ICEMA Protocols Flashcards

Cardiac arrest
Terms Definitions
What are the Adult Physiologic Trauma Triage Criteria?
GCS<13, LOC > 3 min, assisted ventilations, SPO2 < 90% Respiratory Rate <10 or >29, inadequate tissue perfusion, B/P<90mmhg, tachycardia
What are the Adult Anatomic Trauma Triage Criteria?
penetrating injuries to torso, head, neck, groin, extremities proximal to elbows/knees, blunt chest trauma with ecchymosis, unstable chest wall, flail segments, severe tenderness to head, neck, torso, abdomen, or pelvis, suspected spinal injury, loss of senstaion, tenderness to abdomen with firm and rigid abdomen, amputations, above wrist or ankle, two or more long bone fx, skull deformity, major tissue disruption, or pelvic fx.
11010 COPD
ABC VOMIT SPO2
Albuterol 2.5mg with Atrovent 0.5mg may repeat X 2.
Consider CPAP if available
Consider Nasotracheal Intubation
BHC for Additional Orders
11010 Adult Acute Asthma/Bronchospasm
ABC VOMIT SPO2
Albuterol 2.5mg with Atrovent 0.5mg may repeat X 2.
NS 300cc with clear lungs
Consider CPAP if available
Epi 1:1000 0.3mg SC may rpt after 15 min
Benadryl 25mg IV or 50mg IM
Epi 1:10,000 0.1mg IV may rpt to 0.5mg
Consider Nasotracheal Intubation
BHC for Additional Orders
11010 Adult Acute Pulmonary Edema/CHF
ABC VOMIT SPO2
NTG 0.4mg rpt as needed with B/P >90mmHg
Consider CPAP if available
Consider Nasotracheal Intubation
BHC for:
Dopamine 5-20mcg/kg/min
Lasix 40-100mg or 2X daily dose max of 100mg
Albuterol 2.5mg with Atrovent 0.5mg
11040 Asymptomatic Bradycardia
ABC VOMIT SPO2 12 Lead
FC NS 300cc May Rpt w/clear lungs
BHC
11040 Symptomatic Bradycardia
ABC VOMIT SPO2 12 Lead
FC NS 300cc May Rpt w/clear lungs
Atropine 0.5mg may Rpt q 5 min to max of 3mg or 0.04mg/kg
Consider TCP
Dopamine 5-20mcg/kg/min
BHC
11050 Narrow SVT
ABC VOMIT SPO2 12 Lead
FC NS 300cc May Rpt w/clear lungs
Vagal Maneuvers
Adenosine 6, 12, 12 RIVP
Procainamide 20mg/min to 17mg/kg
Sync. Cardioversion
BHC
11050 Wide Complex VT
ABC VOMIT SPO2 12 Lead
FC NS 300cc May Rpt w/clear lungs
Procainamide 20mg/min to 17mg/kg
Lidocaine 1mg/kg, Rpt q 10 min at 0.5mg/kg to 3mg/kg max, 2mg/min maintenance dose
Mag 2gms/100cc over 5min
Consider Adenosine
Percordial Thump if Wittnessed
Sync Cardioversion
If rhythm is suppressed or cardioversion unsuccessful give Lidocaine 1mg/kg, then repeat q 10 min at 0.5mg to max of 3mg/kg, then initiate 2mg/min maintenance drip
BHC
11050 A-Fib/A-Flutter
ABC VOMIT SPO2 12 Lead
Transport to closest most appropriate
If pt deteriorates:
Sync Cardioversion
Verapamil 5mg SIVP may Rpt after 15min at 10mg SIVP
Procainamide 20mg/min to 17mg/kg
BHC
11060 Suspected Acute MI
ABC VOMIT SPO2 12 Lead
ASA 162mg PO
FC NS 300cc may Rpt w/clear lungs
12 Lead, Consider V4R if signs of inadequate tissue perfusion
NTG 0.4mg SL may repeat X 3 with adequate tissue perfusion
MS 2mg Increments to max of 10mg
Complete thrombolytic check list
BHC
11070 Adult V-Fib/Pulseless VT
CPR 2min if no CPR PTA
Advanced Airway
Defib at Appropriate energy settings
CPR 2min after each defib
Epi 1mg IVIO every 2min cycle of CPR after each defib
Reassess rhythm and defib if necessary
After 2 cycles CPR give 1.5mg/kg IV/IO Rpt at 0.75mg/kg q 5min to 3mg/kg max
If Rhythm persists Contact Base Hospital
D50 25gms IV/IO
Narcant 2mg IV/IO/IM
NG/OG
BHC
Dopamine 5-20mcg/kg/min
Lidocane 2mg/min maintenance dose for conversion
