Abdominal Pain

Alcohol Emergencies

Altered Mental Status

Amputation

Anaphylaxsis

Burns

Child Birth

CVA

Dehydration

Diabetic - Hyperglycemia revised 7-28-04 (transport guidelines)

Diabetic - Hypoglycemia revised 7-28-04 (D50 after Glucagon & transport), 2-11-02 (EMT-IV use of D50)

Dyspnea

Eye Injuries

Fracture - General

Fracture - Femur

Fracture - Pelvis

Head Injuries

Hypertensive Crisis

Hyperthermia

Hypothermia

Nausea - Vomiting

Near Drowning

Poisoning - Overdose

Psychiatric Emergencies

Seizure

Sexual Assualt

Spinal Immobilization revised 9-26-02 (selective c-spine)

Shock

Snake bite

Spinal Injury

Syncope

 

SECTION 6

OTHER MEDICAL/TRAUMA PATIENT CARE TREATMENT PROTOCOLS

ABDOMINAL PAIN

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY IF OXYGEN IS TO BE USED
  3. OXYGEN AS INDICATED
  4. INITIATE IV (ATTEMPT REQUIRED)
  5. CARDIAC MONITOR IF INDICATED
  6. TREAT FOR SHOCK IF PRESENT
  7. PLACE IN POSITION OF COMFORT
  8. TRANSPORT AS INDICATED

 

 

ALCOHOL EMERGENCIES

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY IF OXYGEN IS TO BE USED
  3. OXYGEN AS INDICATED
  4. CARDIAC MONITOR IF INDICATED
  5. INITIATE IV
  6. ADMINISTER THIAMINE 100 MG IV OR IM.
  7. DETERMINE GLUCOSE LEVEL
    1. IF GLUCOSE IS <70, GO TO APPROPRIATE DIABETIC PROTOCOL
  8. IF HISTORY OF DRUG ABUSE AND PT. HAS CONSTRICTED PUPILS

    OR RESPIRATORY DEPRESSION, ADMINISTER NARCAN 1-2 MG IV (NARCAN MAY ALSO BE ADMINISTERED IM IF IV ATTEMPTS HAVE BEEN UNSUCCESSFUL)

  9. SUPPORTIVE MEASURES
  10. TRANSPORT AS INDICATED

 

 

ALTERED MENTAL STATUS/COMA

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY
  3. OXYGEN VIA NRB
  4. CARDIAC MONITOR
  5. INITIATE IV
  6. DETERMINE GLUCOSE LEVEL
    1. IF GLUCOSE IS <70 OR >400, GO TO APPROPRIATE DIABETIC PROTOCOL.
  7. IF HISTORY OF ALCOHOLISM OR MALNURISHED, ADMINISTER 100 MG THIAMINE IV (THIAMINE MAY BE GIVEN IM IF IV ACCESS IS NOT OBTAINABLE)
  8. IF HISTORY OF DRUG ABUSE AND PT. HAS CONSTRICTED PUPILS OR RESPIRATORY DEPRESSION, ADMINISTER 1-2 MG NARCAN. (NARCAN MAY BE ADMINISTERED IM IF IV ATTEMPT HAS BEEN UNSUCCESSFUL).
  9. TRANSPORT AS INDICATED

 

AMPUTATED PARTS

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. CONTROL BLEEDING
  3. PULSE OXIMETRY
  4. OXYGEN VIA NRB
  5. INITIATE IV (LRS OR NS) AND TREAT FOR SHOCK
  6. IF PT. IS NOT HYPOTENSIVE, HAS NO EVIDENCE OF HEAD INJURY, AND IS NOT ALLERGIC TO MORPHINE, CONSIDER MORPHINE 0.05 - 0.1 MG/KG IV PUSH. MAY BE REPEATED IN 5 MINUTES IF NEEDED
  7. RINSE AMPUTATED PART. DO NOT SCRUB!!!
  8. WRAP PART IN MOISTENED GUAZE AND PLACE IN A PLASTIC BAG
  9. PLACE SEALED BAG IN A CONTAINER FILLED WITH ICE WATER (IF THIS IS POSSIBLE).
  10. LABEL CONTAINER WITH NAME, DATE, AND TIME
  11. TRANSPORT AS INDICATED
  12. REASSURE PT. WITHOUT PROVIDING FALSE HOPES

