Prehospital Care Manual online - Contra Costa Health Services

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A9–ADULT OTHER CARDIAC DYSRHYTHMIAS SINUS TACHYCARDIA – Heart rate 100-160, regular ATRIAL FIBRILLATION – Heart rate highly variable, irregular ATRIAL FLUTTER – Variable rate depending on block. Atrial rate 250-350, “saw-tooth” pattern. INITIAL THERAPY BLS: Low flow unless ALOC / respiratory distress / shock OXYGEN ALS: Titrate to sPO of at least 94% 2 CARDIAC MONITOR CONSIDER 12-LEAD ECG CONSIDER IV TKO 12-lead ECG pre-and post-treatment may be useful for comparisons at hospital The computerized rhythm analysis on 12-lead printout should not be used for determination of rhythm UNSTABLE ATRIAL FIBRILLATION OR ATRIAL FLUTTER Ventricular rate greater than 150, and: BP less than 80, or unconsciousness / obtundation, or severe chest pain or severe dyspnea OXYGEN High flow. Be prepared to support ventilation. CONSIDER Prepare for CARDIOVERSION. If awake and aware, sedate with SEDATION MIDAZOLAM - initial dose 1 mg IV, titrate in 1-2 mg increments (max. dose 5 mg) Atrial Flutter: • Initial: 100 joules (low energy setting – 75 joules) SYNCHRONIZED • Subsequent: 200, 300, 360 joules (low energy settings 120, 150, 200 joules) CARDIOVERSION Atrial Fibrillation • Initial: 200 joules (low energy setting – 120 joules) • Subsequent: 300, 360 joules (low energy settings 150, 200 joules)
Key Treatment Considerations • Sinus tachycardia commonly present because of pain, fever, anemia, or hypovolemia • Atrial fibrillation may be well-tolerated with moderately rapid rates (150-170) and often requires no specific treatment other than observation (oxygen, monitoring and transport) • If sedation used for cardioversion, monitor respiratory status closely and support ventilation as needed • Rhythm analysis should be based on review of P and QRS waves on printed strip, not monitor screen or computerized readout of 12-lead ECG • Computerized analysis for Acute MI (STEMI) may be incorrect with very fast rhythms. If ***Acute MI***, ***Acute MI Suspected*** or ***Meets ST-Elevation MI Criteria*** message encountered, the patient’s heart rate is important information to relate to the STEMI center at time of activation.
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 14 and 15: A6-ADULT SYMPTOMATIC BRADYCARDIA He
Page 16 and 17: A7-ADULT VENTRICULAR TACHYCARDIA WI
Page 18 and 19: A8-ADULT SUPRAVENTRICULAR TACHYCARD
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
Page 65: 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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