-
mandatory notifications :cardiac arrest after/during admin of paralytic, pain management or antiarrhythmic agents
- can't maintain airway w/in credentials
- harm to pt, bystander, crew
- needle or surgical airway
- field terminations
- MCI
-
consent :18 or younger consent if: Active duty
- 16+ and residing away from parent&own finances
- consents to infectious, contagious or communicable disease treatment required by law to be reported
- unmarried &pregnant to hospital or treatment related to pregnancy
- exam and treatment for addiction
- married or emancipated
-
fridge meds :36-46F
- Diltiazem(cardizem)
- lorazepam
- rocuronium
- Succinylcholine(anectine)
-
geographical area of response :Madison/Burleson/Grimes or Brazos county
- mutual aid request in all counties w/ MOA estb
- counties in Texas w/ contract/request of SJREMS
- respond to request from agency w/ authority
- immediate vicinity of actual/perceived ER til responsible EMS etc able to respond
- incidents authorized by EMS Director/medical director
-
pain management :BOTH airway/O2 as appropriate
-
RSII :BOTH: airway/O2
- PREOXYGENATE Pt
- assess BGL
-
chemical restraint :BOTH airway/O2
- scene safety
- BGL
- 12 lead ECG for tazer pt
- remv tazer barbs if not in face/groin/breast/spine=HOSP
- albuterol 2.5 mg via neb if signs of bronchospasm
-
Air Medical use :GCS<10
- blunt/penetratin abdomen pelvis neck or head/pregnant
- amputation (except single digit)
- crushing
- scalping/degloving
- spinal cord=>paralysis or deformity
- major burns 2/3rd BSA>9%; hands,feet,face or perinuem; electrical, inhalation or chem burns
- Presenting significant injury FROM
- ejection from MVA
- extrication time>20 min
- fall from >12'
-
Level 1 trauma :VITAL SIGNS
- BP<90
- Respirations<10 or >29
- AMS GCS<13
- Revised trauma score<11
- Pediatric Trauma score <9
- TRAUMA
- penetrating jead, neck, torso or groin
- Burns >20%BSA
- amputation above wrist/ankle
- paralysis
- flail chest
- long bone FX
- open or suspected skull FX
- unstable or suspected pelvis FX
-
level 2 trauma :ejection/death of other occupant/ signif MOI MVA
- fall>12'
- auto pedestrian
- steering wheel damage
- motorcycle atv or bike impact
- serious assault/altercation
-
Paramedic required to manage :Chest pain
- SOB
- AMS not typical of ot
- abdominal pain
- HR>110
- BP systolic >160 or <100; diastolic >90 or <40
- pulse ox<92%
-
cardiac/hyperkalemia arrest managment :BOTH: ABCs, AED(Defib then 2min compressions prior to pulse check)
- 2 min compressions pre defib if not witnessed CA by EMS
- airway adjunct
- core temp
- BGL
-
Post resucitation :BOTH: O2/ventilation
-
Bradycardia :BOTH: airway/O2
12 Lead ECG
-
atrial fibrillation unstable/stable :suspected with PT w/ irregular pulses
- BOTH: airway/O2
- determine time of onset
- 12 lead ECG
-
narrow complex tachycardia unstable/stable :ADULT: airway/02
- vagal maneuvers
- NO carotid massage
- 12 lead ECG
- PEDI: airway/O2
- 12 lead ECG
-
wide complex tachycardia unstable :ADULT: airway/02
- NO carotid massage
- 12 lead ECG
- PEDI: airway/O2
- 12 lead ECG
-
wide complex tachycardia stable :ADULT: airway/02
- vagal maneuvers
- NO carotid massage
- 12 lead ECG
- PEDI: airway/O2
- 12 lead ECG
-
Acute Coronary syndromes :Adult: airway/O2
- 12 lead ECG w/in 5 min
- 324mg Asprin PO
- contact OLMC
- PEDI: OLMC
-
Pulmonary Edema :BOTH: airway/O2
- 12 Lead ECG
- if systolic <80/90=> remove CPAP if not effective/LOC altered
-
malignant hypertensionh :BOTH: airway/O2
12 Lead ECG
-
hypoperfusion :orthostatic vitals if possible
-
stroke/CVA :ADULT: airway/o2 (maintain SO2 >95%)
- Cincinnati stroke score
- BGL
- 12 lead
- PEDI:
- airway/o2
- 12 lead
- OLMC
-
stroke/CVA destination :<3 hrs: closest stroke facility
- 3-6 hrs:level 1-SJRHC; st. luke, methodist
- >6 level 1 or 2 facilities
-
allergic reaction :ADULT: EpiPen(.15mgIM BLS only)
- assist MDI
- albuterol 2.5mg/3mL every 5 min(if in extremis)
- PEDI:EpiPen(.3mgIM BLS only)
- assist MDI
- albuterol 2.5mg/3mL every 5-10 min(if in extremis)
-
diabetic emergencies :ADULT: airway/O2
- BGL
- oral glucose 15gPO to maintain BGL>60
- focus on up BGL then discontinuing BGL
- unconsious=12 lead
- PEDI: airway/O2
- BGL
- oral glucose 7.5g PO to maintain BGL>60
- focus on up BGL then discontinuing BGL
- unconsious=12 lead
-
nausea and vomiting :BOTH airway/O2 as appropriate
-
narcotic overdose :BOTH: airway/O2
- 12 lead
- BGL; <60=> hypoglycemia
- shallow resp, altered LOC; unresponsive/pinpoint pupils; tachycardia; hypotension
-
dystonic reaction overdose :BOTH: airway/O2
- 12 Lead ECG
- deviation of eyes, protrusion of tounge, forced jaw opening; difficulty speaking, facial grimace
-
cyclic antidepressant overdose :BOTH: airway/O2
- 12 Lead ECG
- tachycardia>120; wide qrs; hypotenstion
-
calcium channel blocker :BOTH: airway/O2