 

ANAPHYLAXIS/ALLERGIC REACTION

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY
  3. OXYGEN VIA NRB
  4. CARDIAC MONITOR
  5. INITIATE IV (IF UNABLE TO OBTAIN AFTER 1 ATTEMPT GO TO STEP 6, AFTER STEP 6, TRY TO INITIATE THE IV AGAIN THEN PROCEED TO STEP 7)
  6. ADMINISTER EPINEPHRINE 1:1,000 SUBCUTANEOUSLY 0.01 MG/KG, MAX DOSE 0.3 MG
  7. ADMINISTER BENADRYL 25 OR 50 MG SLOW IV OR IM
  8. REPEAT EPINEPHRINE IF NEEDED
  9. TRANSPORT AS INDICATED
  10. CONTACT MEDICAL CONTROL FOR FURTHER TREATMENT

 

 

BURNS

 

 

GUIDELINES FOR CARE

 

  1. REMOVE PT. FROM FLAMES AND EXTINGUISH ANY FLAMES ON THE PT
  2. ASSURE ABC’S
  3. REMOVE DRY CHEMICALS BY BRUSHING AND LIQUID CHEMICALS BY FLUSHING WITH LARGE AMOUNTS OF WATER
  4. ASSURE AIRWAY CONTROL
    1. CONSIDER R.S.I.I. IF NECESSARY
  5. PULSE OXIMETRY
  6. OXYGEN VIA NRB
  7. CARDIAC MONITOR
  8. INITIATE IV (NS OR LRS)
  9. TREAT BURN AREA ACCORDING TO TYPE
  10. IF PT. IS NOT HYPOTENSIVE, HAS NO EVIDENCE OF HEAD INJURY, AND IS NOT ALLERGIC TO MORPHINE, CONSIDER MORPHINE 0.05 - 0.1 MG/KG IV PUSH. MAY BE REPEATED IN 5 MINUTES IF NEEDED
  11. TRANSPORT AS INDICATED

 

 

 

CHILD BIRTH

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY AS NEEDED
  3. OXYGEN AS INDICATED
  4. CARDIAC MONITOR
  5. INITIATE IV OF LRS
  6. OBTAIN PERTINENT HISTORY
    1. NUMBER OF PREGNANCIES/DELIVERIES
    2. HISTORY OF PROBLEMS WITH PREGNANCY
    3. LAST MENSTRUAL PERIOD AND DUE DATE
    4. CURRENT COMPLAINTS
    5. PAST MEDICAL HISTORY
  7. PERINEAL EXAMINATION (DO NOT PERFORM AN INTERNAL VAGINAL EXAM)
    1. IF IN ACTIVE LABOR WITH NO BLEEDING OR CROWNING, TRANSPORT AS INDICATED
    2. IF VAGINAL BLEEDING WITH NO SIGN OF SHOCK, TRANSPORT AS INDICATED
    3. IF HEAVY BLEEDING TRANSPORT AND TREAT FOR SHOCK
  8. IF DELIVERY IS IMMINENT
    1. PREPARE AREA FOR DELIVERY
    2. PREPARE MOTHER FOR DELIVERY
    3. ASSIST DELIVERY
    4. PROTECT INFANT FROM FALL AND TEMPERATURE LOSS
    5. CHECK INFANT VITAL SIGNS
    6. CLAMP CORD AND CUT
    7. SUCTION, WARM, DRY, AND STIMULATE THE INFANT
    8. PREPARE THE INFANT FOR TRANSPORT
    9. ASSIST WITH THE DELIVERY OF THE AFTERBIRTH
    10. PREPARE MOTHER FOR TRANSPORT
  9. IF PROLAPSED CORD
    1. PLACE MOTHER IN POSITION, ELEVATE HIPS.
    2. PLACE STERILE GLOVED INDEX AND MIDDLE FINGERS INTO THE VAGINA AND PUSH THE INFANT UP TO RELIEVE THE PRESSURE
    3. CHECK CORD FOR PULSE, PLACE CORD IN WARM, MOIST DRESSING LEVEL WITH VAGINA.
    4. TRANSPORT IN POSITION
  10. IF ABNORMAL PRESENTATION OR DECREASED FETAL HEART TONES, PLACE PT. IN BEST POSSIBLE POSITION AND TRANSPORT
  11. NOTIFY HOSPITAL OF ARRIVAL

NOTE: REMEMBER THAT YOU HAVE TWO PATIENTS TO CARE FOR.

