SMOs Procedures

Question 1

Nitrous Oxide Administration (81)

Answer 1

Indications (PB&K):
1. Pain from musculoskeletal trauma
2. Non-respiratory burn
3. Kidney stones
Rules:
1. 50/50 with oxygen
2. Monitor pulse ox
3. Self administered by patient
4. NO contraindications
Contraindications:
1. ALOC
2. Shock
3. Severe facial injuries
4. COPD
5. Abdominal trauma
6. Distended abdomen
7. Head injury
8. Pregnant
9. Fire hazard situation

Question 2

External Jugular Vein Cannulation (82)

Answer 2

1. Trendelenburg position
2. Turn head away
3. IV at 30 degrees
4. Secure

Question 3

Decompression of Tension Pneumothorax (83)

Answer 3

1. Oxygen high flow
2. Identify the side that needs decompression (decreased breath sounds)
3. Clean site
4. Introduce the needle into the 2nd intercostal space, directing it perpendicularly over the
   superior aspect of the 3rd rib or 4th intercostal space mid axillary line
5. Insert needle (14g, 1.5in of length) until rush of air sounds
6. Remove needle and leave in catheter
7. Secure
8. Reassess breath sounds

Question 4

Medication Assisted Intubation (84)

Answer 4

Indications:
1. GCS <8
2. Imminent respiratory arrest
3. Imminent tracheal closure
4. Sever chest flail or severe open chest wound with cyanosis and RR >30 or <10
Adult:
1. Versed 5mg IV/IO/IM/IN increments until sedation
-max 10
-2.5mg Versed to maintain sedation
or
Ketamine: 2mg/kg IV/IO/IM/IN
-may repeat x1

Peds:
1. Versed .1mg/kg slow IV/IO q 2 minutes
-max of 5mg
-.15mg/kg if IM
or
Ketamine: 2mg/kg IV/IO/IM/IN
may repeat x1
-Versed .1mg/kg to maintain sedation

Question 5

Adult Airway (85)

Answer 5

ET–BVM–Supraglotic–cric
Able to intubate with ET tube?
Yes= Intubate
No= Able to ventilate with BVM?
Yes=BVM
No= Insert supraglottic device
Able to ventilate with supraglotic device?
Yes= Ventilate
No= Perform needle cric
Transport

Question 6

Needle Cricothyrotomy (86)

Answer 6

1. Attach an empty syringe to a large gauge (14)
2. Locate site and cleanse
3. Puncture cricoid membrane at a 45 degree angle (The plunger of syringe will move freely when the needle has entered the trachea)
4. Remove needle and advance catheter into the trachea
5. reattach syringe and attach the plastic adapter from a #3 ET tube and ventilate
6. Ventilate with 2-3 seconds of inspiration and passive exhalation

Question 7

Transcutaneous Cardiac Pacing (87)

Answer 7

Notes
70bpm

Question 8

Concealed Carry/Firearm (88)

Answer 8

1. Avoid having to transport the weapon
   -If immediate transportation needed, do not delay
   -If patient is stable, may delay until law enforcement arrives

Question 9

Refusal of Care

Answer 9

1. Begin Eval
   Once patient refuses
2. Are they
   -Altered mental status?
   -Altered decision making capacity?
   -Age<18?
   Yes= Deny refusal
   No=
3. Document situation in all cases of refusal and contact medical control
   -Narrative must include:
   –evidence of decision making capacity (A&Ox4)
   –potential consequences
   –alternative care
   –signature of patient (If they refuse to sign, document the situation)
   –Try to get witness signature