MEDICAL GUIDELINES

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Consider possible causes:\u003cbr\u003e\n\u003cbr\u003e\nAny female of childbearing age who presents with abdominal pain, and signs \u0026 symptoms of shock, is considered to have suffered a ruptured ectopic pregnancy .\u003cbr\u003e\nAEMT / PARAMEDIC\u003cbr\u003e\n1.\tIn-route, initiate IV/IO access; if necessary, titrate isotonic solution to end organ perfusion; may use one or two large bore IV/IOs (determined by patient condition) of an isotonic fluid \u003cbr\u003e\n2.\tAnalgesics per pain management guidelines if stable vital signs\u003cbr\u003e\n3.\tIf nausea and/or vomiting is present administer:\u003cbr\u003e\na.\tONDANSETRON (Zofran) 4mg IV/IO or PO (ODT) Max. 8 mg.\u003cbr\u003e\nb.\tPeds \u003e 6mo Ondansetron (Zofran) 0.15 mg/kg IV/IO or 2mg PO (ODT)\u003cbr\u003e\ni.\t\u003e2yo Zofran 4mg PO (ODT-Oral dissolving tablet)\u003cbr\u003e\n4.\tApply cardiac monitor if \u003e 50 y/o and upper abdominal pain","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040667"},{"listId":10040670,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"AIRWAY MANAGEMENT GUIDELINES","summary":"","detail":"AIRWAY MANAGEMENT\u003cbr\u003e\nALL PROVIDERS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nThe patient is not breathing, not breathing adequately, or experiencing agonal respirations with inadequate rate and/or depth. See Foreign Body Airway Obstruction Protocol if obstruction suspected.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nMaintain a patent airway and assist ventilations\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s, manage as indicated.\u003cbr\u003e\n2.\tIf respirations are inadequate or absent, maintain airway patency by:\u003cbr\u003e\na.\tPositioning maneuvers as indicated by patient condition (jaw thrust, sniffing postion, ramped if spine clear)\u003cbr\u003e\nb.\tSuction as needed (oropharynx, nasopharynx, or stoma)\u003cbr\u003e\nc.\tPlace Nasopharyngeal airway (NPA), Oropharyngeal airway (OPA)\u003cbr\u003e\nd.\tOxygen\u003cbr\u003e\ne.\tContinuous SpO2 and EtCO2\u003cbr\u003e\nf.\tCPAP up to 10 cm PEEP\u003cbr\u003e\ng.\tAssist respiration with BVM 10-12 bpm as needed\u003cbr\u003e\nh.\tPlace Supraglottic Airway (SGA). LMA preferred.\u003cbr\u003e\n3.\tIf available may consider Positive Pressure Ventilatory Devices (PPVD)\u003cbr\u003e\n4.\tEnsure that the ventilatory device is connected to a supplemental oxygen source, if available, using an adequate oxygen flow (8-12 LPM with an oxygen concentration \u003e 40%).\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tLaryngoscopic (Video or blade) visualization with oral endotracheal intubation\u003cbr\u003e\na.\tDuring cardiac arrest apply NRB mask at high flow oxygen for first two cycles of CPR. Then apply a NC at 15 liters/minute prior to and during intubation attempts.\u003cbr\u003e\nb.\tMay attempt x 2 per provider.\u003cbr\u003e\nc.\tIf you do not have confirmation of ETT placement with capnograph waveform or are unsure of ETT location remove tube and BLS airway or place SGA/EGA.\u003cbr\u003e\n2.\tNasotracheal intubation (blind or visualized if breathing)\u003cbr\u003e\na.\tIf you do not have confirmation of NTT placement with capnograph waveform or are unsure of NTT location remove tube and BLS airway or place SGA/EGA.\u003cbr\u003e\n3.\tStoma intubation\u003cbr\u003e\n4.\tSurgical cricothyrotomy\u003cbr\u003e\n5.\tCPAP PPVD Operation:\u003cbr\u003e\na.\tIf the patient is not intubated, make sure the PPVD mask is properly sealed on the patient's mouth and nose. If the patient is intubated, connect the device to the tube.\u003cbr\u003e\nb.\tVentilate the adult patient at a rate of 10-12 bpm, with inspiratory time of 1 - 2 seconds if supplemental oxygen is available. If supplemental oxygen is not available, use an inspiratory time of 2 seconds. Inspiratory/expiratory times should be at a 1:2 ratio. \u003cbr\u003e\nc.\tFor infants, ventilate at 20-30 bpm, with an inspiratory time of 0.5 - 1.0 seconds and for children, 12 - 20 bpm at 1 - 1.5 seconds.\u003cbr\u003e\nd.\tAuscultate lung sounds and watch for symmetric chest rise.\u003cbr\u003e\ne.\tAvoid inspiratory pressures \u003e20 cm H2O in non-intubated patients which can lead to gastric distention or barotrauma. \u003cbr\u003e\nf.\tContinuously monitor the ventilatory device to ensure there are no malfunctions of equipment or use.\u003cbr\u003e\ng.\tAirway adjuncts should be monitored for proper placement.\u003cbr\u003e\nh.\tPulse oximetry (including room air SAO2), end-tidal C02 detectors (ETC02) and capnometry/capnography is the standard for tube placement verification.\u003cbr\u003e\nPOST INTUBATION SEDATION\u003cbr\u003e\n\u003cbr\u003e\n1.\tMany intubated patients require sedation to tolerate the tube. There are reasons to add sedation when transporting intubated patients and it shouldn’t be withheld if the patient isn’t in arrest. Consider Fentanyl in patients with painful conditions or injuries. Ketamine serves as both a sedative and an analgesic. Patients who are regaining consciousness or improving their level of consciousness need sedation. Consider whether the patient has improved sufficiently to remove the adjunct from their airway.\u003cbr\u003e\n2.\tThe following can be used for post-intubation sedation:\u003cbr\u003e\nA.\tMIDAZOLAM 5 mg. IV/IO q 10 minutes as needed..\u003cbr\u003e\nB.\tKETAMINE 0.5-1.0 mg/kg slow IV/IO q 5-15 minutes as needed and tolerated. Caution advised if increased intracranial pressure is an issue. Consider MIDAZOLAM.\u003cbr\u003e\nC.\tFENTANYL 50-150 mcg IV/IO q 5 minutes as needed for pain.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040670"},{"listId":10040668,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"ALTERED MENTAL STATUS","summary":"","detail":"ALTERED MENTAL STATUS\u003cbr\u003e\n\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms may include any or all of the following: limited or no response to verbal or painful stimuli, inappropriate responses, irrational behavior and unable to ascertain causation.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nAirway management, adequate perfusion\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated. If occult trauma is possible, consider spinal restriction.\u003cbr\u003e\n2.\tSecondary Management - History, physical exam, Vital Signs\u003cbr\u003e\n3.\t Perform glucometry\u003cbr\u003e\na.\tIf the glucose is \u003c 60 mg/deciliter and associated signs and symptoms of hypoglycemia, follow Diabetic Emergencies Treatment Guidelines.\u003cbr\u003e\nb.\tIf the glucose is \u003e 60 mg/deciliter and narcotic overdose suspected, follow:\u003cbr\u003e\nPoisoning/ Overdose Treatment Guidelines.\u003cbr\u003e\n4.\tIf narcotic overdose or hypoglycemia is not suspected, transport the patient without delay to an appropriate medical facility.\u003cbr\u003e\n\u003cbr\u003e\n5.\tIf no AEMT/ALS capability, radio for AEMT or ALS intercept.\u003cbr\u003e\n\u003cbr\u003e\n6.\tIf patient exhibits signs and symptoms of shock, follow Shock Treatment Guidelines.\u003cbr\u003e\n\u003cbr\u003e\n7.\tTransport with head elevated 30-45 degrees\u003cbr\u003e\n\u003cbr\u003e\n8.\tEvaluate AMS using Cincinnati Pre-hospital Stroke Scale (CPSS)\u003cbr\u003e\n9.\tNALOXONE 0.4 mg IV/IM/IO/IN for suspected narcotic overdose with respiratory depression, may repeat x5. Consider possible causes of AMS:\u003cbr\u003e\nA- Alcohol / Acidosis\u003cbr\u003e\nE- Endocrine / Epilepsy / Electrolytes / Encephalopathy I– Infection\u003cbr\u003e\nO– Opiates / Overdose U– Uremia\u003cbr\u003e\nT– Trauma I– Insulin\u003cbr\u003e\nP– Poisoning / Psychosis S– Stroke\u003cbr\u003e\nAEMT / PARAMEDIC\u003cbr\u003e\n\u003cbr\u003e\n8.\tInitiate IV access; if necessary, titrate isotonic solution to end organ perfusion\u003cbr\u003e\n9.\tConsider IO access if patient condition warrants and peripheral IV site is unobtainable.\u003cbr\u003e\n\u003cbr\u003e\nNote: Dextrose administration may be harmful for patients with ischemic brain injury. However, dextrose should never be withheld in any patient suspected of hypoglycemia. When in doubt, treat for hypoglycemia if unable to perform glucometry.\u003cbr\u003e\n•\tTitrate use of Naloxone in patients with respiratory depression to avoid transition to combative behavior by patient.\u003cbr\u003e\n•\tUse appropriate discretion regarding immediate intubation of patients who may quickly regain consciousness, such as hypoglycemic after administration of dextrose or opiate overdoes cases after administration of Naloxone.\u003cbr\u003e\n\u003cbr\u003e\nCINCINNATI PREHOSPITAL STROKE SCALE (CPSS)\u003cbr\u003e\nFacial Droop \u003cbr\u003e\nNormal: Both sides of face move equally\u003cbr\u003e\nAbnormal: One side of face does not move at all \u003cbr\u003e\n\u003cbr\u003e\nArm Drift \u003cbr\u003e\nNormal: Both arms move equally or not at all\u003cbr\u003e\nAbnormal: One arm drifts compared to the other\u003cbr\u003e\n\u003cbr\u003e\nSpeech \u003cbr\u003e\nNormal: Patient uses correct words with no slurring\u003cbr\u003e\nAbnormal: Slurred or inappropriate words or mute\u003cbr\u003e\nInterpretation: If any 1 of these 3 signs is abnormal, the probability of a stroke is 72%.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040668"},{"listId":10040669,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"ANAPHYLACTIC REACTION","summary":"","detail":"ANAPHYLACTIC REACTION\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms may include any one or all of the following: wheezing associated with bronchoconstriction and/or stridor associated with upper airway edema, tachycardia, tachypnea, dyspnea, diminishing lung sounds, diaphoresis, tripod positioning, facial swelling, hives, shock and perhaps a history of severe allergies. Respiratory involvement may or may not occur in all cases of anaphylaxis. Be aware of “silent chest” presentation in cases of severe respiratory distress associated with poor air exchange.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nMaintenance of airway, adequate oxygenation, adequate perfusion\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n2.\tRapidly transport the patient to an appropriate medical facility. Consider AEMT or ALS intercept.\u003cbr\u003e\n3.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\n4.\tRemove injection mechanism if still present and treat wound.\u003cbr\u003e\n5.\tIf patient exhibits respiratory distress:\u003cbr\u003e\n\u003cbr\u003e\na.\tAdminister EPINEPHRINE 1:1000 [0.3mg or 0.3 ml.] IM from a pre-measured, pre-filled device or IM using 0.3 ml. syringe with 1 1/4 inch needle to anterolateral thigh. If needle length does not allow IM injection administer SQ. Pediatric (\u003c25 kg.) 0.15 ml. IM as above.\u003cbr\u003e\n\u003cbr\u003e\nb.\tIf available, consider administration of pre-measured inhalation device.\u003cbr\u003e\n\u003cbr\u003e\nc.\tConsider administration of ALBUTEROL [2.5 - 5 mg] by nebulizer or ALBUTEROL/IPRATROPIUM combination by nebulizer.\u003cbr\u003e\n\u003cbr\u003e\nNOTE: EMT-Basics may not administer Epinephrine 1:1000 to PEDIATRIC patients weighing less than 10 kg without medical direction.\u003cbr\u003e\nAEMT\u003cbr\u003e\nTreatment should continue at the AEMT and PARAMEDIC as follows:\u003cbr\u003e\n\u003cbr\u003e\n1.\tEPINEPHRINE 1:1,000 (1 mg./ml.) ADULT (over 25 kg.) 0.3 ml. IM anterolateral thigh (preferred). May give SQ. PEDIATRIC 0.15 ml. IM anterolateral thigh (preferred) or SQ. May repeat if needed q 10 minutes.\u003cbr\u003e\n2.\tAdult - consider DIPHENHYDRAMINE [25-50 mg] slow IV/IO/IM.\u003cbr\u003e\na.\tPEDIATRIC - consider DIPHENHYDRAMINE [1mg/kg] slow IV/IO or deep IM with a max dose of 50 mg.\u003cbr\u003e\n3.\tConsider METHYLPREDNISOLONE [125 mg] for adults, for PEDIATRICS [1mg/kg] IV/IO infusion over 5 minutes. \u003cbr\u003e\n4.\tConsider DEXAMETHASONE orally as alternative to Methylprednisolone. Draw 0.6 mg./kg. (0.06 ml./kg.) from vial with TB (1 ml.) syringe. Remove needle and administer orally. Maximum dose 10 mg. (1.0 ml.) Concentration in vial should be confirmed; usual concentration is 10 mg./ml.\u003cbr\u003e\n5.\tKeep in Mind that the administration of METHYLPREDNISOLONE in the field should NEVER delay transport as effects from this medication will not be apparent until hours after administration\u003cbr\u003e\n\u003cbr\u003e\n6.\tIn-route, initiate a large bore IV/IO of an isotonic solution titrated to maintain end organ perfusion.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nAge\tSystolic Blood Pressure\u003cbr\u003e\n(mm Hg)\u003cbr\u003e\nTerm neonates (0 to 28 days)\t\u003c 60\u003cbr\u003e\nInfants (1 to 12 months)\t\u003c 70\u003cbr\u003e\nChildren (1 to 10 years)\t\u003c 70 + (age in years x 2)\u003cbr\u003e\nChildren (\u003e 10 years)\t\u003c 90\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tIf there is a marked decrease in blood pressure or the patient is displaying signs \u0026 symptoms of respiratory and/or cardiovascular collapse\u003cbr\u003e\n\u003cbr\u003e\na.\tAdult - administer EPINEPHRINE 1:10,000 0.3-0.5 mg slow IV/IO (3.0-5.0 ml. IV/IO)\u003cbr\u003e\n\u003cbr\u003e\na.