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Steps of emergency

Know the next steps to Emergencies

QuestionAnswer
Airway obstruction positioning on tongue #1 steps 3 Digital traction of the tongue with gauze,tongue forceps,a hemostat or tongue suture
Airway obstruction positioning on tongue #1 step 1-2 100%O2 : place Pt. in trendelenburg and pack off surgical site
Airway obstruction positioning on tongue #2 tongue continues to occlude airway steps 1-2 A nasapharyngeal airway can be used in a conscious or semiconscious pt. : In an unconscious pt. an oropharyngeal airway can be used
Airway obstruction positioning on tongue #2 tongue continues to occlude airway steps 3-4 Consider using an LMA, igel or other supraglottic (above the level of vocal cords) airway : Endotracheal intubation
Airway obstruction positioning on tongue #2 All other options have failed, Cricothyrotomy steps 1-2 Cleanse the overlying skin : Locate the cricothyroid membrane by palpation
Airway obstruction positioning on tongue #2 All other options have failed, Cricothyrotomy step 3 Utilize the emergency cricothyrotomy needle/ cannula kit or large gauge to enter the trachea beneath the vocal cords through the cricothyroid membrane.
Airway obstruction positioning on tongue #2 All other options have failed, Cricothyrotomy step 4 Attach the tube of the cricothyrotomy device to an oxygen source such as an anesthesia machine or ambu bag and ventilate with 100% O2
Airway obstruction of foreign body step 1 Digital removal of foreign body only if it can be well visualized, do not attempt blind finger sweep that may push object farther down the airway
Airway obstruction of foreign body step 2 Chest compressions if no airflow during ventilation with PT. in supine. Chest compression s over abdominal thrusts. Heimlich if Pt. is upright
Airway obstruction of foreign body step 3 Direct laryngoscopy for visualization and retrieval of foreign body with forceps or suction
Airway obstruction of foreign body step 4 If foreign body cannoy be removed and severe obstruction persists, a cricothrotomy may be necessary
Lyryngospasm emergency steps 1-2 Administer 100%O2 via nasel hood : establish proper head position to maintain / establish airway
Lyryngospasm emergency steps 3-4 Pack off surgical site : suction of oral cavity and oropharynx with tonsil suction tip.
Lyryngospasm emergency steps 5-6 Positive pressure 100%O2 via bag/mask system : administer succinylcholine 10-20 mg IV support ventilation manually until effects of drug dissipated and strong spontaneous respiration has resumed.
Bronchospasm emergency steps 1-3 100%O2 via bag/mask : albuterol inhilation 4-8 puffs every 20 min : Ipratropium bromide ( atrovent) 2 puffs stat; repeat every 4 hours
Bronchospasm emergency step 4 Epi. Injection (0.5 mL of 1:100 solution IM or subling. if anaphylaxis is suspected and/or hypotension) or IV epi 3-5 mL 1:10,000 sol. slowly in small increments ( only with severe bronchospasm in pt. with hypotension.
Bronchospasm emergency step 5-6 Intubation/ventilation ( endotracheal tube, LMA, igel or Combitube) : Steroid injection such as dexamethasone/Decadron 4-6mg IV or hydrocortisone 100mg IV
Bronchospasm emergency steps 7-8 Benadryl 50mg IV : Aminophylline is no longer considered a first time drug for management of bronchospasm.
Bronchospasm emergency step 9 If bronchospasm has not completely responded to steps 1-6, EMS should be activated and transport the patient to an acute care facility
Emesis with Aspiration emergency steps 1-3 Avctivate EMS, protect integrity of the IV catheter : 100%O2 via bag/mask : turn pt. on side with head down ( trendelenburg)
Emesis with Aspiration emergency steps 4-5 Tonsil suction of oral cavity/ oropharynx : Removal of visible foreign bodies with a laryngoscope and Magill forceps
Emesis with Aspiration emergency steps 6-7 Intubation ( ETT- preferred, LMA, igel or combitube) with suction via a suction catheter : Transport to an acute care facility
Hyperventilation emergency steps 1-2 Terminate treatment and remove foreign bodies from mouth and remove surgical instruments from view : maintain the airway.
