Protocols Flashcards
Abdominal Discomfort GI/GU (non traumatic) - (S-120)
- BLS
Ensure patent airway
02 saturation prn
02 and/or ventilation prn
Transport suspected symptomatic aortic aneurysm to facility with surgical resources immediately available
Abdominal Discomfort GI/GU (non traumatic) - (S-120)
- ALS (general)
- Monitor EKG
- IV/IO SO, adjust prn
- Treat pain as per Pain Management Protocol (S-141)
….. (extra credit):
- Suspected Volume Depletion:
500 ml fluid bolus IV/IO - SO
- Suspected AAA:
500 ml fluid bolus IV/IO - SO; for BP<80 to maintain BP of 80, MR (may repeat) 1x SO
- For nausea or vomiting:
Zofran 4mg IV/IM/ODT - SO; MR 1x q 10’ SO
RUQ (right upper quadrant) of abdomen: what organs?
Small bowel Ascending colon Transverse colon Liver Gallbladder Head of pancreas
RLQ (right lower quadrant) of abdomen: what organs?
Small bowel
Ascending colon
Appendix
R ureter
LUQ (left upper quadrant) abdominal: what organs?
Small bowel Descending colon Transverse colon Stomach Spleen Body of Pancreas
LLQ (left lower quadrant) abdominal: what organs?
Small bowel
Descending colon
L ureter
Common causes of abdominal pain in RUQ
AMI, appendicitis, CHF, duodenal/gastric ulcer, gastritis, hepatitis, hepatomegaly, herpes zoster, pancreatitis, pericarditis, pneumonia, cholecystitis
Common causes of abdominal pain in LUQ
AMI, aortic dissection, gastritis, herpes zoster, lower lobe pneumonia, pericarditis, splenic rupture, Ulcer, pancreatitis
Common causes of abdominal pain in RLQ
Appendicitis, endometriosis, hernia, intestinal obst., kidney stones, ovarian cyst, PID, pyelonephritis, ruptured ectopic pregnancy, UTI
Common causes of abdominal pain in LLQ
AAA, appendicitis, diverticulitis, endometriosis, intestinal obst., kidney stones, ovarian cyst, PID, pyelonephritis, ruptured ectopic pregnancy, UTI
Common causes of abdominal pain: Epigastric
AMI, aortic aneurysm, appendicitis, esophageal disease, gastroenteritis, heartburn, ulcer
Common causes of abdominal pain, Midline
Aortic aneurysm, bladder/UTI, early appendicitis, intestinal disease, uterine disease
Common causes of abdominal pain, Diffuse
Appendicitis, diabetes, dissecting/ruptured aortic aneurysm, gastroenteritis, intestinal obstruction, ischemic bowel, pancreatitis, peritonitis, sickle cell crisis
Common causes of abdominal pain, FLANK
Diverticulitis, kidney stones, pyelonephritis
Common causes of abdominal pain, SHOULDER
Abdominal aortic aneurysm, ectopic pregnancy, splenic rupture
Common causes of abdominal pain, BACK
AMI, aortic aneurysm, cholecystitis, diverticulitis
Airway Obstruction (foreign body): S-121
BLS protocol
For a conscious patient:
- reassure, encourage to cough
- 02 prn
For inadequate air exchange:
- abdominal thrusts
- use chest thrusts for obese or pregnant patients
If patient becomes/found unconscious:
- begin CPR
Once obstruction is removed:
- high flow 02, ventilate prn
- 02 saturation prn
Airway Obstruction (foreign body): S-121
ALS protocol
If patient becomes unconscious or has a decreasing LOC:
- direct laryngoscopes and Magill forceps SO - MR prn
- capnography SO prn
Once obstruction is removed:
- monitor/EKG
- IV/IO SO adjust prn
Note: if unable to secure airway, transport STAT
Airway Obstruction (foreign body) - S-121: Respiratory Disease Chart
Asthma
Lung Sound: wheezing, diminished
S/S - other: Hx allergies/asthma. Taking bronchodilators. Episodic
Airway Obstruction (foreign body): S-121 Respiratory Disease Chart
Bronchitis
Lung Sound: Wheezing; crackles
S/S-others: recent respiratory tract infection. Smoker. Productive cough
Airway Obstruction (foreign body): S-121
Respiratory Disease Chart
CHF (pulmonary edema)
Lung Sound: crackles (rales); wheezing; dismissed
S/S-other: Hx CHF, MI, HTN. Taking diuretics. Gradual onset, orthopedic. JVD, pedal edema. R/O aspiration/infection
Airway Obstruction (foreign body): Respiratory Disease Chart
COPD (emphysema)
Lung sounds: Wheezing/diminished
S/S-other: smoker, barrel chest, chronic cough. On home 02. Exertional
Airway Obstruction (foreign body): Respiratory Disease Chart
Hyperventilation
Lung sounds: Clear
S/S-other: hand/face numbness, hand cramping. R/O cause: PE, shock, sepsis, OD etc.
