ADULT TREATMENT GUIDELINES - CARDIAC · Consider Causes: Acidosis - adequate ventilation Hypoxia -...

ADULT TREATMENT GUIDELINES - CARDIACVENTRICULAR FIBRILLATION - PULSELESS VENTRICULAR

TACHYCARDIA (SJ-AO1) effective 03/01/2002

PRIORITIES ABC's Identify Dysrhythmia

DEFIBRILLATE*: 200 J, 300 J, 360 J; Reassess as Indicated( <200J if Biphasic technology )

INTUBATE: BV & 100% O2IV ACCESS: rate as indicated

DEFIBRILLATE: at last highest Joules



BASE CONTACT

EPINEPHRINE IVP: 1.0 mg 1:10,000 Repeat q 3-5 min., Double dose if via ET

LIDOCAINE: 1.5 mg/kg IVP, repeat q 3-5 min x 1Double dose if via ET (single dose, do not repeat)

BRETYLIUM: 5.0 mg/kg IVPrepeat q 5 min at 10 mg/kg (max 35 mg/kg)

MgSO4: 1-2 gm in 10-20 mL IVP over 1-2 min

CONSIDERLIDOCAINE DRIP: 2-4 mg/min if Pt. converts (after bolus or defib)


REASSESS:Airway,Pulse,ECG,

throughout.

If hyperkalemia suspected, give

Sodium Bicarbonate

early

Revision #5 01/11/02

34

In the case of alternative waveforms (e.g., Biphasic), AHA guidelines will be followed or used after approval of the EMS medical director.

ADULT TREATMENT GUIDELINES - CARDIACPULSELESS ELECTRICAL ACTIVITY (SJ-AO2) effective

05/01/02

PRIORITIES ABC's Identify Dysrhythmia Auscultate Heart Sounds

INTUBATE: BV & 100% O2IV ACCESS: 2 Large bore at wide open

EPINEPHRINE IVP: 1.0 mg 1:10,000; Repeat q 3-5 min., Double dose if via ET

ATROPINE (for Bradycardia): 1.0 mg IVP, Repeat q 3-5 min.Max 3.0 mg (0.04 mg/kg), Double dose if via ET

BASE CONTACT

DOPAMINE DRIP: 5-20 ug/kg/min for hypotensive patients refractory to IV fluidsTitrate to SBP >90 (consider second IV)

San Joaquin EMS Agency


throughout.


35

ADULT TREATMENT GUIDELINES - CARDIACASYSTOLE (SJ-AO3) effective 05/01/02

PRIORITIES ABC's Identify Dysrhythmia Define in two (2) leads minimum Consider Causes: Acidosis - adequate ventilation Hypoxia - provide ventilation Hypothermia - refer to guideline A62 Drug Overdose - refer to guidelines A51-A56 Hypokalemia - Hyperkalemia - Sodium Bicarbonate, 1 mEq/kg IVP (after base contact)

INTUBATE: BV & 100% O2IV ACCESS: rate as indicated

BASE CONTACT

EPINEPHRINE IVP: 1.0 mg 1:10,000; Repeat q 3-5 min., Double dose if via ET

ATROPINE: 1.0 mg IVP, Repeat q 3-5 min. to max 3.0 mg (0.04 mg/kg)Double dose if via ET



throughout.


CONSIDERTERMINATION OF EFFORTS (PER BASE PHYSICIAN): if patient

remains in Asystole after intubation and initial medications, if no reversible causes are identified.

36

Consider TCP if patient was witnessed asystolic <8 minutes

Simultaneous

ADULT TREATMENT GUIDELINES - CARDIACBRADYCARDIA (SJ-AO4) effective 03/01/02


OXYGEN: high flow via maskIV ACCESS: rate as indicated

BASE CONTACT

ASSESS FOR SYMPTOMS RELATED TO HYPOTENSION:

chest pain, dyspnea, decreased LOC, shock, pulmonary congestion, CHF


EPINEPHRINE DRIP: 2-10 ug/min Titrate to SBP >90 (consider second IV)



throughout.

