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ICEMA Protocols adul

Adult Protocol questions

QuestionAnswer
SVT protocol (old) vaso vagal, 300 cc bolus, 6, 12, 12 of adenosine followed by 20ml NS, procainamide 20mg/min, if suppressed hang drip at 2mg/min, sych cardiovert 100, 200, 300, 360
V tach (old) procainimide 20mg/min, suppressed hang drip 2mg/min, lido at 1mg/kg every 10min at 0.5mg/kg to a max of 3mg/kg, hang drip 2mg/min, mag 2gms 100ml over 5 min for torsades, adenosine svt, precordial thump witnessed v tach, sync cardio, lido
a fib, a flutter (old) transport, if condition deteriorates sync cardioversion, verapamil for narrow complex at 5mg over 3 min, repeat in 15 at 10mg over 3 min, procainimide 20mg/min hang at 2mg/min
AMI O2, rhythm strip, asa 162, IV, ITP &CBS 300cc NS, may repeat, 12 lead, if RVI 300ml bolus may repeat, TCP, for LVI 0.4mg nitro every 3 min, MS 2mg every 3 min, RCF 10mg additional MS
Cardiac Arrest (old)VF/VT start cpr, advanced airway, defib 360 v tach/fib, 2 min cpr after defib, epi 1:10,000 1mg, reassess, defib if VF/VT, after 2 cycles of Cpr lido 1.5mg/kg repeat 0.75mg/kg every 5, call base after 5 cycles
Cardiac Arrest PEA/Asystole CPR,Advanced Airway,300cc bolus, may repeat,epi 1:10,000 1mg during every 2 min of CPR after each rhythm eval,1.0mg Atropine after 2nd cycle of CPR to max of 3.0mg, consider termination PEA<60, asystole, agonal rhythm, successful intubation, initial meds
Cardiac Arrest treatment modalities Blood sugar give D50 if indicated, NG/OG tube for gastric distention, Narcan 2mg for opiate overdose.
Cardiac Arrest Additional Dopamine for inadequate tissue perfusion 400mg in 250ml, 5-20mcg/kg/min, Lido infusion 2mg/min for conversion from VF/VT, contact base to terminate, copy of ECG.
ALOC C spine, IV, monitor, hypoglycemic: D50, Glucagon 1mg IM,SC,IN, repeat D50. Active Seizure versed 5-10 IM, 2.5-5IV/IO/IN, repeat. Opiate OD:narcan 2mgIV/IN/IM 2-3min repeat
Non traumatic shock Airway, O2, monitor, trendelenburg, IV, bp<90 500cc, may repeat, peds 20ml/kg may repeat 1, BP>90 150ml/hr, TKO for peds, base may order (RCF): 2nd large IV, Dopamine
Burns-Adult Advanced Airway-uto go closest,monitor,IV/IO,BP<90 250ml up to 1000, stable 500ml/hr,5mg MS every 5min to 20mg, IM 10mg,minor=closest,major=burn center,ele arrest=medical,resp. 2.5/.5 neb. 3 times, deter. vital,pulseless,apneic=closest.
