The document outlines protocols for universal patient care and various medical and trauma emergencies. It provides assessment steps and specific treatment guidelines for conditions like cardiac arrest, airway management, and diabetic emergencies. Key steps include assessing ABCs, giving epinephrine for cardiac arrest, limiting intubation attempts, and treating hyperglycemia and hypoglycemia in diabetics.
The document outlines protocols for universal patient care and various medical and trauma emergencies. It provides assessment steps and specific treatment guidelines for conditions like cardiac arrest, airway management, and diabetic emergencies. Key steps include assessing ABCs, giving epinephrine for cardiac arrest, limiting intubation attempts, and treating hyperglycemia and hypoglycemia in diabetics.
The document outlines protocols for universal patient care and various medical and trauma emergencies. It provides assessment steps and specific treatment guidelines for conditions like cardiac arrest, airway management, and diabetic emergencies. Key steps include assessing ABCs, giving epinephrine for cardiac arrest, limiting intubation attempts, and treating hyperglycemia and hypoglycemia in diabetics.
The document outlines protocols for universal patient care and various medical and trauma emergencies. It provides assessment steps and specific treatment guidelines for conditions like cardiac arrest, airway management, and diabetic emergencies. Key steps include assessing ABCs, giving epinephrine for cardiac arrest, limiting intubation attempts, and treating hyperglycemia and hypoglycemia in diabetics.
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EMS Prehospital Protocol \ Jordan
COLOR CODES Chapter One Universal Patient Care Protocol Universal Patient Care Protocol Universal Patient Care Protocol Universal Patient Care Protocol Universal Patient Care Protocol Universal Patient Care Protocol Universal Patient Care Protocol Universal Patient Care Protocol Universal Patient Care Protocol • The patient history should not be obtained at the expense of the patient. Life-threatening problems detected during the primary assessment must be treated first. • Cardiac arrest due to trauma is not treated by medical cardiac arrest protocols. Trauma patients should be transported promptly with CPR, control of hemorrhage, cervical spine immobilization, and other indicated procedures attempted enroute. • In patients who require IV’s, only two attempts at IV insertion should be attempted; additional attempts must be made using IO if available. • Patient transport, or other needed treatments, must not be delayed for multiple attempts at endotracheal intubation. Limit to two attempts prehospital. • Verbally repeat all orders received before their initiation. • Any adult medical patient or patients of any age with a cardiac history, irregular pulse, unstable blood pressure, dyspnea, chest pain, medication administration, or venous access must be placed on a cardiac monitor, a 12-lead ECG if available, and transmitted to the emergency department. • If the patient’s condition does not seem to fit a protocol or protocols, contact Medical Direction for guidance if available. If not available; consider stabilizing the patient and transfer to the nearest hospital. • All trauma patients with a high-risk mechanism of injury or history of multiple system trauma should be transported as soon as possible. The scene time should be 10 minutes or less. • Advanced life support therapy should be provided at the scene if it would positively impact patient care. • Justification for scene times greater than 10 minutes should be documented Universal Patient Care Protocol • Although the intent is to suction foreign matter, air and oxygen also are being suctioned out of the patient. Never suction for greater than 15 seconds. After suctioning, reoxygenate the patient.
• If resistance to passage of the NPA is felt, DO NOT FORCE the NPA in, as injury may occur. Remove NPA and attempt insertion in the other nostril. Chapter Two CARDIAC EMERGENCIES CARDIAC EMERGENCIES CARDIAC EMERGENCIES CARDIAC EMERGENCIES CARDIAC EMERGENCIES CARDIAC EMERGENCIES • Epinephrine IV/IO dose: 1mg every 3-5 mins • Amiodarone IV/IO dose: First dose: 300mg bolus. Second dose: 150mg. • The use of Amiodarone (Cordarone) in heart block can worsen bradycardia and lead to asystole. Chapter Three A , B AND C MANAGEMENT PEDIATRIC AIRWAY MANAGEMENT PEDIATRIC AIRWAY MANAGEMENT PEDIATRIC AIRWAY MANAGEMENT PEDIATRIC AIRWAY MANAGEMENT PEDIATRIC AIRWAY MANAGEMENT PEDIATRIC
• Infants 0 ‐12 months DO NOT receive abdominal thrusts. Use chest thrusts
alternating with back blows.
• NEVER perform blind finger sweeps in infants or children.
• Even with a complete airway obstruction, positive ‐pressure ventilation is often
successful. CARDIAC EMERGENCIES PEDIATRIC Chapter Four PATIENT ASSESSMENT PATIENT ASSESSMENT - MEDICAL
SCENE SIZE-UP
- Determines the scene/situation is safe.