37

ECG Rhythm

Type II second-degree heart block

orThird-degree heart

block

First-degree heart block

orType I second-degree

heart block

Unstable StableUnstable Stable

TCPIf Available

Atropine, 0.5 mg IVP, repeat q 3-5

min to max 3.0 mg (0.04 mg/kg)

Observe Atropine 0.5 mg IVP, repeat q 3-5 min to max

3.0 mg (0.04 mg/kg)

Observe

Valium, 2-5 mg IV, titrate(if available)Versed 2-5

mg IV/IM to max of 10 mg

TCPIf Available

Valium, 2-5 mg IV, titrate (if available)Versed 2-5

mg IV/IM to max of 10 mg

If no response

Simultaneous

If no response

Revision # 4

ADULT TREATMENT GUIDELINES - CARDIACWIDE COMPLEX TACHYCARDIA OF UNCERTAIN TYPE WITH

PULSES (SJ-AO5) effective 03/01/02


Secure airway as appropriateOXYGEN: high flow via mask

IV ACCESS: rate as indicated (proximal as possible)

ASSESS FOR UNSTABLE vs. STABLE

UNSTABLE: chest pain, CHF, decreased LOC, dyspnea, hypotension, pulmonary congestion

STABLE: no serious signs or symptoms

FOR UNSTABLE PATIENTS

FOR STABLE PATIENTS

LIDOCAINE: 1-1.5 mg/kg IVPRepeat q 5 min at 1/2 initial dose to

total 3 mg/kg if no conversion

ADENOSINE: 6 mg rapid IVP, repeat q 3 min with 12 mg rapid IVP

x 2 if no conversion

BRETYLIUM: 5 mg/kg IVP over 8-10 min. Repeat at 10 mg/kg to

total dose of 35 mg/kg if no conversion

Avoid in cyclic O.D.

DIAZEPAM: (if available) 2-10 mg titrated for sedation if time allows

Versed 2 mg IV/IM

BASE CONTACT



throughout.

LIDOCAINE: 1-1.5 mg/kg IVPSingle Dose, if condition permits



BASE CONTACT

38

CARDIOVERT: 100J, 200J, 300J, 360JReduce by 1/2 for digitalized patient

Revision# 3

ADULT TREATMENT GUIDELINES - CARDIACVENTRICULAR TACHYCARDIA WITH PULSES (SJ-AO6) effective 03/01/02


Secure airway as appropriateOXYGEN: high flow via maskIV ACCESS: rate as indicated





FOR STABLE PATIENTS



BRETYLIUM: 5 mg/kg IVP over 8-10 min. Repeat at 10

mg/kg to total dose of 35 mg/kg if no conversion


DIAZEPAM: (if available) 2-10 mg titrated for sedation if time allows, or

Versed 2 mg IV/IM



throughout.

LIDOCAINE: 1-1.5 mg/kg IVPSingle Dose, if condition permits



BRETYLIUM: 5 mg/kg IVP over 8-10 min. Repeat at 10

mg/kg to total dose of 35 mg/kg if no conversion


BASE CONTACT

BASE CONTACT

39


Revision# 3

ADULT TREATMENT GUIDELINES - CARDIACPAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA (SJ-AO7) effective 03/01/02



IV ACCESS: rate as indicated (proximal as possible)





FOR STABLE PATIENTS




VERSED 2 mg IV/IM

BASE CONTACT

Valsalva's Maneuver

BASE CONTACT



throughout.



40


Revision# 3

ADULT TREATMENT GUIDELINES - CARDIACATRIAL FIBRILLATION - ATRIAL FLUTTER* (SJ-AO8) effective 03/01/02


Secure airway as appropriateOXYGEN: high flow via maskIV ACCESS: rate as indicated





FOR STABLE PATIENTS


VERSED 2 mg IV/IM

CARDIOVERT: 100J, 200J, 300J, 360J

Reduce by 1/2 for digitalized patient

OBSERVE and REASSESS as appropriate

BASE CONTACT



throughout.

*Due to high incidence of chronic Atrial Fibrillation, cardiovert only if patient in extremis.