Burn classifications ADULT Adult <10% TBSA or <2% Full thickness=minor, moderate=10-20% TBSA,2-5% full,high voltage inj.,susp inhalation,circumferential, predisposing med issues,Major= >20%TBSA,>5% full,high voltage burn,known inhalation,sig. burn to face,eye,ear,genital,joint,
Burn classification PEDS <5% TBSA,<2%full,moderate=5-10TBSA,2-5full,high voltage inj.,susp. inhalation,circumferential,predisposed med issues,major= >10TBSA,>5full,high voltage,known inhal.,sign. burn to face,eye,ear,genital,joints
Determination of death on scene decomp,obvious rigor, signs of venous pooling,lividity,decapitation,incineration of head or torso,massive crush or penetrating injury w/evisceration of heart or brain, gross dismemberment of trunk,cardiac arrest w/sev blunt force trauma,no vitals,asystole
COPD ADULT O2 sat,nebulized albuterol/atrovent 2.5mg/.5mg, may repeat twice,CPAP up to 15cms in 3cms incriments,naso tracheal intubation
Acute Asthma/Bronchospasm Airway adjunts/O2 sat,nebulized albuterol 2.5mg/atrovent .5mg, repeat twice, 300cc for inadequate tissue perfusion may repeat, CPAP up to 15CMS,EPI 0.3mg SQ 1:1,000,repeat after 15min,nasotracheal intubation
Allergic reaction/anaphylactic shock Nebulized atrovent/albuterol,2.5/.5 3times,CPAP,epi .3 1:1,000 repeat after 15 min,Diphenhydramine 25mgIV,50IM,EPI 1:10,000 .1mg as needed to .5mg, nasotracheal intubation
Acute Pulmonary Edema/CHF O2 sat,airway adjuncts,Nitro 0.4mg repeat W/signs of adequate tissue perfusion,CPAP,Nasotracheal intubation RCF(dopamine,Lasix 40-100mg,nebulized albuterol/atrovent once stabilized)
Airway obstruction Adult Heimlich/chest thrusts,C-spine if indicated,head tilt/jaw thrust,2 ventilations,if apneic establish advanced airway,visualize w/laryngoscope remove with Magill, needle cric if obstruction persists and unable to ventilate
Non traumatic hypertensive crisis Airway adjuncts,O2 room air sat,monitor,IV saline lock
Bradycardia ADULT non symptomatic=300cc may repeat,monitor. symptomatic=consider advanced airway,300cc bolus,set rate at 300cc if lungs remain clear,monitor/strip,atropine 0.5 max of 3.0mg,TCP for 2nd type 2/3rd,Dopamine 5-20mcg/kg/min
Poisonings Poison control,monitor vitals,expeditious transport,ABC's,IV,hypotensive=500cc,20ml/kg may repeat for peds,charcoal 50gms(1gm/kg ped) PO alert w/gag,organophosphate=2mg ivp atropine repeat as needed.
Poisonings base may order phenothiazine=diphenhydramine 25mg IVP, 50mg IM for ataxia muscle spasms.tricyclic 1mEq/kg sodium bicarb, calcium channel blocker=1gm(10cc) of calcium choloride,beta blocker=1mg glucagon,repeat atropine at 2-4mg
Heat related minor heat illness=remove heat source,O2,rehydrate,c-spine.heat exhaustion=IV,300cc,reassess repeat if BP<90,Peds 20ml/kg repeat until palpable pulse,blood glucose.heat stroke=aggressive cooling,rhythm strip, seizure,ALOC,peds seizure precautions
Cold related: frostbite/mild hypothermia frostbite=elevate,IV,pain relief=2mg MS up to 10mg IV/10mg IM adult, .1mg/kg up to 2mg, up to 5mg,.2IM to 10, RCF may repeat MS.Mild hypothermia=IV,monitor,glucose.
cold related:severe hypothermia severe=advanced airway,>9y/o 300cc warmed may repeat,birth-8y/o 20ml/kg warmed may repeat,strip,VF/VT pulseless=defib 1 at 2/kg or 200,asystole=Cpr,additional bolus
Obstetrical emergencies excessive bleeding=500cc may repeat,maintain at 150ml/hr,2nd large IV.hypertension/eclampsia=IV TKO,left lateral,strip,tonic/clonic=mag 4gms/20ml/3-4min,versed 2.5IVX2,5IMX2,base order dopa,2gm/100/30ml/hr,repeat versed after 10min,continued tonic/clonic
OB RCF Dopamine 5-20mg/kg/min,magnesium 2 in 100ml of NS at 30ml/hr,after administration of 4grams,repeat versed after 10min of continued tonic/clonic activity
Newborn care if reps<20 or gasping tactile stimulation and assisted ventialtion,if hr<100 ventilate BVM 30sec,HR<60 chest compressions 120/per min.IV/IO,advanced airway,epi 0.01mg/kg if hr<60,OG >2min ventilation,heel stick,
Newborn care base may order 10-20ml/kg IV NS over 5min,RCF 10ml/kg over 5 min may repeat.persistnet hypotension despite adequate ventilation and fluid resuscitation EPI 1:10,000 0.005mg/kg every 10 min.