11070 Adult Asystole/PEA
CPR for 2min in no CPR PTA eval rhythm every 2 min
FC NS 300cc NS may Rpt
Epi 1mg IV/IO after every rhythm eval
Atropine 1mg after second CPR cycle may Rpt X 2 to max of 3mg
Consider Termination of efforts if PEA < 60, asystole, or other agonal rhythm with successful intubation and medication administration
D50 25gms IV/IO
Narcan 2mg IV/IO/IM
NG/OG
BHC
Dopamine 5-20mcg/kg/min
11080 ALOC
ABC VOMIT SPO2
D50 25gms IV may Rpt X 1
Glucagon 1mg IM/SC
Versed 5-10mg IM or 2.5-5mg IV may Rpt for extended transport
Narcan 2mg IV/IM q 2-3 min as needed
BHC
11090 Non-Traumatic Shock
ABC VOMIT SPO2
B/P <90
Adult 500cc NS may Rpt X 1
Peds 20cc/kg may Rpt X 1
B/P >90
Adult 150cc/hr
Peds maintain IV TKO
BHC
2nd Large Bore IV
Dopamine 5-20mcg/kg/min
11100 Adult Burns
15 years and older
ABC VOMIT SPO2
B/P<90
IV NS 250cc may Rpt up to 1000cc
B/P>90 500cc/hr
MS 5mg IV q 5min to 20mg max with B/P >90
MS 10mg IM
Albuterol 2.5mg with Atrovent 0.5mg may Rpt X 2
BHC
11020 Adult Airway Obstructions
ABC VOMIT SPO2
Responsive = Abd Thrusts
Unresponsive = CPR
Attempt Magill Forceps
Consider Needle Cric
11030 Non-Traumatic Hypertensive Crisis
ABC VOMIT SPO2
Monitor and Transport
12010 Determination of Death Criteria
Decomposition
Rigor Mortis
Lividity
Decapitation
Incineration
Massive Crush Injury/Penetrating Trauma with eviceration of the heart, and/or brain
Gross dismemberment of the trunk
13010 Poisonings
ABC VOMIT SPO2
IV NS 500cc to maintain B/P>90 or 20cc/kg in peds to maintain B/P>80
Charcoal 50gms PO or 1gm/kg PO for Peds
Atropine 2mg IV rpt as needed
BHC
Benadryl 25mg IV or 50mg IM for Phenothiazine OD
Sodium Bicarb 1mEq/kg for TCA OD
Calcium Chloride 1gm IV for CCB OD
Glucagon 1mg IV for BB OD
13020 Heat Related Injury
ABC VOMIT SPO2
IV NS 300cc May Rpt or 20cc/kg in Peds
BHC
14010 Pediatric Respiratory Emergencies
ABC VOMIT SPO2
Albuterol 2.5mg with Atrovent 0.5mg may Rpt X 2 Pts < 1 Year Atrovent 0.25mg
Epi 1:1000 0.01mg/kg max 0.3mg
Consider Allergic Reaction Protocol
BHC
14020 Pediatric Airway Obstruction
ABC VOMIT SPO2
Responsive Abd Thrusts/Back Blows
Unresponsive CPR
Magills
Pts > 2 years Needle Cric
BHC
14030 Pediatric Airway Obstruction
ABC VOMIT SPO2
Albuterol 2.5mg with Atrovent 0.5mg may Rpt X 2 Pts < 1 Year Atrovent 0.25mg
Epi 1:1000 0.01mg/kg max 0.3mg
IV NS 20cc/kg to 300cc max Rpt as needed
Benadryl 1mg/kg IV or 2mg/kg IM to 25mg IV max or 50mg IM max
Epi 1:10,000 0.01mg/kg IV not to exceed 0.1mg dose Rpt to max of 0.5mg
BHC
14040 Pediatric Cardiac Arrest
CPR for 2 min if no CPR PTA
Advanced airway
VF/VT
Defib at 2j/kg after each 2min cycle of CPR
Epi 1:10,000 q 2 min cycle of CPR
1day to 8 years 0.01mg/kg
9 to 14 1mg
Lidocaine after 2nd cycle at 1mg/kg may Rpt at 0.5mg/kg to 3mg/kg max
Aystole/PEA
1day to 8 years 20cc/kg
9-14 300cc
Epi 1:10,000 q 2 min cycle of CPR
1day to 8 years 0.01mg/kg
9 to 14 1mg
Pts 9-14 Atropine 1mg Rpt as needed to 3mg max
Consider D50/Narcan
NG/OG
1day to 8 years Epi 1:10,000 0.005mg/kg q 10 min
9-14 Dopamine 5-20mcg/kg/min
BHC
14050 Pediatric ALOC
ABC VOMIT SPO2
IV NS 20cc/kg to 300cc max
Pts <10kg BGL<60 D25 0.5gm/kg
Pts >10kg <25kg BGL <60 D50 1:1 0.5gm/kg
Pts >25kg BGL<80 D50 1:1 0.5gm/kg
Glucagon 0.025mg/kg to 1mg max may Rpt X 1 after 20 min
Narcan 0.1mg/kg to 2mg max
BHC
14070 Pediatric Burns
ABC VOMIT SPO2
Unstable
IV NS 20cc/kg
