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103 Cards in this Set
- Front
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Critical Trauma Patient Criteria-5301
Physiologic Criteria: |
1. GCS LESS THAN OR EQUAL TO 13 2. SYSTOLIC BP LESS THAN 90 3. RESP. RATE LESS THAN 10 OR GREATER THAN 30 4. GERIATRIC SYSTOLIC BP LESS THAN 100 5. INFANT RESP. RATE LESS THAN 20 |
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Critical Trauma Patient Criteria-5301
Anatomic Criteria: |
1. OPEN OR DEPRESSED SKULL FX 2. PENETRATION OF HEAD/NECK/TORSO PROXIMAL TO ELBOW/KNEE 3. FLAIL CHEST 4. ABDOMINAL TENDERNESS 5. SUSPECTED PELVIC FX 6. NEW ONSET PARALYSIS 7. TWO OR MORE PROXIMAL LONG BONE FX'S 8. AMPUTATION/CRUSHED/MANGLED/DEGLOVED PROXIMAL TO WRIST/ANKLE 9. TRAUMA WITH BURNS 10. NEUROVASCULAR DEFICIT OF EXTREMITY |
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Critical Trauma Patient Criteria-5301
Mechanism of Injury Criteria: |
1. FALL-ADULT 15 FT OR GREATER 2. FALL-PED GREATER THAN 10 FT/3 TIMES HT. 3. AUTO VS. PED OR BICYCLE GREATER THAN 20 MPH 4. MOTORCYCLE CRASH GREATER THAN 20MPH 5. EJECTION FROM VEHICLE 6. DEATH IN SAME VEHICLE 7. INTRUSION GREATER THAN 12'' AT OCCUPANT SITE 8. INTRUSION GREATER THAN 18'' ANY SITE |
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Critical Trauma Patient Criteria-5301
Evaluate for co-morbid & other mechanisms: |
1. GERIATRIC 2. PEDIATRIC 3. ANTI-COAGULATION/ANTI-PLATELET THERAPY 4. PREGNANCY GREATER THAN 20 WEEKS 5. MVC GREAT THAN 40MPH 6. LOSS OF CONSCIOUSNESS REPORTED 7. EMS PROVIDER JUDGEMENT |
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4102 UNIVERSAL PATIENT
MAY INITIATE MCI IF:
SUSPECTED CRIMINAL ACTIVITY:
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1. MAY INITIATE MCI IF 5 OR MORE PTS. REQUIRE TRANSPORT OR AS OPERATIONALLY REQUIRED 2. PRESERVE EVIDENCE AND REQUEST PD FOR ANY SUSPECTED CRIMINAL ACTIVITY
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CLASSIFY PATIENT AS PEDIATRIC IF: |
1. APPEARING OR KNOWN TO BE 14 YEARS OF AGE OR LESS |
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MECHANICAL SPINAL IMMOBILIZATION CRITERIA: |
1. NECK OR UPPER THORACIC: PAIN/TENDERNESS OR DEFORMITY 2. NEW ONSET NEUROLOGICAL DEFICITS: NUMBNESS/TINGLING/WEAKNESS OR PARALYSIS 3. HIGH RISK MOI 4. ALOC, DISTRACTING PAIN, OR INFLUENCE OF ALCOHOL/DRUGS OR MEDICATIONS 5. ATYPICAL PRESENTATION, CIRCUMSTANCE, OR PROVIDER UNCERTAINTY |
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HOW OLD MUST A PT. BE TO RECEIVE:
KING AIRWAY?
ET TUBE? |
1. PT. MUST APPEAR TO BE GREATER THAN 8 YEARS OF AGE FOR KING AND ET TUBE. |
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WHEN DO YOU ESTABLISH IV ACCESS FOR THE NON-ENTRAPPED TRANSPORT READY CRITICAL TRAUMA PATIENT? |
1. ESTABLISH IV ACCESS DURING TRANSPORT |
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WHEN DO YOU USE A VOLUME CONTROL CHAMBER IV SET? |
1. DURING ALL PEDIATRIC IV'S. |
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WHEN CAN YOU ESTABLISH AN IV OR AN IO? |
1. AS CLINICALLY INDICATED |
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WHAT CAN YOU GIVE TO EASE IO INFUSION PAIN IN THE CONSCIOUS PATIENT?
ADULT:
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1. LIDOCAINE 2% SLOW IO PUSH OVER 1 MINUTE, WAIT 1 MINUTE BEFORE INFUSING FLUIDS.
