Standing Orders

Question 1

Motor Vehicle crash non injury SO

Answer 1

SO
-Contacts greater than 18yo
-No subject complaints of pain or illness or injury
-no obvious injuries
-AO x 4
Do not use SO
-minor under 18 unless parent or legal guardian
Meets inclusion criteria
-understands risks
-No impaired by drugs or alcohol
-Are physically present on scene
-Pts with ANY drug or alcohol consumption
-Pts meeting Level 1 trauma criteria
-Pts with ant reported loss of consciousness

Exclusion-contact medical direction
Inclusion-Document in accordance with agency

Question 2

CHF/Volume Overload Dyspnea SO

Answer 2

Inclusion- History or volume overload(CHF, Renal failure) with increased work of breathing or dyspnea

Order:
Normotensive SBP>90
ALS:
Initiate CPAP 
12-Lead 
IV saline lock 
Nitro:  .4mg SL. Repeat every 5mins to max of 3 doses. Hold if SBP<90

Hypotensive SBP<90
ALS:
Initiate CPAP
12 Lead 
IV saline lock
Dopamine if heart rate <100

-if altered mental status or failure to respond to CPAP, support ventilation will h BVM

Question 3

Asthma/COPD SO

Answer 3

Inclusion: History of respiratory disease (asthma, COPD) wheezing with increased work of breathing

Orders:
BLS
-Albuterol nebulized therapy
Single unit dose. May repeat every 5 mins to a max of three doses

Question 4

Hypoglycemia SO

Answer 4

Initiate Immediate supportive care
O2 >94
FSBS

Inclusions:
Dizziness
Altered level of consciousness 
Diaphoresis 
Syncope 

SO:
BLS
Adult and Peds FSBS <70
-If alert with gag/swallow reflex administer 1tube of oral glucose . May repeat x1
-If altered mental status or absent gag reflex Initiate IV NS/LR
-Newborn with FSBS <40
Place infant to mothers breast or provide oral feeding

Pt may be released if conditions improve and

• current FSBG >100
• responsible adult is present
• further caloric intake is assured
• no clinical finding consistent with acute illness

Question 5

Anaphylaxis/Allergic Reaction SO

Answer 5

Inclusions:
Unstable Allergic Reaction:
-Signs of shock, severe respiratory distress or airway compromise
Exclusion:
-If none of the above, use stable allergic reaction order

Stable Inclusion:

• hives
• sense of dyspnea
• sense of oropharyngeal swelling
• sense of throat tightness

Orders
Unstable: administer Epinephrine 
-adult auto injector >30kgs
-Peds <30kgs
Continue with orders outlined in stable care 

Stable: if stable or following epi admin
-Albuterol nebu therapy
Single unit dose. May repeat every 5 mins to a max of three doses

Question 6

Dyspnea SO

Answer 6

Inclusions:
Dyspnea, cough, tachypnea, or respiratory distress

Exclusions:

• Chest pain -hemorrhage
• smoke inhalation
• absent breath sounds -seizure
• dysrgythmia
• toxic exposure
• trauma

Supportive Care:

• Place pt in pos of comfort
• Obtain vitals
• IV access
• O2 to keep sat >94
• assist ventilations with BVM