Adult Treatment Protocols Flashcards

Question

Continuous Positive Airway Pressure | ATP-13

Answer 1

Assess clinical condition: •Secure airway–»Assist Ventilations as necessary •O2 (if hypoxic) •Monitor - SpO2/ETCO2 •IV/IO - Lock/Bolus as appropriate—» Don't delay Tx - Minimize Pt effort —» Carry - Place in seated position with head at 45º Tx: if Pt is in respiratory distress despite Hi-flow O2 via NRB a-Connect CPAP to O2 b-attach CPAP to breathing circuit and test function c-Apply/secure breathing circuit mask to Pt d-Titrate increases in pressure to SpO2, *do not exceed 10 cm H2O * Continually reassess Pt/Monitor for pneumothorax * Transport emergently and notify receiving hospital Rx: To decrease anxiety if Pt is benefiting from CPAP consider. •Morphine Sulfate IV: 2-4mg if not hypotensive and no relief from NTG -or- •Fentanyl IV: 50-100µg PRN up to max of 200µg •Fentanyl IM/IN: 2µg/kg to a max of 200µg -or- •Diazepam—2.0-5mg slow IV •Lorazepam—1-2mg slow IV **Consider lower doses when Pt>60 or

Answer 2

Indications: Conscious Pt in severe respiratory distress due to suspected: •Pulmonary edema •Pneumonia •COPD exacerbation (asthma/bronchitis/emphysema)

Answer 3

Contraindications: •Upper airway/facial trauma or abnormalities that prevent mask from sealing •Open stoma or tracheotomy •Severe cardio-respiratory instability (respiratory or cardiac arrest, penetrating chest trauma, suspected pneumothorax, arrhythmias) •Persistent nausea/vomiting •Active upper GI bleeding or Hx of recent gastric Sx •Age

Answer 4

Relative-Contraindications: | •SBP

Answer 5

Conscious or Unconscious No BGL available or BGL

Answer 6

Conscious or Unconscious BGL>60 * Secure airway–»Assist Ventilations as necessary * O2 (if hypoxic) * Test BGL = BGL >60 Establish IV lock or fluids as indicated -if Pt is unconscious- Rx: -may induce nausea, have suction ready- •Naloxone IV: 0.4mg PRN to a max of 4mg •Naloxone IM: (if no IV access) 2mg, may repeat 1x, max of 4mg •Naloxone IN: 2mg into each nostril (4mg) via atomizer Tx: If you suspect: 1-Hypoglycemia - Thiamine 100mg, Dextrose 25G IV 2-Hyperglycemia/ETOH/infection/dehydration/metabolic acidosis—»Administer 300-500ml NS bolus 3-Stroke - proceed to stroke protocol (ATP-14)

Answer 7

* Secure airway–»Assist Ventilations as necessary * O2 (if hypoxic) * Monitor * IV/IO - Lock/Bolus as appropriate * √BGL * Conduct "FAST" assessment * Obtain MHx * Rx history * Document Findings -Did the Pt's symptoms start w/in the last 4 hours?- Yes-»Transport Pt w/ positive prehospital stroke assessment to Primary Stroke Center for possible thrombolysis w/in 4 hours of onset. No—»Early Online Medical Direction (prior to transport) for medical direction to nearest Primary Stroke Center or closest appropriate facility

Answer 8

Stroke Symptoms •Sudden numbness/weakness of face/arm/leg especially on one side of the body. •Sudden confusion, trouble speaking or understanding. •Sudden trouble seeing in one or both eyes. •Sudden trouble walking, dizziness, loss of balance or coordination. •Sudden severe headache with no known cause.

Answer 9

FAST Assessment •FACE: Ask Pt to show teeth—»Facial Droop? •ARMS: Raise both arms w/ eyes closed—»Arm Drift? •SPEECH: Repeat sentence—»Words slurred? Correct? •TIME: What time was onset of S/S? Last seen well time?

