Ems Tx Guidelines

Front 1

ACUTE CORONARY SYNDROME - STEMI

Treatment:

Back 1

o Medical Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
o ASA 324 mg (chewable) if no recent Hx bleeding
disorder or allergy
o Nitrolingual spray 0.4 mg SL (every 5 min) as long as symptoms persist and no sign of hypo-perfusion.
o 12-lead EKG ( + STEMI = rapid transport to STEMI
center)
o *Normal Saline (250-500ml) for hypo-perfusion
(RVI)
o Tridil drip 10 mcg/min IV titrate to pain and SBP > 100 mmHg
o Morphine 2 mg SIVP every 5 min (max total dose 0.1 mg/kg) as long as symptoms persist and no sign of hypo-perfusion

Front 2

ACUTE CORONARY SYNDROME - STEMI

Pearls:

Back 2

• STEMI = S-T segment elevation in two or more related leads. (Regardless of time).
• Medical Control should be notified if ACS patient has LBBB.
• Withhold Nitroglycerine in any patient who has used Viagra, Cialis, Levitra or similar
mediation in the previous 48 hrs.
• Monitor V/S before and after each medication administration and q 5 min thereafter.
• Repeat 12-lead EKG every 10 minutes if possible.
• Diabetic, elderly and female patients often have atypical presentation or generalized
complaints.
• Avoid pre-load reducing medication for hypo-perfusion and/or RVI (Rt. Sided MI).
• *Avoid excessive fluid administration if evidence of pulmonary edema present ie. JVD, crackles.

Front 3

CONGESTIVE HEART FAILURE/ CARDIOGENIC PULMONARY EDEMA

Treatment:

Back 3

o Medical Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
o Nitrolingual spray 0.4 mg SL (every 1 min x 3) as
long as symptoms persist and SBP > 100 mmHg or no sign of hypo-perfusion.
o CPAP per guidelines
o 12-lead EKG ( + STEMI = rapid transport to STEMI
center)
o Tridil drip 10 mcg/min IV (increase by 10 mcg/min
q-5 min) titrate to desired effect not to exceed 50
mcg/min while maintaining SBP > 100 mmHg.
o Furosemide 40 mg SIVP repeat x1 in 5-10 min if not
improving and no sign of hypo-perfusion
o Morphine 2 mg SIVP q 5 min (max total dose 0.1
mg/kg) as long as symptoms persist and no sign of
hypo-perfusion
o Dopamine 5-20 mcg/kg/min for hypo-perfusion.
Titrate to maintain SBP > 100 mmHg

Front 4

CONGESTIVE HEART FAILURE/ CARDIOGENIC PULMONARY EDEMA

Pearls:

Back 4

• STEMI = S-T segment elevation in two or more related leads. (regardless of time)
• Withhold Nitroglycerine in any patient who has used Viagra, Cialis, Levitra or similar mediation
in the previous 48 hrs.
• Consider AMI in all these patients.
• Monitor V/S before and after each medication administration and every 5 minutes thereafter.
• Avoid pre-load reducing medication if s/s of hypo-perfusion. Avoid MS in somnolent patients.
• Avoid excessive fluid administration.
• Monitor level of consciousness and V/S carefully and move to advanced airway if condition
deteriorates.

Front 5

DROWNING / SUBMERSION

Treatment:

Back 5

o Medical / Trauma Supportive Care Guidelines
o Remove wet clothing and ensure warmth
o Continuous SpO2, ETCO2, EKG monitoring
o Focused BLS
o Albuterol 2.5 mg AT for wheezing
o CPAP / PEEP for s/s pulmonary edema
o Normal Saline 500 ml IV bolus if evidence of hypovolemia exists. (repeat as needed)
o Dopamine 5-20 mcg/kg/min IV infusion for hypo-perfusion

Front 6

DROWNING / SUBMERSION

Pearls:

Back 6

Pearls:
• Appropriate Cardiac Arrest protocols should be followed on pulseless patients.
• Rescuers should not enter the water unless specifically trained to do so. For victims struggling
• Always maintain spinal precaution and immobilize if that possibility exists.
• Drowning is the leading COD among would-be rescuers.
• In cold water drowning, resuscitate until warm. (transport)
• All submersion victims should be transported for evaluation. Latent s/s develop as long as 24 hours post-submersion.
• SCUBA diver’s dive computer or dive log should be transported with the patient.
• All suspected barotrauma patients should be transported to a facility that has hyperbaric
chamber (D-2).

