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110 Cards in this Set
- Front
- Back
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Drugs used for a suspected CARDIAC pt with chest pain
(stable) |
*ask about use of viagra, cialis, Levitra, or revation w/i 36 hrs
Baby aspirin 324 ms 4x81mg tabs sbp>100 NITRO 0.4 mg SL may repeat x1 in five minutes if sbp >100 and IV est 12-LEAD Morphine Sulfate 2-10 mg IV 2mg increments q5 min prn |
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signs a chest pain pt is unstable
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AMS, signs of hypoperfusion (sbp<90)
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suspected cardiac pt with chest pain unstable with a p<60
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Treat per bradycardia SOP
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suspected cardiac pt with chest pain unstable with a p>60
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treat per cardiogenic shock SOP
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Drugs required for a pt with Supraventricular bradycardia, second degree type 1 AVB
(unstable) |
Atropine .5mg rapid IV
1mg ET *may repeat q 3-5min up to 3mg until pacing available TRANSCUTANEOUS PACING (if pulse <60 and hypotensive) Consider sedation VERSED 2 mg increments IV max 10 mg if pt remains symptomatic DOPAMINE 2-10 mcg/kg/min IVPB |
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Drugs needed for unstable pt with IVR, Second degree type II or 3rd degree AVB
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Initiate TCP 70bpm
Consider sedation VERSED 2mg increments max 10 IV If still symptomatic DOPAMINE 2-10 mcg/kg/min IVPB |
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What drug is NOT given to pt. with an AVB or IVR?
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LIDOCAINE
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Steps for pediatric BRADYDYSRHYTHMIAS
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-assess for causitive factors, consider h/t (hypoxemia, acidosis and hypothermia)
-Initial medical care -NS 20 ml/kg IVP for hypovolemia -EPI 1:1000 .1mg/kg ET or 1:10,000 .01 mg/kg IV/IO *rpt q 3 min as long as persists ATROPINE .02 mg/kg rapid IV/IO .03 mg/kg ET *rpt q 3 min till max dose administered Contact MC for TCP KEEP CHILD WARM FLUSH ALL DRUGS WITH 5 ML NS |
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Max Dose of atropine in pediactric brady protocol
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max single IVIO dose is 0.5 mg<8 yrs, 1mg>8 yrs
Max total IVIO dose is 1 mg <8 yrs, 3 mg > 8 yrs. FLUSH ALL DRUGS WITH 5ml NS KEEP CHILD WARM |
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STABLE SVT rate >150
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*consider and treat for all possible causes
-heart failure -cardiogenic shock -hypovolemia -side effects of drugs or overdose 1. IMC and start IV 2. VALSALVA 3. ADENOSINE 6mg rapid IVP 4.Adenosine 12 mg rapid IVP 5. Adenosine 12 mg rapid IVP |
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Interventions for UNSTABLE SVT
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-IMC
-Consider Sedation VERSED 2 mg increments q 2 min max 10 -SYNCHRONIZED CARDIOVERSION @ 100 j -if no response repeat..200j, 300j, 360j (check rhythm and pulse between shocks) -still no response...consider cardiogenic shock smo and call med con. |
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What rhythm should not be treated with Adenosine?