- Determines the mechanism of injury/nature of illness
- Determines the number of patients
- Requests additional help if necessary
- Considers stabilization of spine
PATIENT ASSESSMENT - MEDICAL
PRIMARY ASSESSMENT - Verbalizes general impression of the patient - Determines responsiveness/level of consciousness - Determines chief complaint/apparent life threats - Assesses airway a) Opens and assesses airway b) Inserts appropriately sized adjunct - Assesses breathing a) Assesses breathing b) Assures adequate ventilation c) Administers oxygen d) Manages any injury which may compromise breathing/ventilation - Assesses circulation e) Assesses/controls major bleeding f) Assesses skin [either skin color, temperature, or condition] g) Assesses pulse
identifies priority patients/makes transport decision
PATIENT ASSESSMENT - MEDICAL
HISTORY TAKING AND SECONDARY ASSESSMENT
History of present illness
OPQRST
O = onset P = provocation Q = quality R = radiation S = severity T = time PATIENT ASSESSMENT - MEDICAL
HISTORY TAKING AND SECONDARY ASSESSMENT
Past medical history
SAMPLE
Signs & Symptoms
Allergies Medications Pertinent past history Last oral intake Events leading up to the illness/injury PATIENT ASSESSMENT - MEDICAL
Performs secondary assessment
[assesses affected body part/system or, if indicated, completes rapid assessment]
Pulse Blood pressure Respiratory rate Level of consciousness Respiratory quality PATIENT ASSESSMENT - MEDICAL
secondary assessment
Diagnostics [blood glucose test, pulse oximetry, etc.] as indicated
States field impression of patient Verbalizes treatment plan for patient and calls for appropriate intervention Re-evaluates transport decision PATIENT ASSESSMENT - MEDICAL
REASSESSMENT
Repeats primary assessment
Repeats vital signs
Evaluates response to treatments
Repeats secondary assessment regarding patient complaint or injuries
- Determines the mechanism of injury/nature of illness.
- Determines the number of patients .
- Requests additional help if necessary .
- Considers stabilization of spine .
PATIENT ASSESSMENT - TRAUMA
PRIMARY ASSESSMENT - Verbalizes general impression of the patient - Determines responsiveness/level of consciousness - Determines chief complaint/apparent life threats - Assesses airway a) Opens and assesses airway b) Inserts appropriately sized adjunct - Assesses breathing c) Assesses breathing d) Assures adequate ventilation e) Administers oxygen f) Manages any injury which may compromise breathing/ventilation - Assesses circulation g) Checks pulse h) Assesses skin [either skin color, temperature, or condition] i) Assesses for and controls major bleeding if present j) Initiates shock management Identifies priority patients/makes transport decision based upon calculated GCS PATIENT ASSESSMENT - TRAUMA
HISTORY TAKING Selects appropriate assessment (focused or rapid trauma assessment)
DCAP-BTLS a) Deformities b) Contusions c) Abrasions d) Punctures/Penetrations e) Burns f) Tenderness g) Lacerations h) Swelling Attempts to obtain SAMPLE history a) Signs & Symptoms b) Allergies c) Medications d) Pertinent past history e) Last oral intake f) Events leading up to the illness/injury PATIENT ASSESSMENT - TRAUMA
SECONDARY ASSESSMENT
Head a) Inspects the head b) Palpates the skull c) Assesses eyes for creativeness Neck d) Inspects position of trachea e) Inspects jugular veins f) Palpates cervical spine Chest g) Inspects chest h) Palpates chest i) Auscultates chest PATIENT ASSESSMENT - TRAUMA
Abdomen/pelvis a) Inspects abdomen b) Palpates abdomen c) Assesses pelvis Lower extremities Inspects, palpates, and assesses motor, sensory, and distal circulatory functions Upper extremities Inspects, palpates, and assesses motor, sensory, and distal circulatory functions Posterior thorax, lumbar, and buttocks a) Inspects posterior thorax b) Palpates posterior thorax Manages secondary injuries and wounds appropriately Reassesses patient Chapter Five Medical EMERGENCIES DIABETIC EMERGENCIES •SIGNS AND SYMPTOMS HYPERGLYCEMIA •Altered level of consciousness HYPOGLYCEMIA /coma •Altered level of •Abdominal pain •consciousness •Nausea / vomiting •Dizziness •Dehydration •Irritability •Diaphoresis •Frequent thirst and •Convulsions urination •Hunger •General weakness • Confusion malaise •Hypovolemic shock •Hyperventilation •Deen/rapid respirations DIABETIC EMERGENCIES DIABETIC EMERGENCIES • Hyperglycemia: • Diabetic ketoacidosis (DKA) is a complication of diabetes mellitus. It can occur when insulin levels become inadequate to meet the metabolic demands of the body for a prolonged amount of time (onset can be within 12-24 hours). Without enough insulin, the blood glucose increases, and cellular glucose depletes. The body removes excess blood glucose by dumping it into the urine. • • Patients can have hyperglycemia without having DKA.
• Hypoglycemia • •Always suspect hypoglycemia in patients with an altered mental status. • •If a blood glucose analysis is not available, a patient with altered mental status and signs and symptoms consistent with hypoglycemia should receive Dextrose or Glucagon if available • • Dextroseis used to elevate BGLbut it will not maintain it. The patient will need to follow up with ameal (carbs), if not transported to a hospital. • Hypoglycemic patients who are receiving oral hypoglycemics should be STRONGLY urged to be transported to the hospital.The half-life of such oral medications is lougand these patients Willneed to be closely monitoredfor recurrent hypoglycemia. ACUTE CHEST PAIN (ACS(
• SIGNS AND SYMPTOMS
• CP (pain, pressure, aching,tightness)
• Location (substernal, epigastric, arm, jaw, neck, shoulder) • Radiation of pain • Pale, diaphoresis • Shortness of breath • Nausea, vomiting, dizziness ACUTE CHEST PAIN (ACS( ACUTE CHEST PAIN (ACS( • If the patient took a dose of Aspirin that was less than 300 mg in the last (24) hours, then additional Aspirin can be • administered to achieve a therapeutic dose of 300 mg. • Pulse oximetry is not an indicator of myocardial perfusion. • Once applied to a known or suspected ACS patient do not remove a 12 lead EKG, even if the initial ECG is unremarkable. Some devices continue to look for ST segment changes and will alert if there are changes. RESPIRATORY DISTRESS / ASTHMA / COPD