ADULT: 50MG
*REPETITION REQUIRES BASE HOSPITAL ORDER
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WHEN DO YOU TRANSMIT 12 LEAD ECG TO A STEMI BASE HOSPITAL? |
1. MACHINE IDENTIFIED STEMI 2. PARAMEDIC IDENTIFIED STEMI 3. ANY REQUESTED TRANSMISSION 4. PARAMEDIC QUESTION ABOUT ECG |
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CONTACT A BASE HOSPITAL IN ALL: |
1. CRITICAL TRAUMA 2. CRITICAL BURNS 3. FX OR DISLOCATION W/ NEURO OR VASCULAR COMPROMISE 4. MCI 5. STEMI 6. SUSPECTED STROKE 7. SYMPTOMATIC BRADYCARDIA/TACHYCARDIA W/ PULSES OR ROSC 8. VENTRICULAR ASSIST DEVICE (VAD) PATIENTS 9. PRE-ECLAMPSIA/ECLAMPSIA/COMPLICATIONS OF CHILD BIRTH OR NEONATAL RESUSCITATION 10. APPARENT LIFE THREATENING EVENT 11. SEXUAL ASSAULT OR PD REQUEST FOR "OK TO BOOK" 12. ATYPICAL PRESENTATION/CIRCUMSTANCE OR PROVIDER UNCERTAINTY |
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BASE HOSPITAL REPORT: |
1. CALL SIGN/IDENTIFIER 2. INDIVIDUAL PROVIDER'S TITLE AND NAME 3. CONTACT FOR "MEDICAL DIRECTION" 4. AGE, SEX, WEIGHT (BROSELOW IF PED) 5. PT. CONDITION MILD/MODERATE/SEVERE 6. CHIEF COMPLAINT, MOI AND HX OF PRESENT ILLNESS 7. PERTINENT FINDINGS UPON INITIAL ASSESS 8. VITALS 9. HISTORY, ALLERGIES, AND MEDS (PERTINENT) 10. INTERVENTIONS PERFORMED 11. INTENDED DESTINATION, ALTERNATIVES AND ETAS 12. REQUESTED ORDERS |
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HANDOFF USING: SBAR |
1. SITUATION 2. BACKGROUND 3. ASSESSMENT 4. RECOMMENDATION |
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ACTIVATED CHARCOAL DOSE |
ADULT: 50 G PO |
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ADENOSINE |
ADULT: 12 MG RAPID IV PUSH WITH 20ML FLUSH |
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ALBUTEROL |
ADULT/PEDS: 2.5 MG IN 3ML VIA NEB |
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AMIODARONE |
ADULT: 300MG IV PUSH MAY REPEAT 150MG IV PUSH |
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ASPIRIN |
ADULT: 324 MG PO |
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ATROPINE |
ADULT: 0.5 MG IV OR 1 MG IM X 2 |
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CALCIUM CHLORIDE 10% |
ADULT: 1 G IV |
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DEXTROSE 10% |
ADULT: 25 G IN 250ML SLOW IV |
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DIPHENHYDRAMINE |
ADULT: 50 MG IV/IM |
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EPINEPHRINE 1:1000 |
ADULT: 0.3 MG IM |
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EPINEPHRINE 1:10000 |
ADULT: 1 MG IV |
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GLUCAGON |
ADULT: 1 MG IV/IM |
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IPRATROPIUM BROMIDE |
ADULT: 0.5 MG IN 2.5ML MIXED WITH ALBUTEROL VIA NEB |
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LIDOCAINE 2% |
ADULT: 100MG IV REPEAT: 50MG IV |
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MAGNESIUM SULFATE |
ADULT: 2G IV
ECLAMPSIA: 5 G IVPB
ECLAMPSIA IM: 2.5 G IM X 2 |
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MIDAZOLAM |
ADULT: 2.5 MG IV/IN
IM: 5 MG
CPAP: 1 MG |
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MORPHINE SULFATE |
ADULT: 5 MG IV/IM |
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NALOXONE |
ADULT: 2 MG IV/IM
IN: 1 MG IN X 2 |
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NITROGLYCERIN |
ADULT: 0.4 MG TAB MAY REPEAT TWICE AFTER 3-5 MINUTES IF BP IS GREATER THAN 90 |
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NITRO PASTE 2% |
ADULT: 1 G/1 INCH TD |
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NORMAL SALINE 0.9% BOLUS |
ADULT: 250ML IV |
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ONDANSETRON |
ADULT: 4 MG IV/IM 4 MG ODT |
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SODIUM BICARB. 8.4% |
ADULT: 50 MEQ IV |
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CARDIOVERSION |
ADULT: INITIAL: 100J SUBSEQUENT: 150-200J |
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DEFIBRILLATION |
ADULT: 200J,300J,360J |
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FENTANYL |
ADULT: 50 MCG IV/IM/IN
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LORAZEPAM |
ADULT: 2.6MG IV
IM: 5 MG
IN: 1.4MG IN X 2
CPAP: 1 MG |
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DIAZEPAM |
ADULT: 2.5 MG IV
IM: 5 MG
CPAP: 1 MG |
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PRALIDOXOME |
ADULT: 600MG IM
IVPB: 600 MG |
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4202- REFUSAL OF TREATMENT AND/OR TRANSPORT.