41

Revision# 3

ADULT TREATMENT GUIDELINES - CARDIACCORONARY ISCHEMIC CHEST DISCOMFORT (SJ-AO9) effective 09/01/00


Secure airway as appropriateAPPLY OXYGEN TO PATIENT

NITROGLYCERINE: 1/150 gr.(0.4 MG) sublingual

(if SBP >90) Repeat q 5 min


REASSESS:Airway,Pulse,

3 Lead ECG,throughout.

ASPIRIN: 320mg P.O. (four 80 mg chewable tablets)if myocardial infarction suspected. Check for history of

allergy.

Revision #7 04/17/2000

42

If available: 12 Lead ECG

CONTACT WITHRECEIVING FACILITY

MANDATORY

Consider the following treatments:

IV ACCESS: rate as indicated1 Large Bore IV

CONSIDERLIDOCAINE: 1.0 mg/kg IVP for frequent, multifocal PVC's with

hypotension

MORPHINE: 2-5 mg increments, slow IVP(if SBP > 90)

Repeat as needed; max 20 mg

BASE CONTACT

ADULT TREATMENT GUIDELINES - RESPIRATORYAIRWAY OBSTRUCTION - STRIDOR (SJ-A21) effective 09/01/95

PRIORITIES ABC's Pulse Oximetry Determine degree of distress:

Unstablevs.

Stable

Stable

Unstable

OXYGEN: flow as indicated or tolerated

ECG: treat dysrhythmia as appropriate

CONSIDER IV ACCESS:rate as indicated

ConsiderCauses

Foreign Body Croup/Epiglottitis

Trauma/Burns Anaphylaxsis

Abdominal thrusts/finger

sweeps

Direct Laryngoscopy

Position of Comfort

Consider humidified

oxygen

Avoid Visualization/

OPA

Consider Intubation

if ventilationinadequate

Intubate and suction as

appropriate

Refer to allergic reaction

guideline A43

BASE CONTACT

NEEDLE CRICOTHYROTOMY: followed by 50 psi transtracheal oxygen ventilation


REASSESS:Frequently

Revision #202/02/95

43

ADULT TREATMENT GUIDELINES - RESPIRATORYCHRONIC OBSTRUCTIVE PULMONARY DISEASEASTHMA - BRONCHOSPASM (SJ-A22) effective 09/01/95

PRIORITIES ABC's Pulse Oximetry Determine degree of distress

Secure airway as appropriateOXYGEN: low flow via nasal cannula,

increase as appropriate


CONSIDER IV ACCESS: rate as indicated

ALBUTEROL: 2.5 mg via Hand Held Nebulizer (or inline)

Repeat as needed

Reassess frequently

BASE CONTACT

EPINEPHRINE: 0.01 mg/kg of 1:1,000 sub-q (max 0.5 mg)Repeat q 20 min.

(Caution with history coronary artery disease, hypertension, age > 35)


REASSESS:Frequently

Consider Intubation

Revision #303/08/95

44

ADULT TREATMENT GUIDELINES - RESPIRATORYACUTE PULMONARY EDEMA (SJ-A23) effective 09/01/95

PRIORITIES ABC's Pulse Oximetry Determine degree of distress



IV ACCESS: rate as indicated

NITROGLYCERINE: 1/150 gr. (0.4 mg) suglingual (if SBP >90)

Repeat q 5 min

MORPHINE: 2-5 mg increments, slow IVP(if SBP > 90)

Repeat as needed; max 20 mg

BASE CONTACT

FUROSEMIDE: 20-80 mg IV over 2-4 min.(if SBP > 90)

DOPAMINE DRIP: 5-20 ug/kg/min for hypotensionTitrate to SBP of 90 (consider second IV)


REASSESS:Frequently

CONSIDER INTUBATION


45

ADULT TREATMENT GUIDELINES - RESPIRATORYTENSION PNEUMOTHORAX (SJ-A24) effective 09/01/95

PRIORITIES ABC's Determine degree of distress Pulse Oximetry

NEEDLE THORACOSTOMY:on affected side(s)




REASSESS and observe frequently


REASSESS:Frequently

BASE CONTACT

Revision #202/02/95

46

ADULT TREATMENT GUIDELINES - NEUROLOGICALTERED LEVEL OF CONSCIOUSNESS (SJ-A31) effective 09/01/95

PRIORITIES ABC's Pulse Oximetry




Test for glucose

DEXTROSE: 25 gm IVPif serum glucose < 75Repeat x1 if needed

NALOXONE: 2-4 mg IVP/IM or ET for depressed respirations or altered level of consciousness.

