BLS Protocols

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BLS Protocols
2013-03-12 00:48:35
BLS protocols

protocols for bls, sd county
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  1. Abdominal Discomfort/GI/GU(Nontraumatic)
    • Ensure patent airway
    • O2 Saturation prn
    • O2 and/or ventilate prn
    • NPO
    • Anticipate vomiting
  2. Airway Obstruction (Foreign Body)
    • For conscious:
    • -Reassure, encourage coughing
    • -O2 prn
    • For inadequate air exchange:
    • -Airway maneuvers (AHA), abdominal thrusts or chest thrusts in obese or pregnant pt
    • If pt becomes unconscious or found unsconscious
    • -Begin CPR
    • Once Obsctruction removed:
    • -High Flow O2 ventilate prn
    • -O2 Saturation prn
  3. Allergic Reaction/Anaphylaxis
    • Ensure patent airway
    • O2 Saturation prn
    • O2 and/or ventilate prn
    • Remove stinger/injection mechanism
    • May assist patient to self medicate own prescribed epipen or MDI one time only. BHC prior to any repeat dose
  4. Altered Neurologic Function (Nontraumatic)
    • Ensure patent airway, O2 and/or ventilate prn
    • O2 Saturation prn
    • Spinal stabilization prn
    • Do not allow pt to walk
    • Restrain prn
    • Secretion problems: position on affected side
  5. Altered neuro: Hypoglycemia suspected or BGL reads <60
    • If pt awake and has gag reflex, give 3 oral glucose tabs or paste (15g total)
    • Pt may eat or drink if able
    • If pt unconscious, NPO
  6. Altered Neuro: CVA/Stroke
    • For suspected stroke with major deficit with onset of symptoms <4 hours, expedite transport
    • Make initial notification early to confirm destination
    • Use Prehospital stroke scale, F.A.S.T.
    • Only use supplemental O2 if sat is below 94%
  7. Altered Neuro: Seizures
    • Protect airway
    • Protect from injury
  8. Burns
    • Move pt to safe environment
    • Break contact with causative agent
    • Ensure patent airway
    • O2 and/or ventilate prn
    • O2 Saturation prn
    • Treat other life threatening injuries
  9. Thermal Burns
    • Burns of <10% bsa, stop burning with non-chilled water or saline
    • Burns >10% bsa, cover with dry dressing and keep warm, do not allow pt to become hypothermic
  10. Chemical Burns
    • Brush off dry chemicals
    • Flush with copious amounts of water
  11. Tar Burns
    • Cool with water
    • Transport
    • Do not remove tar
  12. 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 pt prescribed NTG up to 3 doses max
    • May assist with placement of 12 lead
  13. Dysrhythmias
    • O2 and/or ventilate prn
    • O2 Sat prn
  14. Envenomation Injuries
    O2 and/or ventilate prn
  15. Jellyfish Sting
    • Liberally rinse with alcohol or salt water or vinegar if available, for at least 30 seconds
    • Consider heat as tolerated(not to exceed 110 deg.) Use warm water if available(not to exceed 110 deg.)
  16. Stingray or sculpin injury
    Heat as tolerated (not to exceed 110 deg.)
  17. Snakebites
    • Mark proximal extent of swelling
    • Keep involved extremity at heart level and immobile
    • Remove pre-existing constrictive device
  18. Environmental exposure
    • Ensure patent airway
    • O2 Saturation prn
    • O2 and/or ventilate prn
    • Remove excess/wet clothing
  19. Heat Exhaustion
    • Cool gradually
    • Fanning, sponging with tepid water
    • Avoid shivering
    • If conscious, give small amounts of fluids
  20. Heat Stroke
    • Rapid cooling
    • Spray with cool water, fan, avoid shivering
    • Ice packs to carotid, inguinal and axillary regions
  21. Cold Exposure
    • Gentle warming
    • Blankets, warm packs not to exceed 110deg.