A PATIENT, PARENT, PARENTAL DESIGNEE OR GUARDIAN INITIATING REFUSAL AND OR TRANSPORT MUST BE: |
1. AN APPARENTLY RATIONAL AND COMPETENT LEGAL ADULT 2. ALERT AND ORIENTED TO PERSON,PLACE, TIME AND EVENT 3. FULLY INFORMED OF, UNDERSTAND AND ACKNOWLEDGE A. EMS PROVIDER'S LEVEL OF TRAINING B. EMS PROVIDER'S FINDINGS C. ANY NEED FOR TX, TRANSPORT AND/OR FURTHER EVALUATION BY AN EMERGENCY PHYSICIAN D. THE POSSIBLE CONSEQUENCES OF REFUSAL UP TO DEATH E. THEIR OWN ABILITY TO RECALL 911 F. ANY OTHER OPTIONS TO ACCESS MEDICAL CARE |
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4202- REFUSAL OF TREATMENT AND/OR TRANSPORT.
CONTACT A BASE HOSPITAL FOR: |
1. ANY REFUSAL INVOLVING A NON-EMANCIPATED MINOR 2. ANY REFUSAL INVOLVING A PATIENT IN CUSTODY 3. ANY REFUSAL OF CLINICALLY INDICATED ALS TREATMENT 4. ANY REFUSAL OF TRANSPORT FOLLOWING ALS TREATMENT 5. ANY SITUATION WHERE BASE CONTACT OR DISCUSSION WILL BENEFIT PATIENT CARE |
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4202- REFUSAL OF TREATMENT AND/OR TRANSPORT.
IF REQUIREMENTS ARE MET THEY MUST: |
1. ALLOW THEM TO INITIATE REFUSAL 2. ALLOW THEM TO SIGN APPROPRIATE RELEASES 3. FULLY DOCUMENT ON PCR AND ATTACHMENTS
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4203- DO NOT ATTEMPT RESUSCITATION
DO NOT ATTEMPT WHEN ONE OR MORE OF THE FOLLOWING ARE PRESENT:
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1. MCI WHERE PT. REMAINS APNEIC DESPITE MANUAL AIRWAY MANEUVERS 2. APNEIC AND PULSELESS W/ RIGOR MORTIS AND POSTMORTEM LIVIDITY 3. DECAPITATION 4. GENERALIZED DECOMPOSITION OR INCINERATION 5. SEPARATION OF BRAIN,HEART OR LUNGS FROM BODY 6. TOTAL ABDOMINAL EVISCERATION 7. COMPLETE TRANSECTION OF TORSO 8. A VALID,SIGNED AND DATED ADVANCED DIRECTIVE INDICATING RESUSCITATION NOT DESIRED 9. BLUNT TRAUMA ARREST W/ PERSISTENT ASYSTOLE, AGONAL RHYTHM, OR PEA AT A RATE LESS THAN 40.