Front 7

HYPERTHERMIA

Treatment:

Back 7

o Medical / Trauma Supportive Care Guidelines
o Accucheck: treat if < 60 mg/dl
o Remove from environment, remove clothing as appropriate
• Normal mental status
Cool patient with water to skin and increase evaporation
• AMS
Aggressive cooling to unclothed patient with water misting, fans, ice packs to
groin, axilla and neck.
o Normal Saline IV 500 ml bolus (repeat as needed)

Front 8

HYPERTHERMIA

Pearls:

Back 8

• Appropriate Cardiac Arrest protocols should be followed on pulseless patients.
• Very young and old more prone to develop heat emergencies.
• Cocaine, methamphetamine, amphetamines and salicylates may elevate body temps.
• Many Rx medications alter the body’s thermoregulatory mechanism.
• Sweating generally diminishes/ stops as the core temperature rises above 104F.

Front 9

HYPOTHERMIA

Treatment:

Back 9

o Medical / Trauma Supportive Care Guidelines
o Accucheck: treat if < 60 mg/dl
o Remove from environment / wet clothing; ensure, provide warmth
o Handle patient gently, don’t allow physical exertion
o Normal Saline IV as needed (warmed if
possible)
o Thiamine 100 mg SIVP for hypoglycemic with evidence of ETOH abuse or malnourishment.
o D50W SIVP if hypoglycemic

Front 10

HYPOTHERMIA

Pearls:

Back 10

• Appropriate Cardiac Arrest protocols should be followed on pulseless patients.
• NO PATIENT DEAD UNTIL WARM AND DEAD. (> 95O F)
• Defibrillation and anitdysrhythmics may be ineffective until patient warmed > 88-90o F.
• Primary V-fib common in patients < 88o F.
• Rough handling of the patient may cause V-fib.
• Hypothermia causes progressive bradycardias.
• Very young / old patients more susceptible to hypothermia.
• Obtain 12-lead if possible.

Front 11

BITES AND EVENOMATIONS

Treatment:

Back 11

o Medical / Trauma Supportive Care Guidelines
o Immobilize affected limb if necessary
o Appropriate specific treatment guidelines
o Allergic Reaction Protocol (if indicated)
o Pain Control Protocol
*Diazepam 5 mg SIVP for Black Widow bite abdominal muscle spasm/pain.

Front 12

BITES AND EVENOMATIONS

Pearls:

Back 12

• Human bites are highly infectious and should be treated by a physician.
• All mammal bites have the risk of Rabies exposure and all bites/wounds risk bacterial infection.
• Evidence of infection: pain, swelling, redness, drainage, warm/hot; red streaks and swollen lymph nodes proximal to wound.
• Indigenous venomous snakes in Lee County are: Eastern Diamondback and Pigmy rattlesnakes,
Cottonmouth Water Moccasin and Coral Snake. There are many exotic species kept by dealers and citizens.
• Coral snake venom is neuro-toxic and deadly, but rare and not as painful as a pit viper.
• Pit viper envenomation is highly variable, 25 % are dry bites (no venom injected)
• Envenomated bites are very painful with redness and swelling. (pit vipers)
• No ice, tourniquets, cutting or sucking snake bites. Immobilize extremity in neutral position.
• *Black Widow spider bites are not acutely painful, but may progress to severe abdominal spasms.
• Stingray and catfish injuries should be immersed in very warm water ASAP for immediate pain relief. They need to be seen by a physician to r/o foreign body and dT / antibiotic prophylaxis.
• Jellyfish (cnidaria) should be removed from the skin with sea water or isopropyl alcohol. Pain Control if necessary.

