ICEMA Protocols and Skills Flashcards by K K

Shock (non-traumatic) Field Assessment Indicators

Signs and symptoms of shock.
Determine mechanism of illness,
Hx of GI bleeding, vomiting, diarrhea,
Consider hypoglycemia or narcotic overdose.

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Shock (non-traumatic) ALS Interventions

Maintain airway and use appropriate adjuncts.
Monitor,
Trendelenburg,
Fluid Challenge,
BHmayO: Establish 2nd Large Bore IV enroute
BHmayO: Dopamine

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Shock (non-traumatic) Adult Fluid Bolus Indications

Hypovolemic, signs of inadequate tissue perfusion.

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Shock (non-traumatic) Adult Fluid Bolus Dose/Infusion rate

IF hypotensive or S/S of IATP, 500ml IV/IO open. May repeat 1 time to maintain BP >90 or S/S of Adequate Tissue Perfusion. If BP >90, w/ NO signs of respiratory distress AND Signs of Adequate Tissue Perfusion, maintain IV rate of 150ml/hour (15 drops/ml x 150ml)/60min. = 38 drops/min (approx. 3 drops every 5 seconds)

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Shock (non-traumatic) Peds Fluid Bolus Dose/Infusion rate

IF hypotensive and S/S of IATP, 20ml/kg IV/IO. may repeat 1 time if tachycardia, change in central/peripheral pulses, limb temperature transition, or altered level of consciousness.

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15010 Trauma - Adult ALS interventions(list)

Advanced Airway,
Monitor,
IV/IO Access (warm IV fluids when available)
Transport to appropriate hospital,
Insert naso/orogastric tube as indicated.

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15010 Trauma - Adult Manage Special Considerations(list)

Axial Spinal Immobilization,
Chest Trauma,
Fractures,
Head and Neck Trauma,
Base Hospital Orders,
Impaled Object,
Traumatic Arrest.

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15010 Trauma - Adult, Axial Spinal Immobilization Indicators

Neuro Deficits,
Spinal Tenderness,
ALOC,
Intoxicated,
Distracting Injury.

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15010 Trauma - Adult. How to perform spinal immobilization

Consider maintaining spinal alignment on gurney without use of rigid spine board.

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15010 Trauma - Adult. Isolated Extremity Trauma treatment.

Includes trauma to appendicular skeleton (shoulder or pelvic girdle.
Fentanyl,
Zofran,
250ml NS IV for patients in high altitude, prior to pain medication to reduce nausea, vomiting, and transient hypotension.

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15010 Trauma - Adult Head and Neck Trauma consideration

Consider Lidocaine immediately prior to Intubation

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15010 Trauma - Adult Base Hospital Orders consideration

When considering Nasal Tracheal intubation for pt’s with significant trauma to face, nose, and/or possible basilar skull fracture.

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15010 Trauma - Adult Impaled Object consideration

May be removed with BHO if indicated

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15010 Trauma - Adult Determination of death on scene for a penetrating trauma full arrest who does not meet “Obvious Death Criteria.”

Contact Trauma Base Hospital If patient has documented asystole in at least 2 leads and no reported vital signs (palpable pulse/spontaneous respirations) during EMS encounter.

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15010 Trauma - Adult Precautions and Comments: Electrical Injuries resulting in full arrest

Shall be treated as medical arrests.

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15010 Trauma - Adult Precautions and Comments: Older Patients in Full Arrest

Consider cardiac etiology with low probability of mechanism of injury.

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15010 Trauma - Adult Precautions and Comments: Unsafe Scene

May warrant transport despite low potential for survival

15010 Trauma - Adult Precautions and Comments: Crime Scene

Whenever possible, consider minimal disturbance of potential crime scene.

15010 Trauma - Adult BLS Amputations protocol

Rinse with Sterile Saline, wrap in sterile gauze, place in bag, place bag in ice if available.

15010 Trauma - Adult BLS Partial amputation protocol

Splint limb in anatomical position and elevate extremity.

15010 Trauma - Adult BLS Grossly angulated long bone w/ distal neurovascular compromise

Apply gentle unidirectional traction to improve circulation

15010 Trauma - Adult BLS Genital Injuries

Place moist gauze bandage. apply pressure to control bleeding if necessary. treat amputations as extremity amputations.

15010 Trauma - Adult BLS Brain Injury

Brain injury; place in reverse trendelenburg if no signs of shock.

