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9 Cards in this Set
- Front
- Back
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ALS ADULT CARE
*For patients that do not fit into a specific protocol. |
In addition this protocol is not intended for unstable patients.
Unstable patients include those with: • Pulse less than (<) 50 or over 110 • SBP less than (<) 90mmHg or above 180mmHg • DBP over 110mmHg • Respiratory rate less than (<) 10 or above 29 • Persistent chest pain or discomfort. • Persistent respiratory distress; unresolved AMS. • Status Post Cardiac or Respiratory Arrest. • Multisystem or penetrating trauma.* For EMT-CC and EMT-P • Assist airway/breathing/circulation. • Protect cervical spine if necessary. • Perform patient assessment as per NYS BLS protocols. • Administer Oxygen as per NYS BLS protocols. • If the patient’s signs/symptoms indicate that only BLS care is indicated, refer to appropriate NYS BLS protocol. • If the findings or signs/symptoms indicate that the patient fits into a specific ALS protocol, refer to that protocol immediately. • IV NS to KVO, or Saline Lock • Apply Cardiac Monitor • Perform Blood Glucose determina |
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ADULT ADVANCED AIRWAY
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FOR EMT-CC AND EMT-P
• BLS airway management – OPA/NPA/BVM/Suction as appropriate. • BLS foreign body obstruction techniques as appropriate. • Pulse oximetry, waveform capnography, cardiac monitor as appropriate. • Endotracheal intubation/Supraglottic airway if indicated. • Use of Magill forceps to remove foreign body obstruction. EMT-P • Needle cricothyrotomy for unrelieved airway obstruction. • MFI or RSI if agency is authorized and Paramedic is credentialed. MEDICAL CONTROL • Repeat any of the above. |
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VENTRICULAR FIBRILLATION / PULSELESS VENTRICULAR TACHYCARDIA
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EMT-CC AND EMT-P
• Follow NYS BLS protocols for cardiac arrest care. • Secure airway with an advanced airway, initial use of BLS airway is appropriate if condition and situation warrants. • Cardiac Monitor • Defibrillation 360 joules or biphasic equivalent. • IV/IO/EJ • Defibrillation 360 joules or biphasic equivalent • Epinephrine 1:10,000 1 mg IV/IO/EJ; repeat q 3-5 minutes • Defibrillation 360 joules or biphasic equivalent, and repeat after every medication. • If renal failure, TCA OD or hyperkalemia is suspected and the patient is well ventilated, administer Sodium Bicarbonate 1 mEq/kg IV/IO/EJ. • If Torsade de Pointes is suspected - administer Magnesium Sulfate 2 g IV/IO/EJ • Amiodarone 300 mg IV/IO/EJ bolus, may repeat Amiodarone 150 mg IV/IO/EJ in 3-5 minutes. MEDICAL CONTROL: • Repeat any of the above |
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ASYSTOLE / PEA
Consider the following causes: Hypoglycemia, Hypovolemia, Hypoxia, Acidosis, Hyperkalemia, Toxins, Tension Pneumothorax |
EMT-CC AND EMT-P
• Follow NYS BLS protocols on cardiac arrest care. • Secure airway with an advanced airway. Initial use of BLS airway is appropriate if condition and situation warrants it. • Cardiac Monitor - check the rhythm in more than one lead if the patient presents in Asystole. • IV /IO/EJ of NS • Fluid bolus of 20 ml/kg (may be repeated to a total of 40 ml/kg) • Epinephrine 1:10,000 1 mg; repeat q 3-5 minutes. • If you suspect the arrest was caused by one of the above “Hs” or “Ts” refer to the appropriate protocol during the resuscitation. • If renal failure, TCA OD or hyperkalemia is suspected and the patient is well ventilated, administer Sodium Bicarbonate 1 mEq/kg IV/IO/EJ. • If a Tension Pneumothorax is suspected - perform Needle Chest Decompression. MEDICAL CONTROL: • Repeat any of the above. • Termination of resuscitation • Needle decompression, if indicated. • Calcium Chloride 10% (100 mg/ml) • Glucagon • Naloxone • Dextrose 50% |
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SHOCK / HYPOPERFUSION AFTER ROSC
This protocol is intended for use in patients that are in shock, secondary to post-cardiac arrest. As evidence by *SBP < 90 with signs and symptoms of Inadequate Tissue Perfusion. |
EMT-CC AND EMT-P
• Administer high flow oxygen OR positive pressure - ventilations as indicated. • Cardiac Monitor • IV/IO/EJ of NS • Administer fluid bolus 20 ml/kg. This may be repeated to a total of 40 ml/kg. • 12 lead EKG. • Transport Decision. • Establish 2nd vascular access site, if needed. • Dopamine infusion of 10 mcg/kg/min-if Systolic B/P < 90 mmHg* MEDICAL CONTROL: • Repeat any of the above. • Sodium Bicarbonate • Endotracheal Intubation • Calcium Chloride 10% (100 mg/ml) • Glucagon • Epinephrine infusion • MFI or RSI if agency is authorized and Paramedic is credentialed. |
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THERAPEUTIC HYPOTHERMIA
This protocol is intended for patients with ROSC following cardiac arrest and GCS <8. EXCLUSION CRITERIA: Patients known to be pregnant, trauma patients, suspected sepsis, other causes of coma (such as drug intoxication or status epilepticus), or recent major surgery within 14 days |
EMT-CC:
**Contact Medical Control** EMT-P: • Airway management and appropriate oxygen therapy. • Cardiac Monitor with 12 lead EKG acquired and transmitted as soon as possible. • If arrhythmia is present - **refer to appropriate cardiac protocol** • Ice packs in axilla, groin and neck; change every 10-15 min • Vascular access at 2 sites (no more than one (1) IO) • Infuse chilled normal saline to a total of 30 ml/kg or 2 L maximum • Complete neurologic exam including specific GCS items and pupillary response • Initiate transport to a therapeutic hypothermia center. * • If SBP drops below 90 mmHg, administer Dopamine 10 mcg/kg/min after fluid bolus complete. • Prevent shivering as follows: **Agencies with Controlled Substances: o Midazolam up to 5mg IV or up to 10 mg IM/IN OR Lorazepam up to 4 mg IV/IM **Agencies without Controlled Substances: o Etomidate 10 mg IV every 10 minutes (SBP > 100) |
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THERAPEUTIC HYPOTHERMIA
*MEDICAL CONTROL OPTIONS |
• Repeat any of the above.
• Transport Decision • Fentanyl • Diazepam • Endotracheal Intubation • MFI or RSI if agency is authorized and Paramedic is credentialed. |
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FIELD TERMINATION OF RESUSCITATION
This protocol is intended for use in adult patients that are in cardiac arrest. This protocol is not intended for patents that have a DNR/MOLST Form indicating DNR or for patients that meet obvious death/withhold CPR criteria. |
EMT-CC:
**CONTACT MEDICAL CONTROL** EMT-P: • Begin resuscitation per protocol. • Patient must be normothermic. • Arrest was un-witnessed. • No Shocks were administered. • The cardiac rhythm must be a persistent asystole, and refractory to IV/IO medications. • A minimum of 20 minutes of CPR has been performed by the EMS agency. • Family accepts decision on field termination. MEDICAL CONTROL: • Repeat any of the above. |
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CARDIAC DYSRHYTHMIA ENTRY PROTOCOL
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EMT-CC AND EMT-P
• High concentration oxygen. • Cardiac Monitor* • Obtain Pulse Oximetry • IV NS to KVO, or Saline Lock • Obtain 12-lead EKG, if available. • Refer to the appropriate dysrhythmia protocol. |