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Irregular rapid rhythms
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Interventions for Pediatric
NARROW COMPLEX TACHYCARDIA (rate>220) stable |
-IMC
-IV fluid bolus 20 ml/kg monitor lung sounds repeat as necessary -Support ABC's -Keep Warm -Investigate for possible causes (hypovolemia, fever, etc) |
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Interventions for Pediatric
NARROW COMPLEX TACHYCARDIA (rate>220) UNstable |
*AMS, signs of hypoperfusion
-ADENOSINE .1 mg/kg rapid IV ..use proximal site -if no response in 2 min ADENOSINE .2 mg/kg rapid IV X1 -if no response and pt severly hypoperfused .5 J/kg WHILE ENROUTE -if no response...repeat Cardioversion at 2 J/kg |
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Stable V-tac with pulse
(wide complex tachycardia) |
-IMC (give O2 100% NRB)
-LIDOCAINE 1 mg/kg -if VT persists or PVC's present rebolus with LIDOCAINE .5 mg/kg IV/IO q 3 min up to 3 mg/kg -If VT eliminated rebolus with LIDOCAINE .5 mg/kg IV/IO 10 minutes after initial bolus -IF no responce call MC consider adenosine |
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V-tac with pulse
(wide complex tachycardia) UNstable |
*AMS, signs of hypoperfusion, rate >150
-IMC (GIVE 02 100% NRB) -Consider sedation VERSED 2 mg increments q 2 min max 10 -SYNCHRONIZED CARDIOVERSION @ 100j -LIDOCAINE 1mg/kg IV/IO -If no response repeat Cardioversion 200j 300j 360j -Rpt LIDOCAINE .5 mg/kg IV/IO q 3 min up to max 3 mg/kg -Rpt Cardioversion at 360 j after each LIDO bolus. |
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Things to assess and consider after cardioversion with unstable v-tach with pulse
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-Assess pulse and rhythm after each cardioversion
-consider cardioversion if rhythm persists =if rhythm converts follow appropriate SOP -ANYTIME VT converts to SVT give LIDO 1 mg/kg IV/IO rebolus in 10 minutes with LIDO .5 mg/kg IV/IO |
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V-fib pulseless VT
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-verify pulselessness
-precordial thump if witnessed -cpr -Shock -cpr pulseless...resume cpr intubate, IV/IO access -EPI 1:10,000 1 mg IV/IO or 2 mg ET -Shock at 2 min -LIDO 1 mg/kg IVIO or 2 mg/kg ET -Shock at 2 min -Rpt EPI same dose -Shock 2 min -Rpt LIDO .5 mg/kg IVIO or 1 mg/kg ET -Shock at 2 min keep repeating sequence until converted max total LIDO is 3 mg / kg |
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Important things to remember about vf/vt
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Epi 1:10,000 2 mg ET also acceptable but 1:1000 preferred
-If Epi 1:1000 given ET dilute with NS to total of 10 ml -Flush all IVP meds with 20 ml bolus NS -If V-fib converts to a SV rhythm bolus LIDO 1 mg/kg IV and rebolus LIDO .5 mg/kg after 10 min if not contraindicared to max dose of 3 mg/kg |
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DIFIBRILATION SEQUENCE
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CPR
Rhythm Check SHOCK |
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Pediatric VF/VT
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Verify pulselessness
-cpr shock 2j/kg cpr shock 4 j/kg cpr intubate iv access EPI 1:10,000.01mg/kg IV/IO or 1:1000 .1 mg/kg ET Shock Lido 1 mg/kg IV/IO or 2 mg/kg ET Shock EPI same dose Shock Lido .5 mg/kg IV or 1 mg/kg ET Shock maintain proper sequence max total LIDO is 3 mg/kg keep child warm! |
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Asystole/PEA
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CPR
-place ET -CONSIDER THE h's and t's -EPI 1:10,0000 1 mg iv/io or 1:1000 2 mg ET -if asystole or bradycardia ATROPINE 1 mg rapid IV/IO or 2 mg ET -repeat q 3 min to max of 3 mg IV or 6 mg ET flush all iv meds with 20 ml fluid bolus |
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Pediatric PEA asystole
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-Initiate CPR and intubate
-GRAB braslow tape -EST peripheral IV ASAP IV fluid bolus 20 ml/kg IV/IO -EPI 1:10,000 .01 mg/kg IVIO 1:1000 .1 mg/kg ET -repeat q 3 min -if asystole PEA rate is < 60 ATROPINE .02 mg/kg rapid IVIP or .03 mg/kg ET max dose is .1 mg/kg repeat q 3 min until max given *may call mc to consider higher EPI dose |
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MAX DOSES for atropine in Pedes
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MAX SINGLE
IV/IO .5 mg/kg < 8 yrs 1 mg/kg > 8 yrs MAX TOTAL IV/IO 1 mg < 8 yrs 3 mg > 8 yrs |
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Pulmonary Edema d/t Heart failure
Stable |
IMC
place in high fowlers if SBP > 100 if SBP >100 NTG .4 mg SL If SBP > 100 LASIX 1 mg/kg IV 100 mg MAX If SBP > 100 NTG .4 mg SL For anxiety if SBP > 100 MORPHINE 2 mg increments slow IVP total 10 mg. |
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Unstable pulmonary edema d/t heart failure