 

CVA/STROKE

1. Follow Initial Protocol for all patients

First Responder

 

1. Place patient in position of comfort.

 

2. Oxygen via Nasal Cannula at 4 to 6 lpm.

 

3. If patient is short of breath and/or showing signs

    of hypoxia, apply oxygen via NRB 10 to 15 lpm.

 

4. Control and maintain airway

 

5. Attempt to establish a time line of when the

    patient was last seen without symptoms.

 

6. Attempt to gather or have family member gather

     patients medications.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMT-IV

(In addition to First Responder)

 

1. Check for neurological deficits using the

     CPSS exam.

       A. Check facial drooping

       B. Check arm drift (pt's eyes must be closed)

       C. Check speech.  Ask patient to say the

            phrase, "You can't teach an old dog new

            tricks."

 

2. If there are any deficits in the initial CPSS

    exam, the patient is in a "load and go"

    situation.

 

3. Transport emergency traffic if onset of symptoms

     is < 3 hours

 

4. Place patient in a 30 degree head elevated

    position as tolerated.

 

5. Establish IV of Normal Saline TKO

 

6. Check glucose level

 

7. If glucose level is < 50, administer 12.5 grams

     of D50

 

8. Notify receiving hospital of your "Stroke Alert"

     patient as soon as possible

 

9. Monitor vital signs

 

 

Paramedic

(In addition to First Responder and EMT-IV)

 

1. Monitor cardiac rhythm

 

2. Monitor pulse oximerty

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Special Considerations:

1. Do not treat hypertension in the field due to possibility of impeding blood flow to the ischemic penumbra.

2. Only treat hypoglycemia if it is < 50 because hyperglycemia will cause lactic acidosis which will damage the ischemic penumbra.

3. If symptoms started more than three hours prior to your arrival, the patient is out of their thrombolytic therapy window.

 

DEHYDRATION

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY
  3. OXYGEN AS INDICATED
  4. CARDIAC MONITOR IF INDICATED
  5. INITIATE IV IF INDICATED
  6. TRANSPORT AS INDICATED

 

DIABETIC EMERGENCY (HYPERGLYCEMIA) (REVISED 7-28-04)

 

 

GUIDELINES FOR CARE

  1. ASSURE ABC’S
  2. PULSE OXIMETRY
  3. OXYGEN AS INDICATED
  4. CARDIAC MONITOR
  5. INITIATE IV OF NORMAL SALINE (rev. 7-28-04)
  6. DETERMINE GLUCOSE LEVEL
    1. IF >70 AND <400 TRANSPORT AS INDICATED (rev. 7-28-04)
    2. IF >400 AND PATIENT IS STABLE, TRANSPORT NON-EMERGENCY  (rev. 7-28-04)
    3. IF >400 AND PATIENT IS UNSTABLE, TRANSPORT EMERGENCY (rev. 7-28-04)

 

DIABETIC EMERGENCY

(HYPOGLYCEMIA) (REVISED 7-28-04)

GUIDELINES FOR CARE

  1. ASSURE ABC’S
  2. PULSE OXIMETRY
  3. OXYGEN AS INDICATED
  4. CARDIAC MONITOR
  5. INITIATE IV NORMAL SALINE

**EMT-IV D50 MAY TREAT AND TRANSPORT PROVIDED:

A.    PATIENT IS AWAKE, ALERT AND ORIENTED AFTER ADMINISTRATION OF D50

B.    NO OTHER MEDICATIONS (EXCEPT OXYGEN) HAVE BEEN ADMINISTERED

C.    PATIENT IS A KNOWN DIABETIC

    6.    DETERMINE GLUCOSE LEVEL

        A.    IF <70 ADMINISTER 25 GMS 50% DEXTROSE

        B.    IF ALCOHOLIC/MALNOURISHED, GIVE THIAMINE 100   MG  IV/IM.

        C.    IF UNABLE TO START IV AFTER 3 ATTEMPTS, GIVE GLUCAGON 0.5 – 1.0 MG IM. REPEAT IN 20 MINUTES AFTER RECHECK OF GLUCOSE LEVELS AND STILL <70