Front 13

ALLERGIC REACTION / ANAPHYLAXIS

Adult Treatment:

Back 13

o Medical Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
o Albuterol 2.5 mg AT for bronchospasm
o Normal Saline 500 ml IV bolus if signs of hypoperfusion
and repeat as necessary
o *Diphenhydramine 50 mg SIVP / IM
o Solumedrol 125 mg SIVP
o Epinephrine 0.3 mg IM (1:1,000) for patient in
respiratory distress or shock
o Epinephrine (1:1,000) 2-10 mcg/min IV infusion
titrate to effect for anaphylaxis refractory to previous treatment.
o Epinephrine (1:10,000) 0.5 mg SIVP if patient is pre-arrest (extremis)

Front 14

ALLERGIC REACTION / ANAPHYLAXIS

Pediatric Treatment:

Back 14

o Medical Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
o Albuterol 2.5 mg AT for bronchospasm
o Normal Saline 20 ml/kg IV bolus if signs of hypoperfusion
and repeat as necessary
o *Diphenhydramine 1 mg/kg SIVP/IM (max 25 mg
per dose)
o Solumedrol 1 mg/kg SIVP/IM for patients
greater than 2 y/o.
o Epinephrine 0.01 mg/kg IM (1:1,000) (max 0.3 mg per dose) for patient in respiratory distress or shock
o Epinephrine (1:1,000) 1 mcg/min IV infusion
titrate to effect for anaphylaxis refractory to previous treatment.

Front 15

ALLERGIC REACTION / ANAPHYLAXIS

Pearls:

Back 15

• Contact Medical Control prior to administering Epinephrine to patients who are > 50 y/o, have PMHx of CAD
or have HR > 140 or SBP > 160.
• Safely and rapidly eliminate the source of exposure, if possible.
• *Diphenhydramine for local reactions and rash; Diphenhydramine, Solumedrol and/or Epi for severe
generalized reactions respectively.
• Per individual, each allergic reaction is generally worse than any previous reaction.

Front 16

REACTIVE AIRWAY DISEASE / COPD / ASTHMA

Adult Treatment:

Back 16

o Medical / Trauma Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
o Albuterol 2.5 mg AT for wheezing
o DuoNeb AT if refractory to albuterol
o CPAP / PEEP 5cm/H2O titrate as needed
o Solumedrol 125 mg SIVP
Asthma
o Magnesium Sulfate 2 gm in 100cc D5W IV infusion over 10 mins for patients refractory
to above Tx.
o Epinephrine (1:1,000) 0.3 mg IM for severe respiratory distress refractory to above Tx.
o Epinephrine infusion 2 mcg/min titrate to effect for patient in extremis.

Front 17

REACTIVE AIRWAY DISEASE / COPD / ASTHMA

Pediatric Treatment:

Back 17

o Medical / Trauma Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
o Albuterol 2.5 mg AT for wheezing
o DuoNeb AT if refractory to albuterol
o Solumedrol 1 mg/kg SIVP
o Epinephrine (1:1,000) 0.01 mg/kg (max 0.3 mg) IM
for patient in respiratory distress.
o Magnesium Sulfate 50 mg/kg in 100cc D5W IV
infusion over 10 mins for patients refractory to above
Tx. (For patients > 2 y/o)
o Epinephrine infusion 2 mcg/min titrate to effect for
patient in extremis.
Croup /Epiglottitis /Bronchioliti
• Normal Saline AT if no evidence of bronchospasm.
• Epinepherine 0.5 ml (1:1,000) / 2.5 cc NS AT
if in extremis.

Front 18

REACTIVE AIRWAY DISEASE / COPD / ASTHMA

Pearls:

Back 18

• Contact Medical Control prior to administering Epinephrine to patients who are > 50 y/o, have PMHx of CAD or have HR > 140 or SBP > 160.
• A 12–lead EKG should be obtained on all these patient when possible.
• A silent chest in a patient in respiratory distress is considered a pre respiratory-arrest sign.