Repeat as needed.

BASE CONTACT


REASSESS:Frequently


ORAL DEXTROSE: for suspected hypoglycemia with intact gag reflex

47

ADULT TREATMENT GUIDELINES - NEUROLOGICACUTE CEREBROVASCULAR ACCIDENT (SJ-A32) effective 09/01/95

PRIORITIES ABC's Identify and document neurologic deficits - progressive vs. non-progressive Pulse Oximetry

Secure airway as appropriatePrevent Aspiration

OXYGEN: high flow via mask



Test for glucose


REASSESS neurologic findings

BASE CONTACT

TRANSPORT: code 3 if progressive neurologic deficit evident


REASSESS:Frequently


CONSIDERFUROSEMIDE: 20-80 mg slow IVP if

SBP > 190 and DBP > 110 mmHg

48

ADULT TREATMENT GUIDELINES - NEUROLOGICSEIZURES (SJ-A33) effective 03/01/02

PRIORITIES ABC's Prevent injury




DIAZEPAM: (if available) 2-10 mg slow IVP Titrate in 2 mg increments to max 20 mg or VERSED: 1-2 mg IV/IM, max 10

mg, for active seizure control

Test for glucose



REASSESS:Frequently

BASE CONTACT

49

Revision# 6

ADULT TREATMENT GUIDELINES - NEUROLOGICALTERED LEVEL OF CONSCIOUSNESS (SJ-A31) effective 09/01/95





Test for glucose


NALOXONE: 2-4 mg IVP/IM or ET for depressed respirations or altered level of consciousness.

Repeat as needed.

BASE CONTACT


REASSESS:Frequently


ORAL DEXTROSE: for suspected hypoglycemia with intact gag reflex

47

ADULT TREATMENT GUIDELINES - MEDICALSHOCK, NON-TRAUMATIC (SJ-A41) effective 09/01/95

PRIORITIES ABC's Attempt to determine cause of shock Pulse Oximetry



IV ACCESS: 2 - large bore250cc fluid challenges to SBP of 90

If no signs/symptoms of pulmonary edema

REASSESS as indicated

BASE CONTACT

DOPAMINE DRIP: 5-20 ug/kg/min for hypotensionTitrate to SBP of 90 (consider second IV)


REASSESS:Frequently


51

ADULT TREATMENT GUIDELINES - MEDICALDIABETIC KETOACIDOSIS (SJ-A42) effective 09/01/95




IV ACCESS: 250cc boluses, max 2 liters

Test for glucose

BASE CONTACT


REASSESS:Frequently


52

ADULT TREATMENT GUIDELINES - MEDICALALLERGIC REACTION (SJ-A43) effective 09/01/95

PRIORITIES ABC's Determine type of allergen if possible Determine severity of reaction Pulse Oximetry

Severevs.

Mild/ModSevere

REMOVE ALLERGEN: if possible


EPINEPHRINE: 0.01 mg/kg sub-Q of 1:1,000Max dose 0.5 mg. Caution with age > 35, hx: HTN

IV ACCESS: 2 - large bore. 250cc fluid challenges as indicated

DIPHENHYDRAMINE: 25-50 mg IVP or IM

BASE CONTACT

EPINEPHRINE: 0.1 mg of 1:10,000 slow IVP if SBP < 80. Repeat every 1-2 min.

