Protocols Flashcards
0070 Who can we not refuse?
- Suicidal
- Homicidal
- AMS
- Unable to care self
0070 What makes a person a patient?
- Under 18 years old
- Lacks decision making capability
- Acute illness/injury/intoxication based on appearance
- Person has a complaint
- 3rd party caller indicates individual is ill, injured, disabled
8090 What situations to apply a C collar and ask not to move neck? (if none present, no C collar needed)
- Midline CTL spine tenderness on palp
- Neurologic complaints/deficits (sensory and weakness changes included)
- Distracting injuries
- Mentation changes/drugs or EtOH
- Barrier to evaluate for spinal injury (language or developmental)
- Provider judgement for spinal injury
8090 When to use backboard (full spinal motion restriction)? And when to not?
Any qualifier for C collar PLUS
- neurological deficit
Do not do if
- Patient ambulatory on arrival
- Patient can lay comfortably still and comply with instructions
8090 Pediatric considerations for C - spine: can you use a car seat for spinal motion restriction?
No
8090 Pediatric considerations for C spine - Apply spinal motion restriction (backboard) if any of the following are also present in a peds patient :
- Patient not moving neck
- Numbness and weakness
- Torso or pelvic instability
- High impact diving injury
8090 Pediatric consideration in C spine - What to apply in peds to better fit on backboard?
Padding under shoulders to prevent flexion of neck
8090 If a child can provide reliable history, is spinal motion restriction required?
No
8090 If C collar, for whatever reason, cannot be used, what should you do?
Use foam, towels, etc to reasonably prevent movement. DOCUMENT.
8090 Over what age are patients at higher risk of spinal injuries, even at ground level fall?
65 yoa
8090 Is cervical collar indicated in isolated penetrating neck trauma?
No
4080 Specific information to obtain for overdose/poisoning
- Type of ingestion
- What, when, how much?
- Bring poison, container, medication, questionable substances to ED
- Note actions taken by bystanders or patient (induced emesis, antidote, etc)
4080 What is key to overdose management?
SUPPORTIVE CARE
4080 Stimulant toxidrome signs, treatment
- Tachycardia, HTN, agitation, sweating, psychosis
- Bezos for severe symptoms
4080 Tricyclic antidepressant signs, treatment
- Wide complex tachycardia, seizure
Sodium Bicarb when QRS > 100 msec
If intubated, consider hyperventilation to ETCO2 at 25-30mmHg
4080 Organophosphate or nerve agent signs, treatment
- DUMBBELS
- diarrhea, urination, miosis, bronchorrhea, bronchospasms, emesis, lacrimation, laxation, sweating
- Atropine
4080 Calcium Channel Blocker, signs and treatment?
Bradycardia, hypotension, heart block
- Fluids, Calcium and vasopressor infusion for hypotension
- Glucagon
4080 Beta Blocker overdose, signs and treatment?
- Bradycardia, heart block, hypotension
- Fluids, vasopressor infusion, glucagon
4010 Not Persistent AMS - what to consider?
- Determine character of event.
- Consider SEIZURE (postictal), Syncope, and TIA
4010 Persistant AMS, what to consider?
BGL, trial of Narcan. Treat hypoglycemia if present.
4010 Persistant AMS, not hypoglycemic, not narcotics. What next?
Neurologic assessment, LOC and FAST-ED exam.
-Stroke alert if deficits, determine last normal and stroke alert criteria
4010 Causes of AMS
- Head trauma, overdose, hypoxia, hypercapnea, heat/cold emergency, sepsis, metabolic
- Alcohol, drugs, hypoglycemia, stroke
4010 Unexplained AMS - what do you add to diagnostics?
EKG
4140 What is SIRS criteria? How to use in the field?
- Temp < 36C (96.8)
- Temp > 38C (100.4)
- HR > 90 (or tachy for age)
- RR > 20 or mechanical ventilation (or fast for age)
If 2 or more are present, look for hypo-perfusion ANY OF THE FOLLOWING.
- Hypotension for age.