\tPEDIATRIC - administer EPINEPHRINE 1:10,000 0.01 mg/kg (0.1 ml./kg.) slow IV/IO up to 0.5 mg. (5 ml.)\u003cbr\u003e\nb.\tRepeat EPINEPHRINE 1:10,000 0.3 mg IV/IO every 10 minutes if condition persists\u003cbr\u003e\n2.\tPush Dose Epinephrine\u003cbr\u003e\na.\tIn the patient with severe anaphylaxis who is not responding to Epinephrine and fluid resuscitation, IV Epinephrine should be administered. \u003cbr\u003e\nb.\tInject 1 mg. (1 ml.) of 1:1,000 Epinephrine into a 100 ml. bag of NS and mix well. Draw out 10 ml. giving you a concentration of 1:100,000. \u003cbr\u003e\nc.\tAdminister 1 mL (10mcg) each minute as needed until symptoms improve.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040669"},{"listId":13139810,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"ANXIETY","summary":"","detail":"ANXIETY\u003cbr\u003e\n\u003cbr\u003e\nSevere anxiety, which comes in many forms, can be impairing to a patient and interfere with cognitive function, decision making, focus, and the ability to understand and cooperate with medical and psychological care. Anxiety can be periodic such as in “anxiety attacks” or be in a more chronic form. It is commonly part of a bigger and more complex mental illness state such as major depression, bipolar disorder, or the cognitive disorders (schizophrenia) as well as others. Whatever form it takes if it is of sufficient severity to impair a patient’s function and ability to understand and cooperate with their care it may be in the best interest of the patient to attempt to reduce their anxiety with medication on scene.\u003cbr\u003e\n\u003cbr\u003e\nPanic is a unique and usually episodic severe symptom complex. It is often predominated by physical symptoms that often add to the frightening experience. These include such things as chest pain, shortness of breath, dizziness, tingling, and confusion. Interventions that calm the patient and encourage normal breathing may assist. The physical complaints need to be investigated as part of the work up of these patients before medical intervention.\u003cbr\u003e\n\u003cbr\u003e\nProcedure\u003cbr\u003e\n\u003cbr\u003e\n1.\tAn Intranasal (IN) benzodiazepine can be an effective, safe, and expeditious intervention.\u003cbr\u003e\n2.\tPrior to any medication administration a medical history and appropriate physical examination will be conducted to the extent the patient will allow.\u003cbr\u003e\n3.\tPrepare MIDAZOLAM into an atomizer for administration.\u003cbr\u003e\n4.\tThe recommended dose is 2.5-5.0 mg. IN. This may be repeated as needed every five minutes.\u003cbr\u003e\n5.\tIf indicated the IM route is acceptable.\u003cbr\u003e\n6.\tThe patient should be advised the medication can cause a “buzz” or feelings of unreality or disorientation, sedation, and calming.\u003cbr\u003e\n7.\tThere are few contraindications.\u003cbr\u003e\na.\tAllergy to the medication\u003cbr\u003e\nb.\tSignificant intoxication with alcohol or other sedative drugs\u003cbr\u003e\nc.\tPrior history of a poor reaction to similar medications (Lorazepam, Clonazepam, Diazepam)\u003cbr\u003e\nd.\tEvidence of head trauma or impaired cognition due to an existing medical condition\u003cbr\u003e\n8.\tThe medication can cause impairment itself complicating obtaining informed consent, cooperating with treatment and transport, or completing a refusal of care. This downside must be taken into consideration prior to administering any medication. In most cases the patient is better able to make important decisions and cooperate with care due to the medication’s calming properties. The treating paramedic and team will need to make a determination of the patient’s capacity after the medication has become effective.\u003cbr\u003e\n9.\tAdministration of MIDAZOLAM does not necessitate transport. The overwhelming majority of patients can be left on scene in the company of a responsible adult after use of the medication. Many of these patients, relieved of intense anxiety, will wish to sleep.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/13139810"},{"listId":10040671,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"BEHAVIORAL EMERGENCIES","summary":"","detail":"BEHAVORIAL EMERGENCIES REQUIRING RESTRAINT OR TRANSPORT TO ALTERNATIVE DESTINATION\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nThe patient will have an altered mental status with associated inappropriate actions. Signs and symptoms may include: threatened or attempted suicide, aggression, hallucinations, delirium, or any action that could cause harm to the patient or others. If the EMS provider makes a good faith judgment that the patient is incapable of making an informed decision about his/her own safety or the need for medical attention and is reasonably likely to suffer disability or death without medical intervention the patient should be transported to a medical facility\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nProvider safety, transport decisions\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess airway, breathing and circulation and manage as indicated.\u003cbr\u003e\na.\tIf evidence of immediate danger/severe agitation/delirium exists:\u003cbr\u003e\ni.\tProtect yourself and others (leave the scene, if necessary).\u003cbr\u003e\nii.\tRequest law enforcement.\u003cbr\u003e\niii.\tShow of force utilizing law enforcement should be considered if indicated by patient behavior and if necessary to render care.\u003cbr\u003e\niv.\tWhen considering medication see SEDATION OF THE AGITATED PATEINT WITH MEDICATION guideline in this section.\u003cbr\u003e\n\u003cbr\u003e\nb.\tIf no evidence of immediate danger/severe agitation/delirium exists:\u003cbr\u003e\ni.\tONE EMT should be responsible for assessing, treating, and communicating with patient.\u003cbr\u003e\nii.\tThe SAME EMT should remain with patient during transport.\u003cbr\u003e\n\u003cbr\u003e\n2.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\na.\tPertinent medical history, if possible including:\u003cbr\u003e\ni.\tPrescription and non-prescription drugs.\u003cbr\u003e\nii.\tUnderlying organic cause, i.e. brain tumor, chemotherapy, closed head injury, hypoglycemia, hypoxia, shock, toxin consumption.\u003cbr\u003e\niii.\tPrevious psychiatric problems\u003cbr\u003e\n3.\tTransport\u003cbr\u003e\na.\tTransport the patient in position of comfort, if not contraindicated by injuries.\u003cbr\u003e\nb.\tKeep environment as quiet as possible.\u003cbr\u003e\nc.\tIf Paramedic administers Ketamine he/she must accompany patient in ambulance unless a Ketamine Special Skills approved Paramedic available in the ambulance.\u003cbr\u003e\n\u003cbr\u003e\nNotes: Use physical/chemical restraint only if necessary for protection of EMS providers or the patient. Do not attempt to restrain until you have sufficient resources. \u003cbr\u003e\n\u003cbr\u003e\nA minimum of four people is necessary to assure adequate protection to the rescuers and patient during the restraint process. If restraints have been applied, do not release until transfer at the hospital. A restrained patient will always have an EMT in attendance. \u003cbr\u003e\nPatients will not be restrained in the prone (face down) position or transported as such. This position, particularly in agitated patients, can lead to “positional asphyxia” and must be avoided.\u003cbr\u003e\n\u003cbr\u003e\nSpecial notes on restraint with medications. This is one of those unusual situations where the patient is incapable of giving adequate informed consent. You must be acting in the patient’s best interests (in “good faith”) when making the decision to use medication for restraint and document carefully your justifications. This is a medical decision for the patient’s safety and well-being and should be based on those needs. See SEDATION OF THE AGITATED PATIENT WITH MEDICATION in this section.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nSPECIAL CONSIDERATIONS FOR TRANSPORT TO THE CRISIS TRIAGE CENTER\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nThe Crisis Triage Center is intended to meet the needs of the majority of behavioral and psychiatric patients. They are located next to the Detention Center on Copper Loop. The decision to transport a patient to the CTC will require triage in the field. The CTC has limited medical capabilities but has a staff of an RN and a licensed therapist on duty 24 hours a day. They intend to keep patients who are voluntary admissions up to 24 hours. They do not accept involuntary admissions. A psychiatrist is available remotely. There will be a pharmacy and the ability to administer psychotropic medications. They represent a potentially valuable alternative to emergency departments for select patients. The dedicated phone number to contact the Crisis Triage Center is (505) 420-8204.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nAcceptable patients:\u003cbr\u003e\n\u003cbr\u003e\nMedically stable patients not requiring emergency department medical interventions. \u003cbr\u003e\n\u003cbr\u003e\nMust have the capacity for informed consent and be willing to go to the Crisis Triage Center.\u003cbr\u003e\n\u003cbr\u003e\nDrug and alcohol impaired patients are acceptable if they choose the Crisis Triage Center. Again, the patient must retain the capacity for informed consent to a reasonable degree.\u003cbr\u003e\n\u003cbr\u003e\n\tNo sedating medications have been administered.\u003cbr\u003e\n\u003cbr\u003e\n\tMust be 18 years old or older. If they have a legal guardian, the guardian is welcome.\u003cbr\u003e\n\u003cbr\u003e\n\tCOVID positive or suspected are not acceptable.\u003cbr\u003e\n\u003cbr\u003e\n\tNeeds to be ambulatory.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040671"},{"listId":10040675,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"CEREBROVASCULAR ACCIDENTS (CVA)","summary":"","detail":"CEREBROVASCULAR ACCIDENT (CVA)\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms may include any or all of the following: disorientation, weakness or paralysis to one side, excessive drooling, facial drooping, unequal pupils, difficulty in speaking, elevated BP, headache, and/or seizures. Pt. may have a past history of CVA or TIA.\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nMaintain adequate perfusion, adequate oxygenation, and transport quickly to the nearest\u003cbr\u003e\nstroke center. As of February 2020 both MVRMC and MMC are certified Stroke Centers.\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n2.\tPerform Cincinnati pre-hospital stroke assessment (see below)\u003cbr\u003e\n3.\tEstablish timeline of onset of symptoms. Establish and communicate to hospital the “Last Known Well Time” (LKWT).\u003cbr\u003e\n4.\tTransport the patient to the closest Stroke Center.\u003cbr\u003e\n5.\tObtain blood glucose level.\u003cbr\u003e\n6.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\n7.\tNotify the receiving facility that you are in-route with a suspected stroke patient.\u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\n1.\tIV or Saline Lock\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tCardiac Monitor and obtain 12 lead\u003cbr\u003e\n\u003cbr\u003e\nThe Cincinnati Prehospital Stroke Scale (CPSS)\u003cbr\u003e\nAbnormal Speech Have the patient say “you can’t teach an old dog new tricks” \u003cbr\u003e\nNormal – patient uses correct • words with no slurring\u003cbr\u003e\nAbnormal – patient slurs words, • uses the wrong words, or is unable to speak\u003cbr\u003e\n\u003cbr\u003e\nFacial Droop (have patient show teeth or smile): \u003cbr\u003e\nNormal – both sides of face • move equally\u003cbr\u003e\nAbnormal – one side of face • does not move as well as the other side\u003cbr\u003e\n\u003cbr\u003e\nArm Drift (patient closes eyes and extends both arms straight out for 10 seconds):\u003cbr\u003e\nNormal – both arms move the • same or both arms do not move at all (other findings, such as pronator drift, may be helpful)\u003cbr\u003e\nAbnormal – one arm does not • move or one arm drifts down compared with the other","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040675"},{"listId":10040676,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"DEHYDRATION","summary":"","detail":"DEHYDRATION\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nThe patient has experienced an abnormal loss of body fluids. Diarrhea, vomiting, profuse sweating, hyperthermia, or a decrease in fluid intake may cause this condition. \u003cbr\u003e\nSigns and symptoms may include any or all of the following: \u003cbr\u003e\nLethargy, dry skin, mucous membranes, disoriented, weak, tachycardia, hypotension, weak or absent radial pulses, cool and clammy skin,\u003cbr\u003e\ndiaphoresis, pallor, nausea and vomiting, rapid and shallow respiration. In the pediatric patient: sunken fontanels, fever, crying without tears, diminished number of wet diapers, recent history of diarrhea, lethargic.\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated. Use humidified O2.\u003cbr\u003e\n2.\tTransport the patient as soon as possible to the nearest medical facility.\u003cbr\u003e\n3.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\n4.\tTreat underlying causes (See applicable guidelines).\u003cbr\u003e\n\u003cbr\u003e\n5.