Answer 10

**EVEN if the hospital is on diversion** •AH - Arrowhead Hospital •BEMC - Banner Estrella Medical Center •BBWMC - Banner Boswell Medical Center •BTMC - Banner Thunderbird Medical Center •BDWMC - Banner Del Webb Medical Center •JCL-NM - John C. Lincoln - North Mountain •JCL-DV - John C. Lincoln - Deer Valley •WV - West Valley Hospital •PB - Phoenix Baptist •MH - Maryvale Hospital

Answer 11

*if in 3rd Trimester refer to ATP-21 * Secure airway–»Assist Ventilations as necessary * O2 (if hypoxic) * √BGL * Establish IV access ``` Rx: •If BGL is 60: reduce dose by half -or- Diazepam IV •5-10mg IV in 2mg increments, no faster than 2mg/min •Age>60: reduce dose by half. ``` Symptoms resolve? Yes—»Courtesy Notification No—»Med Control

Answer 12

*if in 3rd Trimester refer to ATP-21 * Secure airway–»Assist Ventilations as necessary * O2 (if hypoxic) * √BGL Rx: •If BGL is 60: Reduce dose by half *For IM administration, inject deep into large muscle mass Establish vascular access Yes—»Courtesy Notification No—»Med Control

Answer 13

* Secure airway–»Assist Ventilations as necessary * O2 (if hypoxic) * Monitor - Tx dysrhythmias as appropriate * Inspect the scene: * Bring Rx containers if possible * Consider effects of substance * Consider consulting Poison Control 602-253-3334 •IV/IO - Lock/Bolus as appropriate Symptoms resolving? Yes—»Courtesy Notification No—»Med Control

Answer 14

* Secure airway–»Assist Ventilations as necessary * O2 (if hypoxic) •Monitor - Tx dysrhythmias as appropriate * Consider PMHx * Consider PRx * Establish IV/IO of NS (Consider 2 large bore IV's) * Administer fluid challenge of 200-300cc ASAP •Repeat VS •S/S resolving? •Yes-»Continue Fluid Therapy-»Courtesy Notification •No—» Dopamine IV infusion: 2-20µg/kg/min(60gtts) Online Med Control

Answer 15

Patient Assessment •ALS provider must assess Pt that has been restrained •Pt must be under direct Supervision at all times •Pt: Airway, breathing, VS, SpO2 •Circulation to extremities must be evaluated every 10 minutes when restraints are applied

Answer 16

Type of Restraint: •Only leather or other agency approved "soft" restraints •If locking restraints used, key must be transported in the ambulance. •Handcuffs may only be used wen law enforcement officer accompanies Pt to Hospital. •Paramedic must have immediate access to keys needed to release handcuffs or devices. •The use of linens as a restrain device is acceptable, providing secured in a manner allowing rapid access in emergency.

Answer 17

Secure airway–»Assist Ventilations as necessary O2 (if hypoxic) ``` Consider all possible medical & trauma causes for behavior •Hypoxia •Alcohol •Medication effect/overdose •Withdrawal syndromes •Hypoglycemia •Head Injuries •Mental illness *Tx appropriately ``` -Is Pt an immediate threat to him/herself or others?- No—» Proceed with appropriate algorithm Yes—» Apply restraints as necessary, Paramedic must accompany Pt to receiving facility. * Monitor - Tx dysrhythmias as appropriate * Establish Lock/IV as indicated * √BGL, if 60 or

Answer 18

Restraint Documentation: •Reason restraint was required •Type of restraint used •Position of Pt during Tx and transport •Data indicating constant supervision of ABC, V/S, SpO2 •Status of circulation distal to restraints •Total time Pt was restrained while in care of EMS •Pt status at the time of transfer of care.