Airway Obstruction (foreign body): Respiratory Disease Chart
Obstruction:
Lung Sound: stridor - inspiratory
S/S-other: anxious, hoarse, cough, cyanosis, drooling, pain
Airway Obstruction (foreign body): Respiratory Disease Chart
Pneumonia
Lung Sounds: Scattered; Crackles; Rhonchi
S/S-other: fever. Taking antibiotics. C/P. Cough/sputum: brown, green, yellow
Airway Obstruction (foreign body): Respiratory Disease Chart
Pneumothorax
Lung Sounds: decreased/absent on affected side, or clear bilaterally.
S/S-other: spontaneous or traumatic. Sudden onset of pain typically pleuritic. Acute= hypotension, tracheal deviation
Airway Obstruction (foreign body): Respiratory Disease Chart
Pulmonary Embolism
Lung Sounds: Clear
S/S-other: tachypnea, tachycardia, pain, dyspnea on exertion (sudden onset). 02 sat low with oxygen and good ventilations
Allergic Reaction/Anaphylaxis: S-122
BLS
- ensure patent airway
- 02 saturation prn
- 02 and/or ventilation prn
- Remove stinger/injection mechanism
- May assist patient to self-medicate own prescribed epinephrine auto-injector or MDI 1X ONLY. Base hospital contact required prior to any repeat dose
- If available & trained:
Epinephrine auto-injector 0.3mg IM x1
Allergic Reaction/Anaphylaxis: S-122
ALS
- Monitor EKG
- IV/IO SO Adjust prn
- capnography SO prn
Hives (Urticaria):
- Benadryl 50mg IV/IM SO
ANAPHYLAXIS:
Anaphylaxis:
- Epinephrine 1:1,000 0.3mg IM per SO. MR x2 q5 min SO
…then
- 500ml fluid bolus IV/IO for systolic BP <90 SO
MR to maintain systolic BP ≥ 90. SO - Benadryl 50mg IM/IV SO
- Albuterol 6ml .083% via nebulizer SO
MR SO for respiratory involvement - Atrovent 2.5ml .02% via nebulizer added to the first dose of Albuterol SO for respiratory involvement
- Epinephrine 1:10,000 0.1mg IV/IO BHO. MR x2 q3-5 min BHO
- Dopamine 400mg/250ml @ 10-40 mcg/kg/min IV/IO drip.
Titrations systolic BP ≥ 90 BHO
Anaphylaxis criteria (may include any):
- Unknown exposure: Skin and respiratory and/or cardiovascular
- Likely allergen exposure - e.g. bee sting, peanut,: 2/4 systems involved (skin, GI, respiratory, cardiovascular)
- Known allergen exposure
Angioedema:
- lip/tongue/face swelling; difficulty swallowing/throat tightness; hoarse voice
Abdominal Discomfort GI/GU (non traumatic): S-122
for suspected volume depletion?
500 ml fluid bolus IV/IO SO
Abdominal Discomfort GI/GU (non traumatic): S-120
For suspected AAA
500 ml fluid bolus SO for BP < 80 to maintain a BP of 80, MR x1 SO
Abdominal Discomfort GI/GU (non traumatic): S-20
For nausea or vomiting
Zofran 4mg IV/IM/ODT SO; MR x1 in 10” SO
Airway obstructio, BLS: S-121
for Conscious patient
- Reassure, encourage coughing
- 02 prn
Airway obstruction, BLS: S-121
for inadequate air exchange?