\tConsider use of oral hydration fluids if the patient is conscious and able to self-protect the airway.\u003cbr\u003e\nAEMT/PARAMEDIC\u003cbr\u003e\n1.\tIn-route, initiate one or two large bore IV’s of an isotonic solution. Bolus the patient with 20 mL./kg. and infuse at a flow rate to maintain adequate end organ perfusion.\u003cbr\u003e\n2.\tUtilize a Buretrol IV set on PEDIATRIC patients and bolus at 20 mL./kg. repeating as necessary. Consider intraosseous (IO) access if the patient’s condition warrants.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040676"},{"listId":10040677,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"DIABETIC EMERGENCIES","summary":"","detail":"DIABETIC EMERGENCIES\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms may include any or all of the following: Hypoglycemia altered men- tal state, seizures, unconscious, drooling, skin is pale and moist, confused, agitated, sud- den onset, headache. Hyperglycemia – hot skin, acetone/fruity breath, Kussmaul respi- rations, polyuria, polydipsia, and polyphagia. There may be a history of recent injury, illness or unusual exertion. Though usually occurring in IDDM, this may also occur in NIDDM. Consider other causes of symptoms.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nMaintain adequate perfusion, glucose replacement if hypoglycemic\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n2.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\nPerform glucometry, if available.\u003cbr\u003e\n3.\tIf Blood Glucose Level (BGL) \u003c 60 mg/dL: or registers “LOW”\u003cbr\u003e\na.\tIf the patient is conscious and able to self-protect the airway, administer 15gm oral glucose. Reassess BGL after administration.\u003cbr\u003e\nb.\tIf the patient is unconscious, initiate transport and consider AEMT/ALS intercept for intravenous glucose administration.\u003cbr\u003e\nIf BGL is \u003e 200 mg/dL or registers “HIGH”:\u003cbr\u003e\na.\tProtect the patient’s airway, administer oxygen, assist ventilations if indicated and consider AEMT/ALS intercept for IV fluids.\u003cbr\u003e\nb.\tIf no change in mental status, transport as soon as possible to an appropriate medical facility.\u003cbr\u003e\nAEMT / PARAMEDIC\u003cbr\u003e\n\u003cbr\u003e\n1.\tIf the patient has an altered mental state and glucose level is \u003c60 mg/dl:\u003cbr\u003e\n\u003cbr\u003e\na.\tInitiate an IV / IO of an isotonic solution and bolus at 20 mL./kg. if associated dehydration or signs of poor perfusion are present\u003cbr\u003e\nb.\tAdminister D-10 250 ml IV solution titrating to recovered mental status. Repeat dose in 10 minutes if patient mentation does not improve. If still no improvement, re-check BGL and if BGL \u003c 60 mg./dl., administer 3rrd dose. \u003cbr\u003e\n•\tPediatric \u0026 neonates dose D-10 5ml./kg. rapid IV infusion.\u003cbr\u003e\nc.\tOnly administer the volume of D-10 needed to restore level of consciousness. It is hypotonic and can create other problems (low Na+) especially in pediatric patients.\u003cbr\u003e\nd.\tIn severe chronic alcoholism and malnutrition consider THIAMINE 100 mg. slow IV/IO/ or IM. (EMT-P only).","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040677"},{"listId":10040678,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"DO NOT RESUSCITATE (DNR)","summary":"","detail":"DO NOT RESUSCITATE ORDERS (DNRs)\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nINTRODUCTION\u003cbr\u003e\n\u003cbr\u003e\nA DNR order is a legally binding document that requires individuals and EMTs to follow its instructions in a situation where a patient is no longer capable of making health care decisions and is in need of resuscitation. A proper DNR order will dictate what should and should not be done in these situations. Except in rare circumstances the DNR should be obeyed and resuscitation efforts limited to those outlined in the document.\u003cbr\u003e\n\u003cbr\u003e\nIn New Mexico there is broad immunity to those who follow the directions of a DNR and penalties for not obeying them except in special situations.\u003cbr\u003e\n\u003cbr\u003e\nTYPES OF DNR DOCUMENTS\u003cbr\u003e\n\u003cbr\u003e\nThere are many ways a DNR can be written and you may encounter any of these.\u003cbr\u003e\n\u003cbr\u003e\n1.\t“MOST” Form from the NM EMS Bureau. It is a DNR with a min-Power of Attorney form on the second page.\u003cbr\u003e\n2.\tThe EMS DNR from the EMS Bureau has been discontinued but you’ll still see them. They are still valid DNR documents.\u003cbr\u003e\n3.\tPower of Attorney for Health Care (Living Will). These are longer documents usually written with legal help that designate an agent to make health care decisions for a patient and include end-of-life resuscitation instructions.\u003cbr\u003e\n4.\tAdvanced Directive (usually associated with institutions, clinics, and hospice). These come in many forms.\u003cbr\u003e\n5.\tPOLST (Physician Order for Life Sustaining Treatment). This is a document usually signed by the patient’s primary physician and often the patient outlining the terms of the DNR.\u003cbr\u003e\n6.\tA written physician order is allowed as a valid DNR.\u003cbr\u003e\n7.\tA “Medic Alert” bracelet or medallion may alert you to the existence of a DNR order.\u003cbr\u003e\n8.\tAn out of state DNR order is considered valid in New Mexico if it is a valid DNR order.\u003cbr\u003e\n9.\tThe most recently executed DNR order is the one to follow when more than one document exists.\u003cbr\u003e\n\u003cbr\u003e\nWHEN IS A DNR INVOKED\u003cbr\u003e\n\u003cbr\u003e\nThe patient is incapable of making health care decisions for themselves\u003cbr\u003e\nThe DNR is properly executed (dated with signatures including the patient when appropriate)\u003cbr\u003e\nThe patient can be accurately identified\u003cbr\u003e\nThe patient is in need of medical intervention to prevent death\u003cbr\u003e\n\u003cbr\u003e\nWHEN IS A DNR NOT INVOKED\u003cbr\u003e\n\u003cbr\u003e\nWhen homicide is suspected\u003cbr\u003e\n\u003cbr\u003e\nWhen suicide is suspected\u003cbr\u003e\n\u003cbr\u003e\nA DNR may be revoked by the patient’s agent identified as having Power of Attorney for the patient’s health care.\u003cbr\u003e\n\u003cbr\u003e\nWhen as a matter of “conscience” an EMT cannot invoke the directions of a DNR. New Mexico law requires that in such cases the patient be expeditiously transported to a facility where the DNR will be honored. A Squad unit should be used to avoid incurring any cost. Immunity extends to these decisions.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nSPECIAL CIRCUMSTANCES\u003cbr\u003e\n\u003cbr\u003e\nThe DNR may not be revoked by a family member, another health care provider, or law enforcement.\u003cbr\u003e\n\u003cbr\u003e\nShould the patient regain the capacity to make a health care decision they may revoke their own DNR at any time.\u003cbr\u003e\n\u003cbr\u003e\nIt is important to recognize these are often high stress situations with indecision or a change of heart occurring in family members or others. There may arise situations where a family member or other person may attempt to overturn the terms of the DNR. Though this is illegal in New Mexico and carries with it a risk of penalties the senior EMT on scene may chose to treat and transport the patient to allow for resolution of the conflict in a more secure setting. On-line medical consultation is strongly recommended by State rule when issues arise concerning a DNR.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040678"},{"listId":13608594,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"GERIATRIC PATIENTS (MEDICAL)","summary":"","detail":"GERIATRIC PATIENTS (MEDICAL)\u003cbr\u003e\nGENERAL CONSIDERATIONS\u003cbr\u003e\nThere is no scientific definition of the age at which a patient should be considered “geriatric”. For years it has been 65. Recent data has made some training programs drop the age to 55 where the anatomic and physiologic changes of age become clinically important. Geriatric patients pose new issues and need to be handled differently. Their vital signs, mental status, use of anti-coagulants, and more complicated medical history are just a few considerations.\u003cbr\u003e\nMEDICAL PATIENTS\u003cbr\u003e\n1.\tA thorough history of past and present medical conditions needs to be obtained.\u003cbr\u003e\n2.\tCurrent medications should be reviewed.\u003cbr\u003e\n3.\tVital signs may be abnormal while appearing within normal limits.\u003cbr\u003e\na.\tGeriatric patients have limited capacity to raise their heart rates when stressed. Tachycardia may be occurring at rates of 90.\u003cbr\u003e\nb.\tGeriatric patients very commonly have uncontrolled high blood pressure. Systolic blood pressures below 120 mmHg may indicate hypotension and commonly accepted levels of 90 mmHg may represent severe hypoperfusion.\u003cbr\u003e\n4.\tAirways can be compromised by dentures, the displacement of dentures, neck immobility and obesity.\u003cbr\u003e\n5.\tA detailed physical examination becomes more important to find clues to additional medical issues and hidden injuries not revealed in the history.\u003cbr\u003e\n6.\tConfusion, disorientation, or frank delirium may occur in a geriatric patient in distress.\u003cbr\u003e\na.\tSevere agitation can occur. Sedation should follow the SEDATION protocol guidelines. Use the lowest effective dose of medications when indicated and repeat as needed. Medication clearance is delayed in the geriatric population.\u003cbr\u003e\n7.\tMultiple medications, inconsistent use of prescribed medications, or overdose and adverse reactions or drug interactions need to be considered.\u003cbr\u003e\n8.\tConsider MIH referral for home safety and follow-up as indicated.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/13608594"},{"listId":13417405,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"HYPERKALEMIA","summary":"","detail":"HYPERKALEMIA\u003cbr\u003e\nINTRODUCTION\u003cbr\u003e\nHyperkalemia (elevated potassium levels) can be subtle but life-threatening. It can result from many conditions. Most commonly it is found in end-stage kidney failure patients on dialysis. But it can occur in patients taking excessive potassium through diet or medications, crush injuries and compartment syndrome, burns, and acidosis such as sepsis or diabetic ketoacidosis. There are much rarer times when electrolytes become disrupted by severe diarrhea and prolonged heat exposure.\u003cbr\u003e\nSymptoms are often vague and include weakness, fatigue, confusion, lethargy, and EKG changes including bradycardia.\u003cbr\u003e\n\u003cbr\u003e\nTREATMENT GUIDELINE\u003cbr\u003e\nGeneral\u003cbr\u003e\n1.\tCardiac monitor\u003cbr\u003e\n2.\t12-lead EKG that should be repeated often\u003cbr\u003e\n3.\tMonitor patient’s vitals closely and be prepared for potential deterioration including cardiac arrest.\u003cbr\u003e\nINTERMEDIATE\u003cbr\u003e\n1.\tEstablish IV/IO and bolus 10 cc./kg. of Normal Saline or Lactated Ringers if patient is hypotensive and unstable. Repeat as indicated.\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tExamine EKG for possible changes. See samples at the end of this protocol.\u003cbr\u003e\n2.\tMild hyperkalemia\u003cbr\u003e\na.\tPeaked T waves, increase in PR interval, decrease in P wave amplitude. Symptomatic.\u003cbr\u003e\nb.\tALBUTEROL 15 mg. by nebulizer. \u003cbr\u003e\n3.\tModerate to Severe\u003cbr\u003e\na.\tLoss of P wave, widening of QRS, in severe cases the QRS-T wave can become a sine wave. Bradycardia. Symptomatic.\u003cbr\u003e\nb.\tALBUTEROL 15 mg. by nebulizer. May repeat if patient remains unstable.\u003cbr\u003e\nc.\tCALCIUM CHLORIDE Adult: 1 gram IV/IO over 10 minutes. Pediatric: 20 mg/kg IV/IO over 10 minutes. Maximum is 1 gram.\u003cbr\u003e\nd.\tCALCIUM GLUCONATE Adult: 3 grams IV/IO over 10 minutes. Pediatric: 60 mg/kg IV/IO over 10 minutes. Maximum is 3 grams.\u003cbr\u003e\ne.\tSODIUM BICARBONATE Adult: 50 mEq IV/IO q 3-5 minutes until QRS narrows. Pediatric: 1 mEq/kg q 3-5 minutes IV/IO until QRS narrows. \u003cbr\u003e\nf.\tReminder: Don’t mix Calcium and Sodium Bicarbonate in the same IV/IO.\u003cbr\u003e\ng.\tEKG changes as hyperkalemia worsens from peaked T waves to sine wave.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/13417405"},{"listId":10040672,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"HYPERTENSION","summary":"","detail":"HYPERTENSION\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nThe patient may be experiencing hypertension sufficient to produce clinical end organ dysfunction most commonly in the cardiovascular system, CNS, and kidneys. Diastolic pressure usually exceeds 110 mmHg. Common presentations may include: chest pain, CHF, blurred vision, and confusion.\u003cbr\u003e\n\u003cbr\u003e\n\tEMPHASIS ON PATIENT CARE\t\t\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n2.\tInitiate transport to appropriate medical facility. \u003cbr\u003e\n3.\tConsider ALS intercept.\u003cbr\u003e\n4.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\n\u003cbr\u003e\nAEMT / PARAMEDIC\u003cbr\u003e\n\u003cbr\u003e\n1.\tIn-route, initiate IV/IO access.\u003cbr\u003e\n2.\tTreat other findings (chest pain, CHF) according to the appropriate guidelines.