15010 Trauma - Adult BLS Eye trauma

protect an injured eye with eye shield, rigid dressing, or cup. stabilize partially torn globe with sterile saline soaked gauze. Do not attempt to replace.

15010 Trauma - Adult BLS Avulsed tooth

Wrap in moist sterile saline gauze and place in plastic bag.

15010 Trauma - Adult Pregnant w/ spinal stabilization precaution.

Elevate right side of board at least 4 inches for large pregnant uterus. usually >24 weeks.

15030 Trauma Triage Criteria - Physiological Indicators of TC Base Hospital Contact and transport to TC.

``` GCS < 14, RR < 10 or > 29 (Adult) RR < 20 (Infant < 1 yr.) or need for ventilatory support. BP < 90 (Adult) Tachycardia (Adult) IATP (Ped) Abnormal VS (Ped) ```

15030 Trauma Triage Criteria Anatomic Indicators

Penetrating Trauma to Head, Neck, or Torso and extremities proximal to knee or elbow, Blunt Trauma to Chest w/ deformity/instability, Pelvic fracture, 2 or more proximal long bone fractures, Depressed or open skull fracture, Amputation proximal to wrist or ankle, Crushed, Degloved, Mangled, or pulseless extremity, Paralysis.

Mechanism of Injury Falls and High Risk Auto Crash

>20 feet (Adult) > 10 feet or 2 to 3 times the heigh of a child. Intrusion >12 inches into occupant site, Ejection (partial or complete) from automobile, Death in same passenger compartment, Vehicle Telemetry Data consistent with high-risk injury

Mechanism of Injury Auto versus pedestrian/bicyclist and Motorcycle crash

Pedestrain/Bicyclist thrown, run over, >20mph impact. Motorcycle crash >20mph.

If there is only an MOI indication w/o Physiologic or Anatomic Indicator?

Make TC Base Hospital Contact for destination determination.

Age and Co-Morbid Factors, Older Adults >65, and Children

Risk of injury/death increases, SBP < 110 may represent shock, Low impact mechanism may result in severe injury Pediatric should be transported to Pediatric Trauma center if difference is less than 20 minutes from nearest trauma center.

Age and Co-Morbid Factors, Anti-coagulants/bleeding disorders, Burns, Pregnancies,

Patients are at high risk for rapid deterioration (Anti coagulants/bleeding disorders). Burns with trauma mechanism transport to Trauma Center and make Trauma Base Hospital Contact. Pregnancy >20 weeks.

Exceptions for TC transport for pt who meets Trauma Triage Criteria (list of considerations)

``` Unmanageable Airway, Severe Blunt Force Trauma Arrest, Penetrating Trauma Arrest, Burn Patients, EMS Aircraft Indications EMS Aircraft Contraindications Remote Locations ```

Unmanageable Airway Trauma Triage Exception

Adequate airway unable to be maintained with BVM, including unable or not indicated to perform a needle cricothyrotomy, Transport pt. to NRH.

Severe Blunt Force Trauma Arrest Triage Exception

Severe blunt force trauma, pulseless, w/o signs of life, and cardiac electrical activity less than 40 bpm. pronounce on scene if indicated.

Penetrating Trauma Arrest Triage Exception

Contact Trauma Center Base Hospital(TCBH) if pt does not meet "Obvious Death Criteria." and has asystole in 2 leads and no reported vital signs (palpable pulse or spontaneous respirations.) Do not terminate w/o TBHC. If indicated, transport to the NRH.

Burn Patients Trauma Triage Exception

Transport to Trauma Center if Trauma mechanism is present, otherwise transport to nearest or burn center as indicated.

EMS aircraft indications

MCI, Prolonged Extrication >20 minutes Do Not delay patient transport waiting for aircraft Utilize the Hospital as the landing zone or rendezvous point. RSI, Pericardial Centesis.

EMS Aircraft Transport Contraindications

Patients contaminated with Haz Mat who cannot be decoded and who pose a risk to safe operation of EMS aircraft and crew, Violent Pts with psychiatric behavioral problems, uncooperative patients under influence of drug/alcohol who may interfere with safe operation. Stable Patients Ground transport <30 minutes Traumatic Cardiac Arrest Other considerations determined by pilot or crew.

Remote Locations

Remote locations may be exempted from specific criteria with written permission from the ICEMA Medical Director.

Radio Contact for patient refusing assessment, care and/or transportation

If pt meets all Trauma Triage Criteria (Physiological, Anatomical, MOI, and/or age and co-morbid factors) TBHC shall be made