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IMC
Pulse < 60 treat per bradycardia SOP Pulse > 60 Treat per cardiogenic shock SOP make sure to check on erectile dysfunction or pulmonary HTN drug intake. |
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Cardiogenic Shock
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-IMC
- IV fluid challenge in 200 ml increments X2 if lungs are clear check lung sounds after each challenge -DOPAINE DRIP dose dependant on condition. P>60 begin at 5 mcg/kg/min increase q 3 min to achieve BP > 90 max 20 mcg/kg/min P<60 begin at 204 mcg/kg/min increase q 3 min to achieve P > 60 if P raised but BP still below 90 increase to max of 20 mcg/kg/min |
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AIRWAY OBSTRUCTION
conscious and cant speak |
Heimlich
repeat till unconscious if success complete IMC and tp |
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Airway obs
unconscious |
Attempt to ventilate
attempt to clear finger sweep suction VISUALIZE with laryngoscope and attempt to clear with forceps or suction Attempt forced Ventilation INTUBATE push into RMSB and ventilate Left lung Perform Cricothyriodotomy ventilate @ 100% and tp |
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Drug assisted intubation ETOMIDATE
indications |
*only used for pts 10 or over
GCS less than 8 imminent resp arrest imminent tracheal laryngeal closure due to severe edema secondary to trauma or allergic reaction Flail chest and or open chest wounds with cyanosis and RR less than 10 greater than 40 ALWAYS HAVE CRIC EQUIPTMENT AVAILABLE |
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DRUG ASSISTED INTUBATION ETOMIDATE
HEAD INJURY |
BENZOCAINE x2 posterior pharynx
ETOMIDATE .6 mg/kg rapid IV Sellicks Manuver Attempt oral in-line intubation verify and secure Versed 2 mg increments q 2 min max 10 |
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DRUG ASSISTED INTUBATION Etomidate NON TRAUMA
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Benzocaine x 2 posterior pharynx
ETOMIDATE .3 mg/kg rapid IV Sellicks Manuver Attempt oral or oral in line intubation May repeat ETOMIDATE after 60 sec .3 mg/kg rapid IV verify and secure tube versed 2 mg increments q 2 min max 10 |
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Drug Assisted Intubation VERSED ADULT
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IMC, prep cric, suction
VERSED 4 mg IVIO may repeat 2 mg increments max 10 till sedation achieved Sellick Manuver Benzocaine x 2 posterior pharynx attempt intubation verify placement and secure versed 2 mg increments ivio as necessary max 10 |
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Drug Assisted Intubation Versed Pediatric
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VERSED .05 mg/kg slow IVIO q 2 min to max of .2 mg/kg if no IV .1 mg/kg IM x 1
Sellick Manuver Benzocaine to posterior pharynx Attempt Intubation verify and secure tube Versed .05 mg/kg slow iv q 2 min to max of .2 mg/kg as necessary |
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PED. RESP Arrest
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IMC
SECURE AIRWAY CSPINE 100% 02 BVM observe for increase in hr and improved color If no improvement intubate or cric EST IV/IO Glucose level *consider NARCAN call MC |
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ACUTE ASTHMA
OR COPD WITH WHEEZING REACTIVE/LOWER AIRWAY DISEASE OLDER THAN 8 YRS |
IMC O2O2O2O2!
ALBUTEROL 2.5 MG (3ML) or XOPENEX 1.25 mg (3ml) via NEB partial response repeat above immediately no response OR in severe resp distress AND older than 50 with no hx of cardiac disease EPI 1:1000 .3mg IM (call mc if younger than 50 or with cardiac hx) If Iminent resp arrest INTUBATE and use in-line albuterol 2.5 mg (3ml) or xopenex 1.25 mg (3ml) |
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ACUTE ASTHMA
OR COPD WITH WHEEZING REACTIVE/LOWER AIRWAY DISEASE less THAN 8 YRS |
IMC
02020202!! Albuterol or xopenex 3ml for both partial response repeat above asap no response or in severe distress EPI 1:1000 10kg or less .1 mg/1ml IM 11-20 kg .2mg/ 2ml IM more that 20 kg .3 mg/.3ml IM If imminent resp arrest INTUBATE and use in line albuterol or xopenex (3 ml) |
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Partial Upper Airway OBS
croup/Epiglottitis STABLE |
IMC
DONT place anything in mouth to see larynx Start IV unless impending arrest Monitor EKG BRADY MEANS DETERIORATION! Give 02!! hold mask near pt. PREP ALL POSS. EQUIPTMENT -NS 6 mk neb, by mask or aim at childs face ALBUTEROL if wheexing or xopenex at 6 lpm DONT DELAY TP while waiting for response |
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stable croup means...
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no cyanosis, mild resp distress no retractions with effective air exchange
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stable epiglottitis means....