\u003cbr\u003e\n3.\tMost hypertensive patients are asymptomatic and DO NOT require pre-hospital interventions to lower blood pressure","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040672"},{"listId":10040684,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"INVOLUNTARY TREATMENT AND TRANSPORT","summary":"","detail":"RESTRAINT AND TRANSPORT / INVOLUNTARY\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nEmergency treatment applies to any age patient. Emergency treatment without consent implies that a life threat exists and patient is mentally incapable of making decisions on their own behalf. Reasonable force can be used, but only that force necessary to treat and transport the patient. Consider medication for sedation as the safer and more effective alternative to the risks of physical restraint. See SEDATION OF THE AGITATED PATIENT WITH MEDICATION guideline in this section.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nProvider safety, transport decisions\u003cbr\u003e\n1.\tSeveral attempts to gain consent for treatment and transport must be made prior to any attempts to subdue the patient.\u003cbr\u003e\n2.\tIf the patient meets the following criteria, the EMT may use reasonable force or sedation to treat and transport.\u003cbr\u003e\na.\tThe patient words or actions indicate that he/she is mentally incapable of making decisions on their own behalf. Such as:\u003cbr\u003e\ni.\tDisplays inappropriate and erratic behavior\u003cbr\u003e\nii.\tPatient has inappropriate responses to questions.\u003cbr\u003e\niii.\tEvidence of significant drug or alcohol impairment.\u003cbr\u003e\niv.\tDisoriented to time, person, place, or event\u003cbr\u003e\nv.\t Suicide attempt, or talking about attempting suicide or homicide.\u003cbr\u003e\nb.\tA life-threat is suspected or present.\u003cbr\u003e\n3.\tUse the following guidelines to secure and treat the patient.\u003cbr\u003e\na.\tCall for law enforcement assistance,\u003cbr\u003e\nb.\tHave enough personnel to safely secure patient and assure that all personnel are in- formed of plans and are involved.\u003cbr\u003e\nc.\tAdequately restrain the patient to stretcher or other device, as needed.\u003cbr\u003e\nd.\tAt least two EMTs should be present at all times if the patient is or suspected of being combative.\u003cbr\u003e\ne.\tKeep bystanders and onlookers away from the patient as they may agitate the patient.\u003cbr\u003e\nf.\tAll resuscitative measures to sustain life may be executed.\u003cbr\u003e\ng.\tMedical Control should be consulted if any questions arise.\u003cbr\u003e\nh.\tTransportation to an appropriate health care facility.\u003cbr\u003e\n4.\tDocument all actions, statements, and responses to your questions that support your decision to treat the patient without consent.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nThe Non-Patient\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nFor the purposes of refusal of treatment and/or transport there is a subgroup of individuals that constitute the “non-patient”. This is a small group and care should be taken in making the determination that the individual in fact meets the criteria for a “non-patient”. Non-patients still need documentation of their situation that lead to an EMS request and any relevant information concerning potential illness or injury. All demographics should be included. Seriously consider obtaining a formal informed consent refusal when any question of the individual’s actual patient status is present. “Non-patients” do not need to sign a refusal form, however.\u003cbr\u003e\n\u003cbr\u003e\nMinors present a unique problem. They can’t consent to assessment and treatment just as they can’t refuse it. If they meet the criteria for a “non-patient” when time allows a good faith effort should be made to contact parents or guardians and inform them of their minor child’s status and wishes. The guidance of the parent or guardian should be followed.\u003cbr\u003e\n\u003cbr\u003e\nA “non-patient” is one that declines all assessment and treatment and meets all of the following criteria:\u003cbr\u003e\n\u003cbr\u003e\n1.\tDid not request EMS assistance or an ambulance\u003cbr\u003e\n2.\tPresents with no current physical or psychological complaints\u003cbr\u003e\n3.\tHas no symptoms, signs, or complaints of an active medical illness or a traumatic injury or evidence of the same\u003cbr\u003e\n4.\tIs not impaired in anyway\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nSpecial notes:\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n“Lift assist” and similar calls for service where the potential for occult injury or illness is present should be carefully considered before being designated a “non-patient”. In an excellent study, patients who called for “lift assist” and similar calls had greater than a 20% need for emergency services within two weeks of the initial call. Look carefully for any sign of injury or illness and encourage assessment and treatment if it appears appropriate. In a similar manner consider getting an informed refusal if you suspect injury or illness in the face of the patient’s refusal of assessment and treatment. As usual, all refusals need to be well documented.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040684"},{"listId":10040679,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"NAUSEA/VOMITING","summary":"","detail":"NAUSEA / VOMITING\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nAny patient who is complaining of nausea and/or actively vomiting\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nAirway management, adequate oxygenation, evaluation of underlying causes\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management – ABC’s and have suction available. If patient is in spinal protocol, turn patient to one side, maintain spinal restriction manually.\u003cbr\u003e\n\u003cbr\u003e\n2.\tSecondary Management - History, physical exam, and vital signs:\u003cbr\u003e\na.\tCheck orthostatic vital signs\u003cbr\u003e\nb.\tCHECK BLOOD GLUCOSE.\u003cbr\u003e\nc.\tSAMPLE history\u003cbr\u003e\nd.\tAssess skin turgor and evaluate for dehydration\u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\n1.\tInitiate an IV/IO of isotonic crystalloid\u003cbr\u003e\n\u003cbr\u003e\n2.\tConsider fluid bolus (250-500mL) as dictated by patient condition\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n3.\tConsider an Antiemetic\u003cbr\u003e\n\u003cbr\u003e\na.\tONDANSETRON (Zofran): 4 mg slow IV/IO/IM or PO (ODT) may repeat x1\u003cbr\u003e\nb.\tPO Zofran may be followed by an IV dose of 4 mg. if not responding. Max 8 mg\u003cbr\u003e\n•\tPediatric 0.1mg/kg IV/IO/IM or 2 mg PO if \u003e 2 y/o 4 mg if \u003e4 y/o\u003cbr\u003e\n\u003cbr\u003e\nc.\tPROMETHAZINE (Phenergan) 12.5-25 mg IV/IO to be diluted in 100 ml of NS administered as a piggy back on a patent IV, or 25-50 mgs Deep IM\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tECG monitor\u003cbr\u003e\n2.\tMonitor patients' vital signs and continue to reassess\u003cbr\u003e\n3.\tTransport to appropriate facility","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040679"},{"listId":10040673,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"OBVIOUS DEATH ON SCENE","summary":"","detail":"CRITERIA FOR OBVIOUS DEATH ON SCENE\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nRESUSCITATION EFFORTS SHOULD BE WITHHELD UNDER THE FOLLOWING CIRCUMSTANCES:\u003cbr\u003e\n1.\tValid New Mexico Do Not Resuscitate Order present: Refer to Do Not Resuscitate (DNR)\u003cbr\u003e\n2.\tScene Safety: The physical environment is not safe for providers to treat patient.\u003cbr\u003e\n3.\tPt is Dead on Arrival (DOA): A person is presumed dead on arrival when all five \"Signs of Death\" or at least one associated \"Factor of Death\" present.\u003cbr\u003e\n\u003cbr\u003e\nMINIMUM SIGNS OF DEATH (All FIVE signs of death must be present)\u003cbr\u003e\n1.\tUnresponsiveness.\u003cbr\u003e\n2.\tApnea.\u003cbr\u003e\n3.\tAbsence of palpable pulses at carotid artery.\u003cbr\u003e\n4.\tUnresponsive pupils.\u003cbr\u003e\n5.\tAsystole is recorded on the Cardiac monitor in all three (3) leads.\u003cbr\u003e\nFACTORS OF OBVIOUS DEATH\u003cbr\u003e\n1.\tDamage or destruction of the body incompatible with life, such as:\u003cbr\u003e\n2.\tDecapitation\u003cbr\u003e\n3.\tDecomposition\u003cbr\u003e\n4.\tDeforming brain injury\u003cbr\u003e\n5.\tIncineration or extensive full thickness burns\u003cbr\u003e\n6.\tLividity/Rigor mortis of any degree.\u003cbr\u003e\n7.\tMajor blunt or penetrating trauma.\u003cbr\u003e\n8.\tExanguination\u003cbr\u003e\nPatients with ventricular assist devices (VAD) should not be pronounced dead at the scene.\u003cbr\u003e\n\u003cbr\u003e\nSUDDEN UNEXPLAINED INFANT DEATH (SUID)\u003cbr\u003e\nAn infant \u003c12 months who is apneic, asystolic (no heartbeat or umbilical cord pulse), and exhibiting lividity and/or rigor mortis may be presumed dead. Contact Medical Control for confirmation of death.\u003cbr\u003e\n\u003cbr\u003e\nNEONATE\u003cbr\u003e\nA neonate who is apneic, asystolic, and exhibits either neonatal maceration (softening or degeneration of the tissues after death in utero) or anencephaly (absence of a major portion of the brain, skull, and scalp) May be pronounced dead. Contact Medical Control for confirmation of death.\u003cbr\u003e\n \u003cbr\u003e\n\u003cbr\u003e\nWhen efforts to resuscitate are not initiated or are terminated EMS providers shall:\u003cbr\u003e\n\u003cbr\u003e\n1.\tDocument time that efforts are stopped or when you decided not to start efforts.\u003cbr\u003e\n2.\tNotify law enforcement, who will alert the Office of Medical Investigation.\u003cbr\u003e\n3.\tConsider the possibility of a crime scene and restrict access.\u003cbr\u003e\n4.\tAny decision to move the body must be made in collaboration with law enforcement and the medical examiner.\u003cbr\u003e\n5.\tLeave any resuscitation adjuncts such as advanced airway devices, IV/IO access devices, electrode pads, etc., in place.\u003cbr\u003e\n6.\tInform family on scene of patient's condition and offer to contact family, friends, clergy, or other support systems.\u003cbr\u003e\n\u003cbr\u003e\nDOCUMENTATION\u003cbr\u003e\n1.\tComplete a patient care report in all cases. Include ECG rhythm strips and code summary with the patient care report.\u003cbr\u003e\n2.\tDocument special orders including DNR, on-line Medical Control, etc.\u003cbr\u003e\n3.\tMCI conditions may require a triage tag in addition to a PCR.\u003cbr\u003e\n4.\tRecord any special circumstances or events that might impact patient care or forensic issues.\u003cbr\u003e\n5.\tDocument everything you observed and assessed during patient contact.\u003cbr\u003e\n6.\tIn adults prolonging resuscitation efforts, beyond 30 minutes without ROSC is usually futile unless cardiac arrests compounded by hypothermia or submersion in cold water.\u003cbr\u003e\n7.\tEMS providers are not required to transport every victim in cardiac arrest to a hospital. Unless special circumstances are present, it is expected that most resuscitations will be performed on scene until ROSC or a decision to terminate resuscitation efforts is made based on the listed criteria. Transportation with continuing CPR is justified if hypothermia is present or suspected. \u003cbr\u003e\n8.\tAn ETCO2 level of 20 mmHg or less measured 20 minutes after the initiation of advanced cardiac life support accurately predicts irreversible death in most patients in cardiac arrest.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040673"},{"listId":13327029,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"OVERDOSE PSYCHIATRIC MEDICATIONS","summary":"","detail":"OVERDOSE PSYCHIATRIC MEDICATIONS\u003cbr\u003e\n\u003cbr\u003e\nOverdoses are common. They can be intentional or non-intentional. Intentional overdose may be a manifestation of a suicide attempt. Unintentional overdose can be the result of confusion over taking prescription medications or misuse of recreational or illicit drugs. Overdoses of psychiatric psychoactive medications pose a unique challenge. Often these overdoses involve more than one medication confusing the presentation and management of the patient.\u003cbr\u003e\n\u003cbr\u003e\nGeneral treatment of overdoses\u003cbr\u003e\n\u003cbr\u003e\n1.\tThe patient needs a comprehensive history taken including all medications and a physical examination.\u003cbr\u003e\n2.\tA search for prescription bottles must be undertaken and an estimate made of the types and quantity of medications that may have been taken.\u003cbr\u003e\n3.\tAny history of a recreational drug or illicit drug should be investigated.\u003cbr\u003e\n4.\tThe patient should be evaluated with a monitor that can obtain vital signs, pulse oximetry, end tidal CO2 and the cardiac rhythm.\u003cbr\u003e\n5.\tOxygen should be given if indicated.\u003cbr\u003e\n6.\tIntravenous access should be obtained if indicated.\u003cbr\u003e\n7.\tSuicide interventions should be conducted if needed.\u003cbr\u003e\n8.\tThe New Mexico Poison Control Center offers excellent information if more is needed for the evaluation, treatment, and monitoring of overdose patients. (800) 222-1222.