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BSO EMS Protocols > Chemical Control > Flashcards

Chemical Control Flashcards

1
Q

Physical Restraint

Information

A

Restrain patients only if necessary to protect the patient or personnel from harm. Restrained patients shall be positioned supine

RESTRAINED PATIENTS SHALL NOT BE PLACED IN A PRONE POSITION.

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2
Q

Physical Restraint

Adult & Pediatric

A
  • Do not compress the head or neck with a knee, foot, etc.
  • Keep patient in an upright position to allow for hyperventilation
  • Restrained patients shall not be left unattended.
  • Frequently monitor and document vital signs, airway, and neurovascular status.
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3
Q

Chemical Restraint
Excited Delirium
Patient presentation

A

presents as bizarre, aggressive behavior which may be associated with cocaine or “crack”, PCP or “angel dust”, MDMA, methamphetamine or
amphetamine, and FLAKKA use.

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4
Q

Chemical Restraint
Violent Patients: Indications
How to treat when ketamine is not available

A

Indicated for violent, agitated patients who place themselves and/or crew
in danger.

  • When Ketamine is not available for adult violent patients: substitute
    Haldol 5 mg IM one dose and Benadryl 50mg IM one dose – These can be given in the same syringe with retractable needle
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5
Q

Chemical Restraint

Adult - procedure

A

• Law enforcement must first gain physical control of the patient.
• KETAMINE: 200-400mg IM. May repeat 1x prn. Max single dose 400mg.
• Allow patient to hyperventilate.
• Do not hold the patient in a prone position.
• Once calm, physical restraints may be unnecessary, but may be used as an added
precaution.

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6
Q

Chemical Restraint

Adult - After Ketamine Administration

A

• Continuously monitor and maintain patient’s SpO2 at 95% and EtCO2 between 35-45mmHg.
• Obtain IV/IO access.
• If patient begins to wake up: Repeat DOSE OF KETAMINE
• BE PREPARED FOR RESPIRATORY DEPRESSION AND HYPOTENSION.
• Obtain and document a temperature early into treatment and monitor the
temperature throughout delivery to the ED.

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7
Q

Chemical Restraint

Adult - Adverse Reaction to Ketamine

A
  • Hypersalivation: Administer ATROPINE 0.5mg IV/IM/IO.
  • Laryngospasm (Stridor): Try the following interventions in the order of: High flow O2, BVM, rapid sequence intubation.
  • Laryngospasm is uncommon and is usually self-limiting. It almost always resolves with high flow O2 or brief ventilation via BVM.
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8
Q

Chemical Restraint

Adult - Rapid cooling for a temperature of greater than ____

A
  • 103 degrees F
    • Apply ice packs to axilla and groin area.
    • COLD NORMAL SALINE: (If available) 1L NS IV/IO, assess lung sounds and blood pressure every 500mL. Maximum 2L.
    • SODIUM BICARBONATE 50 mEq IV/IO, each amp administered slow
    over 2 minutes
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9
Q

Chemical Restraint

Adult - Special considerations for Ketamine:

A

For these patients give 200mg IM Ketamine

  • Over 65 years of age
  • Head Trauma
  • <50kg (110lbs)
  • Other sedatives on board (Benzodiazepines or alcohol)

May repeat 3x prn in 5 min intervals to gain control of the patient.

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10
Q

Pain Management

Information

A

When administering pain medications continuously monitor the ECG. Maintain the SpO2 at 95% and the EtCO2 between 35-45 mmHg. Monitor patient’s blood pressure and
respirations prior to and after administering Fentanyl and/or Ketamine. Pain management can be administered to all patients complaining of pain with the exception of pregnant women near term (32 weeks or greater) or in active labor.

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11
Q

Pain Management

Adult

A

• Fentanyl is the front line medication for pain, however Ketamine is preferred for
hypotensive patients or patients who have opiate contraindications (allergy, history of abuse, etc.)

  • FENTANYL: 100mcg slow IV/IO/ IM/IN. May repeat once AFTER 5 minutes prn. Max
    total dose 200mcg.
  • Monitor patient for respiratory depression.
  • Discontinue if patient becomes drowsy.
  • To reverse respiratory depression or chest wall rigidity: NARCAN -as per protocol
    • Administer Zofran 4mg for treatment of nausea and vomiting secondary to
    Fentanyl.
    • ZOFRAN: 4mg IM, or slow IV/IO/PO over 2 minutes prn nausea/vomiting secondary to
    Fentanyl administration. Max dose 4mg.
    • Nitrous Oxide:
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12
Q

Pain Management

Adult - For continued pain management

A
  • Ketamine should be given after Fentanyl max dose for severe pain.
  • KETAMINE: 25 MG IV/IO/IM. May repeat 2x every 5 minutes prn. Max total dose 75mg..

IO INFUSION PAIN MANAGEMENT: (1%lidocaine=10mg/ml)
-LIDOCAINE: 40mg IO over one minute (FOR PT GREATER THAN 20KG). Allow Lidocaine to dwell in IO space for one minute and flush with NORMAL SALINE 10mL. May administer
additional LIDOCAINE: 20 mg IO over one minute prn.