D.    IF >70 transport as indicated (rev. 7-28-04)

     7.    IF STEP 5 AND 6.A. WAS SUCCESSFUL, REPEAT GLUCOSE TEST. IF REPEAT GLUCOSE TEST IS <70 GIVE 25 GMS 50% DEXTROSE

        IF IV IS ESTABLISHED AFTER GLUCAGON HAS BEEN ADMINISTERED BECAUSE OF INITIAL UNSUCCESSFUL ATTEMPTS FOR AN IV - FOLLOW THESE D50 ADMINISTRATION GUIDELINES:

      9.    If IV is successful after Glucagon administration, IV D50 may be given if: (rev. 7-28-04)

                A. Glucose test is <70 but >50 - give 12.5 grams D50

                B. Glucose test is <50 - give 25 grams D50

 

     10.    Transport as indicated by patients stability and level of consciousness. (rev. 7-28-04)

 

DYSPNEA  •revised 12-12-03

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY
  3. OXYGEN AS TOLERATED
  4. CARDIAC MONITOR
  5. INITIATE SALINE LOCK OR IV (IF PATIENT IS CRITICAL GIVE ALBUTEROL AND THEN ATTEMPT IV)
  6. IF WHEEZING OR POOR AIR MOVEMENT AND/OR HISTORY OF ASTHMA OR COPD
    1. ALBUTEROL, 2.5 MG VIA NEBULIZER.
    2. •Magnesium Sulfate, 1-2 grams, slow IV push over 5-10 minutes IF NO RESPONSE
    3. REPEAT ALBUTEROL IN 10 MINUTES (IF AN IV OR SALINE LOCK IS SUCCESSFULLY IN PLACE. OTHERWISE CONTACT MEDICAL CONTROL FOR ORDERS TO GIVE 2ND ALBUTEROL TREATMENT)

 

   7.  IF RALES AND /OR HISTORY OF CHF

    1. LASIX  SLOW IV Push.  Not to exceed the amount the patient takes P.O. or 80mg wich ever is the lesser.

              2.  MORPHINE 0.05 - 0.1 mg/kg IF NO RESPONSE.

    8.   INTUBATE AND/OR VENTILATE AS NEEDED

   9.  IF ALLERGEN EXPOSURE GO TO ANAPHYLAXIS PROTOCOL

  10. TRANSPORT AS INDICATED

 

EYE INJURIES

 

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. SECONDARY SURVEY FOR ADDITIONAL INJURIES
  3. IF CHEMICAL INJURY, FLUSH WITH LARGE AMOUNT OF WATER AND CONTINUE FLUSHING ENROUTE
  4. TREAT AND COVER THE EYE(S), WITHOUT PLACING PRESSURE ON THE GLOBE, AS INDICATED BY THE INJURY
  5. CALM PATIENT
  6. TRANSPORT AS INDICATED

 

FRACTURES (GENERAL CARE)

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. SECONDARY SURVEY
  3. IMMOBILIZE FRACTURE BY SECURING BOTH FRACTURED ENDS AND THE DISTAL AND PROXIMAL JOINT
  4. DOCUMENT PULSE, MOVEMENT, AND SENSATION BEFORE, DURING, AND AFTER SPLINTING
  5. INITIATE AND IV OF NS OR LRS
  6. IF YOU DO NOT SUSPECT A HEAD INJURY, AND THE PATIENT IS NOT HYPOTENSIVE, CONSIDER MORPHINE 0.05 - 0.1 MG/KG SLOW IV PUSH. THIS DOSE MAY BE REPEATED IN 5 MINUTES IF NEEDED. CONTRAINDICATION: ALLERGIC TO MORPHINE
  7. TRANSPORT AS INDICATED. NEVER DELAY TRANSPORT TO APPLY SPLINTS TO A CRITICAL PATIENT.

