Protocols - Revision history

Shadmin: Removing IFT from Protocol pages

2025-05-01T15:15:48Z

Removing IFT from Protocol pages

Shadmin at 15:13, 1 May 2025

2025-05-01T15:13:46Z

← Older revision		Revision as of 15:13, 1 May 2025
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	'''DOSAGE:'''		'''DOSAGE:'''

			'''-Adult (Oral):''' 325mg to 1,000mg, may repeat every 6 hours

	'''-Adult (IV):''' 500mg or 1,000mg infused over 15 minutes. May repeat every 6 hours.		'''-Adult (IV):''' 500mg or 1,000mg infused over 15 minutes. May repeat every 6 hours.
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	== '''Protocol 1007: IFT Intermittent Suctioning''' ==


			== '''Protocol 1007: IFT Intermittent Suctioning, Airway and Gastric suctioning''' ==

	# AEMTs and Paramedics may initiate nasotracheal suctioning intermittently if requested by the sending facility.		# AEMTs and Paramedics may initiate nasotracheal suctioning intermittently if requested by the sending facility.
	# Measurement of soft-tip catheter for nasotracheal suctioning is done by starting at the tip of the nose, measuring to the earlobe and then over to the cricothyroid membrane. Lubricate the sides of the tip and insert to the full depth measured to obtain deep tracheal suctioning effectiveness. This measurement works for adults, children and infants.		# Measurement of soft-tip catheter for nasotracheal suctioning is done by starting at the tip of the nose, measuring to the earlobe and then over to the cricothyroid membrane. Lubricate the sides of the tip and insert to the full depth measured to obtain deep tracheal suctioning effectiveness. This measurement works for adults, children and infants.
	# Paramedics may perform intermittent suctioning for intubated patients if requested by the sending facility, or if signs of a mucous plug are present that inhibit effective ventilation.		# Paramedics may perform intermittent suctioning for intubated patients if requested by the sending facility, or if signs of a mucous plug are present that inhibit effective ventilation.
	## Consider use of 5 ml of saline to loosen the mucous, flushed down the ET tube.		## Consider use of 5 ml of saline to loosen the mucous, flushed down the ET tube.
	## Apply soft tip suction catheter for the full length of the ET tube, plus approximately 5 cm, suctioning as the catheter is removed, for no longer than 10 seconds at a time.		## Apply soft tip suction catheter for the full length of the ET tube, plus approximately 5 cm, suctioning as the catheter is removed, for no longer than 10 seconds at a time.
			# The recommended pressures for suctioning are as follows:
			## Neonates: 60-80 mm Hg
			## Infants: 80-100 mm Hg
			## Children: 100-120 mm Hg
			## Adults: 100-150 mm Hg
			# Negative pressures should not exceed 150 mm Hg as higher pressures have been shown to cause trauma, hypoxemia and atelectasis.
			# In regards to gastric suctioning, both nasogastric and orogastric suctioning, current equipment available does NOT allow for intermittent suctioning, only continuous suctioning. Therefore, these tubes should be capped for the duration of the transport.

	== '''Protocol 1008: IFT CPAP/BiPAP''' ==		== '''Protocol 1008: IFT CPAP/BiPAP''' ==

