Emergencies
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| Airway obstruction secondary to posterior positioning of the tongue or a foreign body #1 | A.100% O2 via nasal mask, B. place patient Tren.Burg. Position, C. digital traction of tongue with gauze/tongue forceps/hemostat or tongue suture, D. suction the oropharynx.
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| Airway obstruction secondary to posterior positioning of the tongue or a foreign body #2 if tongue continues to fall into throat. | A. nasopharyngeal airway can be utilized in a conscious or semi con. PT., B. unconscious patient an oropharyngeal airway can be used, C. consider using LMA or supraglottic airway. D. Endotracheal intubation
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| Airway obstruction secondary to posterior positioning of the tongue or a foreign body #3 cricothyrotomy | A. Cleanse the overlying skin. B. Locate cricothyroid membrane by palpation. C. Utilize emergency cricothyrotomy needle/ cannula kit or large gauge to enter trachea beneath vocal cords through crico. membrane. D.
Attach tube to oxygen source 100% O2
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| Laryngospasm | 1. 100% O2 via Basel hood, 2. Head position to maintain airway, 3. Pack off surgical site, 4. Suction oral cavity/ oropharynx with tonsil suction, 5. Positive pressure 100% O2 bag mask system
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| Bronchospasm | 1. 100% O2 bag mask, 2. Albuterol, 3. Ipratropine bromide, 4. Epi. Injection, 5. Intubation/ventilation, 6. Steroid injection such as dexamethasone, 7. Benydryl, 8. Aminophylline no longer considered first. 9. EMS if all else fails
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| Emesis with aspiration | 1. Act. EMS protect IV catheter, 2. 100% O2 bag/mask, 3. Turn PT. On side with head down T.burg, 4. Tonsil suction, 5. Removal of visible foreign bodies with laryngoscope and magill forceps, 6. Intubation with suction catheter. 7. Transport to care fclty.
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| Hyperventilation | 1. Terminate tx. Remove foreign bodies from mouth, 2. Maintain airway, 3. Verbally try to calm PT. 4. Monitor vitals, 5. Do not give O2, 6. Have PT. Breathe into bag.
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| Hyperventilation Advanced | 1. Non sedated patient fails to respond, administer IV medazolam, diazepam, propofol, etc. 2. Con. Monitor vitals, 3. Discontinue rebreathing bag as breathing returns to normal, 4. Activate EMS if condition deteriorates.
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| Myocardial Infarction | 1. EMS closely observe vitals, 2. 100%O2, 3. Make PT. Comfrtble/ reassure, 4. Attach AED or defib, 5. Aspirin 325mg, 6. IV access w/ normal saline slow drip, 7. Morphine for pain 2-4mg IV. Repeat every 5-10 min as needed.
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| Symptomatic bradycardia | 1. Terminate procedure, 2. 100%O2, 3. IV if not already placed, 4. Atropine 0.5mg ( no more than 3mg) 5. PT. May need to to transported to ER for transcutaneous pacing
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| Supraventricular tachycardia | 1. Supine position, 2. Adenosine 6mg IV push over 1-3 sec. followed by immediate flush of 20cc saline. Asystole may occur 6-10 secs. 30 at most. 3. After 1-2 min, Adenosine 12mg. Rapidly flush as above. 4. Third dose may be given 1-2 min if needed.
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| Premature ventricular contractions | 1. Determine cause of PVCs ( e.g., hypoxia) and correct, 2. Lidocaine 0.5 - 1.5mg/kg IV; repeat 0.5 - 0.75 mg/kg every 5 - 10 min. Up too 3mg/kg
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| Ventricular tachycardia | 1. 100% O2., 2. Amiodarone 150 mg IV over 10 min. Max dose 2.2 gms in 24 hours. 3. Prepare for synchronous cardioversion.
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| Ventricular fibrillation. | 1. Check lead placement, if v fib. Confirmed call 911. 2. CPR, attach AED, shock if advised, 3. Con. CPR, est. IV, shock if indicated, 4. Con. CPR, give epi. 1mg IV. Prep amiodarone. 5. CPR, amiodarone 300mg, 6. CPR, epi. 1mg, 7. CPR, amiodarone 150mg,
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| Asystole/PEA | 1. CPR,
2. Epi. 1mg IV. May repeat every 3-5 minutes. May I've one dose of vasopressin 40 U to replace 1st and second dose of epi.
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| Hypertension | 1. Stop procedure, 2. Check monitor/cuff malfunction, 3. Determine cause(pain or anxiety) 4. Record vital signs 5 mins. 5. Consider EMS. 6. IV access. 7. Beta blockers A. Labetalol. B. Esmolol. C. Atenolol
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| Hypotension | 1. Trendelenburg position. 2. Support airway 100% O2, monitor vitals. 3. Consider EMS. 4. IV. 5. Saline 10-20 mL/ kg. 6 Ephedrine 2.5 - 5mg IV
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| Intra-arterial injection | 1. Activate EMS. 2. Secure catheter DO NOT REMOVE. 3. 10cc of 1% lidocaine without epinephrine Injected into catheter. 4. Ice pack to limb
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| Severe hypoglycemia | 1. Activate EMS. 2. IV. 3. Measure blood sugar w/ glucometer. 4. 1 all of IV glucose(50 mL of 50% glucose solution) 5. IV infusion of dextrose, if no IV access then 1 mg glucagon IM
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| Acute adrenal insufficiency | 1. Stop procedure. 2. Monitor vitals. 3. Trendelenburg position if hypotensive. 4. EMS. 5. IV access ( if not already done) 6. Steroid administration. Dexamethasone 4mg IV or IM hydrocortisone 100mg IV. 7. Fluid bolus of normal saline. 8. Trans. To hsptl
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| Syncope | 1. Trendelenburg position. 2. ABCs. 3. Head tilt/chin lift to maintain airway. 4. 100%O2. 5. Monitor vitals. 6. If bradycardia persists, consider atropine 0.5 mg IV q 3-5 minutes to a total dose of 0.03 mg/kg. 7. Reassure and relax patient.
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| Seizures | 1. Obtain IV access. 2. Midazolam 3mg/min IV or IM up to 6 mg or Valium 5mg IV/min up to 10 mg or 3. Continue to monitor and support. 4. Activate EMS if refractory or recurrent seizures
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| CVA or stroke | 1. EMS note time of incident. 2. Place in position of comfort. 3. 100%O2. Mask/nasal cannula. 4. IV NS or lactated ringer. 5. Do not treat BP if > 220/120. 6. Transport to stroke center ASAP.
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| Allergic reaction MILD | 1. Place PT. Upright. 2. 100%O2. 3. Monitor vitals. 4. Benadryl 25-50 mg orally every 4-5 hours max 300 mg/day
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| Allergic reaction severe / anaphylaxis | 1. EMS. 2. 100%O2. 3. Monitor vitals. 4. Epi. 5. Benadryl. 6. Decadron. 7. ACLS protocols while awaiting EMTs
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| Malignant hyperthermia | 1. EMS. 2. Hyperventilate with 100%O2. 3. Dantrolene sodium 2.5 mg/kg rapid injection IV. 4. IV cold saline( not ringers lactate) 5. Ice pack to grain, axilla, neck. 6. Cold saline lavage to stomach, bladder, rectum. 7. Transport to hospital.
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