Front 19

ABDOMINAL PAIN
(NON-TRAUMA)

Adult treatment:

Back 19

o Medical Supportive Care Guidelines
o Orthostatic vitals (if not already symptomatic)
o Normal Saline 500 ml IV bolus if symptomatic of
hypo-perfusion and repeat as necessary
o Promethazine 6.25-12.5 mg SIVP for vomiting
o Fentanyl 1 mcg/kg SIVP for moderate-severe pain

Front 20

ABDOMINAL PAIN
(NON-TRAUMA)

Pediatric treatment:

Back 20

o Medical Supportive Care Guidelines
o Orthostatic vitals (if not already symptomatic)
o Normal Saline 20 ml/kg IV bolus if symptomatic
of hypo-perfusion and repeat as necessary
o Fentanyl 1 mcg/kg SIVP for severe pain

Front 21

ABDOMINAL PAIN
(NON-TRAUMA)

Pearls:

Back 21

• Definitive care for abdominal pain occurs at the hospital and rapid transport may be indicated.
• Repeat vital signs after each fluid bolus and give additional fluids based on patient condition.
• Strict NPO should be maintained
• Use lower dose of Phenergan in the elderly; always give slowly through wide open IV in all patients.
• Abdominal pain in women of childbearing age assumed to be ectopic pregnancy until proven otherwise.
• Appendicitis begins as diffuse peri-umbilical pain later becoming intense and localized to the RLQ.

Front 22

ALTERED MENTAL STATUS
HYPO / HYPERGLYCEMIA

ADULT

Back 22

o Medical Supportive Care Guidelines
o Accucheck: treat if < 60 mg/dl
o Oral Glucose 15 gms (+ self-protected airway)
o Hypoglycemic

Front 23

ALTERED MENTAL STATUS
HYPO / HYPERGLYCEMIA

PEDIATRIC (<40 KG)

Back 23

o Medical Supportive Care Guidelines
o Accucheck: treat if < 60 mg/dl
o Oral Glucose 7.5 gms (+ self-protected airway)
o Hypoglycemic

Front 24

ALTERED MENTAL STATUS
HYPO / HYPERGLYCEMIA

Pearls:

Back 24

• Maintain high index of suspicion for the many causes of AMS
• Do NOT let alcohol confuse the clinical picture, alcoholics frequently develop hypoglycemia.
• Thiamine may be omitted if the patient has no sign or suspicion of malnutrition.
• Do not give oral glucose if the patient cannot protect their own airway.
• Hypoglycemics can be violent, protect emergency personnel and the patient with necessary restraint.
• All IV doses can be given IO.
• If hypoglycemic patient has insulin pump on, turn off or disconnect if at all possible.
• When patient’s mental status returns to baseline, the patient should be encouraged to eat.

Front 25

EXCITED / AGITATED DELIRIUM

Treatment

Back 25

o Scene Safety
o Medical Supportive Guidelines
• Appropriate levels of patient restraint for these patients must
continually be evaluated, as patient condition may rapidly
deteriorate and the potential for positional airway compromise
develop.
• Remove patient from stressful environment.
o Focused history and physical exam.
• Accucheck: treat if < 60 mg/dl.
• If patient HOT to touch, begin passive and active cooling measures
as soon as safe to do so.
o Continuous ETCO2 and Pulse Oximetry monitoring.
o IV access ASAP, infuse 1000 ml N/S to rehydrate patient.
o Midazolam 5 mg IM/IN with SBP> 100 mmHg or peripheral pulses
present.
-or
Midazolam 2.5– 5.0 mg IV titrated to effect with SBP> 100 mmHg peripheral pulses present.
o Lorazepam 2.0 mg IV if necessary.

Front 26

EXCITED / AGITATED DELIRIUM

Pearls:

Back 26

• Do NOT load a violent patient into the the ambulance until the patient is adequately controlled with physical
and/or chemical restraint.
• Be sure to consider possible medical/trauma causes for behavior (hypoglycemia, over-dose, substance abuse,
hypoxia, hyperthermia, head injury, etc.).
• Patients should not be transported in a prone or hog-tied position. Any position that impedes respiration should
be avoided.
• Do not overlook the possibility of associated domestic violence or child abuse.
• More than 1 liter of NS may be required for adequate hydration.
• If Cardiac Arrest, consider fluid bolus and Sodium Bicarb early.