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no cyanosis, effective air exchange
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Partial Upper Airway OBS
croup/Epiglottitis UNSTABLE signs and symptoms |
Cyanosis, marked stridor and/or resp. distress evidence of inadequate air exchange bradycardic, AMS, retractions, innefective air exchange, actual or impending respiratory arrest.
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Partial Upper Airway OBS
croup/Epiglottitis UNSTABLE and breathing |
IMC
O2 EPI 1:1000 3 mg (3ml) VIA neb mask or aim at face |
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Partial Upper Airway OBS
croup/Epiglottitis UNSTABLE not breathing |
IMC
put in sniffing pos. ventilate BVM 100% o2. SLOW COMPRESSIONS. If unable to ventilate stop rig and make ONE attempt at intubation If Unsuccessful Preform needle cric if 12 and under. |
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LOCALIZED ALLERGIC REACTION Adult
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*no no wheezing no diffuse hives, no airway involvement
IMC Apply ice/cold pack to bite Benadryl 50 mg IM or slow IV |
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LOCALIZED ALLERGIC REACTION Peds.
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*no no wheezing no diffuse hives, no airway involvement
IMC Apply ice/cold pack to bite Benadryl 1 mg/kg IM or slow IV |
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Allergic reaction with systemic signs ADULT
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* wheezing diffuse hives or prior hx of systemic reaction..WITHOUT SIGNS OF HYPOPERFUSION.
IMC Ice/cold pact to bite or injection site Benadryl 50 mg IM or slow IV EPI 1:1000 .3 mg IM may repeat x1 after 15 min if minimal response. If wheezing consider ALBUTEROL 2.5 (3ml) or XOPENEX 1.25 mg (3ml) per acute asthma. |
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Allergic reaction with systemic signs PEDS.
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* wheezing diffuse hives or prior hx of systemic reaction..WITHOUT SIGNS OF HYPOPERFUSION.
IMC Ice/cold pact to bite or injection site Benadryl 1 mg/kg IM or slow IV EPI 1:1000 10kg or less .1 mg or .1ml IM 11-20 kg .2 mg or .2 ml IM 21 plus .3 mg or .3 ml IM Wheezing consider albuterol or xopenex per ped. acute asthma protocol |
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ANAPLYLAXIS ADULT
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*multisystem reactiong with signs of hypoperfusion AMS or severe resp. distress/ wheezing/ hypoxia
IMC Ice/cold pact to bite or injection site if ssx of hypoperfusioin IV fluid challenges 200 ml increments EPI 1:10,000 .5 mg slow IVP or 1 mg ET or 1:1000 .5 mg injected SL or IM *may repeat q 3 min Benadryl 50 mg slow IVP or IM Consider albuterol or xopenex consider dopamine per cardiogenic shock sop for refactory hypotension |
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ANAPLYLAXIS PEDS
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*multisystem reactiong with signs of hypoperfusion AMS or severe resp. distress/ wheezing/ hypoxia
IMC Ice/cold pact to bite or injection site if ssx of hypoperfusioin IV fluid blous NS 20 ml/kg EPI 1:10,000 .1 mg/kg slow IV/IO or 1:1000 .02 mg/kg ET or 1:1000 .01 mg/kg SL/IM *may repeat q 3 min BENADRYL 1mg/kg slow IV up to 50 mg. no iv give IM Albuterol or xopenex per ped. asthma SOP |
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DIABETIC / GLUCOSE EMERGENCY adult
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IMC
*get med hx and last oral intake!! VOMIT AND SEIZURE PREC. BS <60 or ssx of insulin shock or hypoglycemia.... DEXTROSE 50% 24 g (50 ml) IV If unable to start IV GLUCAGON 1 mg IM ACCUCHECK |
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DIABETIC EMERGENCY PEDS < 8YRS
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IMC
*get med hx and last oral intake!! VOMIT AND SEIZURE PREC. BS <60 or ssx of insulin shock or hypoglycemia.... AGE 1-8 dextrose 25% 2ml/kg IV <1 Dextrose 12.5% 2 ml/kg IV if unable to start IV GLUCAGON .5 mg IM |
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diabetic/ glucose emergencies
with BS >180 and s/sx of hyperglycemia/ ketoacidosis ADULT |
IV fluid challenge in consec. 200 ml increments unless contraindicated
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diabetic/ glucose emergencies
with BS >180 and s/sx of hyperglycemia/ ketoacidosis PEDS less than 8 yrs |
IV fluid bolus 20 ml/ kg
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SYNCOPE/NEAR SYNCOPE
NON-TRAUMA AND STABLE |
IMC
Accucheck monitor EKG doc. changes in GCS anticipate underlying med. etiologies and treat per SOP metabolic cardiac hypovolemic CNS disorder Vasovagal TP |
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SYNCOPE/NEAR SYNCOPE
NON-TRAUMA AND UNSTABLE adult |
*AMS/hypoperfusion
IF lungs clear.. IV fluid challenge 200 ml increments if indicated by decreasing sensorium and pinpoint pupils, depressed resp, and poss. hx of narcotic/ synthetic narcotic ingestion NARCAN 2 mg IV may repeat q 5 min PRN if transient response obs. |
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SYNCOPE/NEAR SYNCOPE NON-TRAUMA UNSTABLE PEDS.
