2017 Nyc Remac - The Simple Essence Of Als Protocols

Front 1

SMOKE INHALATION

Back 1

Tube if needed. Check C.O., Draw bloods and administer the antidotes via separate lines along with saline infusion, then administer standing Norepi or Dopamine if the hemodynamics don't improve.

Front 2

CYANIDE EXPOSURE

Back 2

Seek class order if more than 5 patients. Exercise caution. Tube if needed. Draw bloods and administer the antidotes via separate lines along with saline infusion, then administer standing order Norepi or Dopa if the hemodynamics don't improve.

Front 3

OBSTRUCTED AIRWAY

Back 3

Ma gills, tube, and push the foreign object into the right mainstem if necessary.

Front 4

V-FIB/PULSELESS V-TACH

Back 4

CPR, defibrillate, tube and line. Epi, amio, epi. Call for more Amio, Bicarb, Mag and/or Calcium.

Front 5

PEA/ASYSTOLE

Back 5

Begin CPR, look for underlying cause, and decompress as needed. Tube and I.V., Epi, Dextrose, Epi. Call for Bicarb, Calcium or fluids.

Front 6

AMI/Ischemia.

Back 6

Get a rhythm, Get a 12-lead, and run. Start a line enroute. Give aspirin and nitro.

Front 7

AMI/Cardiogenic Shock.

Back 7

Get a rhythm, get a 12-lead, and run. I.V. enroute. Give fluid and norepi or dopa enroute, standing orders.

Front 8

SVT

Back 8

Sedate and cardiovert the unstable; adenocard the stable. If BP normal or high, call for Dilt. If BP low, call for more rounds of cardioversion. You may also call for Amiodarone.

Front 9

A-Fib/Flutter

Back 9

Sedate and cardiovert anything unstable; call the doc for stable above 150 BPM for Dilt (normal/high BP) or Amio.

Front 10

V-TACH w/PULSE or WIDE COMPLEX

Back 10

Sedate and cardiovert the unstable; amio the rest on standing. Call doc for additional cardioversion, Mag, Calcium, or Bicarb.

Front 11

BRADY/COMPLETE BLOCK

Back 11

Try atropine once, then sedate and pace. If no luck, call doc for additional atropine, dopa, calcium or bicarb.

Front 12

APE

Back 12

Attach monitor, pop a line and give Nitro and CPAP. Call for Lorazepam, Midazolam, and/or Furosemide.

Front 13

ASTHMA

Back 13

Start breathing treatments. Give Epi IM if it looks bad, and pop a line. Try mag followed by methyprednizolone or dexamethazone, then call doc for more epi.

Front 14

COPD

Back 14

Give breathing treatments, pop a line, try methylprednizolone or dexamethazone, and hit the road.

Front 15

ANAPHYLACTIC REACTION

Back 15

Be prepared to tube. If there's shock or a history, IM Epi right away, otherwise skip the Epi. Pop a large bore, run fluids, and give I.V. steroids, then Benadryl. If bronchospasms, give one albuterol neb. Call doc for repeats and some Norepi or Dopa.

Front 16

AMS

Back 16

Check sugar. Try Dextrose, Glucagon, Naloxone. Repeat Dextrose once, then call doc for repeat of standing if no change.

Front 17

SEIZURE

Back 17

Give Dextrose, maybe Glucagon, and one of the three sedatives (L or D or M). Call for more LDM if needed.

Front 18

NON-CARDIOGENIC SHOCK

Back 18

Decompress PRN, pop a large bore, IO if needed. Run fluids, and apply monitor.

Front 19

SEPTIC SHOCK

Back 19

Tube as needed. Drop two hoses and pump two liters, IO if needed. Record the rhythm, lactate and temp, if possible. Call the doc for a third liter.

Front 20

TRAUMATIC ARREST

Back 20

Load and go, decompress and tube on the fly. EKG if no chest holes. Pop two large bores and run fluids on the way in.

Front 21

HEAD INJURIES

Back 21

Tube, monitor, and line. Lorazepam, Diazepam or Midazolam to control seizures. Hyperventilate if herniating. Call doc for more "LDM" if needed.

Front 22

CHEMICAL EYE INJURIES

(Pediatric and Adult)

Back 22

Remove any contact lenses, give Proparacaine or Tetracaine drops to facilitate irrigation. You may repeat the drops once.