EPINEPHRINE DRIP: 2-10 ug/min Titrate to SBP >90 (consider second IV)



CONSIDER ALBUTEROL: 2.5 mg via Hand Held Nebulizer (or inline) for persistent respiratory distress

CONSIDER INTUBATION

(OR)



Mild/Moderate

REMOVE ALLERGEN: if possible

CONSIDER DIPHENHYDRAMINE: 25-50 mg IVP or IM

CONSIDER ALBUTEROL: 2.5 mg via Hand Held Nebulizer

CONSIDER EPINEPHRINE: 0.01 mg/kg sub-Q of 1:1,000. Max dose 0.5 mg.

Caution with age > 35, hx: HTN

BASE CONTACT

REASSESS:Frequently


53

ADULT TREATMENT GUIDELINES - MEDICALHYPERTENSION (SJ-A44) effective 09/01/95

PRIORITIES ABC's




TREAT ASSOCIATED SYNDROMES

Acute Cerebrovascular Accident - refer to guideline A32Coronary Ischemic Chest Discomfort - refer to guideline A09

Pregnancy - if seizing, refer to guideline A75Pulmonary Edema - refer to guideline A23

BASE CONTACT


REASSESS:Frequently


54

ADULT TREATMENT GUIDELINES - POISONINGSBETA BLOCKER OVERDOSE (SJ-A51) effective 09/01/95

PRIORITIES ABC's Determine type, amount, and when ingestion occurred Severity of distress




ATROPINE: 0.5 mg IVP every 3-5 min to max 3 mg (0.04 mg/kg). For symptomatic bradycardia.

DEXTROSE: 25 gm IVP if serum glucose < 75Repeat x1 if needed

DIAZEPAM: 2-10 mg slow IVP. Titrate in 2 mg increments to max. 20 mg for active seizure control.

ALBUTEROL: 2.5 mg via Hand Held Nebulizer(or inline). Repeat as needed.

ACTIVATED CHARCOAL: 25-50 gm P.O.

Test for glucose

BASE CONTACT

EPINEPHRINE DRIP: 2-10 ug/min. Titrate to SBP >90(consider second IV)

DOPAMINE DRIP: 5-20 ug/kg/min for hypotensive patients refractory to IV fluids. Titrate to SBP >90 (consider second IV)


REASSESS:Frequently


55

ADULT TREATMENT GUIDELINES - POISONINGSCALCIUM CHANNEL BLOCKER OVERDOSE (SJ-A52) effective 09/01/95

PRIORITIES ABC's Determine type, amount, and when ingestion occurred




ATROPINE: 0.5 mg IVP every 3-5 min to max 3 mg (0.04 mg/kg). For symptomatic bradycardia.

ACTIVATED CHARCOAL: 25-50 gm P.O.

BASE CONTACT


DOPAMINE DRIP: 5-20 ug/kg/min for hypotensive patients refractory to IV fluids. Titrate to SBP >90 (consider second IV)



REASSESS:Frequently

56

ADULT TREATMENT GUIDELINES - POISONINGSCAUSTICS - CORROSIVES (SJ-A53) effective 09/01/95

PRIORITIES Scene Safety - HAZMAT ABC's Determine type, amount, and when exposure occurred




REMOVE AGENT: brush then flush

DO NOT INDUCE VOMITING: if ingestion occurred

BURN or SHOCK GUIDELINES:as indicatedBurn = A81Shock = A41

BASE CONTACT

WATER or MILK: p.o. if ingestion occurred



REASSESS:Frequently

CONSIDER: early intubation if respiratory burn likely

57

ADULT TREATMENT GUIDELINES - POISONINGSCYCLIC ANTIDEPRESSANTS (SJ-A54) effective 03/01/02

PRIORITIES ABC's Determine type, amount, and when ingestion occurred Pulse Oximetry


ECG

IV ACCESS: rate as indicated. Caution with fluid boluses due to high incidence of pulmonary edema

SODIUM BICARBONATE: 1 mEq/kg slow IVP for dysrhythmias, altered mental status, or QRS > 0.10 sec. Max dose 2 mEq/kg.

Treatment of choice for cardio-respiratory and neurologic dysfunction.

ACTIVATED CHARCOAL: 50-100 gms via NG Tube after intubation. Early administration encouraged.