	# '''Scope of practice''': AEMT, Paramedic.		# '''Scope of practice''': AEMT, Paramedic.
	# ~~interfacility~~ transfers do not change the scope of practice referenced in medication protocols. Personnel may only administer procedures relevant to their scope of practice. If a higher level of medication is required, then the higher certified individual must attend on the patient.		# Interfacility transfers do not change the scope of practice referenced in medication protocols. Personnel may only administer procedures relevant to their scope of practice. If a higher level of medication is required, then the higher certified individual must attend on the patient.
	# CPAP may be initiated under EMS Protocol 207 during transport if the patient meets criteria. Since the sending provider knows the underlying condition of the patient best, every attempt should be made to discuss initiation of CPAP with the sending provider, either before or shortly after initiating CPAP, as there are respiratory conditions where it may appear useful but could inadvertently be detrimental to the patient.		# CPAP may be initiated under EMS Protocol 207 during transport if the patient meets criteria. Since the sending provider knows the underlying condition of the patient best, every attempt should be made to discuss initiation of CPAP with the sending provider, either before or shortly after initiating CPAP, as there are respiratory conditions where it may appear useful but could inadvertently be detrimental to the patient.
	# BiPAP requires am AEMT or Paramedic to be in attendance. Either the facility’s BiPAP machine or the agency’s ventilator on BiPAP settings may be used, provided the paramedic is familiar with and comfortable with the settings and operability of the machine. In instances where the equipment appears significantly unfamiliar as to pose a risk of equipment failure during transport, the transport crew should consider either contacting Medical Control and/or declining the transfer.		# BiPAP requires am AEMT or Paramedic to be in attendance. Either the facility’s BiPAP machine or the agency’s ventilator on BiPAP settings may be used, provided the paramedic is familiar with and comfortable with the settings and operability of the machine. In instances where the equipment appears significantly unfamiliar as to pose a risk of equipment failure during transport, the transport crew should consider either contacting Medical Control and/or declining the transfer.

Shadmin: /* Protocol 217: Stoma/Tracheostomy Suctioning */ Suctioning pressures added

2025-05-01T14:53:38Z

Protocol 217: Stoma/Tracheostomy Suctioning: Suctioning pressures added

← Older revision		Revision as of 14:53, 1 May 2025
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	'''Considerations:'''		'''Considerations:'''

			* Recommended suctioning pressures:
			** Neonates: 60-80 mm Hg
			** Infants: 80-100 mm Hg
			** Children: 100-120 mm Hg
			** Adults: 100-150 mm Hg
			** Negative pressures should not exceed 150 mm Hg as higher pressures have been shown to cause trauma, hypoxemia, and atelectasis.
	* Loose, bleeding or infected stomas or tracheostomies should be treated cautiously. Any fluid draining into the airway may require active suction, but may limit the depth at which the catheter is placed, to limit stimulation of coughing and/or inhalation of draining fluid. Therefore, any suction of fluid/blood/pus occurring at or near the skin level should be done by placing the suction tip just at the immediate site of drainage, and not deeper into the airway.		* Loose, bleeding or infected stomas or tracheostomies should be treated cautiously. Any fluid draining into the airway may require active suction, but may limit the depth at which the catheter is placed, to limit stimulation of coughing and/or inhalation of draining fluid. Therefore, any suction of fluid/blood/pus occurring at or near the skin level should be done by placing the suction tip just at the immediate site of drainage, and not deeper into the airway.

Shadmin: /* Protocol 207: CPAP */ Consideration 4 added.

2025-05-01T14:50:54Z

Protocol 207: CPAP: Consideration 4 added.

← Older revision		Revision as of 14:50, 1 May 2025
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	# Some fixed pressure CPAP devices do not have FiO2 adjustment and will only administer up to 30% oxygen. If no improvement in oxygenation with a fixed pressure CPAP device, consider adding supplemental oxygen.		# Some fixed pressure CPAP devices do not have FiO2 adjustment and will only administer up to 30% oxygen. If no improvement in oxygenation with a fixed pressure CPAP device, consider adding supplemental oxygen.
	# If exposure precautions are advised, utilize viral filter between mask and vent circuit as well as covering patients head with towel due to possible mask leaks if tolerated.		# If exposure precautions are advised, utilize viral filter between mask and vent circuit as well as covering patients head with towel due to possible mask leaks if tolerated.
			# Any paramedic, AEMT or EMT-B who utilizes this modality must maintain regular competency evaluations as set fourth by the medical director or his representatives.