Answer 19

Pt positioning: •Positioned not to compromise airway •Access to airway maintained for adv. airway mgmt. •Access to chest for CPR/defibrilation •Access to extremities for IV/IO •ø prone position/hogtied •ø placed between backboards/stretchers •restrained to backboard for Pt transfer/vomiting •restraints placed to facilitate assessment/prevent injury

Answer 20

Initial Medical Care Establish IV lock/fluids as indicated SBP

Answer 21

Pregnancy (>20w) w/ labor pain, ab pain or "High Risk" Establish an airway Preform ventilation and oxygenate as indicated Minimize external stimuli Establish IV of LR @ minimum rate of 30cc/hr Place in Left Lateral Recumbent position Determine whether "High Risk" - if not—»Med Control Yes- "High Risk" Pre-eclamptic: Magnesium Sulfate IV: 4-6G over 10-15min Add 4G to 100ml in D5W/LR/NS = 40mg/ml Eclamptic (Seizing): Mag. Sulfate IV: 4-6G over 5-10min If seizure continues, patcher consideration of Benzo. ``` Transport to nearest Level III that receives OB: •St Joseph's •Maricopa Medical Center •Banner Good Samaritan •Banner Desert •Banner Thunderbird •Scottsdale Healthcare-Shea ``` Online Medical Direction for further orders. Courtesy Notification for facilities with Neo-natal ICU

Answer 22

``` High Risk Pregnancies- Transport to Level III perinatal facility if stable •Prematurity ( •Premature rupture of membranes •Ante-partum hemorrhage: Abruption Placenta Placenta Previa Uterine Rupture •Any other complications or labor: Breech Prolapsed Cord •Recent illicit Rx use ```

Answer 23

Eclamptic Syndrome can occur up to 6w post-delivery

Answer 24

Pregnant (>20w) Trauma Patients with abdominal pain should be taken to Level 1 trauma Center with perinatal capability. Pregnant Trauma Codes or Pregnant patients in extremis should be taken to closest Level I Trauma Center.

Answer 25

All OB patients should be taken to ED if L/D doesn't have ground floor direct entrance. Patient should be rapidly assessed in ED, if Patient need to go to L/D, a RN/DR will accompany EMS to L/D

Answer 26

Documentation should include: LMP: Last Menstrual Period EDD: Estimated Delivery Date Time fetal movement was last felt.

Answer 27

Level II w/ Specialty Care >28 Weeks •Arrowhead Hospital •Banner Estrella Medical Center •Chandler Regional Medical Center

Answer 28

``` Level II w/ Specialty Care >32 Weeks •Banner Baywood •Banner Del Webb •Banner Gateway •Maryvale •Mercy Gilbert •Mountain Vista •Paradise Valley •PIMC •Tempe-St. Lukes •Scottsdale-Osborne •West Valley Hospital ```

Answer 29

Establish an airway Provide adequate oxygenation Place in position of comfort Establish IV Lock/Fluids as indicated Consider: Ondansetron IV: 4-8mg slow over 2-5min (IV form may be given PO) -or- Ondansetron ODT (Orally Dissolving Tablet) 4-8mg PO

Answer 30

Establish an airway Preform ventilation and oxygenate as indicated Establish IV Lock/Fluids as indicated Administer: Diphenhydramine IV: 50mg slowly -or- Diphenhydramine IM: 50mg if IV is not available. S/S resolve? Yes—» Courtesy Notification No—» Online medical direction

Answer 31

Dystonia is a neurological mvmt. disorder characterized by involuntary muscle contractions, which force certain parts of the body into abnormal, painful, mvmt's, and postures. Dystonia can affect any part of the body including arms, legs, trunk, neck, eyelids, face, or vocal cords.

Answer 32

Signs & Symptoms may include: •protruding or pulling sensation of tongue •twisted neck or facial muscle spasm •roving or deviated gaze •abdominal rigidity and pain •and/or spasm of the entire body

Answer 33

Partial list of Rx that cause dystonia: •Chlorpromazine (Thorazine) - Antipsychotic •Halperidol (Haldol) - Antipsychotic •Metaclopramide (Reglan) - Antiemetic •Prochloperazine (Compazine) - Antipsychotic •Promethazine (Phenergan) - Antiemetic •Acetophenazine - Antipsychotic •Amoxipine - TCA •Fluphenazine - Antipsychotic •Loxapine - Antipsychotic •Mesoridazine - Tx of schizophrenia •Molindone - Antipsychotic •Perphenazine - Antipsychotic •Piperacetazine - Antipsychotic •Promazine - Antipsychotic •Thiethylperazine - Antiemetic/Antipsychotic •Thioridazine - Tranquillizer •Thiothixene - Antipsychotic •Trifluoperazine - Antipsychotic •Triflupromazine - Antipsychotic •Trimeprazine - Antiemetic/Antipruritic

