INITIAL CARE

  •  Follow basic and advanced life support and airway algorithms as indicated based on current AHA Guidelines.
  •  Obtain and document the chief complaint, (OPQRST, see Abdominal Pain), SAMPLE history, and vitals per patient condition:
    •  SAMPLE: Signs and Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading up to present illness or injury.
  • Utilize cardiac monitor and other monitoring devices, pulse oximeter, etc. as appropriate.
  •  IN medication administration must be via Mucosal Atomizer Device (MAD).
  • Start IV crystalloid solutions which have been changed to include balanced crystalloid solution (Normosol, Plasmalyte, Isolyte), LR or NS in that order. Their pH is closer to neutral. Saline Lock (SL) as appropriate.
  •  IVs: Follow shock protocol .
    •  Shock (not related to penetrating trauma): IV fluid run wide-open, using macro-drip or blood tubing except for penetrating chest or abdominal trauma. Decrease fluid rate if SBP >100.
    • P  IV fluid 20 ml/kg using macro-drip tubing. Titrate to maintain adequate perfusion.
    •  Medical emergencies, head trauma, cardiac problems with stable BP: Use TKO rate.
    •  IV medication administration: Slow IV = over 2 minutes, unless otherwise specified.
    • Any medication given IV can also be administered intraosseous, IO.
  • Use of IO devices for both Adults and Peds is limited to patients who are unresponsive or hemodynamically unstable, and only when less invasive means are not available or are ineffective (e.g., Glucagon IM, Narcan IN, and Versed IN).
  • An unresponsive patient with gasping breaths and poor color should get supplemental oxygen via BVM
  • * If a patient with an existing IV pump experiences an allergic reaction, call the MCP for an order to discontinue the pump. Otherwise, the IV pump must be maintained.
  •  Bring medications or a list of the medications; include the dose and frequency administered.
  • Monitor blood glucose. See hypoglycemia.
  • Maintain normothermia. Unconscious diabetics are often hypothermic.

NOTE: Pedi refrence guide may be used as a reference for pediatric vital signs.

  • Patient care should proceed by ensuring airway protection, oxygenation, and adequate ventilation without causing harm. Injury reduction strategies may include noninvasive ventilation when appropriate, titration of oxygen in certain settings, and being cautious not to over ventilate. You should tailor treatment to the overall clinical picture. With the exception of suspected acute cerebral herniation, the rate and depth of ventilation in the prehospital setting should not be guided by the EtCO2 reading alone. For the patient with cerebral herniation, ventilate the patient at 20 times per minute to obtain an end tidal value of 30 mmHg. Doing so acutely can result in over ventilation leading to pneumothorax, barotrauma, breath stacking, hypotension, and compromised hemodynamics. "Permissive hypercapnia" in most cases is appropriate particularly in those with chronic lung disease who may chronically retain CO2. Listening to the chest to ensure that adequate exhalation is occurring during manual ventilation is recommended.
 

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