Front 27

PAIN / ANXIETY MANAGEMENT

ADULT

Back 27

o Fentanyl 1 mcg/kg (per dose) SIVP/IM/IN titrate
to effect for pain. w/o evidence of hypo-perfusion.
(may repeat x 1)
o Midazolam 2 mg SIVP/IM/IN for severe anxiety and/or muscle spasm without evidence of hypoperfusion.

Front 28

PAIN / ANXIETY MANAGEMENT

Pediatric

Back 28

o Medical / Trauma Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
o Fentanyl 1 mcg/kg (per dose) SIVP/IM/IN titrate
to effect for pain. w/o evidence of hypo-perfusion (may repeat x 1)
o Midazolam 0.1 mg/kg (max 2 mg per dose)
SIVP/IM/IN for severe anxiety adversely affecting clinical status without evidence of hypo-perfusion.

Front 29

PAIN / ANXIETY MANAGEMENT

Pearls:

Back 29

• Pain severity (1-10) is a vital sign to be recorded pre and post medication delivery and at disposition.
• Full V/S should be obtained before and after every medication and every 15 min there-after.
• All patients should have drug allergies documented prior to administering any medication.
• Opioids and Benzodiazepines cause respiratory depression. Use cautiously in patients with head injuries, COPD and respiratory distress. Airway/ventilation must be monitored closely.

Front 30

OVERDOSE / TOXIC INGESTION

Tratment:

Back 30

o Medical / Trauma Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
o Normal Saline 500 ml for hypotension without evidence of pulmonary
edema.
o Naloxone 0.4-2.0 mg (per dose) SIVP or IN for suspected opiate OD if
respiratory rate < 12. DO NOT give naloxone to an intubated patient
except when ordered by Medical Control or in cardiac arrest.
o Diphenhydramine 50 mg IV/ IM for patient with evidence of dystonic
reaction.
o Sodium bicarbonate 1 mEq/kg SIVP for TCA O.D. with sustained HR
> 120, QRS > 100 ms.
o Dopamine 5-20 mcg/kg/min IV infusion for hypotension unresponsive
to fluids. Titrate to maintain SBP > 100 mmHg.
o Midazolam 2-10 mg (2 mg increments) SIVP titrate to effect for
hyperadrenergic state from (meth) amphetamines, cocaine or PCP use.
Usually presents with HR>120 and HTN.
o Atropine 1-2 mg SIVP q 5 min for SLUDGEM (no max dose)

Front 31

OVERDOSE / TOXIC INGESTION

Pearls:

Back 31

• Do not rely on patient’s history of ingestion, especially in suicide attempt.
• Bring medicine bottles, containers, contents, emesis to ED.
• Tricyclic Antidepressent (TCA): major area of toxicity: seizure, dysrhythmia, hypotension, AMS-coma. The
patient may rapidly progress from alert to death.
• Acetaminophen: normal early, then N/V progressing to liver failure and death (especially with alcohol)
• Opiates / Benzodiazepines: Bradycardia, hypotension, respiratory depression/arrest.
• Hyperadrenergics: tachycardia, hypertension, hyperthermia, dilated pupils, seizures.
• Cholinergics: (wet) SLUDGEM, confusion, weakness, diaphoresis, seizure.
• Anticholinergics: (dry) delirium, tachycardia, dilated pupils, seizure, dysrhythmias.
• Solvents: N/V, changes in mental status, ataxia, dermatological changes.
• Insecticides: (organophosphates/carbamates) “see cholinergics”
• MARK 1 kits contain Atropine 2 mg and pralidoxime 600 mg in an autoinjector for self administration.
• Consider CPAP/PEEP for any patient with Pulmonary Edema.
• Consider contacting Poison Control Center for consultaion: 1-800-222-1222 or Medical Control

Front 32

SEIZURE MANAGEMENT

Adult

Back 32

o Medical / Trauma Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
o Accucheck: treat if < 60 mg/dl
o Lorazepam 2.0 mg SIVP for
seizures
o Midazolam 2.0-5.0 mg SIVP
-or
o Midazolam 5.0 mg IM / IN if no IV/IO.
o Magnesium Sulfate 4 gms in100 cc D5W wide open
for active seizures secondary to eclampsia until
seizure stops then slow to finish dose.
o Thiamine 100 mg SIVP for hypoglycemic w/
evidence of ETOH abuse or malnourishment.
o D50W 25 gms SIVP for hypoglycemia