Answer 34

Consider scene safety for rescuers and patients Rapid extrication from hazardous environment (SCBA) Address airway issues CO measurement if available Administer High-flow Oxygen via NRB ``` If Patient: •Is pregnant •Has motor skill impairment •COHb level of ≥25% •Exhibits cardiovascular dysfunction •Continued AMS •Had LOC or seizure Contact Medical Control—»consider rapid transport to hyperbaric facility ``` Exhaled COHb is >20%, or if unknown is symptomatic—» Consult with Medical control for Tx and transport direction.

Answer 35

Assure ABC Administer O2 via NRB, if unconscious—»intubate. Keep patient in position of comfort Apply Monitor/monitor dysrhythmias/monitor temperature Start IV Lock/Fluids as indicated (NS) Protect against Hypo/Hyperthermia Monitor and Tx: Pneumothorax/Shock/Seizures ``` Consider: Morphine IV: 2-5mg prn for pain -or- Fentanyl IV: 50-100µg slow, may repeat for max of 200µg Fentanyl IM/IN: 2µg/kg to a max of 200µg ``` Transport to hyperbaric facility: •Scottsdale Memorial- Osborn- OMD#480-941-0973 •For remote areas utilize air medical transport If possible obtain: •detailed Hx of dive: depth, duration, air pressure, timing, onset of symptoms -or- •transport with dive computer

Answer 36

* Cold water dive * Strenuous diving * Hx of previous DCI * Overstaying time at dive depth * Rapid ascent-panic * Heavy exercise before or after the dive * Flying after the dive * Driving to altitude after the dive * Fatigue- lack of sleep before the dive * Alcohol consumption before or after the dive * Can occur at any depth

Answer 37

* Pain: usually in joint or tendon, common in shoulder * Pain is usually mild at first, growing more intense * CNS disturbances: ALOC, memory loss, headache, Blurred vision * Parasthesias - Pins and needles, tingling * SOB or Cough * Burning sensation in chest * Skin: itching, mottled, or marbled * Edema * Subcutaneous air * Fatigue

Answer 38

Initial medical care Evaluation of ABC's and VS including monitor Is Pt an immediate threat to self or others? No: Must be evaluated by ALS and have monitor/12-lead strip attached to chart for any situation involving TASER. Must have OMD for refusal or BLS transport. Yes: Apply restraints as necessary, ALS required for transport. Refer to ALS-19 Behavioral Emergencies as needed

Answer 39

1. When safe evaluate patient, with special attention to S/S of excited delirium 2. These patients will be in custody of law enforcement, and will need transport for medical clearance. 3. Unless CI, restrain in upright position prior to transport

Answer 40

1. TASER Probes should not be removed by EMS personnel unless they interfere with safe transport 2. If probes must be removed for safe transport •Verify wires have been severed •Use PPE •Place one hand at site and stabilize with two fingers keeping fingers away from probe, with other hand in one motion pull probe straight out of site. 3. Reinsert probes, point down, into the discharged cartridge and hand it to the law enforcement officer 4. Apply direct pressure with sterile dressing.

Answer 41

Establish Airway with spinal immobilization Perform ventilations and oxygenate. •Ventilate w/ 100% O2 at no more than 10/min, titrating to ETCO2 of ±40mmHg If TBI or Multi-system trauma requiring intubation follow EPIC-TBI (ATP-30) in addition to interventions below *DO NOT DELAY TRANSPORT FOR PROCEEDURES* Establish 2 IV/IO's of NS with large bore catheters. Infuse as indicated Apply monitor √BGL Maintain tissue perfusion as indicated Consider hemostatic hemorrhage control If Tourniquets —» T written on Pt's forhead Stabilize LE trauma or pelvic Fx (sheet or binder) and Pt is hypotensive Do Triage or Treatment intervention problems exist? Yes: OMD No: Courtesy Notification