	== '''Protocol 208: Needle Decompression''' ==		== '''Protocol 208: Needle Decompression''' ==

Shadmin: /* Protocol 126: Ketamine */ 2025 Protocol Update

2025-05-01T14:41:16Z

Protocol 126: Ketamine: 2025 Protocol Update

← Older revision		Revision as of 14:41, 1 May 2025
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	* Induction: 1-2 mg/kg '''IV'''		* Induction: 1-2 mg/kg '''IV'''
	* Maintenance after Induction: 0.25-0.5 mg/kg '''IV''' every 5-10 minutes		* Maintenance after Induction: 0.25-0.5 mg/kg '''IV''' every 5-10 minutes
	* '''''Agitation/excited delirium: 4mg/kg IM. Ensure access to airway at all times regardless of restraints.'''''		* '''''Agitation/excited delirium: 4mg/kg IM. Maximum dose is 400mg Ensure access to airway at all times regardless of restraints. Patient requires continuous cardiopulmonary monitoring.'''''
	* Analgesia for major trauma:		* Analgesia for major trauma:
	** 50mg '''IM''' or IntraNASAL, repeat every 30 minutes as needed		** 50mg '''IM''' or IntraNASAL, repeat every 30 minutes as needed

Shadmin: Update Diazepam

2025-05-01T14:35:29Z

Update Diazepam

← Older revision		Revision as of 14:35, 1 May 2025
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	* Once a particular pain medication has been chosen, personnel should generally not switch to different opioid medications without discussing with MEDICAL CONTROL		* Once a particular pain medication has been chosen, personnel should generally not switch to different opioid medications without discussing with MEDICAL CONTROL

	== '''Protocol 116: Benzodiazepines (Lorazepam ~~and Midazolam~~)''' ==		== '''Protocol 116: Benzodiazepines (Midazolam, Lorazepam, Diazepam)''' ==

	'''SCOPE:''' '''<u>AEMT, Paramedic</u>'''		'''SCOPE:''' '''<u>AEMT, Paramedic</u>'''
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	'''INDICATION:'''		'''INDICATION:'''

	AEMT: ACTIVE tonic-clonic seizures with potential for airway compromise, - OR-		Paramedic/AEMT: ACTIVE tonic-clonic seizures with potential for airway compromise, - OR-

	* '''''sedation and excited delirium (in consultation with Medical Control)'''''		* '''''sedation and excited delirium (in consultation with Medical Control)'''''
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	** PR (rectal) DIASTAT may be used as alternative if prescribed to the patient		** PR (rectal) DIASTAT may be used as alternative if prescribed to the patient
	* Sedation, Procedure or Severe Agitation in a child (Paramedic): Contact MEDICAL CONTROL		* Sedation, Procedure or Severe Agitation in a child (Paramedic): Contact MEDICAL CONTROL
			DIAZEPAM, Adult: 2 doses. '''IV/IO''' route

			* ACTIVE Seizure (Paramedic/AEMT), '''up to 2 doses every 5 minutes for status seizures.'''
			** '''IV/IO/IM''' route: 5 mg
			* Sedation of severely agitated or combative patient
			** '''IV/IM''' route: 5mg
			** Contact Medical Control for additional sedation orders

			DIAZEPAM, Pediatric: 2 doses. '''IV/IO route'''

			* ACTIVE Seizure
			** 5 to 12 years: 1 mg, '''up to 2 doses every5 minutes for status seizures.'''
			** 1 month to < 5 years: 0.5 mg, dose may be repeated x 1 aver 5 minutes if still seizing
			** Neonate: Not indicated
			** Contact Medical Control for more than 3 doses
			* Sedation, Procedure, or Severe Agitation in a child (Paramedic): '''contact MEDICAL CONTROL'''

	'''CONSIDERATIONS:'''		'''CONSIDERATIONS:'''

Czimmerman: /* Protocol 1008: IFT CPAP/BiPAP */

2024-12-10T17:17:13Z

Protocol 1008: IFT CPAP/BiPAP

← Older revision		Revision as of 17:17, 10 December 2024
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	== '''Protocol 1008: IFT CPAP/BiPAP''' ==		== '''Protocol 1008: IFT CPAP/BiPAP''' ==