 

FRACTURE OF THE FEMUR

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY IF OXYGEN APPLIED
  3. OXYGEN AS INDICATED
  4. INITIATE IV
  5. TREAT FOR SHOCK IF SIGNS AND SYMPTOMS ARE PRESENT
  6. APPLY TRACTION SPLINT OR DEVICE AS NEEDED. REMEMBER, NEVER DELAY TRANSPORTS TO APPLY SPLINTS
  7. TRANSPORT AS INDICATED
  8. IF PATIENT DOES NOT HAVE A SUSPECTED HEAD INJURY, IS NOT HYPOTENSIVE AND IS NOT ALLERGIC TO MORPHINE, CONSIDER MORPHINE 0.05 - 0.1 MG/KG SLOW IV PUSH FOR PAIN CONTROL. THIS DOSE MAY BE REPEATED IN 5 MINUTES IF NEEDED

 

 

FRACTURE OF THE PELVIS

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY IF OXYGEN TO BE USED
  3. OXYGEN AS INDICATED
  4. CARDIAC MONITOR
  5. INITIATE IV
  6. TREAT FOR SHOCK (SEE SHOCK PROTOCOL) IF SIGNS AND SYMPTOMS ARE PRESENT
  7. APPLY MAST TROUSERS AND INFLATE FOR IMMOBILIZATION.

 

  1. IF PATIENT DOES NOT HAVE A SUSPECTED HEAD INJURY, IS NOT HYPOTENSIVE AND IS NOT ALLERGIC TO MORPHINE, CONSIDER MORPHINE 0.05 - 0.1 MG/KG SLOW IV PUSH FOR PAIN CONTROL. THIS DOSE MAY BE REPEATED IN 5 MINUTES IF NEEDED
  2. TRANSPORT AS INDICATED

 

HEAD INJURY/INTERCRANIAL PRESSURE

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. MAINTAIN "C" SPINE PRECAUTIONS
  3. PULSE OXIMETRY
  4. VENTILATE WITH 100% OXYGEN AND INTUBATE AS SOON AS POSSIBLE, IF INDICATED
  5. CONSIDER R.S.I.I., IF INDICATED
  6. CARDIAC MONITOR
  7. INITIATE IV, RESTRICT FLUID TO TKO UNLESS TREATING FOR SHOCK. Look for underlying reasons for shock
  8. INCLINE HEAD OF SPINEBOARD 15 DEGREES
  9. RESTRAIN AS NEEDED TO L.S.B.
  10. TRANSPORT AS INDICATED

 

HYPERTENSIVE CRISIS

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY
  3. OXYGEN VIA NC AT 4 LPM, UNLESS DYSPNEA EXISTS
  4. CARDIAC MONITOR
  5. INITIATE IV (NS OR LRS)
  6. IF PATIENT HAS A SYSTOLIC >200 OR DIASTOLIC >110, GO TO STEP 7.
  7. GIVE NTG TIMES ONE DOSE, Q 5 MINUTES UP TO THREE DOSES AS NEEDED TO REACH DESIRED B/P (SBP <200, DBP <110) (SKIP STEP 7 IF STEP 8 BELOW APPLIES)
  8. IF HYPERTENSION IS SECONDARY TO PAIN, GIVE MORPHINE INSTEAD OF NTG, 0.05 - 0.1 mg/kg TITRATED TO EFFECT UP TO 10 MG MAXIMUM TOTAL DOSE
  9. TRANSPORT AS INDICATED

 

 

NOTE: IF THE PATIENT IS ON THE ANTI-IMPOTENCE DRUG VIAGRA, DO NOT GIVE ANY NTG IF THE PT HAS TAKEN THE MEDICATION IN THE PAST 12 HOURS. VIAGRA AND NTG IN COMBINATION CAN CAUSE LIFE THREATENING HYPOTENSION

 

HYPERTHERMIA

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. IF HISTORY IS SUGGESTIVE OF HEAT EXHAUSTION OR HEAT STROKE:
    1. REMOVE TO COOLER ENVIRONMENT
    2. COOL WITH ICE PACKS AND/OR MOIST SHEETS
  3. PULSE OXIMETRY
  4. ADMINISTER OXYGEN AS INDICATED
  5. CARDIAC MONITOR
  6. INITIATE IV
  7. IF SEIZURES ARE PRESENT, PROTECT AIRWAY AND ADMINISTER 2-10 MG VALIUM IV TITRATED TO SEIZURES STOPPED (ALSO SEE SEIZURE PROTOCOL FOR FURTHER TREATMENT)
  8. TRANSPORT AS INDICATED