\u003cbr\u003e\n9.\tOverdose patients should be transported to an appropriate medical facility for evaluation and treatment.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nMedical Interventions\u003cbr\u003e\n\u003cbr\u003e\n1.\tTRICYCLIC ANTI-DEPRESSANTS\u003cbr\u003e\n\u003cbr\u003e\nA.\tThese highly toxic medications often produce serious and occasionally fatal results when overdosed. Expeditious transport to an appropriate medical facility should be undertaken once the patient is prepared for treatment and transport.\u003cbr\u003e\nB.\tIn addition to monitoring a 12-lead EKG should be obtained.\u003cbr\u003e\nC.\tCommon arrythmias associated with tricyclic overdoses include a variety of AV blocks, sinus and ventricular tachycardias, prolongation of the PR, QRS, and QT intervals and rarely Torsades.\u003cbr\u003e\ni.\tArrythmias that compromise the patient’s hemodynamic stability or are a threat such as Ventricular Tachycardia with a pulse should be treated with intravenous SODIUM BICARBANATE. This may need to be repeated to contain the arrythmia.\u003cbr\u003e\nii.\tCPR and cardiopulmonary resuscitation may be required.\u003cbr\u003e\niii.\tHypotension should be managed with fluid resuscitation. Shock states may require a vasopressor. NOREPINEPHRINE is recommended. See LCFD Treatment Guidelines for dosing.\u003cbr\u003e\nD.\tSome examples of Tricyclic Anti-Depressants in common use include Amitriptyline, Nortriptyline, Imipramine, Desipramine, and Doxepin. There are others less commonly prescribed.\u003cbr\u003e\n\u003cbr\u003e\n2.\tBENZODIAZEPINES\u003cbr\u003e\n\u003cbr\u003e\nA.\tThese medications have a wide safety range but can prove fatal especially when taken with other sedating medications or alcohol. Sedation and compromise of breathing are the most common results of overdose.\u003cbr\u003e\nB.\tThe treatment is primarily supportive. This includes maintaining a patent airway, ensuring adequate ventilation and oxygenation, and supporting blood pressure. \u003cbr\u003e\n\u003cbr\u003e\nSECOND GENERATION ANTI-DEPRESSANTS\u003cbr\u003e\n\u003cbr\u003e\n1.\tSSRI, SNRI\u003cbr\u003e\n\u003cbr\u003e\nA.\tThis is a large class of medications including Fluoxetine, Sertaline, Citalopram, Escitalopram. The SNRI’s include Duloxetine, Venlafaxine, and Desvenlafaxine. There are many others\u003cbr\u003e\nB.\tOverdoses with this class of drugs generally have a favorable outcome with proper monitoring and supportive care.\u003cbr\u003e\nC.\tSigns and symptoms include: Muscle spasms (Clonus), Tremors, Sweating, Dilated pupils, Tachycardia, Tachypnea, Confusion, Agitation, and Delirium.\u003cbr\u003e\nD.\tTreatment is largely supportive. Maintaining a patent airway and ensuring adequate ventilation and oxygenation are important.\u003cbr\u003e\nE.\tKETAMINE is not recommended in treating these patients for undifferentiated severe agitation or delirium.\u003cbr\u003e\n\u003cbr\u003e\n2.\tBUPROPRION\u003cbr\u003e\n\u003cbr\u003e\nA.\tThis unique antidepressant is potentially more toxic than the SSRI and SNRI anti-depressants. It is in common usage.\u003cbr\u003e\nB.\tSigns and symptoms include Tachycardia, Drowsiness, Agitation, Hallucinations, Vomiting, Tremors, and in severe cases Seizures.\u003cbr\u003e\nC.\tCardiac toxicity is rare but reported. Prolongation of the QRS and QT can be seen along with various arrythmias. Hypotension can occur.\u003cbr\u003e\nD.\tSeizures should be treated as any other seizure. MIDAZOLAM IM is the treatment of choice. See the LCFD SEIZURE Treatment Guideline for dosing.\u003cbr\u003e\nE.\tHypotension should be treated with fluids.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n3.\tMAO INHIBITORS\u003cbr\u003e\n\u003cbr\u003e\nThese highly toxic medications are not in common usage.\u003cbr\u003e\n\u003cbr\u003e\nA.\tThe toxidrome is primarily adrenergic over stimulation. Signs and symptoms are many including Altered Mental Status, Coma, Agitation, Sweating, Tachycardia, Vomiting, Seizures, Cardiorespiratory compromise, Muscle rigidity and Myoclonus (Muscle Spasms), and Fever.\u003cbr\u003e\nB.\tCardiac toxicity is reported and includes a variety of arrythmias and hypertension.\u003cbr\u003e\nC.\tTreatment is largely supportive including securing a patent airway and ensuring adequate ventilation and oxygenation.\u003cbr\u003e\nD.\tSeizures should be managed as any other seizure with MIDAZOLAM IM. See the LCFD Treatment Guidelines for dosing.\u003cbr\u003e\nE.\tExpeditious transport should be obtained.\u003cbr\u003e\n\u003cbr\u003e\nSECOND GENERATION (ATYPICAL) ANTI-PSYCHOTICS\u003cbr\u003e\n\u003cbr\u003e\nA.\tMuch more commonly prescribed than the first-generation anti-psychotic agents these include Resperidone, Quetiapine, Olanzapine, Aripiprazole, and Clozipine with other newer agents coming on the market rapidly.\u003cbr\u003e\nB.\tThe signs and symptoms are often complicated by multiple medications being ingested. There are very often multiple medications prescribed. The signs and symptoms include Delirium, Fever, Tachycardia, Blurred vision, Red Dry Skin, Agitation, Hallucinations, Mumbling Speech. The patient rarely recalls the event.\u003cbr\u003e\nC.\tCardiac toxicity has been reported with QT interval prolongation. Torsades is rarely reported, however.\u003cbr\u003e\nD.\tTreatment is largely supportive care ensuring a patent airway and adequate ventilation and oxygenation.\u003cbr\u003e\nE.\tHypotension if it occurs should be managed with fluids.\u003cbr\u003e\n\u003cbr\u003e\nLITHUM\u003cbr\u003e\n\u003cbr\u003e\nA.\tLithium has been used as a mood stabilizer in bipolar disorder for over a century. It has a narrow range of safety and unintentional overdose is common.\u003cbr\u003e\nB.\tSymptoms and signs vary with the serum concentration of Lithium. They range from Tremor, Overactive Reflexes, Nystagmus (eye tremor), and Ataxia (poor muscle control) to more severe symptoms and signs of Confusion, Agitation, Delirium, and Tachycardia leading to Coma, Seizures, Fever, and Hypotension.\u003cbr\u003e\nC.\tCardiac toxicity is usually non-specific and mild.\u003cbr\u003e\nD.\tTreatment is largely supportive. Ensure a patent airway and adequate ventilation and oxygenation.\u003cbr\u003e\nE.\tHypotension should be managed with fluids.\u003cbr\u003e\nF.\tSeizures are rare and can be managed with MIDAZOLAM. See the LCFD Treatment Guidelines for dosing.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/13327029"},{"listId":10040680,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"PAIN MANAGEMENT GUIDELINES","summary":"","detail":"PAIN MANAGEMENT GUIDELINES\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nRoutine Patient Care. Consider all patients as candidates for pain control regardless of transport time. Assess pain severity. Have the patient rate his/her pain from 0 -10. Document value each time pain is assessed. Non-pharmacological control: Splint injury; apply ice pack.\u003cbr\u003e\nUse distraction techniques: engage patient in conversation, etc. \u003cbr\u003e\n\u003cbr\u003e\nStanding orders for controlled substances are found throughout this document.\u003cbr\u003e\nListed below is the framework of intent for EMT-Intermediates and EMT-Paramedics to administer Ketamine (Paramedic Only Special Skill) or controlled substances within their Scope of Practice. \u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\nUSE OF CONTROLLED SUBSTANCES\u003cbr\u003e\n\u003cbr\u003e\n1.\tIn a poly-trauma patient if the patient is in severe enough distress that analgesia would provide a better assessment and allow overall improved patient management, then selective analgesia may be provided with vigilant hemodynamic monitoring. \u003cbr\u003e\n\u003cbr\u003e\n2.\tAny patient receiving analgesics will be placed on a cardiac monitor to document cardiac activity, oxygen therapy and ETCO2 to monitor the respiratory side effects of these medications.\u003cbr\u003e\n\u003cbr\u003e\n3.\tThe highest trained provider (EMT-I or EMT-P) should attend patients receiving narcotics at all times.\u003cbr\u003e\n\u003cbr\u003e\n4.\tAntidote: For Hypoventilation from Opiate administration by EMS personnel, administer \u003cbr\u003e\n\u003cbr\u003e\na.\tNALOXONE 0.4-2.0 mg SQ/IV/IO/IM/IN\u003cbr\u003e\nb.\tPediatric: NALOXONE 0.01 mg/kg to 0.1 mg/kg IV/IO/IM/SQ/IN up to 2 mg total dose.\u003cbr\u003e\n\u003cbr\u003e\n5.\tProbably safe in pregnancy though animal studies have shown chronic exposure could have adverse effects. If any question contact on-line medical direction.\u003cbr\u003e\n\u003cbr\u003e\n6.\tAny administration outside this realm should be done with on-line MEDICAL CONTROL\u003cbr\u003e\n\u003cbr\u003e\n7.\tIf the patient becomes nauseated after administration of narcotic analgesics consider administration of an anti-emetic agent:\u003cbr\u003e\n\u003cbr\u003e\na.\tONDANSETRON (Zofran) [4 mg] IV/IO, PO (ODT) or deep IM for adults, or [0.1mg/kg] IV/IO or deep IM for PEDIATRIC.\u003cbr\u003e\nb.\tPROMETHAZINE (Phenergan) 12.5-25 mg IV/IO to be diluted in 50 ml of NS administered as a piggy back on a patent IV, or 25-50 mg Deep IM\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nINTERMEDIATE and PARAMEDIC\u003cbr\u003e\n\u003cbr\u003e\nNo preference for analgesic (Ketamine versus Narcotics) is indicated by the order in this page.\u003cbr\u003e\n\u003cbr\u003e\nADMINISTRATION OF KETAMINE (by Special Skill trained Paramedic only)\u003cbr\u003e\n\u003cbr\u003e\nAdult/Pediatric\u003cbr\u003e\n\u003cbr\u003e\n\t0.20 mg./kg. slow IV/IO push over one to two minutes. (10 mg./ml. vial)\u003cbr\u003e\nMay repeat times one in 5 minutes. If protracted contact time the IV/IO dosing sequence of Ketamine may be repeated as needed approximately every 5-10 minutes for continuous pain management.\u003cbr\u003e\n\u003cbr\u003e\n0.20 mg./kg. IM. May repeat times one in 10 minutes. (10 mg./ml. vial). Additional doses may be administered in approximately 15 minutes as needed for continuous pain management.\u003cbr\u003e\n\u003cbr\u003e\nADMINISTRATION OF CONTROLLED SUBSTANCES (Available to Intermediates and Paramedics\u003cbr\u003e\nAdults\u003cbr\u003e\n1.\tFENTANYL 50 – 100 mcg IV/IM/SQ/IN q 5 min until no longer tolerated or pain control achieved.\u003cbr\u003e\na.\tFor severe pain may use weight-based dosing: Fentanyl 0.5-1mcg/kg\u003cbr\u003e\nPediatric\u003cbr\u003e\n1.\tFENTANYL 1 mcg/kg q 5 minutes until no longer tolerated or pain control achieved.\u003cbr\u003e\n\u003cbr\u003e\nADMINISTRATION OF KETOROLAC (Toradol) Non-steroidal anti-inflammatory (NSAID) analgesic.\u003cbr\u003e\n\u003cbr\u003e\nAdults\t\t60 mg. IM (deep in muscle) as single dose in the buttocks. Onset 10 minutes.\u003cbr\u003e\n\t\tFor extreme pain may consider 15 mg. slowly administered IV/IO as single dose.\u003cbr\u003e\nPediatric\t(2-16 years) 1 mg./kg. up to maximum of 30 mg. IM. Onset 10 minutes.\u003cbr\u003e\n\t\tFor extreme pain may consider 0.5 mg./kg. slowly administered IV/IO maximum 15 mg.\u003cbr\u003e\nNOTES:\u003cbr\u003e\nKetamine and opiate analgesics may be combined if patient is otherwise a candidate for opiate analgesics.\u003cbr\u003e\nKetamine preferred as initial agent when support of vital signs (blood pressure and pulse) important such as in trauma patients (See below). Ketamine is effective in controlling pain-associated anxiety when used as an analgesic.\u003cbr\u003e\nAny patient receiving Ketamine will be accompanied by the administrating Paramedic in the ambulance unless a Ketamine Special Skills Paramedic is available in the ambulance. See Drug Section for more information.\u003cbr\u003e\nKetorolac contraindicated in renal failure, L\u0026D patients, breastfeeding, pregnancy.\u003cbr\u003e\nKetorolac effective in opioid tolerant patients.\u003cbr\u003e\nKetorolac effective in moderate to severe pain. May be combined with other analgesics in these Treatment Guidelines.\u003cbr\u003e\nAvoid Ketorolac in bleeding (covert or overt) bleeding patients if alternative available.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040680"},{"listId":10040681,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"POISONING/OVERDOSE","summary":"","detail":"POISONING / OVERDOSE\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nEvidence of inhalation, ingestion, or injection of a substance causing an untoward effect. Signs and symptoms may include any one or all of the following: respiratory depression, apnea, tachycardia, bradycardia, cardiac arrhythmia's, altered mental status, unconsciousness, nausea, vomiting, and cardiac arrest.\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nAirway management, adequate oxygenation and maintain adequate perfusion\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n2.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\na.\tIf medication overdose, ascertain:\u003cbr\u003e\ni.\tAmount of and type\u003cbr\u003e\nii.\tTime taken\u003cbr\u003e\niii.\tAccidental vs. intentional\u003cbr\u003e\niv.\tMixed OD\u003cbr\u003e\nv.\tHistory of underlying illness, if appropriate\u003cbr\u003e\nvi.\tTreatment prior to arrival\u003cbr\u003e\nb.\tIf poisoning: Identify the following\u003cbr\u003e\ni.