Stable
>5 years 150cc/hr
>5 years 250cc/hr
MS 0.1mg/kg IV to 5mg dose max Rpt as needed to 20mg max
MS 0.2mg/kg IM to 10mg max
Albuterol 2.5mg with Atrovent 0.5mg may Rpt X 2 Pts<1 year Atrovent 0.25mg
BHC
14080 Obstetrical Emergencies
ABC VOMIT SPO2
IV NS 500cc Rpt as needed, if stable
IV NS 150cc/hr
Consider 2nd Large bore IV
Mag 4gms in 20cc over 3-4min
Versed 2.5-5mg IV or 5mg IM may Rpt to max dose of 10mg
BHC
Dopamine 5-20mcg/kg/min
Mag Infusion of 2gms in 100cc at 30cc/hr
Rpt Versed
14090 Newborn Care
ABC VOMIT SPO2
HR<100 BVM
HR<60 Chest Compressions
IV/IO
Epi 0.01mg/kg if HR<60 after 1 min
Place OG tube if BVM for more than 2min
BGL<40 d25 0.5gms/kg
BHC
20cc/kg IV NS
Epi 1:10,000 0.005mg/kg q 10 min
9020 Physician on Scene
Inform Base of Physician on Scene
Proper ID
Sign written statement assuming responsibility
Stay with Pt During Transport
Maintain BHC
15010 Adult Trauma >15 Years
ABC VOMIT SPO2 C-Spine
Blunt Trauma
Unstable: IV NS open until stable to 2000cc max
Stable: TKO
Penetrating Trauma
Unstable: IV NS 500cc X1 Only
Stable: TKO
Closed Head Injury
Unstable: IV NS 250cc may Rpt X 1
Stable: TKO
Chest Trauma
Consider Needle Thor
Isolated Extremity
MS 5mg IVP q 5 min to 20mg max with B/P>90 or 10mg IM
Head/Neck Trauma
Lido 1.5mg/kg Prior to ET or NT
BHC for NT if facial trauma is present
15020 Pediatric Trauma <15 Years
ABC VOMIT SPO2 C-Spine
IV NS 20cc/kg may Rpt X 1
or TKO if stable
Go to LLUMC if less than 20 min difference to the closest
Consider needle thor for blunt chest trauma
MS 0.1mg/kg IV/IO may Rpt q 5min to 20 mg max or 5mg inc max
MS 0.2mg/kg IM to 10mg max
Lido 1.5mg/kg prior to ET/NT
10010 Adult King Airway >15 Years
Unresponsive/apenic
No Gag
Above 4ft Tall
4-5 ft size 3 yellow 60cc
5-6ft size 4 red 70cc
6ft + size 5 purple 80cc
Contraindications
Gag
Caustic substances
FBAO
Facial and or esophageal trauma
Esophageal disease
10020 Pediatric King Airway <15 Years
Unresponsive/apenic
No Gag
35-45" or 12-25kg size 2 green 25-30cc
41-51" or 25-35k size 2.5 orange 30-40cc
Contraindications
Gag
Caustic substances
FBAO
Facial and or esophageal trauma
Esophageal disease
10050 Nasotracheal Intubation
C-spine injury or clenched jaw
inaccessible for direct laryngoscopy
severe respiratory distress
nare able to accomodate 7.0, 7.5, or 8.0 et tube
BHC for significant facial trauma or possible basilar skull fx or pts on anticoagulant therapy
Lido 1.5mg/kg
Neo 1 metered dose 0.5mg
10060 Needle Thoracostomy
Increased agitation
Progressively worsening dyspnea
Diminished breath sounds
Hypotension
JVD
Tracheal deviation
>50kg 14-16g 2-2.5" Needle
<50kg 18g 1-1.25" Needle
10070 Needle Cricothyrotomy
FBAO
Contraindicated in Pts less than 2 years of age
Adult 10-15g needle
Peds 12-15g needle
TLJV 1 sec on 3 sec off
10080 OG/NG
Contraindications
Esophaageal strictures/varices
Caustic ingestion
Significant facial/head trauma
Bleeding disorders
Adults 16-18fr
Adolescents 12-14fr
Children 8-10fr
Infants 5-6fr
10110 TCP
must be 8 years or older
start at rate of 60 and ma of 0
can titrate rate to max of 100
for witnessed asystole set to max ma
Versed 1-2mg for conscious pt
MS 1-2mg inc to max of 10 for pain with adequet perfusion
10120 Sync Cardioversion
Versed 1-2mg for conscious pt
MS 1-2mg inc to max of 10 for pain with adequet perfusion
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