Answer 42

The most common new Rx you'll see Pt's on are: Xarelto Pardaxa Several cardiologists are starting to use these for patients with A-fib, instead of Coumadin. Aggrenox is used for a lot of stroke/TIA patients

Answer 43

``` More common blood thinners: •Warfarin (Coumadin) •Salicylate (Aspirin) •Clopidogrel (Plavix) •DABIGATRAN (PRADAXA) - A-fib •RIVAROXABAN (XARELTO) - A-fib •Prasugrel (Effient) •Ticagrelor (Brilinta) •Dipyridamole (Persante) •DIPYRIDAMOLE/ASPIRIN (AGGRENOX) - TIA •Enoxaparin (Lovenox) •Heparin •Fondaparinux (Arixtra) •Apixaban (Eliquis) ``` ``` Less Common: •Dicumarol •Dalteparin (Fragmin) •Bivalirudin (Andiomax) •Anisinidione (Miradon) •Danaparoid (Orgaran) •Tinzaparin (Innohep) •Argatroban •Lepirudin (Refludan) ```

Answer 44

Establish Airway with spinal immobilization Perform ventilations and oxygenate. *DO NOT DELAY TRANSPORT FOR PROCEEDURES* Seal open chest wounds and stabilize flail segments as indicated If physical findings suggest Tension Pneumothorax: •Lift occlusive dressing -and/or- •Preform NCD Establist 2 IV/IO - Large bore, NS - infuse as indicated Apply cardiac monitor and monitor SpO2. Maintain Tissue percussion as indicated Do Triage or Treatment intervention problems exist? Yes: OMD No: Courtesy Notification

Answer 45

Establish Airway Perform ventilations and oxygenate Establish IV/IO (if IO place in burn site) Infuse LR @ 150cc/hr or greater to maintain SBP>100 Administer bolus of 500cc Administer: Morphine IV/IM/IO at 2-10mg, may repeat up to 20mg total -or- Fentanyl IV: 50-100µg slow, may repeat up to 200µg total Fentanyl IM/IN: 2µg/kg to a max of 200µg OMD for transport destination

Answer 46

Burn Transportation Criteria: •Partial thickness 2º > 5% BSA •Any Full thickness 3º burn of any age group •Any burns with trauma •Burns w/ inhalation injury/airway compromise •2º/3º involving: face, eyes, hand/feet, genitalia, perineum, and major joints •All high voltage electrical burns, including lightening •Chemical burns •Radiation burns •Burns with pre-existing medical conditions •Burn injury in pt's that will require special social and emotional, or long-term rehabilitative support, including cases of suspected child abuse and neglect •Burned children in hospital without qualified personnel or equipment •Circumferential burns

Answer 47

Suspicion of TBI by: Mechanism/GCS/exam [Airway/Breathing] Is SpO290 •Continue careful monitoring of BP and HR •Watch for early signs of shock: Tachycardia, Falling SBP [Disability] Evaluate mental status/GCS •Alway evaluate for hypoglycemia it can mimic/cause TBI •√BGL if

Answer 48

``` Consider impending herniation if: •dilated and unresponsive pupils •GCS2 points •Extensor posturing •Asymmetric pupils (one or both non-reactive) •Re-evaluate ever 3-5min ``` *If Pt has signs of impending herniation, elevate head 30º

Answer 49

Establish and maintain airway. Apply high-flow O2 via NRB or BVM Expose bleeding site and apply direct manual pressure ``` For continued hemorrhage: •Apply Hemostatic gauze •Pack wound •Mound dressing above wound •Apply direct pressure for ≥3 min •Confirm hemorrhage control •secure with pressure dressing over wound ``` If bleeding persists, apply tourniquet. Establish large bore IV and initiate fluid bolus of 20cc/kg if hypotensive.