Front 33

SEIZURE MANAGEMENT

PEDIATRIC (<40 KG)

Back 33

o Medical / Trauma Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
o Accucheck: treat if < 60 mm/dl
o Midazolam 0.2 mg/kg SIVP/ IM/ IN per dose,
max total 5 mg.
o Diazepam 0.2 mg/kg -or- Lorazepam 0.1
mg/kg SIVP for seizures refractory to
midazolam.
o D25W 0.5 gm/kg SIVP for hypoglycemia

Front 34

SEIZURE MANAGEMENT

Pearls:

Back 34

• Protect patient from injury during active seizure.
• 5 minutes of continuous seizure activity or two or more seizures w/o conscious period are emergent. Treat
aggressively to stop seizure activity. Be prepared to support ventilations.
• All Benzodiazepines are respiratory depressants, closely monitor airway / ventilation status of patient and
assist/control when necessary.
• Ensure patients experiencing febrile seizures are not excessively dressed or bundled and determine last
acetaminophen/ibuprofen dose.

Front 35

STROKE / CVA

Treatment

Back 35

o Medical Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
• Maintain SpO2 > 92% while avoiding unnecessary high
flow O2.
• Advance airway as needed.
o Accucheck: treat if < 60 mg/dl
o Cincinnati Stroke Scale: acutely positive = Stroke Alert
o 12-lead EKG ( + STEMI = transport to STEMI/STROKE center)
o Thiamine 100 mg SIVP/IM for hypoglycemic w/ evidence of
ETOH abuse or malnourishment.
o D50W 25 gms SIVP if hypoglycemic

Front 36

STROKE / CVA

Pearls

Back 36

• Stroke Alert = rapid transport to Stroke Center
• Monitor airway closely, dysphagia and vomiting are common.
• Correct hypoglycemia early
• Try to pinpoint on-set of symptoms and document time
• Avoid excessive fluid administration unless indicated
• Head of stretcher at least 30 degrees unless contraindicated

Front 37

OBSTETRICAL EMERGENCIES (seizures Tx)

Back 37

o Medical / Trauma Supportive Care Guidelines
o Accucheck: treat is < 60 mg/dl

Front 38

OBSTETRICAL EMERGENCIES

Pearls:

Back 38

• Severe headache, vision changes, or RUQ abdominal pain may indicate pre-eclampsia.
• In the setting of pregnancy, hypertension is defined as SBP > 140 or DBP > 90 mmHg.
• Maintain patient in a left lateral position to minimize risk of supine hypotensive syndrome.
• Ask patient to quantify any bleeding by # of pads used per hour.
• Magnesium Sulfate and benzodiazepines may cause hypotension and decreased respiratory drive, monitor the
patient closely.

Front 39

NORMAL DELIVERY PROCEDURES

Back 39

• Apply gentle palm pressure to the infant’s head to prevent explosive delivery and tearing of perineum.

Front 40

COMPLICATED DELIVERY

Back 40

• Significant blood loss or delayed placental delivery.

Front 41

Prolapsed cord

Front 42

Breech presentation

Front 43

Shoulder dystocia

Front 44

Stillborn/abortion

Front 45

HEAD INJURY / TBI

Treatment

Back 45

o Medical / Trauma Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
o Accucheck: treat is < 60 mg/dl
o Basic/Advanced airway as needed -ventilate to
maintain low-normal ETCO2 (32-35 mmHg)
o Seizure protocol as needed for seizure
o Dopamine 10-20 mcg/kg/min IV infusion for
persistent hypotension unresponsive to fluid.
Titrate to maintain SBP >100 mmHg.

