Important Things to Study Flashcards
12 Situations That Require Base Hospital Contact Prior to Transport
Critical Trauma
Critical Burn
Fracture or dislocation with neuro and/or vascular compromise
MCI
STEMI
Stroke
Symptomatic Brady/Tachy or ROSC
VAD pt
Pre-eclampsia/Eclampsia/Childbirth complications/neonatal resuscitation
ALTE
Sexual Assualt
Provider uncertainty
Pediatric Intubation Cutoff
The pt must appear to be above the age of 8
6 Reasons to Discontinue Resuscitation Prior to Transport (Must meet all 6)
Medical (non-traumatic) pt
Unwitnessed arrest
No shock indicated
Resuscitation has been attempted for 20 minutes without ROSC
Persistent PEtCO2 less than 15 mmHg
Persistent aystole/agonal rhythm/ PEA<10
9 Reasons Not to Attempt Resuscitation
MCI pt remains apneic after airway positioning
Pulseless/Apneic with rigor or lividity
Decapitation
Generalized decomposition or incineration
Separation of brain/heart/lungs from body
Total abdominal evisceration
Complete transection of torso
Valid DNR
Blunt trauma arrest w/ persistent asystole/agonal rhythm/PEA<40
Blunt Trauma Arrest Destination
Closest receiving facility
Penetrating Trauma Arrest Destination
Closest trauma center if bypassing closest receiving increases transport time by no more than 10 minutes
Critical burn criteria (5)
2nd degree > 30%
3rd degree > 10%
2nd or 3rd degree involving face, feet, hands, genitals/perineum, major joints, fractures or circumferential burns
High voltage electrical burns
Burns with significant pre-existing medical conditions
Do’s and Don’t’s for VAD pt’s
NO NTG
YES chest compression
YES cardioversion/pacing/defib
NO BP
Do’s and Don’t’s for TAH pt’s
YES NTG for SBP>140
NO chest compressions
NO electircal therapy
YES BP
Flow heat illness hyperthermia
Remove from heat Active cooling Baseline temp BGL Cool IV fluids 250mL NS Repeat Temp Nebulized Albuterol 2.5mg (BHO) Calcium Chloride 1g IV(BHO) Midazolam 2.5mg IV (BHO) Bicarb 50mEq IV (BHO)
Flow for hypothermia
Remove from cold Active warming Baseline temp BGL Warm IV fluids Fentanyl 50 mcg x 2
Flow for ACS
ASA 324mg PO (NO PEDS)
NTG 0.4mg spray or Tab x 3 every 3 to 5 min(NO PEDS)
NTG paste 1g TD (NO PEDS)
Fentanyl 50mcg x 2
Make STEMI center contact before transport if indicated
Flow for Symptomatic tachy w/ pulses
Make Base prior to transport IV (large bore AC) 250 mL NS Vasalva Adenosine 12mg IV Rapid with 20mL rapid saline flush (BHO PEDS) Midazolam 2.5 mg IV/IN x 2 (BHO PEDS) Synchronised cardioversion 100j, 150j, 200j (BHO PEDS) Amiodarone (BHO) Lidocaine (BHO)
Flow for symptomatic brady w/ pulses
Make base prior to transport
IV
Atropine 0.5mg IV x 6 (BHO PEDS)
Midazolam 2.5 mg IV/IN 5mg IM x 2 (BHO PEDS)
TCP begin at 70BPM and 20mA minimum current to gain capture, increase bpm by 10 until perfusion increases max 100bpm (BHO PEDS)
Fentanyl 50mcg IV x 2 (BHO PEDS)
Epinephrine for peds (BHO)
Flow for cardiac arrest