	# Scope of practice: interfacility transfers do not change the scope of practice referenced in medication protocols. Personnel may only administer procedures relevant to their scope of practice. If a higher level of medication is required, then the higher certified individual must attend on the patient.		# '''Scope of practice''': AEMT, Paramedic.
			# interfacility transfers do not change the scope of practice referenced in medication protocols. Personnel may only administer procedures relevant to their scope of practice. If a higher level of medication is required, then the higher certified individual must attend on the patient.
	# CPAP may be initiated under EMS Protocol 207 during transport if the patient meets criteria. Since the sending provider knows the underlying condition of the patient best, every attempt should be made to discuss initiation of CPAP with the sending provider, either before or shortly after initiating CPAP, as there are respiratory conditions where it may appear useful but could inadvertently be detrimental to the patient.		# CPAP may be initiated under EMS Protocol 207 during transport if the patient meets criteria. Since the sending provider knows the underlying condition of the patient best, every attempt should be made to discuss initiation of CPAP with the sending provider, either before or shortly after initiating CPAP, as there are respiratory conditions where it may appear useful but could inadvertently be detrimental to the patient.
	# BiPAP requires a Paramedic to be in attendance. Either the facility’s BiPAP machine or the agency’s ventilator on BiPAP settings may be used, provided the paramedic is familiar with and comfortable with the settings and operability of the machine. In instances where the equipment appears significantly unfamiliar as to pose a risk of equipment failure during transport, the transport crew should consider either contacting Medical Control and/or declining the transfer.		# BiPAP requires am AEMT or Paramedic to be in attendance. Either the facility’s BiPAP machine or the agency’s ventilator on BiPAP settings may be used, provided the paramedic is familiar with and comfortable with the settings and operability of the machine. In instances where the equipment appears significantly unfamiliar as to pose a risk of equipment failure during transport, the transport crew should consider either contacting Medical Control and/or declining the transfer.
	## Sending facility should provide written BiPAP settings in written orders.		## Sending facility should provide written BiPAP settings in written orders.
	## Consideration of intubating the patient may be discussed with the sending facility in order to facilitate a safe transfer if BiPAP is not a reliable option.		## Consideration of intubating the patient may be discussed with the sending facility in order to facilitate a safe transfer if BiPAP is not a reliable option.

Czimmerman: TXA and Tylonel IV

2024-12-09T22:53:35Z

TXA and Tylonel IV

← Older revision		Revision as of 22:53, 9 December 2024
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	== '''Protocol 125: Tranexamic Acid''' ==		== '''Protocol 125: Tranexamic Acid''' ==
	'''SCOPE:~~''' '''<u>~~AEMT, Paramedic~~</u>~~'''		'''SCOPE: AEMT, Paramedic'''

	'''MECHANISM OF ACTION:''' Displaces plasminogen from fibrin, resulting in inhibition of fibrinolysis, ~~which~~ preserves the initial clot formation. Secondarily, inhibits proteolytic activity of plasmin.		'''MECHANISM OF ACTION:''' Displaces plasminogen from fibrin, resulting in inhibition of fibrinolysis, w preserves the initial clot formation. Secondarily, inhibits proteolytic activity of plasmin.

	~~'''ONSET:''' 2-5 minutes; Peak effect at 5-10 minutes~~

	'''~~DURATION~~:''' ~~Up to~~ 2 ~~hours~~		'''ONSET:''' 2-5 minutes; Peak effect at 5-10 minutes

	'''~~INDICATION~~:''' ~~Massive Truncal (chest, abdomen, pelvis) trauma with signs of hemorrhagic shock, including~~		'''DURATION:''' Up to 2 hours

	SBP < 90mmHg or resting HR > 110bpm		'''INDICATION:''' Massive Truncal (chest, abdomen, pelvis) trauma with signs of hemorrhagic shock, including SBP < 90mmHg or resting HR > 110bpm

	'''CONTRAINDICATIONS:''' ~~not~~ approved for pediatric < age 12, suspected CVA, MI, PE or hypersensitivity to medication		'''CONTRAINDICATIONS:''' Not approved for pediatric < age 12, suspected CVA, MI, PE or hypersensitivity to medication.