Front 46

HEAD INJURY / TBI

Pearls:

Back 46

• If GCS < 12 consider air medical transport or rapid ground transport and < 8 intubation should be considered.
• Increased ICP may cause hypertension and bradycardia (Cushing’s reflex).
• Hypotension should be treated aggressively to maintain SBP > 100 mmHg. (> 80 mmHg in Peds)
• Limit IV fluids if not hypotensive. (SBP>100 mmHg).
• Monitor and document changes in the level of consciousness.
• With potential or obvious skull fracture, use caution when applying direct pressure.
• Open skull fracture should be covered with non-pressure DSD.
• Control scalp / facial bleeding as above. Massive blood loss can result from small wounds.
• All clear fluid in the outer ear IS NOT CSF. (tears, sweat, water)

Front 47

EXTREMITY TRAUMA / AMPUTATIONS / CRUSH
INJURY

Treatment

Back 47

o Medical / Trauma Supportive Care Guidelines
o Pain Management Protocol
o *Crush injury syndrome*: prior to release of
compression when possible

Front 48

Uncomplicated fractures/dislocations

Back 48

with adequate circulation should be splinted in position of function

Front 49

Fractures/dislocations with circulation compromise and/or angulation

Back 49

should be manipulated to restore
circulation and be splinted in position of function if possible. (following appropriate pain control if possible). If
the attempt is unsuccessful, splint in position found and expedite transport.

Front 50

Femoral shaft fractures

Back 50

may be immobilized utilizing a traction splint unless one of the situations listed below is
present:

Front 51

Incomplete Amputated body part or tissue

Front 52

Amputated body part or tissue

Front 53

*Crush injury syndrome *

Front 54

MULTIPLE TRAUMA

Treatment:

Back 54

o Medical/Trauma Supportive Care Guidelines
o Continuous SpO2, ETCO2, EKG monitoring
o Airway / Ventilation control / support
o Rapid Trauma Assessment and GCS
o Scene time < 10 minutes
o Lactated Ringer’s IV titrate to maintain SBP >
100 mmHg. Two large bore sites if possible.
o Pain Management Protocol
o Needle Chest Decompression if evidence of
tension pneumothorax.

Front 55

MULTIPLE TRAUMA

Pearls

Back 55

• Rapid transport is the primary objective and most procedures should be done enroute.
• Request air medical transport early, when appropriate.
• Trauma Alert patients that are immediately accessible are frequently transported faster by ground.
• Control all blood loss that is accessible.
• Scalp and facial wounds bleed profusely, assure they are controlled.
• Absence of breath sounds alone does not equal tension pneumothorax.
• Apply SAM pelvic splint for suspected pelvic fractures.
• Reduce / align long bone fractures when possible.
• Always consider a medical event may have led to the traumatic event. i.e. hypoglycemia, seizure
• Cardiac Arrest secondary to blunt force trauma is rarely survivable.
• All traumatic cardiac arrest patients that resuscitation is attempted; bilateral needle chest decompression and
pericardiocentesis should be performed in addition to standard resuscitative measures.
• Give LMH Trauma Alert-criteria as early as possible.

Front 56

BURNS / ELECTROCUTION

Treatment

Back 56

o Medical / Trauma Supportive Care Guidelines
o Stop the burning process, remove from the
environment
o Continuous SpO2, ETCO2, EKG monitoring
o Remove all jewelry / constricting items
o Monitor airway closely and begin O2 therapy early
o Apply Water-Jel dressing to all burn areas, then
cover to minimize evaporation / heat loss
o Lactated Ringer’s 500 ml IV if evidence of hypoperfusion
(repeat as necessary)
o Pain Control Protocol
o High voltage electrical injury or direct lightning
strike with significant tissue destruction
• Lactated Ringer’s 1000 ml IV bolus
• Sodium Bicarbonate 1 mEq/kg IV

Front 57

BURNS / ELECTROCUTION

Pearls:

Back 57

• Critical Burns: any burn > 25% BSA; 3o burns > 10% BSA; 2o and 3o burns to the face, eyes, hands or feet; airway/respiratory
burns; burns with extremes of age or co-morbidities; electrical burns.
• Early ET intubation is required in significant inhalation injuries.
• Consider CO toxicity if removed from confined space.
• Consider child/elder abuse in those populations.
• Burn patients are prone to hypothermia, minimize heat loss.
• Decontaminate all chemical/radiation burns before transport.
• Tar burns should be immediately cooled with water. Do not attempt to remove the tar from the patient.
• Reverse triage electrocution/lightning strike victims.
• Safely evacuate patient from source and protect rescuers/public.