TC Protocol ALS Upgrades Flashcards
Universal ALS upgrades
Signs or symptoms of shock
Any blood loss or suspected fluid loss with auscultated systolic BP < 90 mmHg
(or absent radial pulse)
Pulse < 50 or > 130
Unconscious
Status epilepticus
Step 1 or 2 trauma
SOB with RR < 10 or > 32 or noisy or absent lung sounds
Respiratory Distress: accessory muscle use, retractions, altered mental status
Airway compromise or impaired gag reflex
Uncontrollable bleeding
Prolonged extrication (complex forcible entry to vehicle)
Intoxicated Step 3 or 4 trauma patient
abdominal/back pain ALS upgrades
Upper abdominal pain, age greater than 35
Lower abdominal pain, women ages 12-50 with dizziness, syncope or heavy
vaginal bleeding
Abdominal/back pain with syncope or near syncope if age greater than 50
Acutely distended, rigid, or tender abdomen
Unequal or absent femoral pulses
Allergic Reaction ALS upgrades
Patient is presenting with signs and/or symptoms of an anaphylactic reaction
within 1 hour of exposure to an allergen AND has a history of anaphylactic
reaction to this allergen
Difficulty swallowing or swelling in throat, lips, or tongue
Severe abdominal cramps, nausea, vomiting, or diarrhea with urticaria or flushing
Any use of epinephrine (requires ALS transport)
Animal Bites ALS upgrades
Bite from venomous snakes or reptiles
Serious injury to the face or neck
Breathing Difficulty ALS upgrades
Systolic BP greater than 220 or diastolic BP greater than 110 with associated signs or symptoms
Altered or decreased mental status
chest pain/discomfort/heart problems ALS upgrades
Patients presenting with typical or atypical symptoms of Acute Coronary Syndrome
Chest discomfort associated with the use of street drugs
Upper abdominal pain, age greater than 35
Choking ALS upgrades
Inability to speak/cry/cough
Signs or symptoms of anaphylaxis
Diabetic Emergencies ALS upgrades
Altered or decreased mental status
If pt receives caloric supplement
Environmental Emergencies ALS upgrades
Altered or decreased mental status
Rectal temperature less than 95° F or greater than 105° F
Patient very cold to touch without shivering
Headache ALS upgrades
Altered or decreased mental status
Severe or multiple episodes of vomiting
Unequal pupils (greater than 2 mm difference)
Systolic BP greater than 220 or diastolic blood pressure greater than 110
When asked, “How does this compare to other headaches you’ve had?” the
patient states, “This is the worst headache of my life.”
Lateralizing signs
Seizure
mental/emotional/psych ALS upgrade
Violent/combative patient requiring restraint for transportation from the scene to
the hospital
overdose/poisoning ALS upgrade
Polypharmacy
Intentional overdose with prescription meds
Seizure associated with street drug use
Follow recommendation of Washington Poison Center
Pregnancy/OBGYN ALS upgrade
Imminent delivery:
o Contractions 2 min apart (first pregnancy)
o Contractions less than 5 min apart (other pregnancy)
o Urge to push/move bowels
o Crowning or bulging
Recently completed childbirth
Abdominal trauma greater than 20 weeks gestation with uterine contractions
Vaginal bleeding greater than 20 weeks gestation, more than a few streaks
Lower abdominal pain, women age 12 to 50 with dizziness, syncope, or heavy
vaginal bleeding
Infant transfer situation (Appendix D)
BP greater than 160 mmHg systolic or greater than 90 mmHg diastolic
Seizure
Pre-eclampsia
Seizure ALS upgrades
Actively seizing upon arrival of EMS
First time seizure or unknown history
Seizure with pregnancy, street drug use, recent head injury, or abrupt onset of severe headache
Stroke ALS upgrades
Altered or decreased mental status
Uncontrolled nausea/vomiting
Systolic BP greater than 220 with new onset of stroke symptoms
Dysarthria with absent gag reflex
Unconcious/Syncope ALS upgrade
Altered or decreased mental status
Severe abdominal or back pain
Severe headache
Abdominal Trauma ALS upgrade
Altered or decreased mental status
Impaled object
Evisceration of abdominal organ(s)
Pelvic fracture
Burn ALS upgrade
Partial/full thickness or chemical burns to the face, or suspicion of airway involvement
Partial/full thickness or chemical burns greater than 10% BSA
Partial/full thickness or chemical burns if patient less than 5 y/o
Electrical burns
Chest Trauma ALS upgrade
Penetrating chest injury
Flail chest
Unilateral decreased lung sounds
Head and Neck Trauma ALS upgrade
Repetitive
Severe or multiple episodes of vomiting
Seizures with recent history of head trauma
Spinal Trauma ALS upgrade
Paralysis secondary to the trauma
Submersion ALS upgrade
Paralysis following a diver/jumping injury
SCUBA diving accident