	'''ADVERSE REACTIONS:''' hypotension, nausea/vomiting, blurry vision, clot formation, seizures		'''ADVERSE REACTIONS:''' hypotension, nausea/vomiting, blurry vision, clot formation, seizures
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	'''DRUG-DRUG INTERACTIONS:''' no acute drug interactions in the emergent setting		'''DRUG-DRUG INTERACTIONS:''' no acute drug interactions in the emergent setting

	'''DOSAGE:''' ~~ADULT: 1~~ gram administered over 10 minutes, ~~'''~~mixed in 100ml of Normal Saline'''		'''DOSAGE: ADULT:''' 2 gram administered over 20 minutes, mixed in 100ml of Normal Saline - Not indicated for pediatric use

			'''CONSIDERATIONS:'''

	* A second dose of ~~1 gram administered over 10 minutes may be administered if no hypersensitivity is noted after~~ the ~~first dose~~		- This protocol was developed with input from the Centura Trauma System’s medical direction and with consideration towards standards of care identified in the Rural Trauma Team Developme Course, from the American College of Surgeon’s Committee on Trauma.
	* Not indicated for pediatric use

	~~'''CONSIDERATIONS:'''~~		- Patients with an identified hypercoagulable state; contact MEDICAL CONTR

	* This protocol was developed with input from the Centura Trauma System’s medical direction and with consideration towards standards of ~~care identified in the Rural Trauma Team Development Course~~, ~~from the American College~~ of ~~Surgeon’s Committee on Trauma~~.		- The use of this medication requires signs of significant internal bleeding, including but not limit to unstable vitals, altered LOC, and mechanism of truncal traumatic injury.

	* Patients with an identified hypercoagulable state should receive only the initial dose, then contact MEDICAL CONTROL		- This medication is not approved for routine non-traumatic use, but may be ordered by MEDICAL CONTROL for certain life-threatening medical indications such as postpartum or post-operative hemorrhage.
	* The use of this medication requires signs of significant internal bleeding, including but not limited to unstable vitals, altered LOC, and mechanism of truncal traumatic injury.
	* This medication is not approved for routine non-traumatic use, but may be ordered by MEDICAL CONTROL for certain life-threatening medical indications such as postpartum or post-operative hemorrhage.

	== '''Protocol 126: Ketamine''' ==		== '''Protocol 126: Ketamine''' ==
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	== '''Protocol 132: Acetaminophen''' ==		== '''Protocol 132: Acetaminophen''' ==
	'''~~SCOPE:~~''' '''~~<u>~~EMT-Basic, AEMT, and Paramedic~~</u>~~'''		'''Acetaminophen (Oral, IV)'''

			'''SCOPE:''' ORAL: EMT-Basic, AEMT, and Paramedic.

			'''IV:''' AEMT AND PARAMEDIC.

	'''MECHANISM OF ACTION:''' Acetaminophen metabolizes to p-aminophenol, which can cross the blood-brain barrier where it acts on brain and spinal tissue at COX and opioid receptor sites, to lower fever and decrease pain.		'''MECHANISM OF ACTION:''' Acetaminophen metabolizes to p-aminophenol, which can cross the blood/brain barrier where it acts on brain and spinal tissue at COX and opioid receptor sites to lower fever and decrease pain.

	'''ONSET:''' Approximately 30 minutes		'''ONSET:''' Approximately 30 minutes (ORAL), Approximately 5 minutes (IV).

	'''DURATION:''' Up to 6 hours		'''DURATION:''' Up to 6 hours

	'''INDICATION:''' Fever, pain		'''INDICATION:''' Fever, pain

	'''CONTRAINDICATIONS:''' ~~Liver~~ failure, ~~known sensitivity~~		'''CONTRAINDICATIONS:''' Known sensitivity, known or suspected liver disease or failure (cirrhosis), therapeutic doses of acetaminophen within past 6 hours or greater than 4 grams in past 24 hours

	'''ADVERSE REACTIONS:''' nausea, vomiting, Stevens-Johnson Syndrome~~, headache~~, anxiety, dyspnea, fatigue,		'''ADVERSE REACTIONS:''' Headache, nausea, vomiting, Stevens-Johnson Syndrome, anxiety, dyspnea, fatigue.

