Adult Blue Protocols BLS

Question 1

Abdominal Discomfort / GI / GU (S-120)

Answer 1

• Ensure patent airway
• O2 saturation PRN
• O2 and/or ventilate PRN
• NPO
• Transport suspected symptomatic AAA
  to facility with surgical resources
  immediately available

Question 2

Airway Obstruction (S-121)

Answer 2

For conscious patient
* Reassure, encourage coughing
* O2 PRN
For inadequate air exchange
Airway maneuvers (AHA)
* Abdominal thrusts
* Use chest thrusts in obese or pregnant patients
If patient becomes unconscious or is found
unconscious
* Begin CPR
Once obstruction is removed
* Ventilate with high-flow O2 PRN
* O2 saturation
Treat per Respiratory Distress Protocol (S-136)

Question 3

Allergic Reaction (S-122)

Answer 3

• Ensure patent airway
• O2 saturation PRN
• O2 and/or ventilate PRN
• Attempt to identify allergen and route
  (injected, ingested, absorbed, or inhaled)
• Remove allergen (e.g., stinger, injection
  mechanism), if possible
• Epinephrine auto-injector 0.3 mg IM x1
  OR
  Assist patient to self-medicate own
  prescribed epinephrine auto-injector or
  albuterol MDI once only. BH contact
  required for additional dose(s)

Question 4

Altered Neurologic Function (Non-Traumatic)

Answer 4

“POSEDRM” then “OSSS Opioid Sugar Stroke Seizure”
* Ensure patent airway
* O2 saturation, O2 and/or ventilate PRN
* Spinal motion restriction PRN
* Position on affected side if difficulty managing
secretions
* Do not allow patient to walk
* Restrain PRN
* Monitor blood glucose
Symptomatic suspected opioid OD with RR <12.
Use with caution in opioid-dependent, painmanagement patients
* Naloxone 4 mg via nasal spray preloaded
single-dose device. Administer full dose in one
nostril
OR
* Naloxone 2 mg via atomizer and syringe.
Administer 1 mg into each nostril
EMTs may assist family or friend to medicate with
patient’s prescribed naloxone in symptomatic
suspected opioid OD
Suspected hypoglycemia or patient’s blood
sugar is <60 mg/dL
* If patient is awake and able to manage oral
secretions, give 3 oral glucose tabs or paste
(15 gm total)
* Patient may eat or drink, if able
* If patient is unconscious, NPO
Stroke/TIA
* Treat per Stroke and Transient Ischemic Attack
(S-144)
* Pediatric patients presenting with stroke
symptoms should be transported to Rady
Children’s Hospital

Seizures
* Protect airway and protect from injury
* Treat associated injuries

Question 5

Burns (S-124)

Answer 5

“MOCBET” “Thermal Toxic Chemical Tar”
* Move patient to safe environment
* Break contact with causative agent
* Ensure patent airway, O2, and/or ventilate
PRN
* O2 saturation PRN
* Treat other life-threatening injuries
* Carboxyhemoglobin monitor PRN, if available
Thermal burns
* For burns <10% BSA, stop burning with nonchilled water or saline
* For burns >10% BSA, cover with dry dressing
and keep patient warm
* Do not allow patient to become hypothermic
Toxic inhalation (e.g., CO exposure, smoke,
gas)
* Move patient to safe environment
* 100% O2 via mask
* Consider transport to facility with hyperbaric
chamber for suspected CO poisoning,
particularly in unconscious or pregnant
patients
Chemical burns
* Brush off dry chemicals
* Flush with copious amounts of water
Tar burns
* Do not remove tar
* Cool with water, then transport

Question 6

Discomfort / Pain of suspected Cardiac Origin (S-126)

Answer 6

“Every One Understand Only Missionary Intimacy Matters Most”
* Ensure patent airway
* O2 saturation PRN
* Use supplemental O2 to maintain saturation at
94-98%
* O2 and/or ventilate PRN
* Minimize patient exertion, including walking,
when possible
* If SBP >100 mmHg, may assist patient to selfmedicate own prescribed NTG1 SL (maximum
3 doses, including those the patient has
taken)
* May assist with placement of 12-lead EKG
leads
* May assist patient to self-medicate own
prescribed aspirin up to a max dose of 325 mg

Question 7

Adult CPR / Arrhythmias (S-127)

Answer 7

“CUMROA” “VAD & TAH”
* Continuous compressions of 100-120/min
with ventilation rate of 10-12/min
* Use metronome or other real-time
audiovisual feedback device
* Rotate compressor at least every 2 min
* Use mechanical compression device (unless
contraindicated)
* O2 and/or ventilate with BVM
* Monitor O2 saturation
* Apply AED during CPR and analyze as soon
as ready
VAD
* Perform CPR
* Contact BH for additional instructions
TAH
* Contact BH for instructions

Question 8

Envenomation Injuries (S-129)

Answer 8

“JSS J = heat Sting/Sculpin = Immersion”
* O2 and/or ventilate PRN
* If antivenin available on site, transport with
patient to hospital
Jellyfish sting
* Liberally rinse with seawater
* Scrape to remove stinger(s)
* Heat as tolerated (not to exceed 110 °F / 43 °C)
Stingray or sculpin injury
* Immersion in hot water (as hot as tolerated, not
to exceed 110 °F / 43 °C)
Snakebite
* Mark proximal extent of swelling and/or
tenderness
* Keep involved extremity at heart level and
immobile
* Remove constrictive device(s)
* Remove jewelry distal to bite

Question 9

Environmental Exposure (S-130)

Answer 9

“EOORO”
* Ensure patent airway
* O2 saturation PRN
* O2 and/or ventilate PRN
* Remove excess/wet clothing
* Obtain temperature
Heat exhaustion
* Cool gradually
* Fan and sponge with tepid water
* Avoid shivering
* If conscious, give small amounts of fluids
Heat stroke
* Rapid cooling
* Spray with cool water and fan
* Avoid shivering
* Apply ice packs to carotid, inguinal, and
axillary regions
Cold exposure
* Gentle warming
* Apply blankets, warm packs, and dry
dressings
* Avoid unnecessary movement or rubbing
* If alert, give warm liquids. If altered LOC, NPO
* Prolonged CPR may be indicated
Drowning
* CPR, if cardiac arrest. Emphasize ventilations.
* High-flow O2 if spontaneous respirations
* Remove wet clothing
* Spinal motion restriction PRN

Question 10

Hemodialysis Patient (S-131)

Answer 10

• Ensure patent airway
• O2 saturation
• Give O2 to maintain SpO2 at 94% to 98%
• Ventilate PRN