Prehospital Care Manual online - Contra Costa Health Services

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A6–ADULT SYMPTOMATIC BRADYCARDIA Heart rate less than 50 with signs or symptoms of poor perfusion (e.g., acute altered mental status, hypotension, other signs of shock). Correction of hypoxia should be addressed prior to other treatments. OXYGEN CARDIAC MONITOR BLS: High flow initially ALS: Titrate to sPO of at least 94% 2 IV TKO. If not promptly available, proceed to external cardiac pacing. Consider IO ACCESS if patient in extremis and unconscious or not responsive to painful stimuli. CONSIDER FLUID BOLUS 250-500 ml NS if clear lung sounds and no respiratory distress 12-LEAD ECG Consider pre- and post-treatment if condition permits TRANSCUTANEOUS Set rate at 80 PACING Start at 10 mA, and increase in 10 mA increments until capture is achieved If pacing urgently needed, sedate after pacing initiated CONSIDER • MIDAZOLAM - initial dose 1 mg IV or IO, titrated in 1-2 mg increments SEDATION (maximum dose 5 mg), and/or • MORPHINE SULFATE 1-5 mg IV or IO in 1 mg increments for pain relief if BP 90 systolic or greater May be used as a temporary measure while awaiting transcutaneous pacing but should not delay onset of pacing CONSIDER • 0.5 mg IV or IO if availability of pacing delayed or pacing ineffective ATROPINE • Consider repeat 0.5 mg IV or IO every 3-5 minutes to maximum of 3 mg Use with caution in patients with suspected ongoing cardiac ischemia Atropine should not be used in wide-QRS second- and third-degree blocks TRANSPORT
Key Treatment Considerations • Sinus bradycardia in the absence of key symptoms requires no specific treatment (monitor / observe) • Fluid bolus may address hypotension and lessen need for pacing or treatment with atropine • Sedation prior to starting pacing is not required. Patients with urgent need should be paced first. • The objective of sedation in pacing is to decrease discomfort, not to decrease level of consciousness. Patients who are in need of pacing are unstable and sedation should be done with great caution • Monitor respiratory status closely and support ventilation as needed • Atropine is not effective for bradycardia in heart-transplant patients (no vagus nerve innervation in these patients) • Patients with wide-QRS second- and third-degree blocks will not have a response to atropine because these heart rates are not based on vagal tone. An increase in ventricular arrhythmias may occur.
Page 1 and 2: contra costa county emergency medic
Page 3: A1 — Adult Patient Care A2 — Ch
Page 6 and 7: A2-ADULT CHEST PAIN SUSPECTED ACUTE
Page 8 and 9: A3-ADULT CARDIAC ARREST - INITIAL C
Page 10 and 11: A4-ADULT VENTRICULAR FIBRILLATION P
Page 12 and 13: A5-ADULT PULSELESS ELECTRICAL ACTIV
Page 16 and 17: A7-ADULT VENTRICULAR TACHYCARDIA WI
Page 18 and 19: A8-ADULT SUPRAVENTRICULAR TACHYCARD
Page 20 and 21: A9-ADULT OTHER CARDIAC DYSRHYTHMIAS
Page 22 and 23: A10-ADULT SHOCK / HYPOVOLEMIA HYPOV
Page 24 and 25: A11-ADULT POST-CARDIAC ARREST CARE
Page 26 and 27: A12-ADULT PUBLIC SAFETY DEFIBRILLAT
Page 29: G1 — Allergy and all patients G9
Page 33 and 34: If serious progression of symptoms
Page 35 and 36: Key Treatment Considerations • Na
Page 37 and 38: CONSIDER CHEMICAL RESTRAINT MONITOR
Page 39 and 40: Key Treatment Considerations • Ai
Page 41 and 42: COMPLICATED DELIVERY BREECH DELIVER
Page 43 and 44: G7-GENERAL ENVENOMATIONS (Bites/Sti
Page 45 and 46: Key Treatment Considerations • Se
Page 47 and 48: Key Treatment Considerations • Av
Page 49 and 50: • Closed head injury • Altered
Page 51 and 52: ORGANOPHOSPHATE POISONING Hypersali
Page 53 and 54: Key Treatment Considerations SAFETY
Page 55 and 56: NITROGLYCERIN CONSIDER MORPHINE SUL
Page 57 and 58: Key Treatment Considerations • Mo
Page 59 and 60: CINCINNATI STROKE SCALE If any one
Page 61 and 62: INDICATIONS AND PRECAUTIONS FOR MOR
Page 63 and 64: G16-GENERAL TRAUMA - EXTREMITY cons
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CONSIDER ONDANSETRON For severe nau
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P1-PEDIATRIC PEDIATRIC PATIENT CARE
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P2-PEDIATRIC CARDIAC ARREST - INITI
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P3-PEDIATRIC NEONATAL CARE AND RESU
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P4-PEDIATRIC VENTRICULAR FIBRILLATI