	'''DRUG-DRUG INTERACTIONS:''' No acute interactions; chronic ~~Tylenol~~ use can interact with blood thinners and/or lead to liver toxicity.		'''DRUG-DRUG INTERACTIONS:''' No acute interactions; chronic acetaminophen use can interact with blood thinners and/or lead to liver toxicity.

	'''DOSAGE:''' ~~Adult: 325mg to 1,000mg, may repeat every 6 hours.~~		'''DOSAGE:'''

	* Pediatric or ~~Alternative Adult dosing~~, ~~weight-based: 10-15mg/kg~~ every 4-6 hours.		'''-Adult (IV):''' 500mg or 1,000mg infused over 15 minutes. May repeat every 6 hours.

	'''~~CONSIDERATIONS:~~'''		'''-Pediatric,''' weight-based: 10-15mg/kg infused over 15 minutes. May repeat every 4-6 hours.

	* Acetaminophen is an ingredient in most combination pain medications (Norco, Vicodin, Percocet) and over-the-counter cold preparations. The total maximum 24 hr dose should not exceed 4 grams in an adult when all acetaminophen components are added together.		'''CONSIDERATIONS:''' - Acetaminophen, which may also be referred to as Tylenol, APAP or Paracetamol, is an ingredient in most combination pain medications (Norco, Vicodin, Percocet) and over-the-counter cold preparations. The total maximum 24 hr dose should not exceed 4 grams in an adult when all acetaminophen components are added together.

	== '''Protocol 201: Initial BLS Airway''' ==		== '''Protocol 201: Initial BLS Airway''' ==

Czimmerman: Protocol 120

2024-12-09T21:39:38Z

Protocol 120

← Older revision		Revision as of 21:39, 9 December 2024
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	'''CONTRAINDICATIONS:''' Age > 60 with Severe tachycardia (>200), or concern for Acute MI		'''CONTRAINDICATIONS:''' Age > 60 with Severe tachycardia (>200), or concern for Acute MI

	'''ADVERSE REACTIONS:''' tachycardia, palpitations, dysrhythmias (rare), hypokalemia, chest pain, may lower seizure ~~threshhold~~		'''ADVERSE REACTIONS:''' tachycardia, palpitations, dysrhythmias (rare), hypokalemia, chest pain, may lower seizure threshold

	'''DRUG-DRUG INTERACTIONS:'''		'''DRUG-DRUG INTERACTIONS:'''
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	== '''Protocol 120: Naloxone''' ==		== '''Protocol 120: Naloxone''' ==
	'''SCOPE:~~''' '''<u>~~EMT-B, AEMT, Paramedic~~</u>~~'''		'''SCOPE: EMT-B, AEMT, Paramedic'''

	'''MECHANISM OF ACTION:''' ~~competitive~~ opioid receptor antagonist		'''MECHANISM OF ACTION:''' Competitive opioid receptor antagonist

	'''ONSET:''' 2 – 5 minutes		'''ONSET:''' 2 – 5 minutes
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	'''DURATION:''' 1 – 4 hours (varies depending on type and quantity of narcotic)		'''DURATION:''' 1 – 4 hours (varies depending on type and quantity of narcotic)

	'''INDICATION:''' ~~Reverse respiratory~~ depression associated with opioid overdose; coma of unknown etiology		'''INDICATION:''' Reverses cardiopulmonary depression associated with opioid overdose; coma of unknown etiology

	'''CONTRAINDICATIONS:''' ~~Do not give to a conscious, breathing patient.~~ Only use if ~~respiratory~~ depression is present.		'''CONTRAINDICATIONS:''' Only use if evidence of cardiopulmonary depression is present

	'''ADVERSE REACTIONS:''' ~~tachycardia~~, nausea/vomiting, pulmonary edema		'''ADVERSE REACTIONS:''' Tachycardia, nausea/vomiting, pulmonary edema

	'''DRUG-DRUG INTERACTIONS:''' no significant interactions in the acute emergency setting		'''DRUG-DRUG INTERACTIONS:''' No significant interactions in the acute emergency setting'''.'''

