code System below).
Immediate (Red): Patients who have major life-threatening injuries, but are salvageable given the resources available.
Delayed (Yellow): Patients who have non-life-threatening injuries, but are unable to walk or exhibit an altered mental status.
"Walking wounded" (Green): Patients who are able to ambulate out of the incident area to a treatment area.
Expectant (Grey): Patients whose injuries make survival unlikely with resources available.
Deceased (Black): Patients who show no signs of life.
Once codes are determined this will be relayed to the Incident Commander who will then arrange appropriate transportation and will remain in communication with Fire Control (Fire Comm).
Advanced Procedures
Intravenous Therapy: Using a needle to insert a catheter into a vein this is a skill you will do often to administer meds and give patients fluids it can only be done by medics.
Intraosseous Therapy: a drill and a special catheter that are designed to drill into the skin and into the Humeral Head (upper arm near shoulder) or Tibial Head (upper shin just below knee). This is used if IV access can not be achieved or medication needs to be absorbed extremely rapidly. As soon as the IO is established, flush the catheter using Lidocaine mix in saline prior to medicine or bolus.
Endotracheal intubation: If a patient cannot secure his own airway then we might have to do it for him. We do this by putting a tube directly into the patient’s trachea. With this we can actively use a BVM to breathe for a patient that may not be breathing adequately or at all.
Cricothyrotomy: If you are unable to intubate a patient due to swelling or other circumstances where their mouth cannot be cleared as a last resort you as a medic can perform a surgical procedure in order to get a patient air. You cut a hole just under the patient’s thyroid membrane in order to insert an endotracheal tube into their trachea past the vocal cords.
Needle Decompression: Indications of this are if a patient has an active pneumothorax (collapsed lung) and when you listen to a patient's lungs you will hear diminished breath sounds or no breath sounds to one side. We have DARTs that are a long needle with a one way valve fixture. This is inserted into the PTs side between the 2nd and 3rd rib on the side of the pneumothorax to repressurize the cavity around the lungs. If you run out of DARTs on a scene then you could take a needle 18g, 16g, or even 14g (gauge the smaller the number the wider the orifice on the needle) and insert it into the patient's chest and secure it. You do this as many times as it takes in order to make the patient breathe better.
Pharmacology (Medications)
It is ok not to know exact dosages for medications, when you are doing your /me it is better for you to just know the correct medication to use and draw it up.
Ex. /me draws up fentanyl and pushes
Also when able try to add what that specific medication you give to your patient does, if you don’t know it then that is ok as well.
Aspirin: Anti-inflammatory drug that blocks the clotting factor of the blood, it can be used in chest pains as well as other inflammation.
Amiodarone: this can be used on patients in V-Fib and V-Tech as it steadys and slows the electrical impulses on the heart and thus helps regulate them. Given via IV or IO.
Atropine: It's an anticholinergic that increases heart rate, and decreases gastrointestinal secretions. Used when a patient has bradycardia, as well as low blood pressure secondary to bradycardia, as well as any organophosphate poisoning. Given via IV.
Benadryl: Can be used with minor allergic reactions as well as early anaphylaxis.
Cardizem: A calcium channel blocker designed to relax vessel stress, decrease heart rate and blood pressure, and decrease the load on the cardiac muscles. This medication is administered by attaching the vial of cardizem powder to the cardizem IV bag and shake to mix, then connect IV line to PT and administer. This should be given to PTs with unstable Tachycardia, Atrial Fibrillation, Atrial Flutter, and Chest pain as a result of angina and not Myocardial infarction (STEMI). Given Via IV.
Dextrose (D10): Given to patients who are in a hypoglycemic shock (Blood sugar level lower than 60MG/DL) Given via IV
Epinephrine/ Adrenalin: Comes in different concentrations and these concentrations can be used for different things. {Do not administer to patients with elevated heart rates, pregnant, or have heart disease}
1:1000: For bronchodilation (opens up the lungs a bit). For Severe asthma, severe allergic reactions, anaphylactic shock. Given in the muscle or inhaled with nebulizer
1:10,000: treatment and prophylaxis of cardiac arrest. Given Via IV or IO.