 

 

HYPOTHERMIA

 

 

GUIDELINES FOR CARE

  1. ASSURE ABC’S
  2. ACTIONS FOR ALL PATIENTS
    1. REMOVE ALL WET CLOTHING
    2. PROTECT AGAINST HEAT LOSS AND WIND CHILL
    3. MAINTAIN HORIZONTAL POSITION
    4. AVOID ROUGH AND EXCESSIVE MOVEMENT
    5. MONITOR CARDIAC RHYTHM
    6. ADMINISTER WARM HUMIDIFIED OXYGEN AND BEGIN EXTERNAL WARMING

 

 

  1. IF PULSE/BREATHING ABSENT
    1. START CPR
    2. DEFIBRILLATE V-FIB AND V-TACH WITHOUT PULSE UP TO A TOTAL OF THREE SHOCKS
    3. INTUBATE AND VENTILATE WITH 100% WARMED OXYGEN
    4. INITIATE IV WITH WARM FLUID
  2. TRANSPORT AS INDICATED

 

NAUSEA/VOMITING

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. CONTROL AIRWAY AND BE PREPARED TO SUCTION
  3. PULSE OXIMETRY
  4. OXYGEN AS INDICATED
  5. CARDIAC MONITOR IF INDICATED
  6. INITIATE IV
  7. ADMINISTER 12.5 TO 25 MG PROMETHAZINE IV/IM
    1. HOLD THE ABOVE PROMETHAZINE IN THE EVENT OF HEAD INJURY OR OVERDOSE DUE TO ITS SEDATIVE AFFECT.

 

  1. TRANSPORT AS INDICATED

 

NEAR-DROWNING

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY
  3. OXYGEN VIA NRB
  4. CARDIAC MONITOR
  5. INITIATE IV
  6. IF IN CARDIAC ARREST, GO TO APPROPRIATE PROTOCOL
  7. USE AGGRESSIVE AIRWAY CONTROL AND SUCTION AS NEEDED
  8. TRANSPORT EMERGENCY.

 

 

POISONING/OVERDOSE

 

 

GUIDELINES FOR CARE

  1. ASSURE ABC’S
  2. IF INHALED POISON, REMOVE PT FROM THE SOURCE
  3. PULSE OXIMETRY
  4. OXYGEN VIA NRB
  5. CARDIAC MONITOR
  6. INITIATE I.V.
  7. OBTAIN HISTORY
    1. TYPE AND AMOUNT OF POISON, IF POSSIBLE BRING THE CONTAINER WITH THE PATIENT.
    2. ROUTE OF INTAKE
    3. TIME OF INTAKE
    4. HISTORY OF DRUG OR ETOH USAGE
    5. MEDICAL HISTORY
  8. AGGRESSIVE AIRWAY CONTROL WITH VENTILATION IF NEEDED
  9. SUCTION AS NEEDED
  10. IF SEIZING GO TO SEIZURE PROTOCOL
  11. IF INVOLVING A CHEMICAL, BRUSH AND/OR IRRIGATE OFF OF THE PT. NOTE: DO NOT IRRIGATE A DRY CHEMICAL OFF OF A PATIENT.
  12. IF NARCOTIC OVERDOSE IS SUSPECTED, ADMINISTER 2 MG NARCAN, WHICH CAN BE REPEATED. (NARCAN MAY ALSO BE GIVEN IM IF ATTEMPTS AT IV ACCESS HAVE BEEN UNSUCCESSFUL)
  13. FOR ORGANOPHOSPHATE POISONING:
    1. ADULT:
      1. ADMINISTER ATROPINE SULFATE 2 MG IV PUSH EVERY 5-15 MINUTES TO DRY SECRETIONS

    1. PEDIATRIC:
      1. ADMINISTER ATROPINE SULFATE 0.05 MG/KG/DOSE (USUAL DOSE 1-5 MG) IV; MAY BE REPEATED IN 15 MINUTES
  1. TRANSPORT AS INDICATED

 

 

PSYCHIATRIC EMERGENCIES

 

 