PEDS REQUIRE BASE ORDER |
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4203- DO NOT ATTEMPT RESUSCITATION
DISCONTINUE RESUSCITATION WHEN ALL ARE PRESENT: |
1. MEDICAL PATIENT 2. UNWITNESSED ARREST 3. NO BYSTANDER CPR 4. NO SHOCK DELIVERED 5. ALL INDICATED RESUSCITATIVE INTERVENTIONS HAVE BEEN MADE AND REPEATED WITHOUT ROSC 6. PERSISTENT ASYSTOLE, AGONAL RHYTHM OR PEA AT A RATE LESS THAN 10
PEDS REQUIRES BASE ORDER TO DISCONTINUE |
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4203- DO NOT ATTEMPT RESUSCITATION
FOLLOWING PREHOSPITAL DETERMINATION OF DEATH: |
1. LEAVE THE BODY AS FOUND/ AS LAST POSITIONED 2. LEAVE THE SCENE WITHOUT FURTHER DISTURBANCE, LEAVE DEVICES IN PLACE 3. COMFORT AND CARE FOR SURVIVORS 4. NOTIFY PD OF PREHOSPITAL DETERMINATION OF DEATH 5. CONTACT COUNTY OF RIVERSIDE CORONERS OFFICE GIVE REPORT AND ANSWER ALL QUESTIONS 6. REMAIN AT SCENE UNTIL RELEASED BY PD |
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4401- SHOCK UNRELATED TO TRAUMA |
1. POSITION PATIENT SUPINE 2. GIVE 250ML BOLUS AS INDICATED |
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4402- SUSPECTED ACUTE CORONARY SYNDROME
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1. ASPIRIN 324 MG PO CHEWED 2. NITROGLYCERIN 0.4MG TABLET- NO PDE5 INHIBITORS, BP GREATER THAN 90, MAY REPEAT TWICE AT 3-5 MIN. 3. NITROPASTE 1 G/1" REPEAT REQUIRES BHO 4. MORPHINE 5MG IV/IO/IM WHILE BP>90, IF CHEST PAIN AFTER NITRO, MAY REPEAT ONCE |
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4402- SUSPECTED ACUTE CORONARY SYNDROME
SUSPECT STEMI IF: |
1. ECG SHOWS 1MM OR GREATER ST-SEGMENT ELEVATION IN TWO OR MORE CONTIGUOUS LEADS W/ RECIPROCAL DEPRESSION 2. PARAMEDIC INTERPRETS ECG AS STEMI 3. MACHINE READS **ACUTE MI** OR SIMILAR |
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4402- SUSPECTED ACUTE CORONARY SYNDROME
TRANSMIT ECG IF ONE OF THE FOLLOWING: |
1. STEMI SUSPECTED 2. PARAMEDIC HAS QUESTIONS OR CONCERNS 3. STEMI BH REQUESTS TRANSMISSION
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4402- SUSPECTED ACUTE CORONARY SYNDROME
TRANSPORT TO A STEMI CENTER IF: |
1. ESTIMATED TRANSPORT TIME 30 MIN OR LESS AND ONE OF FOLLOWING: i. STEMI BH ORDERS TRANSPORT ii. STEMI SUSPECTED AND CONTACT W/ STEMI BASE FAILS 2. ETA OVER 30 MIN. AND BASE AUTHORIZES TRANSPORT |
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PT.S WITH UNCONTROLLABLE AIRWAYS OR IN CARDIAC ARREST SHOULD BE TRANSPORTED TO: |
CLOSEST PREHOSPITAL RECEIVING CENTER |
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4403- VENTRICULAR ASSIST DEVICES
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1. CONTACT VAD COORDINATOR ASAP TO TROUBLESHOOT EQUIPMENT NOT TO DIRECT CARE 2. NO CHEST COMPRESSIONS 3. NO ASPIRIN OR NITRO 4. CONTACT BASE, DESCRIBE ANY DNR 5. VOLUME REPLACEMENT 1ST LINE THERAPY
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4404- SYMPTOMATIC TACHYCARDIA W/ PULSES
STANDING ORDERS: |
1. NS BOLUS 250ML 2. VALSALVA MANEUVERS FOR SVT 3. ADENOSINE 12 MG RAPID IV PUSH FOLLOWED BY 20ML RAPID FLUSH: CALL BASE FOR REPEAT AND CALL FOR PEDS 4. MIDAZOLAM 2.5 MG SLOW IV/IO OR 5MG IM/IN FOR AMNESIC EFFECTS PRIOR TO SYNCHRONIZED CARDIOVERSION, MAY REPEAT ONCE. CALL FOR PEDS, MULTIPLE BENZO OR REP. 5. SYNCHRONIZED CARDIOVERSION 100J THEN 150-200J FOR SVT OR V-TACH MAY REPEAT AS INDICATED, CALL BASE FOR PEDS *CALL BASE FOR ALL SYMPTOMATIC TACHY PTS.