Hyperventilation emergency steps 3-4 Verbally try to calm the patient : monitor vital signs
Hyperventilation emergency steps 5-6 Do not give O2. : have patient breathe into bag to recapture CO2
Hyperventilation advanced emergency steps 1-2 If a non-sedated PT. Fails to respond, administer IV medazolam, diazepam, propofol, etc. : continue to monitor vital signs
Hyperventilation advanced emergency steps 3-4 Discontinue rebreathing bag as breathing returns to normal. : activate EMS is condition deteriorates.
Myocardial infarction emergency steps 1-3 Activate EMS, closely observe vitals : 100%O2 via mask. : make patient comfortable/ reassure
Myocardial infarction emergency steps 4-6 Attach AED or defibrillator : aspirin 325 mg. : establish IV with normal saline slow drip
Myocardial infarction emergency step 7 Morphine sulfate for pain 2-4 mg IV push. Repeat every 5-10 minutes as needed
Symptomatic bradycardia emergency steps 1-2 Terminate procedure : 100%O2
Symptomatic bradycardia emergency steps 3-4 Establish IV ( if not already in place) : atropine 0.5 mg IV; may repeat to total dose of 3mg
Symptomatic bradycardia emergency step 5 The patient may be transported to Ear for transcutaneous pacing
Supraventricual tachycardia emergency steps 1-2 Place PT. In supine : Adenosine 6mg rapid IV push over 1-3 seconds and follow with immediate flush 20cc saline.
Supraventricual tachycardia emergency steps 3-4 After 1-2 min, Adenosine 12mg rapidly flush as above : a third dose may be given in 1-2 minutes if needed.
Premature ventricular contractions emergency step 1 Try to determine the cause ( e.g., hypoxia) and correct
Premature ventricular contractions emergency step 2 Lidocaine 0.5 - 1.5 mg/kg IV; repeat 0.5-0.75 mg/kg every 5-10 minutes up to 3mg/kg
Ventricular tachycardia emergency steps 1-2 100%O2.: Amiodarone 150 mg IV over 10 minutes. Maximum dose 2.2 gms in 24 hours
Ventricular tachycardia emergency step 3 Prepare for synchronous cardioversion
Ventricular fibrillation emergency steps 1-2 Check lead placement and if V. Fib confirmed call 9/11. : begin CPR. Without discontinuing CPR attach AED or defibrillator and deliver shock if indicated at the end of sequence.
Ventricular fibrillation emergency step 3 Continue CPR, during this sequence establish IV access and prepare to give epinephrine. Deliver a shock if indicated at the end of sequence.
Ventricular fibrillation emergency step 4 Continue CPR, during this sequence give epinephrine 1mg IV and prepare Amiodarone for administration during next sequence. Deliver shock, if indicated, at the end of sequence.
Ventricular fibrillation emergency step 5 Continue CPR during this sequence give Amiodarone 300 mg IV and prepare epinephrine for administration during the next sequence. Deliver shock, if indicated, at the end of sequence
Asystole/PEA emergency step 1 CPR
Asystole/PEA emergency step 2 Epinephrine 1mg IV. May repeat every 3-5 minutes. May give one dose of Vasopressin 40 U to replace 1st and 2nd dose of epinephrine.
Hypertension emergency step 1-2 Terminate procedure : check monitor or cuff malfunction
Hypertension emergency step 3-4 Attempt to determine cause ( e.g., pain or anxiety) and manage the cause appropriately. : record vitals every 5 minutes
Hypertension emergency step 5-7 Consider EMS activation : establish IV access : beta-blockers ( Labetalol, Esmolol, Atenolol)
Hypotension emergency steps 1-2 Trendelenburg position : support airway, 100%O2 monitor vital sign.