DIAZEPAM: (if available) 2-10 mg slow IVP Titrate in 2 mg increments to max 20 mg or VERSED: 2-5 mg,IV/IM

max of 10mg

BASE CONTACT

SODIUM BICARBONATE DRIP: 100 mEq/1000mL for dysrhythmias or QRS > 0.10 sec. (consider second IV)



REASSESS:Frequently

MgSO4: 1-2 gm in 10-20 mL IVP over 1-2 minFor Torsades de Pointes refractory to Sodium Bicarbonate

ECG: treat dysrhythmia as appropriate if refractory to Sodium Bicarbonate

58

Revision# 6

ADULT TREATMENT GUIDELINES - POISONINGSPHENOTHIAZINE REACTIONS (SJ-A55) effective 09/01/95

(DYSTONIC REACTIONS)

PRIORITIES ABC's Determine type, amount, and when ingestion occurred



DIPHENHYDRAMINE: 25-50 mg IVP or IMMay repeat x1.



REASSESS:Frequently

BASE CONTACT

59

ADULT TREATMENT GUIDELINES - POISONINGSNARCOTICS - SEDATIVES (SJ-A56) effective 09/01/95

PRIORITIES ABC's Determine type, amount, and Time taken




NALOXONE: 2-4 mg IVP/IM or ET for depressed respirations or L.O.C.

Repeat as needed

ACTIVATED CHARCOAL: 25-50 gms for history of oral ingestion.



REASSESS:Frequently

BASE CONTACT

60

ADULT TREATMENT GUIDELINES - POISONINGSORGANOPHOSPHATES (SJ-A57) effective 03/01/02

PRIORITIES Scene Safety - HAZMAT ABC's Determine type, amount, and time of exposure





ATROPINE: 2.0 - 5.0 mg slow IVP, or 2.0 mg IM, or 4.0 mg ETRepeat q 5 min as needed to control secretions, bronchorrhea, or

dysrhythmias. NOTE: large amounts may be needed.

DIAZEPAM: (if available) 2-10 mg slow IVP Titrate in 2 mg increments to max 20 mg or

VERSED: 2-5 mg IV/IM, max of 10mg

ACTIVATED CHARCOAL: 25-50 gms p.o. for oral ingestion

BASE CONTACTEarly Notification for Hospital Preparation


REASSESS:Frequently

61

Revision# 5

ADULT TREATMENT GUIDELINES - POISONINGSPETROLEUM DISTILLATES (SJ-A58) effective 09/01/95

PRIORITIES ABC's Determine type, amount, and time of exposure





DO NOT INDUCE VOMITING: if ingestion occurred



REASSESS:Frequently

Monitor forAspiration

CONSIDER EARLY INTUBATION

BASE CONTACT

62

ADULT TREATMENT GUIDELINES - ENVIRONMENTALENVENOMATION (SJ-A61) effective 09/01/95

PRIORITIES ABC's Determine type and time of exposure




Identify Cause

Bee/Wasp Spider/Scorpion Snake

Scrape stinger away

Cold packs for pain

Refer to Allergic Reaction Guideline A43

Scrape stinger away

Cold packs for pain

Avoid movementKeep extremity below heart

Circle swelling and note time

Measure proximal circumference and note time

Apply loose restricting band



REASSESS:Frequently

BASE CONTACT63

ADULT TREATMENT GUIDELINES - ENVIRONMENTALHYPOTHERMIA - FROSTBITE (SJ-A62) effective 09/01/95

PRIORITIES ABC's Determine time and duration of exposure

Determine severity of exposure

FrostbiteSevere Hypothermia

Mild/ModerateHypothermia

PREVENT FURTHER HEAT LOSS: remove wet clothing and cover

with dry blankets(move gently)





IV ACCESS: rate as indicated with warm

fluids


fluids


fluids


ECG: observe rhythm/pulse for one minute for organized rhythm. Treat dysrhythmia as appropriate

MORPHINE: 2-5 mg increments, slow IVP (if SBP > 90). Repeat as needed. Max 20 mg.