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4404- SYMPTOMATIC TACHYCARDIA W/ PULSES
BASE ORDERS: |
1. AMIODARONE 300MG 2. LIDOCAINE 50MG
PEDS NEED ORDERS FOR ALL TREATMENTS |
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4301- SHOCK DUE TO TRAUMA
STANDING ORDERS: |
1. DO NOT DELAY TRANSPORT 10 MINS OR LESS 2. CONTROL BLEED USE TOURNIQUET IF NEEDED 3. PLACE SUPINE 4. KEEP WARM 5. DO NOT DELAY CONTACTING BASE AS REQ'D FOR CRITICAL TRAUMA PT. 6. ESTABLISH BILATERAL LARGE BORE DURING TRANSPORT OF CRITICAL TRAUMA PT. 7. 250ML BOLUS 8. NEEDLE-T FOR SUSPECTED TENSION PNEUMOTHORAX |
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4301- SHOCK DUE TO TRAUMA
NEEDLE-T REQUIREMENTS, ALL PRESENT: |
1. PROGRESSIVELY WORSENING RESP. DISTRESS OR APNEA AND, 2. UNILATERAL DECREASED OR ABSENT BREATH SOUNDS ON AFFECTED SIDE AND, 3. HYPOTENSION (LESS THAN 90 W/ SIGNS OF POOR PERFUSION), THIS INCLUDES CARDIAC ARREST PEA MAY BE RHYTHM |
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4301- SHOCK DUE TO TRAUMA
1. BLUNT TRAUMA ARREST GOES TO:
2. PENETRATING TRAUMA GOES TO: |
1. CLOSEST PRC
2. CLOSEST TRAUMA IF BYPASSING PRC TRANSPORT TIME INCREASES BY NO MORE THAN 10 MINUTES, OTHERWISE CLOSEST PRC |
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4302- TRAUMATIC INJURIES
SUSPECTED TRAUMATIC BRAIN INJURY VENT. RATES: |
ADULT: 20 RESP. CHILD: 25 RESP. INFANT: 30 RESP. |
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4302- TRAUMATIC INJURIES
STANDING ORDERS: |
1. MS 5 MG SLOW IV/IO/IM FOR PAIN FROM ISOLATED TRAUMATIC INJURY TO AN EXTREMITY OR APPENDICULAR SKELETON WHILE BP IS GREATER THAN 90, MAY REPEAT ONCE 2. MAY GIVE 250ML BOLUS FOR SUSPECTED HYPERKALEMIA FROM CRUSH INJURIES REP. PRN
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4302- TRAUMATIC INJURIES
BASE ORDERS: |
1. ALBUTEROL FOR HYPERKALEMIA (CRUSH INJ.) 2. CALCIUM CHLORIDE " 3. MIDAZOLAM FOR ANX. FROM TRAUMA INJ. 4. MS FOR PAIN OTHER THAN ISOLATED INJ. 5. SODIUM BICARB FOR HYPERKALEMIA (CRUSH)
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4303-BURNS
1. THERMAL BURNS LESS THAN 20%:
2. THERMAL BURNS MORE THAN 20%: |
1. COOL W/ WET DRESSING FOLLOW W/ DRY CLEAN, NON-ADHERENT DRESSING 2. APPLY DRY, CLEAN, NON-ADHERENT DRESSING |
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4303-BURNS
CHEMICAL BURNS: |
1. BRUSH OFF DRY CHEMICALS 2. DILUTE EXCESS LIQUID CHEMICALS 3. WASH PATIENT WITH MILD SOAP AND WATER 4. RINSE AND FLUSH W/ LARGE AMOUNT OF H20 5. CONSULT CONTAINER LABEL OR ONSITE MSDS FOR DECON INSTRUCTIONS |
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4303-BURNS
ELECTRICAL BURNS: |
CONSIDER SPINAL TRAUMA & TREAT INJURIES |
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4303-BURNS
EYE BURNS:
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1. FLUSH CONTAMINATED EYES W/ SALINE FOR 15 MIN OR MORE 2. CHECK FOR CONTACT LENSES 3. PATCH THE EYE(S) |
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4303-BURNS
TAR BURNS: |
1. COOL WITH WATER 2. DO NOT REMOVE TAR 3. APPLY PETROLATUM GAUZE DRESSING |
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4303-BURNS
STANDING ORDER MEDS: |