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*ams/signs of hypoperfusion
IV fluid bolus 20 ml/kg repeat as necessary. If indicated by decreasing sensorium and pinpoint pupils, depressed respirations, and poss narcotic ingestion less than 20 kg NARCAN .1 mg/kg IV/IO Greater than 20 kg Narcan 2 mg IV/IO |
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SEIZURE/STATUS EPILEPTICUS
NON-TRAUMA FEBRILE |
IMC
-clear and protect airway - protect from injury -position on side unless contraindicated -obtain blood glucose Coole pt by removing clothes place moistened towel with room temp water over pt and fan. DO NOT induce shivering GIVE NOTHING BY MOUTH unless approved by MC |
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SEIZURE/STATUS EPILEPTICUS
NON-TRAUMA adult |
IMC
-clear and protect airway - protect from injury -position on side unless contraindicated -obtain blood glucose if actively seizing VERSED 2 mg increments slow IVP q 2 min up to 10 mg. May give versed 10 mg IM x1 if unable to start IV less than 70 kg = 5 mg 70 and over= 10 mg |
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SEIZURE/STATUS EPILEPTICUS
NON-TRAUMA |
IMC
-clear and protect airway - protect from injury -position on side unless contraindicated -obtain blood glucose if actively seizing VERSED .05 mg/kg slow IVP q 2 min to a max of .2 mg/kg May give versen IM if unable to start IV |
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STROKE
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IMC
limit scene time c-spine if needed Protect airway maintain head and neck in neutral alignment DO NOT FLEX NECK. If SBP > 90mmHg, elevate bed 15-30* Monitor and rec. neuro status using GCS note all changes Cincinnati Stroke Scale facial drop-smile arm drift -close eyes hold arms out speech-"cant teach an old dog new tricks" |
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STROKE with a GCS less than 8
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INTUBATE
Est IV limit to 2 attempts if seizing versed 2 mg increments slow IV q 2 min to max of 10mg call MC early and comm. time of last normal appearance per pt or witness. |
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ACUTE ABDOMINAL PAIN
STABLE |
IMC
no pain meds without calling MC |
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ACUTE ABDOMINAL PAIN UNSTABLE
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*AMS signs of hypoperfusion
ESTABLISH large bore IV enroute IV fluid bolus 200 ml repeat as necessary titrate based on clinical presentation If suspected AAA or ectopic preg. early aggressive fluid resuscitation should be considered. If s/sx of shock present establish second IV |
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TOX. EMERGENCIES STABLE
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IMC
-hazmat prec. |
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TOX EMERGENCIES UNSTABLE
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*AMS, airway compromise and/or hypoperfusion
IMC HAZMAT PREC GCS 8 or less and evidence airway comp. INTUBATE. -no combitube Unknown etiology with resp comp. ADULT- NARCAN 2 mg IV may repeat q 5 min PRN PED less than 20 kg NARCAN .1 mg/kg IVIO 20 or more 2.0 mg IV/IO |
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KNOWN NARCOTC OD
WITH GCS 8 OR LESS |
IMC
hazmat prec GCS 8 or less and evidence of airway comp. INTUBATE. no combitube unknown etiology with resp. compromise. ADULT Narcan 2 mg IV may repeat q 5 min PRN PEDS 20 kg or less NARCAN .1 mg/kg IVIO 20 or more 2 mg IVIO Protect airway and increase o2 to 100% NRB or BVM consider NARCAN before intubation if airway able to be controlled and vents are effective |
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CYCLIC OD
LOOK AT EKG! |
Hypoperfusion associate with wide QRS complex poss cyclic ingestion
IMC hazmat prec GCS 8 or less and evidence of airway comp. INTUBATE. no combitube unknown etiology with resp. compromise. ADULT Narcan 2 mg IV may repeat q 5 min PRN PEDS 20 kg or less NARCAN .1 mg/kg IVIO 20 or more 2 mg IVIO ADULT IV WIDE OPEN SODIUM BICARB 8.4% 1 mEq/kg IV Peds IV fluid Bolus 20 ml/kg increments Sodium Bicarb 8.4 % 1 mEq/kg IV |
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BETA-BLOCKER OR CALCIUM CHANNEL BLOCKER OD