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13
Q

Pain Management

Pediatric

A

• FENTANYL: 1mcg/kg slow IV/IO OVER 2 MIN May repeat every 5 mins prn. Max single dose 100mcg. Max total dose 200mcg. (SEE
PEDIATRIC MEDICATION TOOL)

• FENTANYL: 1.5mcg/kg IN/IM. May repeat every 5 mins prn. Max
single dose 100mcg. Max total dose 200mcg. (SEE PEDIATRIC
MEDICATION TOOL)

• ZOFRAN: 0.1mg/kg, IM, or slow IV/IO/PO over 2 minutes prn
nausea/vomiting secondary to Fentanyl administration. Max
dose 4mg.

  • Monitor patient for respiratory depression.
  • Discontinue if patient becomes drowsy.
  • Contraindicated in age appropriate hypotension.
  • To reverse respiratory depression or chest wall rigidity, administer NARCAN 0.5mg IV/IO/IM or 1mg IN every 2-3 minutes prn. Max total dose 2mg.
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14
Q

Pain Management

Pediatric - For continued Pain Management (>2 years old)

A
  • Ketamine should be given after Fentanyl max dose for severe pain.
  • KETAMINE: 1MG/KG IM MAX 25 MG See Peds Med Tool
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15
Q

ZOFRAN ADMINISTRATION: If IV access is unobtainable,

A

it is acceptable to administer the IV formulation of Zofran via the PO route to the patient.

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16
Q

Chest Wall Rigidity with Fentanyl administration

A

Fentanyl administration can cause rigidity in the chest wall which can result in difficulty ventilating the patient and respiratory failure. Although rare, it can occur at any age. Administering Fentanyl too
fast can increase the risk. If chest wall rigidity occurs after the administration of Fentanyl, it can be reversed with Narcan.

17
Q

Advanced Airway

Information

A

Once paralytics are administered, the designated Lieutenant or Flight Crew shall be responsible for ensuring an airway is obtained & accompany the patient to the emergency department (excluding air rescue transport).

18
Q

Advanced Airway
Facilitated Laryngoscopy/ Supraglottic airway
- Pediatric -

A

➢ Etomidate: 0.3 mg/kg Max 30 mg SEE PEDIATRIC MEDICATION TOOL

OR

➢ Ketamine: 1 mg/kg SEE PEDIATRIC MEDICATION TOOL

19
Q

Advanced Airway
Facilitated Laryngoscopy/ Supraglottic airway
- Adult -

A

➢ Etomidate: Adults: 30 mg IV/IO one dose

OR

➢ Ketamine Adult: 200mg (Diluted) IV one dose

20
Q

Advanced Airway

All patients shall receive ____ prior to and during the procedure.

A

High flow O2 via Nasal Canula

21
Q

Advanced Airway

Indications for paralytics

A 
• Status Epilepticus
• Multi-System Trauma
• Head Injury / GCS 8 or Less
• Trismus (Lock-Jaw) or clenched teeth
• Burn injuries to the upper
airway
• Flight Crew, SWAT Medic, or
EMS Captains Discretion
22
Q

Advanced Airway

Adult RSI/ RSA

A

INDUCTION FOR AIRWAY CONTROL
• ETOMIDATE: 30mg or 0.3mg/kg IV/IO over 30-60 seconds. May repeat 1x prn.

OR

• KETAMINE: 200mg IV/IO. May repeat 1x prn. Max single dose 200mg.

PARALYTIC (FLIGHT CREW, SWAT Medic, or EMS 17)
• Rocuronium 50-100 mg IV/IO (1.0 mg/Kg)

POST INTUBATION SEDATION/PARALYSIS :
• KETAMINE: 200mg IV/IO as needed to maintain sedation. May repeat 1x prn. Max single
dose 200mg.
• Rocuronium: 50-100 mg IV/IO (1.0 mg/Kg) repeat1x as needed
• Failed Airway: exhaust all options with BVM and supraglottic airway, if unable to
ventilate then perform SURGICAL AIRWAY

23
Q

Advanced Airway

Pediatric - Induction for airway control

A

• ETOMIDATE: 0.3mg/kg IV/IO AS PER PED MED TOOL

OR

• KETAMINE 1mg/kg IV/IO/IM. AS PER PED MED TOOL

PARALYTIC (FLIGHT CREW, SWAT Medics, or EMS 17)
• ROCURONIUM 1 MG/KG IV/IO: AS PER PED MED TOOL

POST INTUBATION SEDATION and PARALYSIS
• Once successfully intubated
• SEDATION KETAMINE: 1mg/kg IV/IO AS PER PED MED TOOL

OR

• PARALYSIS: Rocuronium 1 MG/KG IV/IO AS PER PED MED TOOL

24
Q

Advanced Airway

- Failed Endotracheal intubation:

A

If definitive airway cannot be secured with
two ETT intubation attempts, a IGEL should be inserted. Flight Crew may
perform an additional attempt if necessary.

25
Q

Advanced Airway

- Surgical Airway:

A

If an airway cannot be secured by any other means, and
the patient can not be effectively oxygenated or ventilated, a cricothyrotomy should be performed on adult patients (or needle cricothyrotomy for pediatrics).

BSO EMS Protocols (13 decks)

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