	'''DOSAGE:'''		'''DOSAGE: ADULT:''' 0.5 to 2mg IV/IO/IM/IN, repeat until reversal of respiratory depression.

	~~ADULT: 0.5~~ '''~~''to 2mg''''' '''IV/IO/IM/IN~~''', ~~'''''~~repeat ~~until reversal~~ of ~~respiratory depression'''''.~~		'''-EMT-Basic:''' Intranasal administration is authorized -IF respiratory arrest or airway compromise, may bolus 2 mg as initial dose -Anticipate need for repeat doses depending on type and quantity of opioid involved

	* EMT-Basic: ~~Intranasal administration is authorized~~		'''PEDIATRIC''' (age < 12): 0.2 mg IV/IO/IM/IN, up to 2 mg total
	* IF respiratory arrest or airway compromise, ~~may bolus~~ 2 mg ~~as initial dose~~
	* Anticipate need for repeat doses depending on type and quantity of opioid involved

	~~PEDIATRIC (age < 12): 0.2 mg '''IV/IO/IM/IN''', up to 2 mg total~~		'''CONSIDERATIONS:'''

	'''CONSIDERATIONS:'''

	* Patients receiving Narcan should generally be transported to the ER for evaluation given high likelihood of recurrent CNS depression and loss of airway, or concern of other intoxicants.		- Patients receiving Narcan should generally be transported to the ER for evaluation given high likelihood of recurrent CNS depression and loss of airway, or concern of other intoxicants. - Patients who, after receiving Narcan, have the ability to demonstrate decision-making capacity, and have no concern for polysubstance abuse, alcohol intoxication, or suicidal ideation, may have the legal right to refuse transport. This should be considered an Against Medical Advice refusal,and every effort should be made to encourage transport for ER evaluation. If unsuccessful, recommend contacting MEDICAL CONTROL for attempt by the clinician to speak with the patient about the risks of recurrent CNS depression. - When given to a patient that does NOT have cardiopulmonary depression, Narcan can potentiate sudden, severe withdrawal symptoms. This should be avoided.
	* Patients who, after receiving Narcan, have the ability to demonstrate decision-making capacity, and have no concern for polysubstance abuse, alcohol intoxication, or suicidal ideation, may have the legal right to refuse transport. This should be considered ~~and~~ Against Medical Advice refusal, and every effort should be made to encourage transport for ER evaluation. If unsuccessful, recommend contacting MEDICAL CONTROL for attempt by the clinician to speak with the patient about the risks of recurrent CNS depression.
	* When given to a patient that does NOT have ~~respiratory~~ depression, Narcan can potentiate sudden, severe withdrawal symptoms. This should be avoided.

	== '''Protocol 121: Nitro Sublingual''' ==		== '''Protocol 121: Nitro Sublingual''' ==

Bjames at 20:46, 26 July 2024

2024-07-26T20:46:11Z

← Older revision		Revision as of 20:46, 26 July 2024
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	- Limb amputation with hemorrhage.		- Limb amputation with hemorrhage.



	'''Contraindications:'''		'''Contraindications:'''
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	- Proximal extremity location where tourniquet application is not practical (See Junctional TQ)		- Proximal extremity location where tourniquet application is not practical (See Junctional TQ)



	'''Procedure/Approach:'''		'''Procedure/Approach:'''
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	7. Dress wounds per standard wound care protocol.		7. Dress wounds per standard wound care protocol.



