protocolflashcards.txt

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spazgda
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161565
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protocolflashcards.txt
Updated:
2012-07-08 18:35:35
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EMT Protocols San Diego BLS
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San Diego BLS Protocols
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  1. ´╗┐Abdominal Discomfort
    • Ensure patent airway
    • 02 Saturation prn
    • 02 and/or ventilate prn
    • NPO
    • Anticipate vomiting
  2. Airway Obstruction
    • For a conscious patient:
    • Reassure, encourage coughing
    • 02 prn

    • For inadequate air exchange:
    • Airway maneuvers (AHA)
    • Abdominal thrusts
    • Use Chest thrusts in obese or pregnant patient

    • If patient becomes unconscious or is found unconscious:
    • Begin CPR

    • Once obstruction is removed:
    • High flow 02, ventilate prn
    • 02 Saturation prn

    NOTE: If unable to secure airway; transport STAT
  3. Allergic Reaction / Anaphylaxis
    • Ensure patent airway
    • 02 Saturation prn
    • 02 and/or ventilate prn
    • Remove stinger/injection mechanism
    • May assist patient to self medicate own perscribed EpiPen or MDI ONE TIME ONLY. Base Hospital contact requried prior to any repeat dose.
  4. Altered Neurologic Function (Nontraumatic)
    General
    • Ensure patent airway, 02 and/or ventilate prn
    • 02 Saturation prn
    • Spinal stabilization prn
    • Do not allow patient to walk
    • Restrain prn
    • Secrtion problems:
    • position on affected side
  5. Altered Neurologic Function (Nontraumatic)
    Hypoglycemia
    • Hypoglycemia (suspected) or patient's glucometer reads BS < 60
    • If patient is awake and has a gag reflex, give 3 oral glucose tabs or paste (15g total).
    • Patient may eat or drink if able.
    • If patient is unconscious, NPO
  6. Altered Neurologic Function (Nontraumatic)
    CVA/Stroke
    • For suspected stroke with major deficit with onset of symptoms known to be <4 hours in duration, expedite transport.
    • Make initial notification early to confirm destination.
    • Use the Prehospital Stroke Scale in the assessment of possible CVA patients (facial droop, arm drift and speech abnormalities)
    • Only use supplemental 02 for 02 saturation < 94%
  7. Altered Neurologic Function (Nontraumatic)
    Seizures
    • Protect airway, and protect from injury
    • Treat associated injuries
  8. Burns
    General
    • Move patient to a safe environment
    • Break contact with causative agent
    • Ensure patent airway, 02 and/or ventilate prn
    • 02 Saturation prn
    • Treat other life threatening injuires
  9. Burns
    Thermal burns
    • Burns of < 10% body surface area:
    • Stop burning with non-chilled water or saline

    • Burns of > 10% body surface area:
    • Cover with dry dressing and keep warm
    • Do not allow patient to be come hypothermic
  10. Burns:
    Chemical
    • Brush off dry chemicals
    • Flush with copious amounts of water
  11. Tar Burns
    • Cool with water
    • Transport
    • Do not remove tar
  12. Burn Center Criteria
    • Patients with burns invlovling:
    • >= 20% 2nd or >= 5% 3rd degree of BSA
    • Suspected respiratory involvement or significant smoke inhalation in a confined space
    • Significant injury of the face, hands, feet or perineum, or circumferential
    • Significant electrical injury due to high voltage (greater than 110 volts)

    • Disposition:
    • Consider Hyperbaric chamber for suspected CO poisoning in unconscious or pregant patients
  13. Discomfort / Pain of Suspected Cardiac Origin
    • Ensure patent airway
    • O2 Saturation prn
    • O2 and/or ventilate prn
    • Do not allow patient to walk

    • If systolic BP >= 100:
    • May assist patient to self medicate own prescribed NTG SL
    • (maximum 3 doses, including those patient has taken)

    May assist with placement of 12 lead
  14. Envenomation Injuries
    Jellyfish Sting
    02 and/or ventilate prn

    Liberally rinse with alcohol or salt water or vinegar if avaliable, for at least 30 seconds.