Trauma adult Respiratory Advanced airway as indicated,unmanageable airway=transport to the closest most appropriate.Requires intubation=airway can't be maintained with BVM,unable to intubate.For all calls:Monitor ECG warm IV fluids when available, unstable=BP<90 start 2nd IV,
Trauma blunt force, penetrating trauma, isolated closed head injury unstable=IV NS open til stable or 2000ml infused, stable IV NS TKO.Penetrating trauma=unstable IV NS 500ml,stable" ". Isolated closed head injury=unstable:IV NS 250ml to max 500ml,stable IV NS TKO
Chest trauma, isolated extremity fractures occlusive dressing,perform needle thoracostomy,MS 5mg every 5min to 20mg,IV NS 250ml one time,IM pain relief MS 10mg
Head and neck trauma,impaled object,precautionis Lido 1.5mg/kg IV for suspected head/brain injury.Impaled object=remove object upon trauma base physician order if indicated.precautions=consider cardiac etiology with small mechanism of injury.
Critical Trauma Patient Physiologic-GCS,Respiratory,Hypotension Adult=GCS< or =13,LOC>3min,requiring assistance with ventilation,hypoxic or O2 sat less than 90 consistently, RR<10 or >29.inadequate tissue perfusion,BP<90mmHG,Tachycardia
Critical Trauma Patient anatomic penetrating injuries to, blunt chest trauma resulting in, severe tenderness to, penetrating injuries to:torso,head,extremity proximal to the knee or elbow,neck,groin.blunt chest trauma resulting in:eccymosis,unstable chest wall,flail chest.severe tenderness to:head,neck,torso,abdomen,pelvis.
paralysis,abdomen, amputation, fractures. Any: skull deformity, major tissue disruption,suspected pelvic fracture paralysis:traumatic,loss of sensation,suspected spinal cord injury.abdomen:tenderness with firm and rigid abdomen on examination.amputation:above the wrist,above the ankle.fractures evidence of two to more proximal long bone fracture(femur,humerus).
high speed crash high speed crash initial speed>40,major auto deformity>18inches,intrusion into passenger space compartment>12inches,unrestrained passenger, front axle rearward displaced,bent steering wheel/column,starred windshield.
vehicle rollover,motorcycle crash, complete rollover, rollover multiple times,unrestrained,restrained with significant injuries or high rate of speed.motorcycle crash >20MPH and or/separation of rider from the bike with significant injury.
Pedestrain, significant blunt trauma to, extrication auto pedestrain with significant impact >10mph, auto bicycle with significant impact >10mph,pedestrian thrown >15feet or run over. significant blunt trauma to head, neck, or torso. extrication >20 min with associated injuries.
Death of occupant, Ejection, Falls, Submersion with trauma Death of Occupant in same passenger space, ejection partial or complete ejection of patient from vehicle, falls> or = 15feet, submersion with trauma.
Age and co morbid factors for decision of destination for trauma patient ped<9,adult>65,have known resp. cardiac,liver disease or diabetes, hematologic or immunosuppresive conditions,isolated extremity injury w/neurovascular compromise,>20weeks pregnant, inablitly to communicate.
closest receiving hospital unmanageable airway, severe blunt force trauma, penetrating trauma arrest, burn pt meeting CTP.
EMS aircraft indications MCI, Prolonged extrication time >20min,never delay pt transport waiting for an enroute EMS aircraft
contraindications for EMS aircraft HAZ MAT pts who can't be decontaminated, violent or under the influence or drugs or alcohol pts, stable pts,ground transport<30,traumatic cardiac arrest,other safety considerations determined by crew/pilot.
Considerations scene time should be limited to 10 min whenever possible, for patients meeting the trauma triage criteria base hospital contact shall be made in the event of patient refusal of assessment, care and/or transport.
Created by: danielloomis