	'''Considerations:'''		'''Considerations:'''
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	- Lower extremity amputation due to explosive trauma or ejection from vehicle		- Lower extremity amputation due to explosive trauma or ejection from vehicle



	'''Contraindications:'''		'''Contraindications:'''
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	- Uncontrolled lower junctional bleed		- Uncontrolled lower junctional bleed



	'''Procedure/Approach:'''		'''Procedure/Approach:'''
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	* Heart Rate < 60 with symptoms of syncope, chest pain or signs of shock		* Heart Rate < 60 with symptoms of syncope, chest pain or signs of shock


	'''Contraindications:'''		'''Contraindications:'''
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	* Pulseless electrical activity (refer to Medical Cardiac Arrest Protocol)		* Pulseless electrical activity (refer to Medical Cardiac Arrest Protocol)


	'''Procedure/Approach'''		'''Procedure/Approach'''
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	7. Initiate Rapid Transport, and early notification to ER		7. Initiate Rapid Transport, and early notification to ER


	'''Considerations:'''		'''Considerations:'''
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	* Patients fitting a pattern of “Silent MI”: diabetic, female, elderly, or severe hypertension		* Patients fitting a pattern of “Silent MI”: diabetic, female, elderly, or severe hypertension


	'''Contraindications:'''		'''Contraindications:'''
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	* Relative contraindications: age < 12 rarely demonstrate acute coronary syndromes		* Relative contraindications: age < 12 rarely demonstrate acute coronary syndromes


	'''Procedure/Approach:'''		'''Procedure/Approach:'''
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	g. Congestive Heart Failure → CHF Protocol		g. Congestive Heart Failure → CHF Protocol


	'''Considerations:'''		'''Considerations:'''
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	* Age 35 – 85 years old		* Age 35 – 85 years old


	'''Contraindications:'''		'''Contraindications:'''
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	* Outside of age range, consider contacting medical control for guidance		* Outside of age range, consider contacting medical control for guidance


	'''Procedure/Approach:'''		'''Procedure/Approach:'''
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	# Initiate TWO large bore peripheral IVs in forearm or above, sparing the wrists		# Initiate TWO large bore peripheral IVs in forearm or above, sparing the wrists
	# Transport with defibrillation pads in place		# Transport with defibrillation pads in place


	'''Considerations:'''		'''Considerations:'''
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	* Patients presenting with a Ventricular Assist Device and complaint of syncope, chest pain, trouble breathing or presenting with hypotension		* Patients presenting with a Ventricular Assist Device and complaint of syncope, chest pain, trouble breathing or presenting with hypotension


	'''Contraindications:'''		'''Contraindications:'''

	* Not applicable.		* Not applicable.


	'''Procedure/Approach:'''		'''Procedure/Approach:'''
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	* Infant (less than 1 year of age) with episode frightening to the observer characterized by apnea, choking, gagging, color change or change in muscle tone		* Infant (less than 1 year of age) with episode frightening to the observer characterized by apnea, choking, gagging, color change or change in muscle tone


	'''Contraindications:'''		'''Contraindications:'''

	* None.		* None.


	'''Procedure/Approach:'''		'''Procedure/Approach:'''
Line 2,793:		Line 2,770:

	* Upper Airway Stridor, age < 12		* Upper Airway Stridor, age < 12


	'''Contraindications:'''		'''Contraindications:'''
Line 2,804:		Line 2,780:

	* Consider Obstructed Airway Protocol for suspected ingestion or foreign body.		* Consider Obstructed Airway Protocol for suspected ingestion or foreign body.


	'''Procedure/Approach:'''		'''Procedure/Approach:'''
Line 2,826:		Line 2,801:

	5. AEMT/Paramedic: Contact Medical Control for consideration of nebulized medication		5. AEMT/Paramedic: Contact Medical Control for consideration of nebulized medication


	'''Considerations:'''		'''Considerations:'''
Line 2,881:		Line 2,855:
	== '''Protocol 401: Medical Shock''' ==		== '''Protocol 401: Medical Shock''' ==
	'''Scope: <u>EMT-Basic, Advanced EMT and Paramedic</u>'''		'''Scope: <u>EMT-Basic, Advanced EMT and Paramedic</u>'''


	'''Indications:'''		'''Indications:'''