Answer 50

Indication: To control life-threatening bleed after other methods have failed. Tourniquets may be considered prior to application of direct pressure or hemostatic agents for: •Amputations/penetrating injuries proximal to wrist/ankle with significant hemorrhage. •As initial Tx when personnel are limited and/or there are multiple casualties. Place 2-3 inches above the wound, not on joint Mark a T and time on Pt's forehead and document Tourniquets are painful, administer Morphine/Fentanyl per pain protocol ATP-33 2nd Tourniquet may be placed proximal if ineffective Leave in place

Answer 51

Initial assessment and medical care Start IV Lock/Fluids as indicated Systolic BP>90 No: Proceed with appropriate algorithm Yes: Quantify pain: 1 to 10; document this pre and post administration as guide to effectiveness *Constant monitoring of ABC's and VS is required* Morphine for analgesia: IV: 2mg increments until pain is relieved, up to 10mg if SBP>90 IM: 5-10mg if SBP>90 -or- Fentanyl IV: 50-100µg slow, may repeat for total of 200µg Fentanyl IM/IN: 2µg/kg to a maximum of 200µg total Consider: Ondansetron IV: 4-8mg slow/2-5min (may be given PO) Ondansetron ODT: 4-8mg Pain Controlled? Yes: Courtesy Notification No: OMD

Answer 52

For isolated extremity injury, ensure injury is not associated with hemodynamic instability. •Assess and document distal circulation, sensation, and movement of injured extremity. •Immobilize (and elevate if possible) the extremity

Answer 53

Pain MGMT: IV vs IM: •IV route offers better means for titration of Rx. Absorption via IM route may be unpredictable and should be used as a last resort only if no IV access. •Documentation MUST reflect rationale for IM route if used.

Answer 54

S/S of renal colic (kidney stones) •Waves of sharp pain that start in the back or side moving toward the groin or testicle. •Inability to find a comfortable position •N/V •Profuse sweating •Blood in urine •Urge to urinate

Answer 55

* Respiratory failure * Severe head trauma * Spinal cord injury * Facial/Airway burns * ≥15 years of age * Toxic inhalation * Loss of gag reflex * GCS

Answer 56

* Spontaneous breathing w/ adequate respirations * Cric would be difficult * ETT intubation would be difficult * Inability to secure airway by other means

Answer 57

* Hx of neuromuscular disease * Known hypersensitivity to protocol Rx * Cric or ETT impossible (morbid obese, recessed chin, fused neck) * Hx of malignant hyperthermia

Answer 58

IV/O2/Monitor Pre-oxygenate 4-5min with 100%, or give 4 vital capacity breaths Sedate: Etomidate IV: 0.3mg/kg over 30-60sec -or- Ketamine IV: 1.5mg/kg Paralyze: Succinylcholine IV: 1.5mg/kg Intubate: Ventilate between attempts, max 2 attempts If unable to intubate: use OPA and BVM, supraglottic device and BVM, or crichothyrotomy (last resort) ``` Confirm tube placement: Document: •Visualization of ETT passing cords •Equal rise/fall of the chest •Breath sounds bilaterally •Absence of epigastric sounds •Continuous ETCO2 monitoring •SpO2 ``` *Consider OG placement for gastric decompression when advanced airways are placed.

Answer 59

**Assure sedation during transport** Midazolam IV: 2-5mg, may repeat every 10-15min Diazepam IV: 5-10mg, may be given as an alternative Maintain sedation throughout transport. Do not repeat Etomidate/Ketamine/Succinylcholine If Pt has TBI: √BP prior to admin of sedation, and use lower dose If SBP

Answer 60

Pain Management (If necessary) Morphine IV: 2-10mg Fentanyl IV: 50-100µg slow, repeat to max of 200µg Fentanyl IM/IN: 2µg/kg to max of 200µg Maintain sedation throughout transport. Do not repeat Etomidate/Ketamine/Succinylcholine If Pt has TBI: √BP prior to admin of sedation, and use lower dose If SBP

Answer 61

``` Complications of RSI •Inability to secure airway •Arrhythmias •Aspiration •Bronchospasm •Inability to evaluate neurological status •Emesis •Prolonged apnea ```

Answer 62

``` Should include: •GCS •Indications for procedure •Pre-oxygenation •Weight •Pre/post CO2 measurements •Pre/post O2 sats •Correct ventilation rates •Rx dose/route/times •ETI attempts •Airway mgmt device used •Continued sedation dose/route/times •If unsuccessful - reason ```

Answer 63

Before attempting RSI weigh benefits of obtaining airway control against the risk of complications caused by the procedure.