Front 23

BURNS

(Pediatric and Adult)

Back 23

Tube quickly if airway is burned. Apply monitor to electrical burns. Pulse ox and two liters NS. Give Morphine if BP greater than 110 systolic, otherwise go with Fentanyl.

Front 24

PAIN FOR ISOLATED EXTREMITY INJURY

(Pediatric and Adult)

Back 24

If non-isolated injury, scoop and run. Consult doc enroute for pain management options.

If isolated, monitor, pulse ox, line, and watch vitals. Give morphine on standing orders if systolic BP is above 110, otherwise go with Fentanyl. As always, narcan is standing by.

Front 25

EXCITED DELIRIUM

(Adult Only)

Back 25

Go with a quick shot of I.M or I.N Midazolam, preferably I.M.; Once things calm down, try to get a line, monitor, pulse ox, and BGL. Call for a slew of additional options: Ketamine, Midazolam, Lorazepam and Diazepam, via a variety of routes.

Front 26

SEVERE NAUSEA / VOMITING

(Pediatric and Adult)

Back 26

Line, vitals, and treat underlying cause of chunk blowing. Ondansetron with one repeat, standing.

Front 27

OBSTETRIC COMPICATIONS

Back 27

Be alert for BP >160/110, headache, seizure, belly ache, APE. For severe pre-eclampsia, call for Mag once or twice. first round in 50 to 100 cc, but second round must be given in 100 cc.

Front 28

NEONATE RESUSCITATION

Back 28

CPR, tube, and transport as fast as you can. N.G.O.G if distended. Epi down the tube. I.V.I.O if extended or delayed. Infuse saline on the way, and keep pushing epi.

Front 29

PEDIATRIC RESP ARREST

Back 29

Be alert for OD or obstruction. Tube and decompress if needed. Enroute, give Naloxone I.N.I.M., Pass an N.G.O.G if needed. PPMC I.V.I.O.

Front 30

PEDIATRIC OBSTRUCTED AIRWAY

Back 30

Ma gills first. Tube if epiglottis isn't enlarged, and push object into right mainstem if necessary.

Front 31

PEDIATRIC CROUP/EPIGLOTTITIS.

Back 31

Do NOT tube. Transport and ventilate with high pressure BVM, passing N.G.O.G for distention.

Front 32

PEDIATRIC NON-TRAUMATIC ARREST

Back 32

Shock and CPR. Tube and transport. Give high-concentration E.T epi, pass an N.G.O.G, start a line. Shock again, I.V.I.O amio if V.F, Epi Q3-5 either way. Call to repeat standing, or to give Naloxone, Dextrose, Bicarb, Magnesium or fluids.

Front 33

PEDIATRIC ASTHMA WHEEZING

Back 33

Start the first of three Combivents. If 1 year or older, hit severe cases with IM Epi. Begin transport, and call the doc for repeat of Albuterol, repeat of epi after 20min, and I.V.I.O.

Front 34

PEDIATRIC ANAPHYLAXIS

Back 34

Tube and give ET epi if severe, otherwise give Epi IM. Begin transport, and pass an N.G.O.G if needed. Call doc for repeats, I.V.I.O, and fluids.

Front 35

PEDIATRIC AMS

Back 35

Transport, give IM Glucagon, then a line enroute. Give I.V.I.O Dextrose followed by titrated Naloxone. Call medical control to repeat any of the standing orders.

Front 36

PEDIATRIC SEIZURES

Back 36

I.M Glucagon and I.M.I.N Midazolam, standing. Transport. Start a line to give Dextrose, but withhold Glucagon and Dextrose if BGL >60. Call enroute for: Lorazepam or Diazepam, or repeat Midazolam.

Front 37

PEDIATRIC DECOMPENSATED SHOCK

Back 37

EKG if no apparent hypovolemia, and treat any rhythm issues PPMC. Begin transport, start a line enroute on standing orders, and give fluids for shock. Call the doc for more fluids. Request cardioversion for unstable arrhythmias. Ask for Adenocard if the monitor can't deliver.

Front 38

PEDIATRIC TRAUMATIC ARREST

Back 38

Transport. Tube and decompress enroute; line and fluids. Pass an N.G.O.G tube. Call for more fluids PRN.

Front 39

HYPERGLYCEMIA

(Pediatric and Adult)

Back 39

Tube if necessary. BGL over 300 with AMS, rapid breathing, and dehydration gets an I.V and a liter of fluid. Any BGL over 500 gets the same. Call for one additional liter, as needed.