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hypoperfusion associated with bradycardia (possible beta blocker or calcium channel blocker ingestion)
IMC hazmat prec GCS 8 or less and evidence of airway comp. INTUBATE. no combitube unknown etiology with resp. compromise. ADULT Narcan 2 mg IV may repeat q 5 min PRN PEDS 20 kg or less NARCAN .1 mg/kg IVIO 20 or more 2 mg IVIO ADULT Glucagon 1 mg Slow IV may repeat x1 if no response consider TCP PEDS Glucagon .5 mg IV/IO increments may repeat x1 |
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ORGANOPHOSPHATE POISIONING
MNEMONIC |
Salivation
Lacrimation Urination Defecation GI distress Emesis Breathing Diff. Arrhythmias Miosis (pinpoint pupils) |
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ORGANOPHOSPHATE POISIONING
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IMC
Intubate GCS less than 8 Narcan ADULT ATROPINE 2 mg rapid IV repeat q 3 min until condition improves no MAX PEDS ATROPINE .02 mg/kg rapid IV (min .1 mg) no dose limit |
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CYANIDE POISIONING
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IMC
hazmat prec GCS 8 or less and evidence of airway comp. INTUBATE. no combitube unknown etiology with resp. compromise. ADULT Narcan 2 mg IV may repeat q 5 min PRN PEDS 20 kg or less NARCAN .1 mg/kg IVIO 20 or more 2 mg IVIO for known cyanide poisioning. AMYL NITRATE cap broken and taped inside and NRB mask or BVM with 100% O2 begin TP while replacing capsules q 1 min x 12 caps. INTUBATE ONLY if apneic after all 12 caps if Hypotensive or pulseless IV WO |
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CARBON MONOXIDE poisioning
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IMC
hazmat prec GCS 8 or less and evidence of airway comp. INTUBATE. no combitube unknown etiology with resp. compromise. 100%or NRB or BVM DONT rely on pulse ox keep pt as quite as poss to min O2 demands |
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Narcotics
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Morphine, demerol, heroine, methadone, codeine, fentanyl, vicodin, hydrocodone, dilaudid, percocet, darvon, lortab, oxy, duragesic patch
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Cyclic anti-dep
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Elavil (amitriptyline) norpramin, tofranil, pamelor, sinequan
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BENZO's
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Halcion, ativan, restoril, versed, valium, xanax, librium, klonopin, dalmane, pohypnol, ambien
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Beta blockers
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inderal, cargard, lopressor, atenolol, tenormin, timolol
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Calcium channel blockers
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cardizem, procardia, calan, adalat, isoptin, verapimil, Norvasc
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CLUB DRUGS
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GHB, ketamine, MDMA, x, met, triple c, AMT
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SNAKEBITE / Envenomation
IMC |
BSI SCENE SAFETY
IMC secure airway 100% O2 NRB Check Pulse and control Hemorrhage AVPU and monitor Neuro Apply sterile gauze dsg over wound remove all jewlry and constrictive clothing special considerations allow to lie flat try not to move allow bitten lom to rest at heart level contact MC ASAP when snakebite is suspected let them know if antivenom is at scene and to call PC for toxicologist notify of type of snake take photo if others applied compresion wrap dont remove NO ICE HEAT TOURNIQUET or incising the wound! |
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SNAKEBITE / Envenomation
ALS treatment |
IMC
Observe for resp compromise Evaluate cardiac rhythm and treat Est. 2 large bores of NS in unaffected ext. Use direct pressure to control bleeding if necessary reassess frequently ****if tp time is more than 15 min consider contacting specialty tp. if anti venom is available bring to ED with patient. |
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Radiation Injuries
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1. Follow commands of HAZMAT!
