Utsw Biotel Protocols

Front 1

You're called to the residence of a 25 y. o. f. c/o an allergic reaction while working in her yard over an hour ago. Pt. has urticaria and pruritis (itching) to legs only. Name the protocol and treatment.

Back 1

Allergic Reaction: Obtain V/S and apply ECG and ETCO2 monitors if respiratory distress or shock develops and consider obtaining IV access. In this case, the allergic reaction is localized and does not appear to be spreading so 25 to 50 mg of diphenhydramine IM or IV would be appropriate.

Front 2

You respond to a "man down in front of his home". Neighbors said he came to their door gasping and said he had just been stung by a bee and then sat down on the steps and passed out. Name the protocol and treatment. Pt. has a rapid pulse, tachypnea with audible wheezing, and BP of 74/50.

Back 2

Allergic Reaction/ Anaphylictic Shock: -Administer Epinephrine 1:1000 ASAP 0.3 - 0.5 mg SQ (may be repeated q 20 minutes up to three times).
-Apply O2, monitor, ETCO2, SPO2, IV access.
-Fluid bolus (250 mL as needed up to 1000 mL).
-25 to 50 mg diphenhydramine.
- If no response to SQ Epinephrine and fluid bolus within 10 minutes, administer 0.1mg to 0.2mg Epinephrine 1:10,000 IV/IO very slowly. -Albuterol (2.5 mg) via nebulizer for bronchospasm unresponsive to epinephrine SQ and diphenhydramine after 5 minutes.

BioTel treatment options may include additional 250 boluses as needed to maintain bp >90,
-Epinephrine 1:1000 and 1:10,000
-Albuterol for bronchospasm
-1mg to 2mg of glucogon for patients on beta-blockers and is unresponsive to standard measures.

Front 3

In the allergic reaction protocol, why is glucogon one of the biotel options for patients on beta-blockers?

Back 3

Glucagon increases heart rate and myocardial contractility, and improves atrioventricular conduction. These effects are unchanged by the presence of beta-receptor blocking drugs. This suggests that glucagon's mechanism of action may bypass the beta-adrenergic receptor site. Because it may bypass the beta-receptor site, glucagon can be considered as an alternative therapy for profound beta-blocker intoxications. The doses of glucagon required to reverse severe beta-blockade are 50 micrograms/kg iv loading dose, followed by a continuous infusion of 1-15 mg/h, titrated to patient response. Glucagon-treated patients should be monitored for side effects of nausea, vomiting, hypokalemia, and hyperglycemia. The high cost and limited availability of glucagon may be the only factors precluding its future clinical acceptance.

Front 4

You respond to a patient complaining of dyspnea. She tells you she was trying out some new perfume and has had a headache and difficulty breathing since she applied the perfume over two hours ago. She said she took a shower but it didn't help. She is still having difficulty catching her breath and it seems to be getting worse and a rash is developing on her neck where she applied the perfume.
Breath sounds are stridor and some wheezing. BP is 120/80, HR is 98, RR are 24 and and shallow with stridor and some wheezing.

Back 4

Allergic Reaction (dyspnea without shock , hypoperfusion or critical airway): Apply O2 via NRB, ECG/ETCO2/SPO2/12 lead monitor - IV access TKO.
-0.3 to 0.5 mg Epinephrine 1:1000 SQ.
-25 to 50 mg diphenhydramine IM or IV.
-2.5 mg albuterol for bronchospasm unresponsive to Epi after 5 minutes (may be repeated total of three times).

Front 5

When dealing with an allergic reaction patient with dispnea but no S/S of shock, hypoperfusion, or critical airway, the protocol states to administer what medications in what order?

Back 5

0.3 to 0.5 mg Epinephrine 1:1000 SQ
25 to 50 mg Dephinhydramine IM or IV
If after 5 minutes of administration of the above treatments there is no improvement, administer 2.5 mg of albuterol (may be repeated three doses).

Front 6

Name the drugs/dose administered and their order for "localized allergic reaction - hives only".

Back 6

25 to 50 mg diphenhydramine

Front 7

What drug/dose might BioTel order for patients on beta-blockers who are experiencing moderate to severe allergic reactions?

Back 7

1 to 2 mg glucogon IV/IO every 5 minutes

Front 8

You're dispatched to a "drunk man" at a fast food restaurant. When you arrive, you see the man sitting on the floor in the corner of the dining area mumbling. Pulse is fast and he is tachypniac and diaphoretic. Restaurant manager states that "the bumb just walked up to the counter asking for food. I told him to get lost - and I called the cops". Then the crazy old guy just gently sat down in the corner and has been like this ever since. Can you get him out of here? I'm expecting my CEO any minute and this is bad for my career."

You obtain VS and D-stick per Altered LOC protocol and it is 40. Explain your treatment.

Back 8

Assess ABC's, O2, IV, SPO2, Since this patient is too close to losing consciousness and will soon be unable to protect his airway, you cannot give glutose so you quickly establish and administer 25 grams of D-50 via IV (an additional 25 grams may be given in 10 minutes if no improvement).

If IV/IO cannot be obtained, give 1 mg of glucagon via IM or SC.

After the administration of D-50 the man's LOC improves dramatically and he states that he is the CEO of the restaurant chain and he was coming in to meet with the new manager. After parking his beemer, he suddenly became ill and realized he was becoming hypoglycemic because he had not eaten for several hours after taking his insulin. The patient recovers completely and you could not convence him to let you transport him to the ER. He refuses transport, signs all refusals to the hospital and states that he has unfinished business with the new manager.