GUIDELINES FOR CARE

 

  1. ASSURE PERSONAL SAFETY
  2. APPROACH PATIENT SLOWLY
  3. TALK IN AN EVEN, REASSURING TONE
  4. ASSURE ABC’S
  5. APPLY OXYGEN AS TOLERATED
  6. INITIATE I.V. IF NEEDED, IF POSSIBLE
  7. DETERMINE GLUCOSE LEVELS, IF POSSIBLE
  8. RESTRAIN AS NEEDED FOR PATIENT CARE AND SAFETY TO A L.S.B., NOT TO THE COT
  9. TRANSPORT AS INDICATED

 

SEIZURES

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY IF OXYGEN TO BE USED
  3. OXYGEN BY NRB
  4. CARDIAC MONITOR
  5. INITIATE IV (IF IV UNSUCESSFUL AND PATIENT IS A CHILD SEE SECTION 7.5)
  6. DETERMINE GLUCOSE LEVEL
    1. IF <70 ADMINISTER 25 GMS 50% DEXTROSE (IF UNABLE TO OBTAIN IV ACCESS TIME 3 ATTEMPTS, SEE DIABETIC EMERGENCY, HYPOGLYCEMIA FOR GLUCAGON INSTRUCTIONS.)
    2. IF >70 GO TO STEP 6
    3. IF >400 GO TO DIABETIC EMERGENCY (HYPERGLYCEMIA) PROTOCOL
  7. IF ACTIVELY SEIZING
    1. PROTECT PATIENT FROM INJURY
    2. SUCTION AS NEEDED
    3. MAY USE NASAL ROUTE FOR AIRWAY CONTROL
    4. FOR ADULTS
      1. ADMINISTER 5-10 MG VALIUM IF INDICATED
    5. FOR CHILDREN
      1. IV DOSE:
        1. ADMINISTER 0.2-0.3 MG/KG/DOSE IV/IO (NO FASTER THAN 1 MG/MIN) Q 2-5 MIN PRN (MAXIMUM TOTAL DOSE 5 MG)
      2. RECTAL DOSE (IF IV UNSUCCESSFUL)
        1. DRAW UP 0.5 MG/KG (MAXIMUM OF 10 MG) VALIUM IN A SYRINGE AND REMOVE THE NEEDLE
        2. ADMINISTER THE DRAWN UP VALIUM RECTALLY
      1. CONSIDER IO LINE IF NO RESPONSE TO RECTAL VALIUM

    8.    IF NOT SEIZING

    1. OPEN AIRWAY AND CONTROL
    2. SUCTION AS NEEDED

    9.    TRANSPORT AS INDICATED

 

SPINAL IMMOBILIZATION PROTOCOL

I. Spinal Immobilization should be preformed on the basis of mechanism of

injury and patient’s symptoms.

        A.    If the patient has major mechanism of injury as listed in the Trauma Destination Guidelines listed below, then always immobilize.

                B.    If the patient has minor mechanism of injury, then immobilize based on the following criteria. Do not immobile if:
    1. The mechanism is minor as discussed above, and
    2. The patient’s mental status is not impaired by drugs, alcohol or head injury, and
    3. There is no pain to spinal palpation or movement (check palpation first), and
    4. A brief neurological exam is normal, and
    5. There is no severe distracting injury.

II. If the patient refuses immobilization, all risks are to be explained to the patient and documented in the narrative along with documentation put on the response form with a witness signature.

III. Any deviation from this protocol requires contact with Medical Control.

IV. When in doubt, immobilize.

Trauma Destination Guidelines

Criteria to Level I Trauma Center after contacting Medical Control

· Penetrating injury proximal to elbow and Knee

· Flail chest

· Combination trauma with burns of l5%BSA, OR to the face or airway

· 2 or more proximal long bone fractures

· Limb paralysis

· Amputation proximal to wrist and ankle

· Ejection from auto, Death in same passenger compartment

· Extrication time of greater than 20 minutes

· High speed auto accident:

· -initial speed greater than 40 mph

· -velocity change greater than 20 mph

· major auto deformity greater than 20 inches

· passenger intrusion greater than 12 inches

· Auto-Pedestrian injury with > 5 mph impact

· Pedestrian thrown or run over.