Test for glucose

DEXTROSE: 25 gms IVPfor serum glucose < 75

Repeat x1 if needed

NALOXONE: 2-4 mg IVP/IM or ET for suspected

narcotic O.D. Repeat as needed

BASE CONTACT



REASSESS:Frequently

64

ADULT TREATMENT GUIDELINES - ENVIRONMENTALHEAT ILLNESS (SJ-A63) effective 03/01/02

PRIORITIES ABC's

Determine severity of

distress

Heat Stroke

COOLING MEASURES


IV ACCESS: 250cc fluid challenges to SBP of 90

CONSIDER

Test for glucose

DEXTROSE: 25 gms IVPif serum glucose < 75Repeat x1 if needed

DIAZEPAM: (if available) 2-10 mg slow IVP Titrate in 2 mg increments to max 20 mg or

VERSED: 2-5 mg IV/IM, max of 10mg


REASSESS:Frequently

BASE CONTACT

Heat Cramps/Heat Exhaustion

COOLING MEASURES



BASE CONTACT

65

Revision# 6

ADULT TREATMENT GUIDELINES - OBSTETRICSVAGINAL HEMORRHAGE WITH SHOCK (SJ-A71) effective 09/01/95

PRIORITIES ABC's Determine trimester of pregnancy Estimate blood loss (EBL) Early transport



IV ACCESS: two large bore, 250cc fluid challenges as needed to SBP of 90

POSITION: left lateral decubitus if 3rd trimester pregnancy

BASE CONTACT


REASSESS:Frequently

66

ADULT TREATMENT GUIDELINES - OBSTETRICSVAGINAL HEMORRHAGE WITHOUT SHOCK (SJ-A72) effective 09/01/95

PRIORITIES ABC's Determine trimester of pregnancy Estimate blood loss (EBL) Early transport





BASE CONTACT


REASSESS:Frequently

67

ADULT TREATMENT GUIDELINES - OBSTETRICSIMMINENT DELIVERY - NORMAL (SJ-A73) effective 09/01/95

PRIORITIES ABC's Determine trimester of pregnancy Estimate blood loss (EBL)



IV ACCESS: consider if time allows, rate as indicated

DELIVER HEAD: suction mouth/nose

BASE CONTACT

CHECK NECK: for wrapped cord; if present- loosen and slip over infants head, if unable

- double clamp and cut between clamps

PROCEED WITH DELIVERY:

WRAP: in warm, dry, cloth or place on mom and cover

CUT & CLAMP: six (6) inches from baby

APGAR's: at one (1) & five (5) min.

NEONATAL RESUSCITATION FORMAT: per guideline N01

ALLOW DELIVERY OF PLACENTA


REASSESS:Frequently

DRY INFANT

68

ADULT TREATMENT GUIDELINES - OBSTETRICSIMMINENT DELIVERY - COMPLICATED (SJ-A74) effective 09/01/95

PRIORITIES ABC's Determine trimester of pregnancy Estimate blood loss (EBL)



IV ACCESS: if time allows, rate as indicated

BASE CONTACT Early if possible

Type of abnormal

presentation

Breech or Footling Prolapsed cord

Early Transport

Allow delivery to proceed to

waist

ROTATE: infant to

face-down

If head does not deliver, insert gloved hand into vaginal opening and create air passage for infant

Insert gloved hand into vagina, gently push presenting part off cord

Place mom into Trendelenburg position with hips elevated

Transport

BASE CONTACTEarly if possible


REASSESS:Frequently

Transport according to

specialty triage criteria

69

ADULT TREATMENT GUIDELINES - OBSTETRICSPRE-ECLAMPSIA, ECLAMPSIA (SJ-A75) effective 09/01/95

PRIORITIES ABC's Determine trimester of pregnancy Early transport Determine degree of distress





BASE CONTACT

EARLY TRANSPORT: quiet, non-stimulating environment


REASSESS:Frequently



MgSO4: 2-4 gm in 20-40 mL slow IVP over 1-2 min. for active seizure control.