1. 250 ML BOLUS MAY REPEAT PRN 2. MS 5 MG IV/IO/IM FOR PAIN FROM BURNS BP>90, MAY REPEAT ONCE |
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4303-BURNS
1.BURN PTS. W/ AIRWAY INVOLVEMENT GO TO:
2.BURN PTS. W/ CRITICAL TRAUMA GO TO: |
1. CLOSEST PRC AIRWAY HAS PRIORITY 2. TRAUMA CENTER TRAUMA HAS PRIORITY |
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4303-BURNS
CONTACT BASE FOR DESTINATION IN ALL: |
1. 2ND DEGREE GREATER THAN 30% 2. 3RD DEGREE GREATER THAN 10% 3. 2ND OR 3RD INVOLVING FACE,HANDS,FEET,GENITALS/PERINEUM,MAJOR JOINTS, FX, OR CIRCUMFERENTIAL 4. HIGH VOLTAGE ELECTRICAL BURNS 5. BURNS IN COMBINATION W/ SIGNIFICANT PRE-EXISTING MEDICAL CONDITIONS |
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4305- FROSTBITE/HYPOTHERMIA
STANDING ORDERS: |
1. ROUGH HANDLING CAN CAUSE CARDIAC ARRHYTHMIA 2. REMOVE FROM COLD, REMOVE WET CLOTHING, DRY PT. MOVE TO HEATED AREA, INDIVIDUALLY WRAP AND PROTECT COLD AREAS, DO NOT RUB 3. OBTAIN BASELINE TEMP. 4. OBTAIN BGL 5. WARM 0.9% NS BOLUS FOR HYPOTHERMIA MAY REPEAT PRN 6. MS 5MG IV/IO/IM FOR PAIN W/ FROSTBITE BP > 90, MAY REPEAT ONCE |
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4304- HEAT ILLNESS/HYPERTHERMIA
STANDING ORDERS: |
1. REMOVE FROM HEAT: SHADE AND EXPOSE, ENCOURAGE EVAPORATIVE COOLING, MOVE TO A/C 2. OBTAIN BASELINE TEMP. 3. OBTAIN BGL 4. COOL 0.9% NS MAY REPEAT PRN 5. APPLY COOL PACKS TO ANTERIOR NECK, ARMPITS, GROIN 6. REASSESS TEMP., DISCONTINUE IF SHIVERING |
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4304- HEAT ILLNESS/HYPERTHERMIA
BASE ORDERS: |
1. ALBUTEROL FOR HYPERKALEMIA 2. CALCIUM CHLORIDE FOR HYPERKALEMIA 3. MIDAZOLAM FOR SHIVERING 4. SODIUM BICARB FOR HYPERKALEMIA OR RHABDOMYOLYSIS |
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4405-SYMPTOMATIC BRADYCARDIA W/ PULSES
*CALL BASE FOR ALL PEDS*
STANDING ORDERS (ADULTS): |
1. ATROPINE 0.5MG IV/IO MAY REPEAT UP TO 5 TIMES AT 3-5 MINUTES INTERVALS 2.MIDAZOLAM 2.5MG IV/IO OR 5MG IM FOR AMNESIC EFFECTS PRIOR TO TCP, MAY REPEAT ONCE 3. TCP: BEGIN AT 20MA AND 70 BPM, TITRATE IN 5 MA TO FIND MINIMUM CURRENT FOR CAPTURE, INCREASE IN 10 BPM UP TO 100BPM TO GAIN ADEQUATE OUTPUT AND PERFUSION 4. MS 5 MG SLOW IV/IO PUSH OR IM FOR TCP DISCOMFORT WHILE BP>90 MAY REPEAT ONCE *CONTACT BASE FOR ALL SYMP. BRADY W/ PULSE |
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4405-SYMPTOMATIC BRADYCARDIA W/ PULSES
MAY CONTACT BASE TO ORDER: |
1. ATROPINE FOR PEDS 2. EPINEPHRINE FOR PEDS 3. MIDAZOLAM FOR PEDS 4. MORPHINE FOR PEDS 5. TCP FOR PEDS |
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4406-CARDIAC ARREST
STANDING ORDERS: |
1. EPI 1:10000 1MG NO MAX DOSE 3-5 MINS. 2. AMIODARONE 300MG THEN 150MG 3. SODIUM BICARB FOR SUSPECTED ACIDOSIS, HYPERKALEMIA, OR TCA OD, MAY REPEAT ONCE 4. CONTACT BASE FOR ROSC 5. 0.9% NS AS NEEDED 6. USE PED ATTENUATOR FOR LESS THAN 8Y/0 |
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4406-CARDIAC ARREST
REVERSIBLE CAUSES H'S & T'S: |
1. HYPOVOLEMIA 2. HYPOXIA 3. HYDROGEN ION ACIDOSIS 4. HYPERKALEMIA (PEAKED T WAVES, WIDE QRS) 5. HYPOTHERMIA 6. TENSION PNEUMO 7. TAMPONADE, CARDIAC 8. TOXINS 9. THROMBOSIS, CORONARY 10. THROMBOSIS, PULMONARY |