· Motorcycle accident greater than 20 mph or with separation of rider and bike.

· Bicycle accident with significant impact.

A.7.d

SEXUAL ASSAULT

 GUIDELINES FOR CARE

  1. ASSURE ABC’S
  2. REASSURE PATIENT AND PROVIDE EMOTIONAL SUPPORT
  3. TREAT ALL INJURIES ACCORDINGLY
  4. PROTECT THE SCENE AND PRESERVE EVIDENCE. DO NOT ALLOW THE PATIENT TO BATHE, CHANGE CLOTHES, GO TO THE BATHROOM OR DOUCHE
  5. NOTIFY POLICE IF NOT ALREADY INFORMED
  6. PLACE PATIENT ON OPEN SHEET. SAVE SHEET FOR POSSIBLE EVIDENCE.
  7. TRANSPORT TO THE HOSPITAL WITH SAME SEX CREWMEMBER AS ATTENDANT, IF POSSIBLE

 

 

SHOCK

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY
  3. OXYGEN VI NRB
  4. CARDIAC MONITOR
  5. PLACE IN TRENDELENBURG POSITION
  6. INITIATE IV(S), AS LARGE AS POSSIBLE
  7. GIVE 5OO CC FLUID(NS OR LR) CHALLENGE
  8. ATTEMPT TO DETERMINE ETIOLOGY OF SHOCK BY HISTORY AND EXAM.
    1. IF HYPOVOLEMIC/HEMMORRHAGIC, CONTINUE WITH IV FLUID BOLUS UNTIL DESIRED RESPONSE.
    2. IF ANAPHYLACTIC, CONTINUE WITH FLUID BOLUS AND GO TO ANAPHYLAXIS PROTOCOL
    3. IF CARDIOGENIC, GO TO APPROPRIATE PROTOCOL. IF AFTER RATE AND RHYTHM NORMALIZED, PATIENT IS STILL IN SHOCK, BEGIN DOPAMINE AT 2 MCG/KG/MIN AND TITRATE TO EFFECT.
    4. IF SEPSIS, DEGIN DOPAMINE AT 2 MCG/KG/MIN AND TITRATE TO EFFECT.
    5. IF SPINAL CORD INJURY, BEGIN DOPAMINE AT 2 MCG/KG/MIN AND TITRATE TO EFFECT.
  9. TRANSPORT EMERGENCY TRAFFIC.

 

 

SNAKEBITE

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY IF OXYGEN TO BE USED
  3. OXYGEN AS INDICATED
  4. CARDIAC MONITOR
  5. INITIATE IV
  6. SPLINT EXTREMITY IN A DEPENDANT POSITION TO RESTRICT MOVEMENT
  7. REMOVE JEWELRY FROM AFFECTED EXTREMITY
  8. BRING DEAD SNAKE TO THE HOSPITAL IF POSSIBLE. DO NOT ATTEMPT TO CAPTURE /KILL LIVE SNAKE.
  9. TRANSPORT IN SUPINE RESTING POSITION TO DECREASE METABOLISM

 

SPINAL INJURY

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S WITH C-SPINE PRECAUTIONS
  2. PULSE OXIMETRY
  3. OXYGEN VIA NRB
  4. CARDIAC MONITOR
  5. INITIATE IV
  6. INTUBATE AND VENTILATE AS NEEDED
    1. CONSIDER R.S.I.I.
  7. TREAT FOR SHOCK IF PRESENT – SEE SHOCK PROTOCOL
  8. REASSURE PATIENT
  9. TRANSPORT AS INDICATED

 

 

SYNCOPE

 

 

GUIDELINES FOR CARE

 

  1. ASSURE ABC’S
  2. PULSE OXIMETRY
  3. OXYGEN AS INDICATED
  4. CARDIAC MONITOR, TREAT ANY DYSRHYTHMIAS WITH APPROPRIATE PROTOCOLS
  5. INITIATE IV (AS INDICATED)
  6. OBTAIN HISTORY
  7. DETERMINE GLUCOSE LEVEL
    1. IF GLUCOSE IS <70 OR >400, GO TO APPROPRIATE DIABETIC PROTOCOL
  8. SUCTION AND CONTROL AIRWAY
  9. TRANSPORT AS INDICATED