Fentanyl: Narcotic, depressant that decreases sensitivity to pain and vasodialates (drops blood pressure). Given via IV, IO. {once narcan is administered this will stop working, Do not give to patients with respiratory blockage or distress}
Hydroxocobalamin (Vit B12a): used on patients with known or suspected Cyanide toxicity. Given via IV or IO.
Ketamine: can be used as a pain medication in very small doses, used for anesthetics. Given via IV or IO. {Do not administer to PTs with head trauma or Extreme elevation of BP}
Lactated Ringer (LR) solution: is the primary intravenous (IV) fluid you give to dehydrated, trauma patients experiencing blood loss, burn victims, etc. This solution contains more electrolytes and nutrients then regular saline and will rehydrate and maintain a healthy nutrient level. Giving too much fluid on a patient with internal or external bleeding can result in them becoming flooded with too much fluid and not enough blood, therefore keep the Blood pressure stable at 80-90 systolic (top number).
Lidocaine: Anesthetic that can be used to temporarily numb a patient as well as it reduces the speed of electrical impulses in the heart slowing down the patient’s heart. Given via IO or topically via ointment. {do not administer if PTs have WPWs on monitor, Heart blocks noted on monitor, a pre-diagnosed decreased blood potassium level}
Morphine: Narcotic that can be used to reduce pain. Can cause low blood pressure as well as a low pulse. Given via IV, IO {once narcan is administered this will stop working, Do not give to patients with respiratory blockage or distress}
Narcan: A medication that TEMPORARILY negates the effects of opioids. Given via IV or IN.
Nitroglycerine: Comes in a spray or tablet that is dissolved under the tongue it used when patients have chest pain of cardiac origin and their systolic blood pressure is above 180. {do not give to PTs who have a known sensitivity to nitrate medications. Have taken erectile dysfunction medications within the past 24 hours, such as Viagra, Cialis, Levitra, Stendra, Staxyn, sildenafil, avanafil, tadalafil or vardenafil. Are hypotensive (typically <90 SBP)}
Norepinephrine: This is given to Patients in septic shock after an IV Bolus (duel arm saline given via IV or IO) is established. This is used to maintain the heart and keep pollutants from being pushed faster by adrenaline. Given via IV or IO accompanying the Bolus.
Sodium bicarb: Can be used as in a late cardiac arrest, Combines with acids to increase PH. can be used with severe acidosis due to hyperventilation. Can also be given to Patients with suspected Crush trauma. Given via IV or IO.
Succinylcholine: It’s a paralytic and skeletal muscle reactant that can be used with intubation, it paralyzes skeletal muscles, including respiratory muscles. Given via IV or IO.
Tranexamic Acid (TXA): Antifibrinolytic that promotes blood clots and helps control bleeding in severe hemorrhage patients. Note: Before you administer TXA on external bleeding, attempt pressure with sterile dressing, tourniquets, etc., and consider transport time to the nearest hospital. Do not administer TXA if the patient is close to definitive care. If you are close to a hospital, immediately begin administering IV/IO fluid. Given VIA IV or IO.
Tylenol (Paracetamol):: Usually taken orally. It is a pain reliever that reduces pain or fever. Should not be used if the patient has any liver disease.
Versed: Benzodiazepine that can be used for sedation as well as with a seizure and in small doses pain management this drug will make a patient drowsy and out of it. Given via IV, IO, IM, or IN. {Do not give to PTs with history of drug abuse, Kidney failure, heart failure, decreased lung function, decreased blood flow to extremities}
Zofran: used when the patient is experiencing nausea or vomiting for relief. Given via IV, IO, IM, or IN.
These are not all of the meds you can use if you have substantial knowledge about a medication that a paramedic could give; you can give it.
Medication Routes
Intramuscular (IM): you directly inject medication into a patient's muscular tissue, doing this may make the medication work a little slower.
Intranasally (IN): By using a mist with a syringe with a tip on it to squirt medication into a patient's nose the most common medication for this is narcan.
Intravenous (IV): Injecting the medication directly into the patients veins is one of the quickest ways for medication to take effect.
Intraosseous (IO): By drilling directly into the bone the patient receives medication directly into the bone marrow and is another fast way for medication to begin working on a patient.
Equipment: A comprehensive list of common equipment we use, and how/why they are used when they are is listed here. While this isn’t gospel it will go a long way in helping make your use of them correct, and bring knowledge of them to you for use when they are appropriate or not.