\tSubstances and quantity taken and bring medications with you to the hospital.\u003cbr\u003e\nii.\tMethod taken\u003cbr\u003e\niii.\tUnderlying conditions\u003cbr\u003e\niv.\tHas the patient vomited?\u003cbr\u003e\n3.\tContact Poison Control [1-800-222-1222] and transport the patient to an appropriate medical facility. Consider ALS intercept.\u003cbr\u003e\n4.\tIf narcotic overdose is suspected with serious signs and symptoms:\u003cbr\u003e\ni.\tAdminister NALOXONE 0.4 mg IM, SQ or [2 mg (1 mg per nostril)] IN, may repeat every 2-5 min. [0.4 mg increments] until 2 mg has been administered.\u003cbr\u003e\n5.\tIf organophosphate overdose or symptomatic exposure with serious signs and symptoms:\u003cbr\u003e\ni.\tAdminister ATROPINE 1 mg IV q 5 min for bronchorrhea. \u003cbr\u003e\n•\tPediatric ATROPINE 0.04 mg/kg IV q 5 min for bronchorrhea","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040681"},{"listId":10040683,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"REFUSAL OF TREATMENT/TRANSPORT","summary":"","detail":"REFUSAL OF TREATMENT / TRANSPORT (ADULT)\u003cbr\u003e\n\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nA competent adult (18 years or older) may refuse any or all treatment or transport at any time. If patient is not capable or lacks the capacity to make rational decisions, follow Involuntary Restraint and Transport Guidelines. All refusal patients must be evaluated, vital signs obtained (if possible), and informed of the situation and the potential life threat or disability.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nProvider safety, transport decisions\u003cbr\u003e\n\u003cbr\u003e\n1. Primary Management - Assess airway, breathing and circulation and manage as indicated.\u003cbr\u003e\n\t2. Perform Secondary Management including (if patient allows):\u003cbr\u003e\na.\tInform patient of her/his medical condition, potential injury or illness and the potential ramifications if treatment and transport are refused.\u003cbr\u003e\nb.\tAssure the patient fully understands what you are saying.\u003cbr\u003e\n\tc. Attempts to inform should be done in the presence of a witness, i.e. family members,\u003cbr\u003e\nbystander, or Police Officer (preferably not a member of the EMS service).\u003cbr\u003e\nd.\tObtain the patient’s signature on refusal and patient information for report.\u003cbr\u003e\ne.\tHave a witness sign below in appropriate place.\u003cbr\u003e\nf\tEven though you have obtained a signature, take reasonable steps to protect patient by calling a friend or family member to attend to patient.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n3.\t EMS refusal of care represents one of the highest liability exposures that an\t\u003cbr\u003e\n EMS Provider will ever face. All refusals should be carefully documented.\t\u003cbr\u003e\n Consider having medical control speak directly with patient by cell phone or radio.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040683"},{"listId":10040686,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"RESPIRATORY DISTRESS (CHF)","summary":"","detail":"RESPIRATORY DISTRESS PULMONARY EDEMA/CHF\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nPatient presenting with signs, symptoms, and history of moderate to severe dyspnea and or poor perfusion secondary to pulmonary edema. Emphasis will be placed on complete assessment of patient and history with treatment of the underlying cause if possible. Caution should be taken in getting a complete history since many of these patients are taking numerous medications for chronic conditions.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n2.\tCPAP should be initiated if patient able to tolerate mask and pressure.\u003cbr\u003e\n3.\tTitrate oxygen to SpO2 \u003e94%\u003cbr\u003e\n4.\tSpO2 and ETCO2 monitoring\u003cbr\u003e\n5.\tInitiate transport to an appropriate medical facility. \u003cbr\u003e\n6.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\n1.\tIn-route, initiate an IV/IO of an isotonic solution and infuse at a flow rate to maintain adequate end organ perfusion.\u003cbr\u003e\n2.\tClosely monitor IV drip rate. Do not overhydrate the patient.\u003cbr\u003e\n3.\tConsider CPAP early.\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\t12 lead EKG\u003cbr\u003e\n2.\tEvaluate dysrhythmias and treat per appropriate guidelines. \u003cbr\u003e\na.\tMay consider MIDAZOLAM 2 mg IV/IN for anxiolysis for CPAP administration.\u003cbr\u003e\n3.\tConsider NITROGLYCERIN [0.4mg] SL every 5 minutes, if patient is in severe distress, and BP \u003e100 systolic, HR \u003e 60. Must have IV/IO initiated.\u003cbr\u003e\n4.\tConsider FUROSEMIDE (Lasix) Only for use in patients that have Furosemide prescribed for them. Dose is two times their prescribed amount. For example, if the patient takes 20 mg. daily administer 40 mg. IV. Maximum dose is 100 mg. IV. Check vial concentration; the concentration is usually 10 mg./ml","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040686"},{"listId":10040685,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"RESPIRATORY DISTRESS (COPD, ASTHMA)","summary":"","detail":"RESPIRATORY DISTRESS (ASTHMA, COPD)\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nConstriction of the small airways of the lungs resulting in bronchoconstriction, in- creased secretions and wheezing. The patient will almost always have a pertinent history and will be suffering from some degree of dyspnea. Wheezing may not be present and lack of wheezing with decreasing breath sounds is often a sign of impending respiratory arrest. Signs and symptoms may include any or all of the following: inspiratory wheezing, rapid and/or shallow respiratory rate, nasal flaring, and use of accessory muscles. Patient may complain of difficulty in breathing, and cyanosis may be present. LOC may be decreased, diminishing or silent bilateral lung sounds, wheezing, stridor, and/or sternal retractions. The patient may be tachycardic, diaphoretic, with tripod positioning. “See Saw” breathing may be present in children.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n1.\tAirway maintenance, adequate oxygenation \u003cbr\u003e\na.\tCOPD SpO2 goal 88-92% all other conditions \u003e94%\u003cbr\u003e\n2.\tPrimary Management - Assess ABC’S and manage as indicated.\u003cbr\u003e\n3.\tInitiate transport to an appropriate medical facility. \u003cbr\u003e\n4.\tConsider CPAP as an early intervention (Basic level).\u003cbr\u003e\n5.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\n6.\tIf patient is in moderate to severe respiratory distress and acute asthma or COPD is suspected:\u003cbr\u003e\n\u003cbr\u003e\na.\tAdults - administer ALBUTEROL [2.5 - 5.0 mg] and IPRATROPIUM [0.5mg], diluted in 2.5mL of a sterile isotonic solution, over a 5-15 minute period. Some patients may need continuous nebulizer treatment during the entire transport. Providers are encouraged to deliver nebulized ALBUTEROL and IPRATROPIUM via bag valve mask for patients who are unable to provide effective respiratory exchange. Do not delay transportation waiting for the medication to take effect.\u003cbr\u003e\n\u003cbr\u003e\nb.\tChildren – Refer to the Respiratory Distress – Pediatric SOB Treatment Guidelines.\u003cbr\u003e\n7.\tIf no improvement and the patient is refractory to other treatments, administer EPINEPHRINE 1:1,000 [0.3mg] using a pre-measured, pre-filled device or 0.3mL TB syringe IM/SQ \u003cbr\u003e\nAEMT\u003cbr\u003e\n1.\tConsider CPAP early.\u003cbr\u003e\n2.\tIn-route, initiate an IV/IO of isotonic solution at a TKO rate\u003cbr\u003e\n3.\tConsider METHYLPREDNISOLONE [125mg] IV/IO for adults or DEXAMETHASONE 0.6 mg./kg. (0.06 ml./kg.) drawn up with a TB (1 ml.) syringe. Remove needle and administer orally. Maximum dose 10 mg. (1 ml.). Check vial concentration; usual is 10 mg./ml.)\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n\u003cbr\u003e\n1.\tConsider CPAP early. \u003cbr\u003e\n2.\tIf no relief is noted and the patient is unable to exchange oxygen due to bronchoconstriction:\u003cbr\u003e\na.\tAdult - administer EPINEPHRINE 1:1,000 (1 mg./ml.) 0.3 ml. IM in anterolateral thigh. SQ acceptable.\u003cbr\u003e\n3.\tConsider MAGNESIUM SULFATE [2 grams/10 min] IV infusion in adults.\u003cbr\u003e\n4.\tConsider METHYLPREDNISOLONE [125mg] IV/IO for adults or DEXAMETHASONE 0.6 mg./kg. (0.06 ml./kg.) drawn up with a TB (1 ml.) syringe. Remove needle and administer orally. Maximum dose 10 mg. (1 ml.). Check vial concentration; usual is 10 mg./ml.)\u003cbr\u003e\n4.\tDo not delay transport while administering Albuterol. You may continue treatment in-route to hospital. Monitor respiratory rate and depth closely. Avoid hyperinflation of the chest and lungs during positive pressure ventilation.\u003cbr\u003e\n5.\tDo not delay transport to administer steroids. Onset of action is delayed and effects may not be observed in the field.\u003cbr\u003e\n\u003cbr\u003e\nCAUTION: Administration of Beta-agonists to patients with coronary artery disease. Obtain ECG and Contact medical control for medication orders if in doubt.\u003cbr\u003e\n\u003cbr\u003e\nPEARLS:\u003cbr\u003e\nRAD: Reactive Airway Disease.\u003cbr\u003e\n•\tBeware of patients with a \"silent chest\" as this may indicate severe bronchospasm and impending respiratory failure.\u003cbr\u003e\n•\tRemember that not all wheezing is caused by asthma and that not all asthmatics wheeze.\u003cbr\u003e\n•\tPatients with congestive heart failure may present with lung sounds that mimic asthma (\"cardiac wheeze\").","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040685"},{"listId":10040687,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"RESTRAINT USE/PHYSICAL AND MEDICAL","summary":"","detail":"RESTRAINT USE\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nIndications:\u003cbr\u003e\nTo provide guidelines on the use of restraints in the field or during transport for patients who are violent or potentially violent or pose a danger to themselves or others. (e.g. to prevent the dislodgement of medical devices or to protect a patient who is confused or disoriented and unable to follow instructions for his/her safety).\u003cbr\u003e\n\u003cbr\u003e\nDefinitions:\u003cbr\u003e\nPhysical Restraint – means a device approved by this service that is used to limit mobility or immobilize a patient in order to protect the patient, crew or others.\u003cbr\u003e\nChemical restraint – Means a medication given with the intent to control behavior through sedation.\u003cbr\u003e\nIf the EMS provider makes a good faith judgment that the patient is incapable of making an informed decision about his/her own safety or the need for medical attention and is reasonably likely to suffer disability or death without medical intervention the patient should be transported to a medical facility\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nPrecautions:\u003cbr\u003e\nAs a general rule, if a patient needs to be restrained, it should be the responsibility of law enforcement to do so. Use physical restraint only if necessary for protection of EMS providers or the patient. If restraint of the patient is necessary, do not attempt to restrain until you have sufficient resources. A minimum of four people is necessary to assure adequate protection to the rescuers and the patient during the restraint process. If restraints have been applied, do not release until transfer at the hospital. Patients must not be restrained in a prone (face down) position or transported as such.\u003cbr\u003e\nPolicy:\u003cbr\u003e\n1.\tPhysical restraint must be humane and used only as a last resort. Verbal de-escalation must be attempted first.\u003cbr\u003e\n2.\tRestraints applied by law enforcement must allow EMS the ability to assess the patient and provide the patient sufficient slack to take full tidal volume breaths. \u003cbr\u003e\n1.\tIf hand cuffs were applied by law enforcement, EMS must have the ability to remove them if needed in an emergent situation and an officer must accompany the patient.\u003cbr\u003e\n3.\tPhysical restraints applied by EMS personnel must be either the soft wrist restraints supplied by the department or transport agency or restraints fashioned out of sheets. Physical restraints must allow the patient to take full tidal volume breaths.\u003cbr\u003e\n4.\tJustification of restraint use must be documented in the PCR\u003cbr\u003e\n5.\tAny patient who is restrained should be placed on oxygen and monitored through pulse oximetry and end tidal CO2 at a minimum, whenever possible.\u003cbr\u003e\n6.\tAny restrained limb should be evaluated for adequate distal perfusion every 15 minutes\u003cbr\u003e\n7.\tConsider chemical restraint as an alternative in patients incapable of making informed consent and are at risk for injury from physically being restrained. See SEDATION OF THE AGITATED PATIENT WITH MEDICATION guideline in this section.