Answer 64

*Not a substitution for RSI. For agencies not performing RSI ``` Preparation: •Pre-oxygenation •SpO2 •Prepare Rx •Have alt. airway (combitube/cric kit) available ``` Establish IV/IO BVM with 100% O2 - 4 vital capacity breaths Sedate with Midazolam IV: 2.5-5 slowly over 2 min Attempt intubation: •no more than 2 attempts •Check ETT Placement and ETCO2 •If successful, maintain sedation with Midazolam prn If unsuccessful: Repeat Midazolam dose and attempt again If unsuccessful: use OPA/BVM, supraglottic device, Crichothyrotomy (last resort) *Consider OG tube placement for gastric decompression with advanced airway

Answer 65

Establish airway with spinal immobilization as indicated Preform ventilations and oxygenation as indicated Administer Neosynephrine into each are as needed then perform intubation Confirm tube placement with auscultation and ETCO2 Document

Answer 66

Indications: •For immediate vascular access in emergencies •When intravenous fluids and Rx are urgently needed and a peripheral IV cannot be established in 2 attempts or 90 sec. and Pt exhibits one or more of following: •AMS (GCS

Answer 67

Contraindications: •Fx of the bone selected for IO •Excessive tissue at insertion site w/ absence of anatomical landmarks (relative contraindication •Previous significant orthopedic procedures •Infection at the site for insertion *If emergent need for this procedure is required, consider OMD and obtain informed consent from Pt, if possible*

Answer 68

BSI Determine indications, rule out contraindications Locate insertion site: •Proximal tibia (Peds or Adults) •Distal tibia (Adult only) •Proximal humerus (Adult only) Prepare site using aseptic technique Prepare EZ-IO and appropriate needle set Stabilize site and insert needle Remove driver while stabilizing the hub Remove stylet from catheter —»sharps Confirm placement and patency Connect PRIMED tubing Slowly administer: Lidocaine 2% IO: Adults 20-40mg / Pedi 0.5mg/kg with conscious Pt (confirm no Ax to Lido) Rapid syringe flush 10mg NaCl (5mg Pedi) Utilize pressure bag for continuous infusion Dress site and secure tubing Monitor site and PT condition Lidocaine can be given pro to bolus or maintenance infusion, or prn during infusion.

Answer 69

EZ-IO AD (Adult) to be used for Pt's ≥40kg EZ-IO PD (Pedi) to be used for Pt's 3-39kg IO Catheter should be removed w/in 24 hours

Answer 70

Assess for need of SMR (Spinal Motion Restriction) Evaluate mental status FAST Assessment (Face, Arms, Speech, Time) VS Complete 2ndary Assessment- Assess mvmt and for injury √BGL Orthostatic VS Cardiac Monitor Determine cause of fall •Syncope/Near-Syncope •Dizziness prior to fall •CP or difficulty breathing prior to fall •Is Pt normally ambulatory? Is this a mechanical fall? Did they trip, stumble, have balance issues, not using walker/cane, fall out of bed? Pt on blood thinners? New Rx? If Pt wishes to refuse transport and no high risk criteria are met can preform BLS refusal. If "High Risk" Criteria are met, contact medical direction for refusal.

Answer 71

High risk criteria (indicating need for OMD) •Does Pt have concurrent illness that caused the fall? •Is Pt not A/Ox4 or at baseline •Is there a Hx of recent falls? If the Pt lives independently, do they need a higher level of care? • Are there VS abnormalities? •FAST Positive •Orthostatic VS positive •EKG abnormalities present? •Is BGL abnormal? •Does secondary assessment reveal any injury? Contact OMD for injury •Pt stable enough to leave at home? Assure Pt has responsible adult to stay with or check on Pt. Is someone at home with Pt? If not contact friend/relative that is willing to check on Pt.

Answer 72

Risk Assessment: •Assess Pt's house for possible trip hazards •Refusal (ensure pt understands potential risks) •If Pt has a POA, contact POA.