2.Manage pt's per SOP 3. Contact med con asap and indicate # of victims medical status of victims source of radiation amount and kinds of radioactivity present |
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CRF dialysis pt emergencies
UNSTABLE |
*AMS signs of hypoperfusion
*don't take BP in same arm as shunt or fistula *control obvious hemorrhage from shunt or fistula (ARTERIAL BLEED) *Don't try IV on extremity with shunt or fistula IMC IV fluid bolus 200 ml if lungs clear may repeat If signs of hypoperfusion with widened QRS *Dextrose 50% 25 g (50ml) -potential hyperkalemia *Sodium Bicarb 1 mEq/kg IV -potential acidosis If unresponsive to fluid challenge or signs of pulmonary edema present treat per cardiogenic shock SOP If they go into cardiac arrest call med con and IMC |
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HEAT CRAMPS or TETANY
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Initial Trauma Care
move pt to cool environment do not massage cramped muscles |
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Heat exhaustion / Heat Stroke
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-IMC
-Remove as much clothing as possible -Initiate rapid cooling cold packs to lat chest wall, groin, axilla, carotid arteries, temples, behind knees -sponge or mist with cool water and fan, or cover body with wet sheet and fan body -discontinue colling if shivering occurs -check blood glucose if available if < 60 treat per appropriate SOP ADULT IV fluid challenge 200 ml increments If seizures occure refer to protocol PEDS IV fluid bolus 20 ml/kg increments |
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FROSTBITE
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ITC
Rapid rewarming-tepid water *dont thaw if chance of refreezing *handle like burn-light dry sterile dressings dont let rub together Morphine 2mg IV max 10 |
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MILD/MOD. Hypothermia
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Conscious or altered sensorium, SHIVERING
ITC Blood glucose rewarm move to warm hot packs blankets |
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Severe Hypothermia
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NO shivering
rigidity, like rigor mortis confused/withdrawn ITC *cannot confirm triple zero pulse check 30-60 sec *if pulseless start cpr no more than 2 shock and no meds till core temp is 86 or higher cpr only. Intubate IV NS TKO transport gently and maintain in level position |
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Steps in Psychological emergencies...
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-SCENE AND PERSONAL SAFETY! -call cops if nec.
-IMC as warranted -det. and doc. if pt threat to self/others or unable to care for self -protect from self/others -verbally attempt to calm and reorient---dont part. in delusions etc... -use restraints as necessary if combative -consider medical etiologies -hypotension -hypoxia - subs abuse/overdose -neuro disease stroke bleed injury -metabolic hypoglycemia thyroid etc -seizure/postictal -call MC ALWAYS if refusal is being considered may give VERSED for anxiety or agitation 2 mg inc. max 10 slow IVP IM if no IV <70kg=5mg IM >70 10 mg IM |
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ADULT HEAD INJURY
no ams |
ITC
c-spine keep flat vomit and seizure prec. GCS -Ventilate 100% O2 16-20 breaths per min. -speedy t/p call MC |
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Adult head injury with AMS
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ITC
c-spine keep flat vomit and seizure prec. GCS -Ventilate 100% O2 16-20 breaths per min. -speedy t/p call MC -INTUBATE with GCS 8 or less -ACCUcheck -versed if combative |
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Ventilation rate for peds with head injury
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Infants 12 months or less 24-28 BPM
Children 1-15 years 20-24 BPM |
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ADULT with spinal injury
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ITC
cspine keep flat vomit and seizure prec GCS *if signs of hypoperfusion (neuro shock consideration) BP < 90...IV fluid challenge 200 ml increments PRN *if pt remaints hypoperfused or bradycardic ATROPINE 0.5 mg IV q 3 min max 3mg *AMS INTUBATE with GCS 8 or less ACCUcheck |
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PEDS with spinal injury
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ITC
cspine keep flat vomit and seizure prec GCS *if signs of hypoperfusion (neuro shock consideration) IV bolus 20 ml/kg if remains hypoperfused or bradycardic ATROPINE .02mg/kg rapid iv/io OR.03mg/kg ET *min dose .1mg rpt q 3 min until max dose 8 or less 1 mg older than 8 3 mg *AMS INTUBATE ACCUCHECK |
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SUCKING chest wound/ open pneumo
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ITC
Begin t/p Call MC Occlusive dressing taped 3 sides to create flutter valve *if pt deteriorates remove dressing to allow air escape consider intubation |
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Flail Chest
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ITC
Begin t/p Call MC BVM 100 % O2 if in resp dist. to provide internal splinting consider intubation |
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Tension Pneumo
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ITC