Hypotension emergency steps 3-4 Consider activating EMS if condition deteriorates : IV access.
Hypotension emergency steps 5-6 Fluid bolus of normal saline 10-20 mL/kg. : Ephedrine 2.5 - 5 mg IV or Phenylephrine 50-100 mcg IV
Intra-arterial injection emergency steps 1-2 Activate EMS : secure catheter - DO NOT REMOVE
Intra-arterial injection emergency steps 3-4 10 cc of 1% lidocaine without epi. Injected into catheter : ice pack to limb
Severe hypoglycemia emergency steps 1-2 Activate EMS. : establish IV access
Severe hypoglycemia emergency steps 3-4 Measure blood sugar with glucometer : 1 amp of IV glucose ( 50 mL of 50% glucose solution)
Severe hypoglycemia emergency step 5 IV infusion of dextrose ( 5% to 20% in water). If no IV access then 1 mg glucagon IM.
Acute adrenal insufficiency emergency steps 1-3 Terminate procedure : Monitor vitals : Trendelenburg position if hypotensive.
Acute adrenal insufficiency emergency steps 4-6 Activate EMS : IV access ( if not already obtained) : Steroid administration: Dexamethasone 4mg IV or IM; Hydrocortisone 100 mg IV.
Acute adrenal insufficiency emergency steps 7-8 Fluid bolus 10-20 mL bolus of normal saline (NS) : Transport to hospital
Syncope emergency steps 1-3 Trendelenburg : ABCs : Head tolt/chin lift to maintain good airway
Syncope emergency steps 4-6 100% O2 : monitor vital signs : If bradycardia persists, consider atropine 0.5 mg IV q 3-5 minutes to a total dose of 0.03 mg/kg
Syncope emergency step 7 Reassure and relax patient
Seizure emergency steps 1-2 Obtain IV access : Midazolam 3mg/min IV or IM up to 6mg OR valium 5mg IV /min up to 10 mg
Seizure emergency steps 3-4 OR Continue to monitor and support : Activate EMS if refractory or recurrent seizures
CVA/Stroke emergency steps 1-2 Activate EMS, note time of incident, closely monitor all vital signs : place in position of comfort
CVA/Stroke emergency steps 3-4 100%O2 via mask or nasal cannula : IV access, give bolus of NS or lactated ringer solution, 250 cc if hypotensive
CVA/Stroke emergency steps 5-6 Do not treat blood pressure unless it is > 220/120. : Transport to stroke center ASAP
Mild allergic reaction emergency steps 1-2 Place PT. In upright or semi-reclined position. : 100%O2
Mild allergic reaction emergency steps 3-4 Monitor vitals : Benadryl 25-50 mg orally every 4-6 hours ( max 300 mg/day)
Anaphylaxis emergency steps 1-4 Activate EMS : 100%O2. : monitor vitals. : epi. 1:1000 0.3 - 0.5 mg IM, sublingual or subq. In severe cases, especially when there is significant hypotension, consider epinephrine 1:10,000 0.2- 0.5 mg IV slowly in small increments.
Anaphylaxis emergency step 5 Benadryl 50 mg IV
Anaphylaxis emergency step 6 Decadron 4-8 mg IV or IM
Anaphylaxis emergency step 7 ACLS protocols while awaiting arrival EMTs
Malignant Hyperthermia emergency steps 1-3 Activate EMS. : hyperventilate with 100%O2. : Dantrolene sodium 2.5mg/kg rapid injection IV
Malignant Hyperthermia emergency steps 4-5 IV cold saline ( not ringers lactate) 15mL/kg every 15min x3. : ice packs to groin, axilla, neck
Malignant Hyperthermia emergency steps 6-7 Cold saline lavage to stomach, bladder, rectum : transport to hospital
Airway obstruction positioning on tongue #1 steps 4 Suction oropharynx
Created by: Oliverhart