    • Dry dressings
    • Avoid unnecessary movement or rubbing
    • If alert, give warm fluids
    • If severe, NPO
    • Prolonged CPR may be indicated
  22. Hemodialysis PT
    • Ensure patent airway
    • O2 saturation prn
    • Give O2
    • Ventilate if necessary
  23. Near drowning/Diving related incidents
    • 100% O2 and/or ventilate prn
    • O2 saturation prn
    • Spinal stabilization when indicated
  24. Obstectrical Emergencies
    • Mother:
    • Ensure patent airway
    • O2 Saturation prn
    • O2 ventilate prn
    • If no time to transport, deliver baby
    • If time to transport, transport on left side
  25. Eclampsia (pregnant seizures)
    Protect airway and protect from injury
  26. Poisoning/Overdose:Ingestions
    • Identify Substance
    • Ensure patent airway
    • O2 Saturation prn
    • O2 ventilate prn
  27. Poisoning/Overdose:Skin
    • Remove clothes
    • Brush off dry chemicals
    • Flush with copious water
  28. Poisoning/Overdose:Inhalation/smoke/gas/toxic substance
    • Move pt to safe environment
    • 100% O2 via mask
    • Consider facility with hyperbaric chamber for suspected carbon monoxide poisoning for unconscious or pregnant pt
  29. Poisoning/Overdose:Contamination with commercial grade ("low level") radioactive material
    • Mild injury can be decontaminated(removal of clothing, brushing off material) prior to transport
    • If significant injuries, that's priority, decon with not occur if delays transport
  30. Respiratory Distress
    • Ensure patent airway
    • Reassurance
    • O2 Saturation prn
    • O2 and/or ventilate prn
    • May assist pt to self medicate own prescribed MDI once
  31. Respiratory Distress: Hyperventilation
    • Coaching/reassurance
    • Remove pt from causative environment
    • Consider underlying medical problem
  32. Respiratory Distress: Toxic inhalation (CO exposure, smoke gas, etc.)
    Consider tx to facility with hyperbaric chamber
  33. Respiratory Distress: Known Asthmatics
    Consider oral hydration
  34. Respiratory Distress: Croup-like cough
    Aerosolized saline or water 5ml via oxygen powered nubulizer/mask. MR prn
  35. Sexual Assault
    • Ensure patent airway
    • O2 and/or ventilate prn
    • Advise pt to not bathe or change clothes
    • Consult with law enforcement on scene for evidence collection
  36. SART Facilities (Sexual Assault Response Team)
    Pomerado, Palomar, Rady Children's and Independent Forensic Services (PD can contact)
  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. Trauma
    • Ensure patent airway, protecting C-spine
    • Spinal stabilazation prn (except in penetrating trauma without neurological deficits)
    • O2 Saturation prn
    • O2 and/or ventilate prn
    • Control obvious bleeding
    • Keep warm
  39. Trauma: Abdominal
    Cover eviscerated bowel with saline pads
  40. Trauma: Chest
    Cover open chest wound with three-sided occlusive dressing, release dressing if ?tension pneumothorax develops
  41. Trauma: Extremity
    • Splint neurologically stable Fx as they lie, use traction splint as indicated
    • Grossly angulated long bone Fx's with neurovascular compromise may be reduced with gentle undirectional traction for splinting per BHO
    • Apply tourniquet in severely injured extremity when direct pressure or pads fail to control hemorrhage
    • In MCI, direct pressure not required prior to tourniquet application
  42. Trauma: Impaled Object
    • Immobilize and leave impaled objects in place
    • Remove only with BHPO
    • Exception:may remove impaled object in face/cheek or from neck if there is total airway obstruction
  43. Trauma: Neurological Trauma (head and spinal injuries)
    Ensure adequate oxygenation without hyperventilating pt, Goal:6-8 ventilations/min
  44. Trauma: Pregnancy of >6 mo
    Where spinal stabilization precaution is indicated, tilt on spinal board 30 degrees
  45. Trauma: Blunt traumatic arrest
    Consider pronouncement at scene BHPO