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P5-PEDIATRIC PULSELESS ELECTRICAL A
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P6-PEDIATRIC SYMPTOMATIC BRADYCARDI
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UNSTABLE SUPRAVENTRICULAR TACHYCARD
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Key Treatment Considerations Succes
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IFT 1-TRANSFER INTERFACILITY TRANSF
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IFT 3-TRANSFER INTERFACILITY TRANSF
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DESTINATION DETERMINATION - BASIC P
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GENERAL DESTINATION PRINCIPLES PATI
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BASE HOSPITAL DESTINATION DECISION
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OBVIOUS DEATH MEDICAL ARREST TRAUMA
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ABUSE REPORTING RESPONSIBILITIES EM
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RESTRAINT TYPES RESTRAINT ISSUES LA
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BACKGROUND SITE REQUIREMENTS PROCED
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HAZMAT RECOGNITION WHILE ON SCENE (
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ON-VIEWS • In the event that a no
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12-LEAD ACQUISITION AND LEAD PLACEM
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STEMI RECOGNITION STEMI REPORT DEST
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TRANSMISSION OF MONITOR DATA • 12
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AIRWAY POSITIONING Position the pat
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KEY PROCEDURES Skill Indication / C
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Oxygen Safety Initial Indications f
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PAIN ASSESSMENT AND MANAGEMENT Reli
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PEDIATRIC ASSESSMENT Begin interven
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PEDIATRIC MEDICATION ADMINISTRATION
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SEPSIS SCREENING • Sepsis is a li
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VASCULAR ACCESS Skill Indication /
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TREATMENT DESTINATION AND DISPOSITI
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TIER ZERO TIER ONE TIER TWO TIER TH
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SBAR REPORTING SBAR is a tool that
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EMT SCOPE OF PRACTICE (STATE REGULA
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PARAMEDIC SCOPE OF PRACTICE Califor
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PARAMEDIC SCOPE OF PRACTICE (contin
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Kaiser Medical Center - Antioch 500
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OUT-OF-COUNTY SPECIALTY CENTERS Hos
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ADULT DRUG REFERENCE Drug Indicatio
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ADULT DRUG REFERENCE Drug Indicatio
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NALOXONE ADULT DRUG REFERENCE Drug
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PEDIATRIC DRUG REFERENCE Drug Indic
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Yellow (12-14 kg) 2.7 mg 2nd - 0.9
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Assure adequate ventilation before
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Note: Cardioversion energy dosages
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Consider giving one-half dosage dip
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45 kg 0.3 mg 0.3 ml IM / SC 40 kg 0
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45 kg 1 mg 1 ml Green (30-36 kg) 1
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40 kg 4 mg 0.8 ml 45 kg 4.5 mg 0.9
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For patients 19 kg and above may ti
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45 kg 45 kg 101 lbs Green 30-36 kg
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0 0 1-2 MILD 1-2 LEVE PAIN RATING S
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