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4406-CARDIAC ARREST
MAY ORDER FROM BASE: |
1. AMIODARONE FOR PEDS 2. ATROPINE 3. CALCIUM CHLORIDE 4. LIDOCAINE 5. MAG SULFATE FOR V FIB OR TORSADES 6. MIDAZOLAM FOR ANX. FOLLOWING ROSC 7. MORPHINE FOR PAIN FOLLOWING ROSC 8. SODIUM BICARB FOR PEDS |
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4407- NEONATAL RESUSCITATION
1. PROTOCOL:
2. MAY CALL BASE FOR: |
1. CALL BASE FOR ALL NEONATAL RESUSCITATION
2. -DEXTROSE 10% -NALOXONE -EPINEPHRINE -SODIUM BICARB
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4407- NEONATAL RESUSCITATION
APGAR: |
1. APPEARANCE, PULSE, GRIMACE, ACTIVITY, RESPIRATION 2. MAX SCORE OF 2 FOR EACH CATEGORY |
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4408- RESPIRATORY DISTRESS
1. EPIGLOTTIS TX:
2. BRONCHOSPASM TX: |
1. DO NOT VISUALIZE THROAT, POSITION PT. UPRIGHT AND LEANING FORWARD TO ALLOW DRAINAGE OF SECRETIONS, MINIMIZE STIMULATION, MOVEMENT, AND MANIPULATION OF MOUTH, THROAT AND NECK
2. ALBUTEROL REPEAT PRN, IPRATROPIUM BROMIDE MIXED W/ ALBUTEROL REPETITION REQUIRES BASE ORDER |
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4408- RESPIRATORY DISTRESS
CPAP: |
-5-15 CMH2O FOR DYSPNEA W/ SUSPECTED CHF, EXACERBATION OF COPD OR ASTHMA. -BEGIN AT 5 CMH2O AND INCREASE IN 2.5-5 INCREMENTS -TITRATE TO RELIEF OF DYSPNEA, NORMALIZING I:E RATIO 1:2, AND INCREASING SP02 *BP MUST BE ABOVE 90 AND NOT FOR PEDS* |
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4408- RESPIRATORY DISTRESS
STANDING ORDER MEDS: |
1. MIDAZOLAM 1MG VIA CPAP FOR ANXIETY 2. NITRO TABLET MAY REPEAT TWICE, FOR CHF 3. NITROPASTE FOR CHF BP> 90, NO REPEAT |
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4408- RESPIRATORY DISTRESS
MAY CALL BASE TO ORDER: |
1. EPINEPHRINE 1:1000 IM 2. 20 CMH20 CPAP |
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4501-HYPOGLYCEMIA W/ ALOC
STANDING ORDERS:
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1. CHECK BGL, IF BELOW 80 FOR ADULTS AND 70 PEDS WITH ALOC: 2. START IV, GIVE D10% BOLUS DRIP, MAY REPEAT AS CLINICALLY INDICATED 3. GLUCAGON IM OR SQ IF UNABLE TO ADMIN DEXTROSE, CALL BASE FOR REPEAT 4. GLUCOSE GEL PO IF UNABLE TO ADMIN GLUCAGON OR D10.
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4502-SEIZURES
STANDING ORDERS: |
1. PROTECT PATIENT FROM INJURY, COOL IF FEBRILE 2. OBTAIN BGL 3. CALL BASE IF APPARENT LIFE THREATENING EVENT 4. MIDAZOLAM 2.5 IV/IO FOR TONIC-CLONIC UNRELATED TO ECLAMPSIA, MAY REPEAT ONCE
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4503-SUSPECTED STROKE
STANDING ORDERS: |
1. LIMIT SCENE TIME 10 MIN OR LESS 2. BGL 3. DETERMINE TIME OF ONSET AND USE OF BLOOD THINNERS 4. CPSS: FACIAL DROOP, ARM DRIFT, SPEECH 5. CONTACT BASE IF ABNORMAL |
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4504-NAUSEA AND/OR VOMITING
STANDING ORDERS: |
1. ONDANSETRON 4 MG SLOW IV/IO/IM OR ODT REPETITION REQUIRES BASE BROSELOW YELLOW AND SMALL REQUIRES BASE |
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4601-ALLERY AND/OR ANAPHYLAXIS
STANDING ORDERS: |