- AMS
- Delayed cap refill AND mottling
- Systolic BP < 90 mmHg
- MAP < 65 mmHg
- Sustained EtCO2 < 25
4140 If SIRS criteria + hypoperfusion present, whats the treatment?
- IV fluid at 30mL/kg, monitor lung sounds for pulmonary edema AND hemodynamics
- 2 large bore IV’s
- Transport to closest facility
- NOTIFY HOSPITAL of sepsis
**Consider epi drip for ongoing hypertension, poor perfuston, or pulmonary edema present (no fluid)
4140 Sepsis considerations for pediatrics
- Use push/pull with 60mL syringe for less than 40kg
- Compensated shock? Think aggressive fluid treatment, up to 60mL/kg
- Normalize vital signs within an hour is goal.
- Hypotension is LATE sign in peds!
4140 Common infection sites with severe sepsis
- Respiratory
- Bacteremia
- Genitourinary (especially females)
- Abdominal
- Device related
- Soft tissue/wound
- CNS
- Endocarditis
6010 Patient is agitated but cooperative, what do you do?
- Address patient concerns, verbally deescalate (RASS +1 or +2)
- Assume medical cause of agitation
- If escalation to RASS +3 or +4, consider restraints, benzo, droperidol.
6010 Patient is agitated and disruptive/dangerous. What to do if they’re agitated, and a danger to self/providers?
- Consider cause of agitation, treat accordingly if possible. If unknown, can justify using either benzo or droperidol.
- Restrain
- Get capno and SpO2 on ASAP (safely)
- Cardiac monitor.
- Repeat dose of sedative after 5 min if still RAS +3 or +4.
- Still agitated? CALL FOR MORE
- Complete post sedation protocol
6010 EXTREME agitation posing serious and probable bodily harm to self/others
Hyperactive delirium
-10 mg Droperidol or 10 mg Versed
(refer to protocol 6011)
6010 What key things to document for agitated combative patients?
- Specifics on actions or behaviors that put us or the patient at risk.
- RASS scale
1130 Indications for restraints:
- Significant impairment and lacks decision making capacity for care
- Violent, combative, unccoperative behavior without response to verbal judo.
- Suicidal, at risk of dangerous behavior to self or us.
- M1 with elopement concern
3040 Treatment for sinus tachycardia?
- Search for and treat underlying condition, i.e. dehydration, fever, hypoxia, hypovolemia, pain
- Consider medical shock
3040 If patient is stable and in a tachyarrhythmia that is not sinus tach, what do you do next?
- Determine if the rhythm is NARROW or WIDE.
3040 Tachyarrythmia, stable, narrow QRS, regular. What to do?
- Start with vagal maneuver.
- Give Adenosine 12 mg RAPIDLY, with additional 12 mg if needed.
- Convert? Repeat 12 lead, monitor.
- Doesn’t convert? Contact base for consult. Monitor. - If at ANY POINT becomes unstable, CONVERT.
3040 Tacchyarrythmia, stable, WIDE and REGULAR. What to do?
- V Tach or SVT with an aberrancy.
- Call in for amiodarone, 150 mg over 10 min in a bolus.
- Regular and polymorphic?
- Torsades de Pointes, consider MAGNESIUM 2 gm IV/IO.
3040 Tachyarrythmia, stable, narrow QRS, irregular. What to do? What rhythm is likely?
- Likely A-fib, A-flutter, MAT.
- NO ADENOSINE. Monitor, cardiovert if they become unstable.
3040 Tachyarrythmia, stable, narrow QRS, regular. What to consider with a pediatric patient?
- Children with stable AVNRT generally remain so and do not need interventions, just monitoring and transport.
3040 Tacchyarrythmia, stable, WIDE and IRREGULAR. What to do?
- Do not give ADENOSINE. Monitor for stability and transport. Cardiovert if needed.
3050 Bradyarrythmias with a pulse. What to do if adequate signs of perfusion present?
- Monitor and transport.
3050 Bradyarrythmias with a pulse, poor perfusion present (AMS, CP, Shock, Hypotension). What to do?
- Epinephrine infusion. 1 mg 1:1,000 in 1000mL bag. Titrate to effect (BP raises).
- Consider Atropine 0.5 mg, max dose of 3 mg.
3050