    • Consider heat as tolerated (not to exceed 110 deg).
    • Use warm water if avaliable, (not to exceed 110 deg).
  15. Envenomation Injuries
    Stingray or Scuplin injury
    02 and/or ventilate prn

    Heat as tolerated
  16. Envenomation Injuries
    Snakebites
    02 and/or ventilate prn

    • Mark proximal extent of swelling
    • Keep involved extremity at heart level and immobile
    • Remove pre-existing constrictive device
  17. Environmental Exposure
    General
    • Ensure patent airway
    • 02 Saturation prn
    • 02 and/or ventilate prn
    • Remove excess/wet clothing
  18. Environmental Exposure
    Heat Exhaustion
    • Cool gradually
    • Fanning, sponging with tepid water
    • Avoid shivering
    • If conscious, give small amounts of fluids
  19. Environmental Exposure
    Heat Stroke
    • Rapid cooling
    • Spray with cool water, fan
    • Avoid shivering
    • Ice packs to carotid, inguinal and axillary regions
  20. Environmental Exposure
    Cold Exposure
    • Gentle warming
    • Blankets, warm packs -not to exceed 110 F
    • Dry dressings
    • Avoid unnecessary movement or rubbing
    • If alert, give warm liquids
    • If severe, NPO
    • Prolonged CPR may be indicated
  21. Hemodialysis Patient
    • Ensure patient airway
    • O2 saturation prn
    • Give O2
    • Ventilate if necessary
  22. Near Drowning / Diving Related Incidents
    • 100% O2 and/or ventilate prn
    • O2 saturation prn
    • Spinal stabilization when indicated
  23. Obstetrical Emergencies
    Mother
    • Ensure patent airway
    • O2 saturation prn
    • O2 ventilate prn
    • If no time for transport and delivery is imminent (crowning and pushing), proceed with delivery
    • If no delivery, transport on left side.
  24. Obstetrical Emergencies
    Routine Delivery
    • Massage fundus if placenta delivered (Do not wait on scene)
    • Place identification bands on mother and infant
    • Document name of person cutting cord, time cut and address.
  25. Obstetrical Emergencies
    Post Partum Hemorrhage
    • Massage fundus vigorously
    • Baby to breast
    • Trendelenburg position
  26. Obstetrical Emergencies
    Eclampsia (seizures) / Third Trimester Bleeding
    • Eclampsia:
    • Protect airway, and protect from injury

    • Third Trimester Bleeding:
    • STAT transport to facility with OB services
  27. Poisoning / Overdose
    General / Ingestion / Skin
    • General:
    • Ensure patent airway
    • O2 saturation prn
    • O2 and/or ventilate prn

    • Ingestion:
    • Identify substance

    • Skin:
    • Remove clothes
    • Brush off dry chemicals
    • Flush with copious water
  28. Poisoning / Overdose
    Inhilation/Smoke/Gas/Toxic Subsatnce
    • Move patient to safe environment
    • 100% O2 via mask
    • Consider transport to facility with hyperbaric chamber for suspected carbon monoxide poisoning for unconscious or pregnant patient
  29. Poisoning / Overdose
    Contamination with commercial grade ("low level") radioactive material
    Patient with mild injuries may be decontaminated (removal of contaminated clothing, brushing off of material) prior to treatment and transport. Decontamination proceedings SHALL NOT delay treatment and transport of patients with significant or life-threatening injuries. Treatment of signifiant injuries is always the priority.
  30. Poisoning / Overdose
    Hyperthermia from ?Stimulant Intoxication
    Initiate cooling measures
  31. Respiratory Distress
    General
    • Ensure patent airway
    • Reassurance
    • O2 saturation prn
    • O2 and/or ventilate prn