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040687"},{"listId":13056567,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"SEDATION OF THE AGITATED PATIENT WITH MEDICATION","summary":"","detail":"SEDATION OF THE AGITATED PATIENT WITH MEDICATION\u003cbr\u003e\n\u003cbr\u003e\nIntroduction\u003cbr\u003e\n\u003cbr\u003e\nThis Guideline brings together the various elements of the sedation of patients from other Guidelines in this document. Medication-assisted sedation of the severely agitated, delirious, combative, drug impaired, and impaired violent patient who poses a risk of harm to themselves and others is safer and more effective than physical restraint. Patients in these hypermetabolic states are at risk for disability or death, and using physical restraints places them at heightened risk for a poor outcome. Sedation is only undertaken under the following conditions. The individual has been turned over to EMS as a patient, a medical indication for sedation is established, and transport to an appropriate medical facility is available within a reasonable amount of time. \u003cbr\u003e\n\u003cbr\u003e\nAs noted, the treating paramedic and team make the decision to sedate a patient with medications. Medication-assisted sedation is not a law enforcement decision. However, officers may be the source of the referral and may be needed to assist in restraining the patient during medication administration. Always act to ensure the patient's safety and well-being.\u003cbr\u003e\n\u003cbr\u003e\nGuideline\u003cbr\u003e\n\u003cbr\u003e\n1.\tThe patient may be the subject of a 911 call, a referral from the MIH/LIGHT team, or law enforcement. In all cases the subject must be turned over to EMS as a patient to determine the needs of the patient and whether sedation is indicated.\u003cbr\u003e\n2.\tAll patients need to be assessed to the extent that the patient’s condition allows including a history and a physical examination.\u003cbr\u003e\n3.\tSedation has significant risks and should only be done for the safety and well-being of the patient and care providers.\u003cbr\u003e\n4.\tOnce it is determined that sedation is indicated it is paramount that all equipment, manpower, and medications are prepared before an attempt to sedate is made. Personnel will be prepared to administer the medication, monitor the patient, and manage any adverse events. Adverse events are rare but need to be anticipated.\u003cbr\u003e\n5.\tThe following medications are approved for medication assisted sedation:\u003cbr\u003e\n\u003cbr\u003e\nA.\tKETAMINE is a NM Special Skill medication. The dose is 2-4 mg./kg. IM. It is generally effective within five minutes. Limited to patients 13 years and older.\u003cbr\u003e\nB.\tMIDAZOLAM is a benzodiazepine. The dose is 5-10 mg. IM. It may take up to 20 minutes to become effective.\u003cbr\u003e\nC.\tThe choice of medication is up to the treating paramedic. In general, pure cases of psychosis from schizophrenia, manic psychosis, or other isolated psychoses without drug involvement can be managed best with MIDAZOLAM. Ketamine can aggravate psychosis. If psychoactive drugs may be involved KETAMINE may be the preferred agent.\u003cbr\u003e\nD.\tOnce sedation appears effective and the patient is calm and able to cooperate all physical restraint and restraints should be removed. The patient must be kept in a comfortable position that facilitates breathing and hemodynamic stability.\u003cbr\u003e\nE.\tThe patient should be closely monitored by a paramedic. Vital signs, pulse oximetry, and end tidal CO2 will be monitored as well as the patient’s airway and ventilation. Transport to a medical facility should be undertaken when it is safe to do so.\u003cbr\u003e\n\u003cbr\u003e\n6.\tIn unusual situations where KETAMINE appears to be ineffective or even aggravates the patient’s agitated state it is safe to administer MIDAZOLAM. Again, it is necessary to monitor the patient for compromised breathing with two sedating medications in their system.\u003cbr\u003e\n7.\tFor the MIH/LIGHT team it is important that a transporting unit be available within a reasonable period of time in order to safely sedate and transport the patient.\u003cbr\u003e\n8.\tFor MINOR patients there is the opportunity to obtain informed consent from parents or guardians. This opportunity should be taken and a good faith effort made to obtain consent before any medication administration. If no opportunity exists to get informed consent on behalf of the minor patient exercise clinical judgement in determining the appropriateness of sedation in an emergency situation.\u003cbr\u003e\n9.\tPEDIATRIC patients represent an unusual and vulnerable population. Nevertheless, the need for sedation in select severely agitated patients does arise. Again, the opportunity for informed consent is present and should be pursued with the patient’s parents or guardians. KETAMINE has not been extensively studied in pediatric patients and is not recommended below the age of 13. MIDAZOLAM is the preferred medication for sedation. The dose is 0.2 mg./kg. given IM. Maximum dose is 10 mg.\u003cbr\u003e\n10.\tPatients being transported from a facility should be sedated by the facility staff at the facility. No one should be placed in an ambulance unit who is not safe and comfortable in a gurney.\u003cbr\u003e\na.\tThorough history and understanding of medication used to sedate a patient by a facility will be obtained. \u003cbr\u003e\nb.\tContact medical control for direction on continuing sedation if necessary, during transport. \u003cbr\u003e\nc.\tCollaboration with the facility is necessary to ensure safety of the patient and responders.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/13056567"},{"listId":10040689,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"SEIZURES","summary":"","detail":"SEIZURE (ADULT)\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nMost seizures spontaneously end within 5 minutes with a postictal state of varying length, with unconsciousness or altered LOC. Seizures occurring during response should be treated expeditiously.\u003cbr\u003e\nStatus epilepticus exists when witnessed seizure activity continues for \u003e 5 minutes or multiple seizures recur without a return to full mental capacity. Signs and symptoms may include any one or all of the following: may experience an aura, violent spasms of muscles lasting up to 3 - 5 minutes, incontinence, increased salivation, postictal phase, possible history of drug usage for seizures.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n1.\tMaintain adequate airway, adequate oxygenation, protect patient from harm\u003cbr\u003e\n2.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n3.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\n4.\tInitiate transport to an appropriate medical facility, request ALS intercept.\u003cbr\u003e\na.\tDetermine blood glucose level\u003cbr\u003e\nb.\tCardiac monitoring\u003cbr\u003e\nc.\tMonitor the patient’s vital signs\u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\n1.\tIn route, initiate a large bore IV/IO of an isotonic solution at a TKO rate.\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tFor ADULT seizures administer:\u003cbr\u003e\na.\tMIDAZOLAM 10 mg. IM administration has proven to be the safest and easiest route and is nearly as rapid in onset as IV/IO/IN administration. May be repeated as needed.\u003cbr\u003e\nb.\t MIDAZOLAM [2-4mg] slow IV/IO/IN. Repeat dose if needed to max of 10mg.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040689"},{"listId":10040690,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"SEPSIS","summary":"","detail":"SEPSIS\t\t\t\t\t\t\t\t\u003cbr\u003e\n\u003cbr\u003e\nDesignation of condition\u003cbr\u003e\n\u003cbr\u003e\nSevere infectious/inflammatory process occurring generally in older patients but possible in all age groups including infants. Generalized symptoms and signs from an infection that started in a localized form but has spread to involve many organ systems and the body as a whole. Highly lethal.\u003cbr\u003e\n\u003cbr\u003e\nCriteria for probable sepsis\u003cbr\u003e\n\u003cbr\u003e\n18 years and older and not pregnant (appreciate that rarely occurs in much younger patients).\u003cbr\u003e\nAt least two of the SIRS (Systemic Inflammatory Response Syndrome) criteria below\u003cbr\u003e\nTemperature: \u003e38 C (100.4 F) or \u003c36 C (96.8 F)\u003cbr\u003e\n Heart Rate: \u003e90 beats/min without other explanation. May be higher in small children.\u003cbr\u003e\nRespiratory Rate: \u003e20 breaths/min without other explanation. May be higher in small children.\u003cbr\u003e\n\u003cbr\u003e\nAnd\u003cbr\u003e\nSuspected Infection\u003cbr\u003e\nSystolic BP less than 90. May be lower in small children.\u003cbr\u003e\nMAP \u003c 65\u003cbr\u003e\nEnd tidal CO2 levels equal to or lower than 25 correlated with high lactate levels and can indicate septic shock.\u003cbr\u003e\n\u003cbr\u003e\nProcedure\u003cbr\u003e\n\u003cbr\u003e\nNotify hospital of possible septic patient\u003cbr\u003e\nAdminister high flow O2\u003cbr\u003e\n2 large bore IVs of isotonic solution\u003cbr\u003e\n· IV fluid boluses (20 ml./kg. repeated as necessary)","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040690"},{"listId":10040691,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"SEXUAL ABUSE/ASSAULT","summary":"","detail":"SEXUAL ABUSE / ASSAULT\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nThe patient has been forcefully exploited by another person(s). The force used may be physical violence, threats, mental manipulation, or other forms of psychological force.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nSupportive care, management of associated trauma\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n\u003cbr\u003e\n2.\tSecondary Management - History, physical exam, vital signsT\u003cbr\u003e\n\u003cbr\u003e\n3.\tTreat all life threats as indicated.\u003cbr\u003e\n\u003cbr\u003e\n4.\tProtect the scene and preserve evidence in cooperation with law enforcement.\u003cbr\u003e\n\u003cbr\u003e\n5.\tEncourage patient not to bathe, douche, or change clothes.\u003cbr\u003e\n\u003cbr\u003e\n6.\tDo not allow more people than necessary for patient care in contact with the patient or on the scene.\u003cbr\u003e\n\u003cbr\u003e\n7.\tThis may be a highly emotional and volatile situation; be sure your physical examination and treatments are clearly documented on the PCR.\u003cbr\u003e\n\u003cbr\u003e\n8.\tObtain only information needed to treat the patient. Do not attempt to investigate the crime.\u003cbr\u003e\n\u003cbr\u003e\n9.\tTransport decisions will be patient dependent.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040691"},{"listId":10040692,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"SHOCK GENERAL","summary":"","detail":"SHOCK GENERAL \u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms may include any or all of the following: disoriented, weak, tachycardia, systolic \u003c 90, weak or absent radial pulses, cool and clammy skin, diaphoresis, pallor, nausea and vomiting, rapid and shallow respirations. For traumatic shock refer to appropriate trauma sections.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nMaintain adequate perfusion, oxygenation\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\na.\tApply oxygen to keep SpO2 \u003e94%\u003cbr\u003e\nb.\tMonitor EtCO2\u003cbr\u003e\n2.\tTransport the patient without delay to an appropriate medical facility.\u003cbr\u003e\n3.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\na.\tObtain history of incident including:\u003cbr\u003e\ni.\tPossible underlying medical causes\u003cbr\u003e\nii.\tBlunt or penetrating trauma refer to trauma section\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nAEMT \u003cbr\u003e\n1.\tIn-route, initiate two large bore IVs of an isotonic solution and infuse at a flow rate to maintain adequate end organ perfusion.\u003cbr\u003e\n2.\tConsider treatment for possible underlying, reversible etiologies including volume depletion, tension pneumothorax, pericardial tamponade, spinal shock, and sepsis within appropriate scope of practice.\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n\u003cbr\u003e\n1.\tMonitor cardiac rhythm and vital Signs closely\u003cbr\u003e\n2.\tObtain 12 lead ECG.\u003cbr\u003e\n3.\tIf no improvement with fluid bolus, or if fluids are contraindicated because of pulmonary edema administer a vasopressor.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n1.\tNOREPHINEPHRINE (Levophed) drip @ 2-10 mcg/min IV infusion\u003cbr\u003e\n\u003cbr\u003e\na.\tSolution: 1 mg in 250 ml NS (4 mcg/ml);; dose may be titrated to patient response\u003cbr\u003e\n\u003cbr\u003e\n2.\tEPINEPHRINE DRIP @ 2-10 mcg/min IV infusion\u003cbr\u003e\na.\tAdminister an Epinephrine drip (2 mg of 1:1000 Epinephrine in 250 ml of NS) and start the drip of 2 ug/min (15 gtts/min). Titrate up to 10 ug/min or until an acceptable perfusing heart rate and BP are achieved. A second IV line is desired, however, do not withhold medication if second IV is unobtainable.\u003cbr\u003e\n2.\tEPI PUSH-DOSE Inject 1 mg. (1 ml.) of Epinephrine 1:1,000 into a 100 ml. bag of NS and mix well. Withdraw 10 ml. giving a concentration of 1:100,000. \u003cbr\u003e\nb.