Begin t/p Call MC *suspect when ot presents with severe resp dist. or diff. ventilating..hypotension, distended neck veins, absent breath sounds on involved side, and/or tracheal deviation -pleural decompression ADULT-14-16 guage angio 2-2 1/4 inch PEDS 16-18 guage angio 1 1/4-1 1/2 inch MONITOR FOR PEA?ASYSTOLE *2nd intercostal space in midclavicular line insert needle above 3rd rib to avoin intercostal nerve artery and vein |
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TRAUMATIC ARREST
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-if obv. dead consider withholding/withdrawl of efforts
-if injury incompatible with life (massive brain matter visible) comtact MC for on scene pronouncement -if pt loses pulse whil in care -ITC -Consider bilat. chest decomp -consider appropriate cardiac SOP -verify et placement preform all procedures enrouts after airway and CSPINE |
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GEN APPROACH TO OPTHALMIC emergencies
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ITC
assess pain on 0-10 obtain gross visual accuity (light motion acuity) discourage from sneezing, coughing straining or bending at waist elevate head of cot or backboard to semi fowlers vomit prec. MORPHINE 2 mg inc. slow IVP max 10 |
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CHEMICAL SPLASH/BURN TO EYE
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.5% tetracaine 1 gtt to each affected eye may rpt until pain relief
IRRIGATE with saline!! use morgan lens with irrigation |
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SUSPECTED corneal abrasions
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.5% tetracaine 1 gtt in each affected eye until pain relief
patch affected eye |
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Penetrating injury ruptured globe
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DONT remove impaled object, dont irrigate and no tetracaine
avoid eye pressure cover with cup, or metal/plastic protective shield patch unaffected eye |
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BURNS
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-ITC
-EVALUATE burn depth -adults morphine 2mg IV max 10 -Peds Morphine .1 mg/kgmax 10 max single 2mg |
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Thermal Burns
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If 10% or greater BSA
cool no longer than 5 minutes with water/saline if occured w/i 15 min wet dressings may be applied for pain relief -wear gloves and mask till burns covered -dont break blisters cover with dry sterile dressing open dry sheet on stretcher before placing pt for T/P cover pt to maintain body temp |
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Inhalation burns
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*note presence of wheezing, hoaresness, stridor, black sputum, cough, singed nasal hair/eyebrows/eyelashes
O2 100% NRB or BVM Consider intubation if severe resp dist. consider cric if intubation unsucessful IF wheezing ALBUTEROL 2.5 mg 3 ml XOPENEX 1.25 mg 3 ml may rpt X1 |
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Electrical Burns
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Immobilize
Assess ECG, wounds, including neuro status cover with dry sterile dsg. cooling not necessary |
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Chemical Burns
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HAZMAT prec
If powdered chem. Brush away access and remove clothing if poss. Irrigate with copius amounts of water or saline ASAP while enroute |
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MUSCULOSKELATAL injury
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ITC
if stable NITROUS OXIDE for mild pain Morphine for severe pain immobilize/splint if pulse is lost after traction splint DONT RELEASE call MC and notify change elevate and apply cold pack after splinting if long bone fx with displacement/muscle spasm and stable versed 2-10 adult versed .05 mg/kg q2min to .2 mg/kg max if no IV versed .2 mg/kg IM X1 in unaffected limb |
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AMPUTATION/DEGLOVING
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follow basic musculoskelatal inj protocal
if AMP incomplete stabilize with bulky dsg. if uncontrolled bleeding apply tourniquet above amp. as close as possible to injury. Note the time and dont release. Wrap amp part in saline moist guaze or towel place in plastic bad and seal DONT immerse in water Place bad in 2nd container with ICE or cold water or cold packs and bring to hospital |
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Incapacitating back pain
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ITC
severity=pt unable to move or be moved d/t pain asses to differentiate between back pain and triple A -hx and onset and character of pain - hypotension or syncope -pain desc. as tearing or ripping -presense or absence of femoral pulses and mottiling of lower ext. -any negative neuro finding assess for injury and immobilize. check for PMS IF STABLE nitrous or morphine until able to be moved allow 2-3 min inbet. doses to det. effect and need for more. |
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Near drowning
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ITC
Remove wet clothes Assess tempif normothermic treat dysrhythmias per SOP If HYPOthermic treat per hypothermia SOP Treat other sympt. accordingly |
