Know the next steps to Emergencies
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| Airway obstruction positioning on tongue #1 steps 3 | Digital traction of the tongue with gauze,tongue forceps,a hemostat or tongue suture
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| Airway obstruction positioning on tongue #1 step 1-2 | 100%O2 : place Pt. in trendelenburg and pack off surgical site
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| 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
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| 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
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| 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
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| 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.
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| 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
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| 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
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| 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
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| Airway obstruction of foreign body step 3 | Direct laryngoscopy for visualization and retrieval of foreign body with forceps or suction
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| Airway obstruction of foreign body step 4 | If foreign body cannoy be removed and severe obstruction persists, a cricothrotomy may be necessary
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| Lyryngospasm emergency steps 1-2 | Administer 100%O2 via nasel hood : establish proper head position to maintain / establish airway
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| Lyryngospasm emergency steps 3-4 | Pack off surgical site : suction of oral cavity and oropharynx with tonsil suction tip.
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| 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.
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| 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
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| 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.
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| 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
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| Bronchospasm emergency steps 7-8 | Benadryl 50mg IV : Aminophylline is no longer considered a first time drug for management of bronchospasm.
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| 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
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| 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)
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| Emesis with Aspiration emergency steps 4-5 | Tonsil suction of oral cavity/ oropharynx : Removal of visible foreign bodies with a laryngoscope and Magill forceps
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| 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
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| Hyperventilation emergency steps 1-2 | Terminate treatment and remove foreign bodies from mouth and remove surgical instruments from view : maintain the airway.
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| Hyperventilation emergency steps 3-4 | Verbally try to calm the patient : monitor vital signs
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| Hyperventilation emergency steps 5-6 | Do not give O2. : have patient breathe into bag to recapture CO2
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| 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
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| Hyperventilation advanced emergency steps 3-4 | Discontinue rebreathing bag as breathing returns to normal. : activate EMS is condition deteriorates.
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| Myocardial infarction emergency steps 1-3 | Activate EMS, closely observe vitals : 100%O2 via mask. : make patient comfortable/ reassure
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| Myocardial infarction emergency steps 4-6 | Attach AED or defibrillator : aspirin 325 mg. : establish IV with normal saline slow drip
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| Myocardial infarction emergency step 7 | Morphine sulfate for pain 2-4 mg IV push. Repeat every 5-10 minutes as needed
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| Symptomatic bradycardia emergency steps 1-2 | Terminate procedure : 100%O2
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| 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
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| Symptomatic bradycardia emergency step 5 | The patient may be transported to Ear for transcutaneous pacing
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| 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.
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| 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.
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| Premature ventricular contractions emergency step 1 | Try to determine the cause ( e.g., hypoxia) and correct
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| 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
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| Ventricular tachycardia emergency steps 1-2 | 100%O2.: Amiodarone 150 mg IV over 10 minutes. Maximum dose 2.2 gms in 24 hours
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| Ventricular tachycardia emergency step 3 | Prepare for synchronous cardioversion
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| 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.
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| 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.
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| 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.
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| 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
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| Asystole/PEA emergency step 1 | CPR
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| 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.
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| Hypertension emergency step 1-2 | Terminate procedure : check monitor or cuff malfunction
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| Hypertension emergency step 3-4 | Attempt to determine cause ( e.g., pain or anxiety) and manage the cause appropriately. : record vitals every 5 minutes
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| Hypertension emergency step 5-7 | Consider EMS activation : establish IV access : beta-blockers ( Labetalol, Esmolol, Atenolol)
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| Hypotension emergency steps 1-2 | Trendelenburg position : support airway, 100%O2 monitor vital sign.
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| Hypotension emergency steps 3-4 | Consider activating EMS if condition deteriorates : IV access.
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| 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
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| Intra-arterial injection emergency steps 1-2 | Activate EMS : secure catheter - DO NOT REMOVE
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| Intra-arterial injection emergency steps 3-4 | 10 cc of 1% lidocaine without epi. Injected into catheter : ice pack to limb
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| Severe hypoglycemia emergency steps 1-2 | Activate EMS. : establish IV access
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| Severe hypoglycemia emergency steps 3-4 | Measure blood sugar with glucometer : 1 amp of IV glucose ( 50 mL of 50% glucose solution)
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| Severe hypoglycemia emergency step 5 | IV infusion of dextrose ( 5% to 20% in water).
If no IV access then 1 mg glucagon IM.
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| Acute adrenal insufficiency emergency steps 1-3 | Terminate procedure : Monitor vitals : Trendelenburg position if hypotensive.
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| 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.
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| Acute adrenal insufficiency emergency steps 7-8 | Fluid bolus 10-20 mL bolus of normal saline (NS) : Transport to hospital
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| Syncope emergency steps 1-3 | Trendelenburg : ABCs : Head tolt/chin lift to maintain good airway
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| 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
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| Syncope emergency step 7 | Reassure and relax patient
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| 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
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| Seizure emergency steps 3-4 | OR Continue to monitor and support : Activate EMS if refractory or recurrent seizures
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| CVA/Stroke emergency steps 1-2 | Activate EMS, note time of incident, closely monitor all vital signs : place in position of comfort
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| 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
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| CVA/Stroke emergency steps 5-6 | Do not treat blood pressure unless it is > 220/120. :
Transport to stroke center ASAP
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| Mild allergic reaction emergency steps 1-2 | Place PT. In upright or semi-reclined position. : 100%O2
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| Mild allergic reaction emergency steps 3-4 | Monitor vitals : Benadryl 25-50 mg orally every 4-6 hours ( max 300 mg/day)
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| 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.
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| Anaphylaxis emergency step 5 | Benadryl 50 mg IV
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| Anaphylaxis emergency step 6 | Decadron 4-8 mg IV or IM
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| Anaphylaxis emergency step 7 | ACLS protocols while awaiting arrival EMTs
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| Malignant Hyperthermia emergency steps 1-3 | Activate EMS. : hyperventilate with 100%O2. : Dantrolene sodium 2.5mg/kg rapid injection IV
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| Malignant Hyperthermia emergency steps 4-5 | IV cold saline ( not ringers lactate) 15mL/kg every 15min x3. : ice packs to groin, axilla, neck
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| Malignant Hyperthermia emergency steps 6-7 | Cold saline lavage to stomach, bladder, rectum : transport to hospital
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| Airway obstruction positioning on tongue #1 steps 4 | Suction oropharynx
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