- Abdominal thrusts
- chest thrusts for obese or pregnant patients
Airway obstruction, BLS: S-121
after obstruction is removed?
- High flow 02, ventilate prn
- 02 saturation prn
Airway obstruction - ALS, S-121
If patient becomes unconscious or has a decreasing LOC?
Direct laryngoscopy and direct Magill forceps SO… MR prn
Airway obstruction - ALS, S-121
after obstruction is removed?
- Monitor EKG
- IV/IO SO adjust prn
Allergic Reaction/Anaphylaxis: BLS, S-122
how many times can we assist/give epinephrine?
What dose?
(1x - Base Hospital Contact required for any repeat dose
.3 mg IM)
- “May assist patient to self-medicate own prescribed epinephrine auto-injector or MDI, ONE TIME ONLY. Base Hospital contact required prior to any repeat dose
Allergic Reaction/Anaphylaxis, S-122: ALS
For Hives?
Benadryl 50 mg IV/IM SO
Allergic Reaction/Anaphylaxis, S-122: ALS
Initial dose of epinephrine?
Epinephrine 1:1,000 .3 mg IM … MR x2 q 5 min SO
Allergic Reaction/Anaphylaxis, S-122: ALS
Fluids and reason
500 ml fluid bolus IV/IO SO for systolic BP < 90 SO
… MR to maintain systolic BP ≥ 90. SO
Allergic Reaction/Anaphylaxis, S-122: ALS
how much Albuterol?
Albuterol 6ml .083% via nebulizer SO.. MR SO for respiratory involvement
Allergic Reaction/Anaphylaxis, S-122: ALS
How much Atrovent
Atrovent 2.5ml .02% via nebulizer added to the first dose of Albuterol for respiratory involvement
Allergic Reaction/Anaphylaxis, S-122: ALS
Secondary dose of epinephrine?
Epinephrine 1:10,000 - .1m mg IV/IO BHO. MR x2 q3-5 min BHO
Allergic Reaction/Anaphylaxis, S-122: ALS
Dopamine?
Dopamine 400 mg/250ml @ 10-40 mcg/kg/min IV/IO drop
Titrate systolic BP ≥90 BHO
Allergic Reaction/Anaphylaxis, S-122: ALS
Anaphylaxis Criteria?
- Unknown exposure: Skin AND Respiratory AND/OR Cardiovascular
- Unknown Allergen Exposure: (e.g. bee sting; peanut) 2/4 systems involved (skin, GI, respiratory, cardiovascular)
- Known Allergen Exposure
Allergic Reaction/Anaphylaxis, S-122: ALS
Angioedema:
Lip/tongue/face swelling; difficulty swallowing; throat tightness; hoarse voice
Altered Neurologic Function (non-traumatic), S-123:
BLS
Symptomatic suspected opioids OD (w/ respiratory rate <12):
*use caution in opioid dependent pain management patients
- Naloxone nasal spray - 4mg - preloaded single dose device
- administer full dose in one nostril
…. OR….
- Naloxone assemble - 2mg- syringe and atomizer
- administer 1mg (1ml) into each nostril
Altered Neurologic Function (non-traumatic), S-123:
BLS:
Hypoglycemia (suspected) or patient’s glucometer reads <60:
- if patient is conscious and able to swallow: give 3 glucose tabs or paste (15g total). Patient may eat or drink, if able.