CPR Defibrillate if indicated ETCO2 IV Epi 1:10,000 1mg IV every 3-5 x 5 Amiodarone 300mg IV for V-Tach/Fib repeat 150mg IV (BHO PEDS) H's & T's Bicarb 50mEq IV x 2 for extended down time suspected hyperK (BHO PEDS) ROSC care or discontinue if indicated Atropine (BHO) Calcium (BHO) Lidocaine (BHO) Magnesium (BHO) Fentanyl (BHO)
Flow for Neonatal Resuscitation
Dry, stimulate, swaddle PPV CPR BASE CONTACT SPO2 D10 (BHO) Narcan (BHO) Epi (BHO) Bicarb (BHO)
Flow for respiratory distress
Nebulized albuterol 2.5mg Nebulized atrovent 0.5mg mixed with albuterol CPAP, start at 5 work up by 2.5 max 15 (NO PEDS) Midazolam 2.5 mg IV/IN 5 mg IM (NO PEDS) NTG 0.4mg SL x3 every 3-5 (NO PEDS) NGT 1g TD (NO PEDS) Epi 1:1,000 IM (BHO) 20 CM CPAP (BHO)
Flow for Hypoglycemia with AMS
Protect airway
Glucose Gel PO if able to maintain airway
IV
D10 25g IV for BGL<80 adults <70 peds with AMS repeat as needed
Glucagon 1mg IM when unable to administer D10
Glucose Gel PO when unable to administer D10 or Glucagon
Flow for Seizures
Protect from injury Cooling for febrile infants BGL Make base contact Midazolam 2.5mg IV/IN or 5mg IM x 2 for status
Flow for Stroke
Protect airway Prevent injury BGL Scene time<10 mins Base contact LKWT Cincinnati
Flow for N/V
Zofran 4 mg IV/IM/ODTx3 (broselow red and smaller BHO for ODT)(Broselow white and smaller BHO for IV/IM)
Flow for Anaphylaxis
Remove allergen Benadryl 50mg IM or slow IV Epinephrine 1:1,000 0.3mg IM NS 250mL for shock Nebulized Albuterol 2.5mg for bronchospasm
Flow for Overdose Adverse Reaction
BGL
Narcan 2mg IM/IN or IV/IO repeat as needed
Benadryl 50mg IM or slow IVP for dystonia
Activated Charcoal 50g PO (BHO)
Calcium 1g in 50mL NS over 10min (BHO)
Glucagon 1mg IV/IM (BHO)
Bicarb 50mEq IV (BHO)
Flow for Excited Delirium
Restrain
Cooling measures if hyperthermia suspected
Midazolam 5mg IM x 2
NS 250mL
Bicarb 50mEq IV (BHO) suspected metabolic acidosis
Flow for toxic exposure
Remove toxin Identify toxin Nebulized Albuterol 2.5mg for bronchospasm Milk or water (BHO) Activated charcoal 50g PO (BHO) Calcium (BHO) Magnesium (BHO)
Flow for Eclampsia
Maintain calm, dark environment LLR position BGL Magnesium Sulfate 5g in 50mL over 10min IVPB Midazolam 2.5mg IV/IN or 5mg IM (BHO)
Physiologic Trauma Center Transport Criteria (5)
GCS less than or equal to 13 SBP<90 Resp. rate less than 10 greater than 29 or BVM Geriatric SBP<100 Infant resp. rate<20
Anatomic Trauma Center Transport Criteria (10)
Open/depressed skull fracture Penetration of head/neck/torso/proximal extremity Chest wall instability/deformity Abdominal tenderness Suspected pelvic fracture New onset paralysis Two or more proximal long bone fractures Crushed/degloved/mangled/pulseless extremity Trauma with burns Amputation proximal to wrist or ankle
MOI Trauma Center Transport Criteria (8)
Fall- adult 15 ft or greater Fall- Peds>10 feet or 3 times height Auto vs. Ped or bicycle > 20mph Motocycle crash > 20mph Ejection from vehicle Death in same vehicle Intrusion including roof > 12" occupant site Intrusion including roof > 18" anywhere
Trauma Base Hospital Contact Criteria (7)
Geriatric Pediatric Blood thinners Pregnancy > 20weeks MVC > 40mph LOC reported Provider judgement
