Medical - Ocfa Ems Update 2012

Front 1

Treatment for adult/adolescent patients with abdominal pain

Back 1

1. Maintain airway

2. If lungs are clear (no CHF) and signs of dehydration or poor pefusion, IV access with 250 mL infusion up to 1L to maintain perfusion.

3. Zofran 8mg for nausea or vomiting

4. Base contact for further stabilization, if required

5. Transport to appropriate PRC

SO-M-05

Front 2

Signs of Abdominal Aortic Aneurysm include:

Back 2

1. Sudden onset abdominal, back or flank pain

2. Shock

3. Bradycardia or tachycardia

4. Pulsating mass, loss of distal pulses are not always observed

SO-M-05

Front 3

Risk factors for AAA disruption include:

Back 3

1. Male

2. >50 years old

3. History of hypertension

4. Known AAA

5. Family history of AAA

6. Coronary artery disease or other vascular disease

SO-M-05

Front 4

ALS SO for anaphylaxis with respiratory distress, severe wheezing or hypotension:

Back 4

Epi 1:1,000 0.3mg SQ

1. Absent palpable pulses or impending airway obstruction:
*Epi 1:10,000 0.1-0.3mg slow IV or IO
*Diphenhydramine 25mg IV or IO

2. Hypotension, BP <90 systolic or weak pulses
*IV access with 250mL bolus infusion, repeat up to 1L

3. Wheezing:
*Albuterol 5mg nebulized continuous
*Further orders, contact Base
*ALS escort to nearest appropriate PRC, Base contact if no response or condition worsens


SO-M-15

Front 5

ALS SO for altered LOC

Back 5

1. Protect airway

2. Cardiac monitor w/rhythm strip

3. Pulse Ox (<95% = high flow O2)

4. Hypotension/signs of poor perfusion; establish IV access and infuse 250mL normal saline bolus up to 1 liter.

5. Blood glucose anaylsis, treat if <80

6. Respiratory depression (rate <12/minute) give Narcan IV 1mg every three minutes or IM/IN 2 mg every three minutes

7. ALS escort to appropriate PRC

SO-M-20

Front 6

SO for respiratory distress with:
Bilateral basilar rales, suspected CHF or pumlonary edema

Back 6

- If systolic BP >100, administer Nitro 0.4mg SL, may repeat twice if BP remains >100

- If systolic BP >150, administer Nitro 0.8mg SL, may repeat twice if BP remains >150.

- If BP drops from >150, but remains >100, repeat Nitro with 0.4 MgSL dosing

- CPAP if available and not contraindicated

- 12-lead ECG, contact Base for CVRC if acute MI

- ALS excort to appropriate PRC

SO-M-35

Front 7

SO for respiratory distress with:
Wheezes, suspected asthma or other forms of bronchospasm, including COPD

Back 7

-High flow O2 if SpO2 <95%; 2L by cannula for COPD

- Albuterol 5mg nebulized continuous

- CPAP if available and not contraindicated

- For severe wheezing consistent with asthma, not responding to albuterol or CPAP administer:
Epi 0.3mg SQ (1:1,000), hold if history of cardiac disease or age >40 years

ALS escort to appropriate PRC

Contact Base for further patient stabilization orders

SO-M-35

Front 8

Respiratory distress is defined as

Back 8

Labored breathing, rapid respiratory rate (>26/minute), a patient complaint of difficulty breathing or inability to "get enough air"

SO-M-35

Front 9

Signs of respiratory distress include:

Back 9

1. Breathing with use of accessory muscles including abdominal breathing

2. Cyanosis, particulary of lips and facial area

3. Audible noises of breathing, including rhonchi, rales and wheezes

SO-M-35

Front 10

ALS SO for seizure/convulsion for on-going seizure activity:

Back 10

1. Turn to side, protect airway and suction when necessary

2. Midazolam 5mg if IV establish or 5mg IN or IM, may repeat 5mg IV or 5mg IN/IM one time for continued seizure activity 3 minutes after initial dose or for recurrent seizure

3. Monitor SpO2 and apply O2 if less than 95%

SO-M-40

Front 11

ALS SO for seizure activity with Pulse Ox <95%

Back 11

High flow O2 by mask

SO-M-40

Front 12

ALS SO for seizure activity with blood glucose <80

Back 12

Treat with Dextrose 50mL IV

SO-M-40

Front 13

ALS SO for shock (symptomatic hypotension)

Back 13

1. Cardiac Monitor: 12-lead for chest pain or shortness of breath

2. Pulse Ox: high flow O2 if <95%

3. Establish venous access: consider IO if IV in unattainable

4. For signs of poor perfusion infuse 250mL Normal Saline up to 1L to maintain adequate perfusion

5. If rales noted: suspect cardiogenic shock and contact Base for orders

6. If patient require further stabilization: contact Base

7. ALS escort to appropriate PRC

SO-M-45

Front 14

Septic shock should be suspected when:

Back 14

1. Younger or older in age

2. Debilitated and bedridden individuals

3. Immune system deficiency (such as cancer or HIV)

SO-M-45

Front 15

Signs of septic shock:

Back 15

1. Fever, may be evident but not in all cases

2. Altered mental status that commonly presents as a slow response to the environment

3. Hypoxic (O2 saturation <95%) with rapid respiratory rates

4. Vital signs are often within normal parameters

5. Base contact is needed.

SO-M-45

Front 16

ALS SO for suspected stimulant intoxication:

Back 16

1. Assist ventilation with BVM and suction airway

2. Pulse Ox: high flow if <95%

3. Obtain blood glucose: administer dextrose if <80

4. If agitated and a danger, sedate with Midazolam 5mg IM or IV, no repeat.

5. Monitor for respiratory adequacy via visual monitoring and pulse ox

6. Monitor for hyperthermia: initiate cooling measures if necessary

SO-M-50

Front 17

ALS SO for suspected extrapyramidal reaction:

Back 17

Diphenhydramine (Benadryl) 25mg IM or IV

SO-M-50

Front 18

List the criteria FOR ischemic stroke triage to a SNRC.

Back 18

Patient must meet ALL of the following criteria with BS over 80:
1. No seizure prior to or during the call.
2. Last seen well time less than 7 hours.
3. GCS 10 or greater.
4. Arm drift or facial droop.
(SO-M-25)

Front 19

List the criteria for hemmorhagic stroke triage to a SNRC.

Back 19

History of a sudden, severe headache and ANY of the following symptoms:
1. Vomiting (repeated).
2. Neuro deficit.
3. Altered mental status.
4. Elevated BP (diastolic above 100mmHg)
(SO-M-25)

Front 20

Describe SO for excited delerium.

Back 20

1. Pulse Ox and O2 if hypoxia.
2. Cardiac monitor and document rhythm.
3. IV fluid bolus up to 1 liter.
4. Correct hypoglycemia.
5. Midazolam 5mg IM/IV for agitation interfering with loading and transport.
(SO-M-30)

Front 21

Describe SO treatment of nausea and vomiting with signs of dehydration.

Back 21

1. IV fluid bolus up to 1 liter.
2. Zofran 8mg ODT
3. ALS Escort to PRC
(SO-M-60)