1. REMOVE PT. FROM CONTACT W/ ALLERGEN 2. DIPHENHYDRAMINE 50 MG IM OR SLOW IV/IO REPETITION REQUIRES BASE ORDER 3. EPINEPHRINE 1:1000 IM/SQ 0.3MG REPETITION REQUIRES BASE ORDER 4. 0.9% BOLUS MAY REPEAT PRN 5. ALBUTEROL, MAY REPEAT PRN |
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4602- OVERDOSE/ADVERSE REACTION
AEIOUTIPS MEANS: |
ALCOHOL EPILEPSY INSULIN OVERDOSE UREMIA TRAUMA INFECTION PSYCHOSIS STROKE |
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4602- OVERDOSE/ADVERSE REACTION
STANDING ORDERS: |
1. NALOXONE 2MG IV/IO/IM OR 1 IN X2 MAY REPEAT AS CLINICALLY INDICATED 2. DIPHENHYDRAMINE 50 MG IV/IO/IM FOR SUSPECTED DYSTONIC REACTION *REPETITION REQUIRES BHO*
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4602- OVERDOSE/ADVERSE REACTION
MAY CALL BASE FOR: |
1. ACTIVATED CHARCOAL PO W/ IN ONE HOUR 2. CALCIUM CHLORIDE FOR BETA/CALCIUM CHANNEL BLOCKER OD 3. GLUCAGON IV FOR BETA/CALCIUM BLOCK OD 4. SODIUM BICARB FOR ALOC OR DYSRHYTHMIA W/ SUSPECTED TCA OVERDOSE |
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4603- BEHAVIORAL EMERGENCY
STANDING ORDERS:
MAY ORDER: |
1. APPLY FOUR POINT RESTRAINTS, TRANSPORT IN LOW TO HIGH FOWLER'S POSITION 2. PERFORM COOLING MEASURES AS NEEDED 3. MIDAZOLAM 5MG IM IF NO IV, MAY REPEAT ONCE 4. NS BOLUS AS NEEDED
MAY ORDER: SODIUM BICARB FOR SUSPECTED METABOLIC ACIDOSIS/HYPERKALEMIA |
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4604-TOXIC EXPOSURE, INHALATION OR INGEST
STANDING ORDERS: |
1. BEGIN SELF DECON, ESCAPE TO SAFE LOCATION 300 FT UP:WIND,HILL,STREAM 2. MOUNT WIND STREAMER TO ANTENNAE IF HAZMAT IS ENCOUNTERED KEEP BACK 300FT 3. NEVER TRANSPORT CONTAMINATION: PATIENT, CONTAINER, OR MATERIALS 4. ALBUTEROL, MAY REPEAT AS INDICATED |
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4604-TOXIC EXPOSURE, INHALATION OR INGEST
MAY CALL BASE TO ORDER: |
1. SITE SUPPLIED ANTIDOTE 2. MILK OR POTABLE WATER 3. ACTIVATED CHARCOAL PO 4. CALCIUM CHLORIDE FOR DYSRHYTHMIAS 5. MAG SULFATE FOR DYSRHYTHMIAS |
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4605-EXPOSURE TO NERVE AGENTS
STANDING ORDERS: |
1. NAAK MAY REPEAT INJECTION TWICE 2. ATROPINE IV/IO/IM MAY REPEAT PRN |
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4606-SNAKEBITE
STANDING ORDERS |
1. MARK EDGE OF DISCOLORATION SURROUNDING WOUND, RECORD TIME, MEASURE EVERY 15 MINUTES 2. 0.9% BOLUS FOR SHOCK ON NON AFFECTED EXTREMITY, MAY REPEAT PRN 3. MORPHINE FOR PAIN, MAY REPEAT ONCE |
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4701- PRE-ECLAMPSIA AND ECLAMPSIA
STANDING ORDERS:
MAY CALL TO ORDER: |
1. DECREASE STIMULI AND MAINTAIN A QUIET, DARK ENVIRONMENT 2. PLACE PATIENT IN LEFT LATERAL RECUMBENT POSITION 3. OBTAIN BGL 4. MAG SULFATE 50% IV/IO BOLUS DRIP IN 50 ML OVER 10 MINUTES OR IM DIVIDED DOSE REPETITION REQUIRES BASE CONTACT* 5. *CONTACT BASE FOR ALL PATIENTS* 6. MIDAZOLAM IF UNRESPONSIVE TO MAG SULF. |
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4702- LABOR AND DELIVERY
STANDING ORDERS: |
1. IF DELIVERY APPEARS IMMINENT: DELIVER 2. CONTACT BASE FOR: PROLAPSED CORD, BREECH PRESENTATION, OR OTHER COMPLICATIONS OF CHILDBIRTH 3. 0.9% NS FOR SHOCK FROM HEMORRHAGE MAY REPEAT PRN |
