Important Things to Study Flashcards by Rion Commerford

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

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Pediatric Intubation Cutoff

The pt must appear to be above the age of 8

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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

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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

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Blunt Trauma Arrest Destination

Closest receiving facility

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Penetrating Trauma Arrest Destination

Closest trauma center if bypassing closest receiving increases transport time by no more than 10 minutes

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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

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Do’s and Don’t’s for VAD pt’s

NO NTG
YES chest compression
YES cardioversion/pacing/defib
NO BP

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Do’s and Don’t’s for TAH pt’s

YES NTG for SBP>140
NO chest compressions
NO electircal therapy
YES BP

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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)

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Flow for hypothermia

Remove from cold
Active warming
Baseline temp
BGL
Warm IV fluids
Fentanyl 50 mcg x 2

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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

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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)

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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)

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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 &amp; 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)

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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 ```