FOR SEIZURES: refractory to MgSO4, proceed to Guideline A33

70

ADULT TREATMENT GUIDELINES - TRAUMABURNS (SJ-A81) effective 09/01/95

PRIORITIES ABC's Determine time, type, and severity of burn

MOVE PATIENT: to safe environment

STOP THE BURNING PROCESS: brush then flush


CONSIDER: early intubation if respiratory burn likely

IV ACCESS: large bore, wide open for 2nd & 3rd Degree Burns


DRESS BURNS: with sterile drapes

MORPHINE: 2-5 mg increments, slow IVP (SBP > 90) Repeat as needed. Max 20 mg.

BASE CONTACT


Revision #302/02/95

REASSESS: airway

frequently

CONSIDER: second IV, large bore

71

ADULT TREATMENT GUIDELINES - TRAUMATRAUMATIC SHOCK (SJ-A82) effective 09/01/95

PRIORITIES ABC's Determine mechanism of injury Load and Go: to appropriate facility by best method available Early base notification for surgical mobilization


C-SPINE: as indicated

BLEEDING CONTROL: as indicated

IV ACCESS: 2 large bore, 250 cc fluid challenges as needed until SBP of 100

DRESS & SPLINT: as needed. Return extremities to anatomical position. Reassess neurovascular frequently.

CONSIDER

NEEDLE THORACOSTOMY: for tension pneumothorax on affected side(s)

BASE CONTACT


Revision #302/02/95

REASSESS: frequently

72

ADULT TREATMENT GUIDELINES - TRAUMATRAUMATIC ARREST (SJ-A83) effective 09/01/95


INTUBATE: BV & 100% O2




CONSIDER



BASE CONTACT



Revision #403/08/95

REASSESS:airway, rhythm

and pulse frequently

CONSIDERTERMINATION OF EFFORTS (PER BASE PHYSICIAN): if patient remains in Asystole after intubation and initial medications, if no reversible causes are identified

73

ADULT TREATMENT GUIDELINES - TRAUMAHEAD - NECK - FACIAL TRAUMA (SJ-A84) effective 09/01/95

PRIORITIES ABC's Determine mechanism of injury Consider Load and Go: to appropriate facility by best method available Early base notification for surgical mobilization


Hyperventilate via ET to decrease ICPNOTE: medicate head injured patients with Lidocaine 1.5

mg/kg IV prior to intubation as time allows




DRESS & SPLINT: as needed

POSITION: head injured patients with head of board elevated 15 - 20 degrees

(if normotensive)

CONSIDER

MORPHINE: 2-5 mg increments, slow IVP(if SBP > 90) for severe pain. Repeat as needed. Max dose 20 mg

LASIX: 40 mg slow IVP if SBP > 90

BASE CONTACT


Revision #409/15/95

REASSESS: airway

frequently



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ADULT TREATMENT GUIDELINES - TRAUMACHEST TRAUMA (SJ-A85) effective 09/01/95







BASE CONTACT

MORPHINE: 2-5 mg increments, slow IVP(if SBP > 90) for severe pain. Repeat as needed. Max dose 20 mg


Revision #409/15/95

REASSESS: airway

frequently


75


ADULT TREATMENT GUIDELINES - TRAUMAABDOMINAL TRAUMA (SJ-A86) effective 09/01/95







BASE CONTACT

MORPHINE: 2-5 mg increments, slow IVP (if SBP > 90) for severe pain. Repeat as needed. Max dose 20 mg


Revision #302/02/95


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ADULT TREATMENT GUIDELINES - TRAUMAEXTREMITY TRAUMA (SJ-A87) effective 09/01/95

PRIORITIES ABC's Determine mechanism of injury Consider Load and Go: to appropriate facility by best method available Early base notification for surgical mobilization






Cover exposed bone with saline soaked gauze.

BASE CONTACT

MORPHINE: 2-5 mg increments, slow IVP (if SBP > 90) for severe pain. Repeat as needed. Max dose 20 mg


Revision #403/08/95


AMPUTATIONS: partial, dress and splint in anatomical position; complete, place part in sterile container and place container on ice

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ADULT TREATMENT GUIDELINES - CARDIAC · Consider Causes: Acidosis - adequate ventilation Hypoxia -...

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