- 12 Lead ECG
- bradycardia; conduction delay; hypotension; lethargy; slurred speech; nausea and vomiting
-
organophosphate :BOTH: airway/O2
- 12 Lead ECG
- SLUDGE(salivation, lacrimation, urination,defecation, GI cramping,emesis) muscle fasciculation; altered LOC; diarrheal wheezing; pinpoint pupils
-
gestinal complications overall :airway/02
- >20 weeks=> transport on left side
- tilt backboard 15 degrees if must immobilize
-
obsterics uterine inversion :PT supine
- leave placenta and cord
- 1 attempt to replace uterus w/ palm(push fundus toward vagina)
-
abruptio placenta :complaint of sever, constant abdominal pain (seperation of placenta form wall)
-
placenta previa :painless bright red vaginal bleeding
-
abortion :tissues or nonviable fetus present
collect tissue or fetal parts; place in paperbag then into plastic bag
-
prolapsed cord/limb :leave cord; 2 gloved fingers into vagina; check cord pulse
- keep head off cord and mosit w/ sterile saline
- mom in knee-chest position
- transport and notify ASAP
-
breach birth :if possible get to hospital
- request paramedic responder
- assist mom in holding legs flexed-support baby legs-don't pull
- gentle traction upward as head passes pubis
- "V" on either side of nose to allow breathing if head not deliver
-
asthma :ADULT: airway/O2
- CPAP
- albuterol 2.5 mg nebulizer
- 12 lead
- PEDI: airway/O2
- albuterol 2.5 mg nebulizer
-
seizures :BOTH: airway/O2
- be prepared to assist ventilation
- BGL
- ADULT: 12 lead
- urge to transport
-
COPD :BOTH:airway/O2
- albuterol 2.5 mg nebulizer
- ADULT:
- 12 lead
- CPAP
-
sepsis :Adult:airway/O2-sat>95%
- CPAP for pulomonary edema peep at or below 5
- PEDI: airway/O2
-
general trauma guidelines :see book
-
general trauma management :airway/02
- manual Cspine
- control bleeding/tourniquet if needed
- tetracaine to 2-4 drops for eye injury
- assess what facility and mode of transport is necessary for the pt condition
-
amputation :BOTH: airway/O2; general tauma guideline
- wrap body part- sterile guaze moistened by saline
- place in plastic bag/containe then into cold water
- tourniquet as needed
- don't delay transport for prolonged extrication of body parts
-
burns :airway/O2
- stop burning process
- dress wounds
- 2/3rd degrees BSA<10%=> wet sterile
- 2/3rd degrees BSA>10%=> dry sterile dressing
- ID entry/exit wounds
- remove items that may constrict w/ swelling
- mark for swelling
- brush off dry chem and flush (eyes flush>20 min)
- maintain body heat
- transport to burn center via air med if possible
-
crush injury :BOTH airway/O2 as appropriate
-
near drowning :airway/O2
- core temp
- BGL
- CPAP immediate for breathing PT
- note how long and type of water submerged; type of weather etc
-
insect/spider bite :BOTH airway/O2 as appropriate
-
snakebite :airway/O2
- keep PT calm
- treat for shock and preserve body heat
- remove constricting articles
- keep bitten immobilized
- keep bite @ or below heart
- mark edema to determine rate and amt of swelling
-
acetaminophen (tylenol) :nonopioid analgesic antipyretic
- prostaglandin inhibition
- Indication: fever
- contra: liver/renal disease; alcoholism
- effect:liver toxicity
- dosage:650-1000mg PO adult
- pedi: 15mg/kg PO of elixir
-
albuterol :med: B2 adrenergicv bronchodilator
relaxes bronchial muscles
-
Indication:respiratory distress from asthma, COPD or some types of pulmonary edema
-
contra:arrhythmias; hypertension; cardiovascular disorder
- effect:body tremors, headache, insomnia; hypertension; arrhythmias; bronchospasms; tachycardia; uticaria; rash
- dosage:2.5 mg/3ml "bullet" nebulized
-
aspirin :ASA: analgesic, antipyretic and anti-inflamatory
- Indication:chest pain; suspected MI
- contra:hypersensitivity; anticoagulant therapy; known/suspected bleeding or hemorrhage
- effect: prolonge debleeding time; nausea/vomitting; Gastic irritation
- dosage:324 mg PO (4x82 mg tabs)
-
dextrose(glucose) :Indication:hypoglycemia
- contra:intracranial hemorrhage; increased interc pressure; cerebral edema
- effect: necrosis if extravasation; hyperglycemia; neurologic in OH PT
- dosage:15 g PO in adult PT
- 7.5-15 g PO in pedi PT
-
epi :endogenous catecholamine
- stimulate beta receptors of heart, vasculature
- bronchodialtion
- vasodilation
- Indication: asthma; cardiac arrest; anaphylaxis; bradycardia
- contra:hypovolemia shock; ischemic heart disease;
- effect:arrhythmial tachycardia; palpitations; precipitation of angial pain; increased bloodpressure; anxiety
- dosage:
-
tetracaine :local anesthetic agent of ester linkage
- prevents initation and transmission of nerve impulses
- Indication: burns to eye
- contra:hypersensitivity; open or disrupted globe
- effect:stingin, burning, conjunctiva redness
- dosage:1-2 drops prn in injured eye
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