    May assist patient to self medicate own prescribed MDI ONE TIME ONLY. Base Hospital contact required prior to any repeat dose.
  32. Respiratory Distress
    Hyperventilation
    • Coaching/reassurance
    • Remove patient from causative environment
    • Consider underlying medical problem
  33. Respiratory Distress
    Toxic Inhalation (CO exposure, smoke gas, etc.)
    Consider transport to facility with hyperbaric chamber for suspected carbon monoxide poisoning for unconscious or pregnant patient
  34. Respiratory Distress
    Known Asthmatics
    Consider oral hydration
  35. Respiratory Distress
    with Croup-like cough
    Aerosolized saline or water 5ml via oxygen powered nebulizer/mask, MR prn
  36. Sexual Assault
    • Ensure patent airway
    • O2 and/or ventilate prn
    • Advise patient not to bathe or change clothes
    • Consult with law enforcement on scene for evidence collection

    • If the patient requires a medical evaluation:
    • Transport to the closest, most appropriate facility.
    • Law enforcement will authorize and arrange an evidentiary exam after the patient is stabilized.

    • If only evidentiary exam is needed:
    • Should release to law enforcement for transport to a SART facility
  37. Shock
    • O2 saturation prn
    • O2 and/or ventilate prn
    • Control obvious external bleeding
    • Treat associated injuries
    • NPO, anticipate vomiting
    • Remove transdermal Fentanyl and/or NTG patch
  38. Definition of Shock
    • Systolic BP < 80 mmHg
    • or
    • Systolic BP < 90 mmHg AND exhibiting any of the following signs of inadequate perfusion:
    • a. altered mental status (decreased LOC, confusion, agitation)
    • b. tachycardia
    • c. pallor
    • d. diaphoresis
  39. Trauma
    General
    • Ensure patent airway, protecting C-spine
    • Spinal stabilization prn (Excpet in penetrating trauma without neurological deficits)
    • O2 saturation prn
    • O2 and/or ventilate prn
    • Control obvious bleeding
    • Keep warm
  40. Trauma
    Abdominal
    Cover eviscerated bowel with saline pads
  41. Trauma
    Chest
    Cover open chest wound with three-sided occlusive dressing; release dressing if ?tension pneumothorax develops.
  42. Trauma
    Extremity
    • Splint neurologically stable fractures as they lie. Use traction splint as indicated
    • Grossly angulated long bone fractures with neurovasular compromise may be reduced with gentle unidirectional traction for splinting per BHO
    • Apply tourniquet in severely injured extremity when direct pressure or pressure dressing fails to control life-threatening hemorrhage
    • In Mass Casualty direct pressure not required prior to tourniquet application
  43. Trauma
    Impaled Objects
    Immobilize & leave impaled objects in place. Remove BHPO.

    Exception: may remove impaled object in face/cheek or from neck if there is total airway obstruction
  44. Trauma
    Neurological Trauma (head and spine injuries):
    • Ensure adequate oxygenation without hperventilating patient.
    • Goal: 6-8 ventilations/min
  45. Trauma
    Pregnancy of >= 6mo
    Where spinal stabilization precaution is indicated, tilt on spine board 30 degrees
  46. Blunt Traumatic Arrest
    Consider pronouncement at scene BHPO
  47. Pain Management
    • Assess level of pain
    • Ice, immobilize and splint when indicated
    • Elevation of extremity trauma when indicated
  48. Psychiatric / Behavioral Emergencies
    • Ensure patent airway
    • O2 Saturation prn
    • O2 and/or ventilate prn

    Treat life threatening injuries

    Attempt to determine if behavior is related to injury, illness or drug use.

    Restrain only if necessary to prevent injury. Document distal neurovascular status q15'.

    Avoid unnecessary sirens.

    Consider law enforcement support and/or evaluation of patient.

    Law enforcement should remove taser barbs, but EMS may remove barbs if they present a needle stick danger.

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