Answer 73

Apply SMR to any Pt identified by algorithm to have a potential spine injury that might benefit from splinting and packaging. A complete Pt assessment should be preformed prior to application of SMR.

Answer 74

Methods and tools that achieve SMR from Least invasive—»Most invasive: •Fowler's/Semi-Fowlers/Supine with C-Collar •Supine w/ vacuum mattress device splinting head-toe •Child card seat w/ supplemental padding •Supine on scoop stretcher/ w/padding, avoid log roll •Supine on long board, w/padding

Answer 75

1-Provide manual stabilization to restrict head mvmt. Alert, cooperative, sober patients may be allowed to self limit mvmt. w/ or w/out C-collar, especially if ambulating prior to arrival. 2-Place appropriately sized cervical collar. 3-Obtain Hx and preform careful examination to evaluate for complaints of pain, numbness, tingling, GCS, neurological deficits, spine tenderness, deformity, or painful distracting injury. 4-Extricate Pt while limiting flexion, extension, rotation, and distraction of the spine. Tools such as pull sheets, scoop stretchers, and other flexible devices may be used as needed. **Limit usage of longboards due to low friction and resulting mvmt. from torso and head slippage** 5-If Pt is to be transported on hard device, apply adequate padding prevent tissue ischemia and increase patient comfort. 6-Place Pt in the best position suited to protect the airway. 7-Repeat neurological exam and regularly reassess motor/sensory function. 8-Consider use of SpO2 and ETCO2 to monitor respiratory function. 9-Carefully document your exam findings from before/after patient mvmt. and packaging. **If the patient experiences negative effects from a particular SMR method, alternated measures should be implemented.

Answer 76

* Pt's with acute/chronic difficulty breathing: SMR is known to reduce respiratory function by as much as 20%, experienced most often by geriatric/pediatric Pt's secured to long board. * Pediatric Pt's: avoid mvmts that provoke increased spinal motion. If you choose to apply SMR using a car seat, ensure proper assessment of patients back is preformed. * Pt's with metal delay are considered unreliable * Combative patients: Avoid methods or interactions that provoke increased spinal motion or agitation.

Answer 77

``` Potential mechanism for unstable spine injury? -Yes- Altered LOC (GCS ```

Answer 78

``` Low-risk characteristics/mechanisms: •Simple rear-end collision •Ambulatory on scene at any time •No neck pain on scene •No midline cervical tenderness ``` *These low-risk factors allow safe omission of SMR in Pt's with GCS =15

Answer 79

High-risk characteristics/mechanisms: •Age>65 •Trauma triage criteria based on Mechanism •Ejection (partial/complete) from auto/animal •Motorcycle crash > 20mph •Pt run over or significant impact (>20mph) •Falls: •Adults >20ft (1 story =10ft) •Pedi >10ft (2-3x the height of the child) •Intrusion into Pt compartment >12" or 18" anywhere •Death in same Pt compartment •Auto-pedi or auto-bicyclist (with less than 20mph, not run-over or thrown) •Axial loads/diving injuries •Sudden acceleration/deceleration, lateral or bending forces to head, neck, torso, or pelvis •Numbness, tingling, paresthesia's *If any of above Strongly consider SMR•

Answer 80

``` Unreliable patient interactions: •Language barriers; inability to communicate •Lack of cooperation during exam •Evidence of Rx/Alcohol •Painful distracting injuries ```

Answer 81

``` Motor/Sensory exam: •Wrist/hand extension bilaterally •Foot plantar flexion bilaterally •Foot dorsiflexion bilaterally •Gross sensation in all extremities •Check for paresthesias ```

Answer 82

FOCAL deficit or complaint -No—» Omit SMR Yes—» Apply SMR

Answer 83

*Notes* •Unstable spine fx's and spinal cord injuries from penetrating head trauma are extremely rare. * Neuro deficits often present at the moment of injury * Life threatening conditions and evacuation from imminent threat take priority * If Hx suggests combo blunt/penetrating trauma, revert Blunt SMR algorithm **Instructive information: Patients with global deficits do not require SMR

Adult Treatment Protocols Flashcards

(108 cards)