\tPush 0.5-1 ml (5-10 mcg) q 1 min prn hypotension","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040692"},{"listId":13528112,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"SICK PERSON","summary":"","detail":"SICK PERSON\u003cbr\u003e\nGeneral\u003cbr\u003e\nThis dispatch category along with “Minor Medical” is a broad and vague category that coveys very little information to the responding EMT. However, this category of patient is common and includes many complaints without obvious causes like “weak and dizzy” and “malaise”. Frequently this applies to elderly patients who do not have transportation or primary care access and utilize the 911 system.\u003cbr\u003e\nAssessment\u003cbr\u003e\nAll levels of EMT (Basic, Intermediate, and Paramedic) are capable of assessing these patients. The assessment should be thorough in history taking and physical examination as this is largely detective work trying to determine if a significant or even life-threatening cause is behind the patient’s complaints.\u003cbr\u003e\n1.\tHistory is important. Distressed patients, especially those with extensive medical histories, may forget or be unable to communicate everything that may be relevant to their assessment. An effort to determine the details of their current complaints, their past medical history, and especially their current medications is worthwhile. The medication list may give important clues to medical conditions not otherwise mentioned.\u003cbr\u003e\n2.\tThe primary survey (ABC’s) is usually done without prompting.\u003cbr\u003e\n3.\tPhysical examination (the secondary survey) is important. Again, there may be many clues to the cause of the complaints found in a detailed physical examination.\u003cbr\u003e\n4.\tInformation about resuscitation status (DNR or Power of Attorney) should be sought in the event the patient deteriorates during care.\u003cbr\u003e\n5.\tVital signs, a BGL and oxygen saturation are easily accomplished in most patients.\u003cbr\u003e\n6.\tConsider whether an EKG would be helpful. Occult cardiac disease may be present with atypical symptoms in a distressed or confused patient.\u003cbr\u003e\nTreatment\u003cbr\u003e\n1.\tIn general, few interventions are called for in these patients, but a high level of suspicion has to be maintained much like in assessing and treating the “life assist” patient.\u003cbr\u003e\n2.\tConsider whether an IV is needed for medication administration or fluid rehydration.\u003cbr\u003e\n3.\tConsider whether continuous cardiac monitoring is indicated.\u003cbr\u003e\n4.\tEven without a serious cause identified transport is indicated. \u003cbr\u003e\n5.\tConsider whether an MIH referral is called for.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/13528112"},{"listId":10040693,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"SYNCOPE","summary":"","detail":"SYNCOPE\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nPatient has experienced a temporary loss of consciousness - “Fainting”\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n1.\tAirway management, adequate oxygenation, evaluation for underlying cause\u003cbr\u003e\n2.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n3.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\na.\tRule out (see specific guidelines):\u003cbr\u003e\nb.\tDiabetic emergency (check blood glucose)\u003cbr\u003e\nc.\tOverdose\u003cbr\u003e\nd.\tCVA\u003cbr\u003e\ne.\tAMI or arrhythmia\u003cbr\u003e\nf.\tHead trauma\u003cbr\u003e\ng.\tDehydration\u003cbr\u003e\n\u003cbr\u003e\nAEMT / PARAMEDIC\u003cbr\u003e\n2.\tIn route, initiate IV/IO access. If patient condition warrants, infuse an isotonic solution at a flow rate to maintain adequate end organ perfusion.\u003cbr\u003e\n\u003cbr\u003e\n3.\tProvide constant ECG monitoring. Document findings as appropriate. Obtain 12-lead ECG to rule out cardiogenic etiology","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040693"},{"listId":10040674,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"TERMINATION OF RESUSCITATION","summary":"","detail":"TERMINATION OF RESUSCITATION (TOR)\u003cbr\u003e\n\u003cbr\u003e\nFor patients for whom resuscitation has been initiated EMS personnel may terminate resuscitation in the following circumstances. On-line medical direction is required to terminate resuscitation if it is available. \u003cbr\u003e\n\u003cbr\u003e\nBASIC/AEMT:\u003cbr\u003e\nMedical cardiac arrest:\u003cbr\u003e\n1.\tHigh quality CPR has been performed for 30 minutes\u003cbr\u003e\nAND\u003cbr\u003e\n2.\tAED advised “No shock advised” \u003cbr\u003e\nAND \u003cbr\u003e\n3.\tParamedic care is \u003e 20 additional minutes to arrival (total of 40 minutes down time).\u003cbr\u003e\n4.\tCall medical direction for TOR order\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC:\u003cbr\u003e\nMedical cardiac arrest (see also CARDIAC ARREST/MEDICAL): \u003cbr\u003e\n1.\t30 minutes of adequate compressions and ACLS care have been provided\u003cbr\u003e\n \u003cbr\u003e\nAND\tAll of the following are true \u003cbr\u003e\n1.\tThere has been no return of spontaneous circulation (ROSC)\u003cbr\u003e\n2.\tEnd tidal CO2 is less than 15\u003cbr\u003e\n3.\tThe family is supportive of the termination of resuscitation\u003cbr\u003e\n4.\tThere are not mitigating factors that would support transport or continuation of resuscitation (hypothermia, LVAD (Left Ventricular Assist Device), unsafe scene, for example)\u003cbr\u003e\n\u003cbr\u003e\nTraumatic cardiac arrest \u003cbr\u003e\n\u003cbr\u003e\n\tPulseless, apneic, and in asystole\u003cbr\u003e\n1.\t10 minutes of high-quality CPR without ROSC\u003cbr\u003e\n2.\tFinal rhythm continues to be asystole\u003cbr\u003e\n3.\tAll potentially life saving procedures have been performed (i.e. establish airway and decompress the chest)\u003cbr\u003e\n\u003cbr\u003e\nPulseless, apneic, and in rhythm other than asystole\u003cbr\u003e\n1.\tTransport within ten minutes to trauma center if possible\u003cbr\u003e\n2.\tConsider Termination of Resuscitation if transport not advisable and:\u003cbr\u003e\na.\tNo ROSC\u003cbr\u003e\nb.\tAll potentially life saving procedures have been performed (i.e. establish airway and decompress the chest)\u003cbr\u003e\nc.\tArrest is not medical in origin\u003cbr\u003e\nd.\tAt least 10 minutes of high quality CPR have been performed\u003cbr\u003e\n4.\tNotes:\tThere may be mitigating circumstances calling for transport. Transport decision must take risk of continuing resuscitation in moving vehicle into consideration. Hypothermia, lightning strike victim, scene safety, inadvisability of leaving patient at scene, persistent shockable rhythm, LVAD in place (mandatory transport) and other issues are reasonable considerations when considering transport. \u003cbr\u003e\n5.\tOB patients approximately 20 weeks or later should be transported for possible emergency c-section.\u003cbr\u003e\n6.\tContact on-line medical direction for termination.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nRemain with deceased until released by law enforcement or medical examiner\u003cbr\u003e\nAssist surviving loved ones with contacting spiritual support, family or grief resources as needed","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/10040674"},{"listId":13463255,"catId":2122319,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"VENTILATOR FOR INTUBATED PATIENTS","summary":"","detail":"VENTILATOR USE FOR INTUBATED PATIENTS\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nPurpose\u003cbr\u003e\nTo establish guidelines for the use of O-TWO e500 portable ventilator by members of the Las Cruces Fire Department. \u003cbr\u003e\nPolicy\u003cbr\u003e\nThe guideline covers use of the LCFD portable ventilator for ventilation of intubated patients. The steps for setting up the ventilator and care instructions can be found in the OTWO-ESERIES-E500-User Guide located in File Center of Vector Solutions. \u003cbr\u003e\nProcedure\u003cbr\u003e\n1.\tConfirm the ET tube is properly placed, and patient is compliant with BVM ventilations. \u003cbr\u003e\n2.\tConfirm ETCO2 is present via number and waveform to confirm tube is properly inserted.\u003cbr\u003e\na.\tEtCO2 preferred range is between 35-45mmHg\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\nProcedure\u003cbr\u003e\n1.\tAssembly the vent circuit and power on the vent. \u003cbr\u003e\n2.\tCalculate the appropriate ideal weight tidal volume\u003cbr\u003e\ni.\tEstimate patient’s height in feet and inches. Then, subtract the feet by 1 and multiply by 100, then take the inches and multiply by 10, then add these two values, the result is the patent’s ideal tidal volume (TV)\u003cbr\u003e\n1.\tEX: Pt estimated height is 5’ 9”; (5-1=4, 4x100=400) then (9x10= 90) 400+90 = 490. \u003cbr\u003e\n2.\tEX: Pt estimated height is 5’11”; (5-1=4, 4x100=400) and (11x10=110) 400+110= 510. \u003cbr\u003e\nii.\tRound up or down based on lung compliance.\u003cbr\u003e\nb.\tUse tidal volume supplied by medical staff if patient already on a ventilator. \u003cbr\u003e\ni.\tAdvise staff of the limitations of our ventilator. \u003cbr\u003e\n3.\tVentilation rate (Vr or RR) is preset by the vent at 10 bpm for adult or 20 bpm for children.\u003cbr\u003e\n4.\tFiO2 should be set to 60%\u003cbr\u003e\na.\tIncrease to 100% if O2 saturation remains below 90% after a few minutes of ventilation. \u003cbr\u003e\n5.\tSet the PEEP to 5cmH20\u003cbr\u003e\n6.\tPmax is preset to 30cmH20 and Pmin is preset to 3cmH20\u003cbr\u003e\na.\tThese are alarms when the pressure is too high assess lung compliance and breath stacking\u003cbr\u003e\n7.\tAttach the ventilator to the patient, confirm all filters and connections are secure. \u003cbr\u003e\n8.\tEvaluate for proper lung compliance and ventilation. \u003cbr\u003e\na.\tVisible chest rise\u003cbr\u003e\nb.\tConfirm wave forms, both pressure and volume\u003cbr\u003e\ni.\tKeep pressure waveform primary to monitor lung compliance, but assessing volume intermittently is recommended. \u003cbr\u003e\nc.\tAppropriate EtCO2 values between 35 and 45mmHg\u003cbr\u003e\nd.\tAppropriate SpO2 between 93 to 98%\u003cbr\u003e\n9.\tCommon complications to monitor for: \u003cbr\u003e\na.\tDisplacement of ET tube\u003cbr\u003e\ni.\tStop ventilator, extubate and re-intubate. \u003cbr\u003e\nb.\tObstruction of ET or airways\u003cbr\u003e\ni.\tUse suction to clear the tube\u003cbr\u003e\nii.\tConsider bronchodilators for COPD/Asthma\u003cbr\u003e\nc.\tPneumothorax\u003cbr\u003e\ni.\tNeedle decompression if pneumothorax shows signs of becoming a tension pneumothorax\u003cbr\u003e\nd.\tEquipment failure\u003cbr\u003e\ni.\tDiscontinue the ventilator and switch to BVM\u003cbr\u003e\ne.\tBreath stacking\u003cbr\u003e\ni.\tDisconnect the ventilator circuit\u003cbr\u003e\nii.\tSqueeze the chest wall, if feasible\u003cbr\u003e\niii.\tRe-connect the ventilator circuit\u003cbr\u003e\nf.\tPressure Alarms\u003cbr\u003e\ni.\tIf the high pressure alarms sound assess wave form for breath stacking\u003cbr\u003e\nii.\tAssess for lung compliance or the DOPE complications\u003cbr\u003e\niii.\tConsider increasing Pmax as a last resort.\u003cbr\u003e\n\u003cbr\u003e\nNotes: If at any time the ventilator is not providing adequate ventilations to the patient discontinue and initiate manual ventilation with BVM. \u003cbr\u003e\nIf patient is already on a ventilator and we are transporting, provide medical staff the features of our ventilator to determine the proper settings. It is preferable to use the facilities transport ventilator and have their RT or RN ride to the hospital.\u003cbr\u003e\n\u003cbr\u003e\nPost-intubation sedation\u003cbr\u003e\n\u003cbr\u003e\n1.\tInterfacility transfer patients may already be sedated. As long as the medications being used are in the Treatment Guidelines or the state Scope of Practice they can be monitored.\u003cbr\u003e\n2.\tIn cases where sedation is necessary to allow the patient to be pain free or more comfortable with the tube it is advisable to medicate the patient. The following medications can be used:\u003cbr\u003e\n\u003cbr\u003e\nA.\tMIDAZOLAM 5 mg. IV/IO q 10 minutes as needed.\u003cbr\u003e\nB.\tKETAMINE 0.5-1.0 mg/kg slow IV/IO q 5-15 minutes as needed and tolerated. Caution advised if increased intracranial pressure is an issue. Consider MIDAZOLAM.\u003cbr\u003e\nC.\tFENTANYL 50-150 mcg IV/IO q 5 minutes as needed for pain.\u003cbr\u003e\n\u003cbr\u003e\nDocumentation\u003cbr\u003e\n\u003cbr\u003e\n1.\tIt is important to document final ventilator settings in the narrative of your report.\u003cbr\u003e\n2.\tThe following should be recorded if possible:\u003cbr\u003e\na.\tTidal volume\u003cbr\u003e\nb.\tMinute volume\u003cbr\u003e\nc.\tVentilator’s set rate\u003cbr\u003e\nd.\tVentilator actual rate\u003cbr\u003e\ne.\tPEEP\u003cbr\u003e\nf.\tFiO2\u003cbr\u003e\ng.\tPeak pressures","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2122319/13463255"}],"data":false,"categoryData":{"catName":"MEDICAL GUIDELINES","catId":2122319,"catIcon":""},"parentCategoryData":{"catId":2114007,"catName":"GUIDELINES"}},"match":{"hostname":"www.lcfdapp.com","page":"services_1582148118880_5","category":"2122319"}}},"page":"/[...slug]","query":{"slug":["services_1582148118880_5/2122319"]},"buildId":"1234567890","isFallback":false,"dynamicIds":[1204],"customServer":true,"gip":true,"scriptLoader":[]}