- If patient is unconscious: NPO
Altered Neurologic Function (non-traumatic), S-123:
BLS:
CVS/Stroke:
See S-144, Stroke/Transient Ischemic Attack (TIA) for details
Altered Neurologic Function (non-traumatic), S-123:
BLS
Seizures:
- protect airway; protect from injury
- treat associated injuries
Altered Neurologic Function (non-traumatic), S-123:
BLS
Behavioral Emergencies:
Behavioral Emergencies (S-422 and S-142)
Altered Neurological Function (non-traumatic), S-123:
ALS
General:
- monitor EKG
- Capnography SO prn
- IV/IO SO adjust prn
- monitor blood glucose prn SO
Altered Neurological Function (non-traumatic), S-123:
ALS
Symptomatic suspected opioids OD (with respiratory rate <12)
- use caution in opioid dependent pain management patients
- Naloxone .2mg IN/IM/IV, SO. MR SO; Titrate IV dose to effect, to drive respiratory rate
- If patient refuses transport, give additional Naloxone 2mg IM, SO
Altered Neurological Function (non-traumatic), S-123:
ALS
Hypoglycemia: symptomatic patient with altered LOC or unresponsive to oral glucose agents:
- D50 25Gm IV, SO if BS <60
- MR SO if patient remains symptomatic and BS is still <60
- IF NO IV and BS <60: Glucagon 1ml IM, SO
Altered Neurological Function (non-traumatic), S-123:
ALS:
Hyperglycemia:
Symptomatic patient with diabetic history:
- 500 ml fluid bolus IV/IO if BS ≥350 or reads high, SO x1
Altered Neurological Function (non-traumatic), S-123:
ALS
Seizures:
A: ongoing generalized seizures lasting ≥5 minutes (includes seizure time prior to arrival of prehospital provider), SO
B: Recurrent tonic-clinic seizures without lucid interval, SO
C: Eclamptic seizure of any duration, SO
- Versed IN/IM/IV/IO, SO to a max dose of 5mg (d/c if seizure stops) SO; MR x1 in 10 minutes SO; Max 10mg total.
BURNS (S-124): general BLS
- Move patient to safe environment
- Break contact with causative agent
- Ensure patent airway, 02 and/or ventilate prn
- 02 saturation prn
- Treat other life threatening injuries
- Carboxyhemoglobin monitor prn, if available
BURNS (S-124): BLS thermal burns:
- Do not allow patient to become hypothermic
Burns of <10% body surface area:- Stop burning with non-chilled water or saline
Burns >10% body surface area: - cover with DRY dressing and keep warm
- Stop burning with non-chilled water or saline
BURNS (S-124): BLS - Toxic Inhalation (CO exposure, more, gas, etc)
- Move patient to safe environment
- 100% 02 via mask
For suspected CO poisoning for unconscious or pregnant patient: - Consider transport to facility with hyperbaric chamber
BURNS (S-124): BLS- Chemical Burns
- Brush off dry chemicals
- Flush with copious amounts of water
BURNS (S-124): BLS - Tar Burns:
- Cool with water, transport; do not remove tar
BURNS (S-124): ALS, general
- Monitor EKG
- IV/IO SO adjust prn
- Treat pain as per Pain Management Protocol (S-141)
BURNS (S-124): ALS
For patients with ≥20% partial thickness or ≥5% full thickness burns and ≥15 yrs old:
- 500 ml fluid bolus IV/IO then TKO, SO
BURNS (S-124): ALS
In the presence of respiratory distress with bronchospasm:
- Albuterol 6ml .083% via nebulizer, SO. MR SO
BURNS (S-124):
Base Hospital Contact and Transport (per S-415):
Will be made to UCSD Base Hospital for patients meeting burn center criteria
BURNS (S-124):
Burn Center Criteria:
Patients with burns involving:
- ≥20% BSA partial thickness or
- ≥5% BSA full thickness
- Suspected respiratory involvement or significant smoke inhalation in a confined space
- Injury of the face, hands, feet, or perineum, or circumferential
- Electrical injury due to high voltage; (greater than 120 volts)
BURNS (S-124):
“Rule of Nines”… adult
Head: 9
Left arm: 9
Right arm: 9
Front torso: 18
Back torso: 18
Left leg: 18
Right leg: 18
Groin: 1
BURNS (S-124)
“Rule of Nines” - child
Left Arm: 9
Right arm: 9
Head: 18
Front: 18
Left Leg: 14
Right Leg: 14
Groin: 1
BURNS (S-124):
“Rule of Palms”
The surface of the patient’s palm represents approx. 1% of body surface area and is also helpful in estimating BSA
