Prehospital Care Manual online - Contra Costa Health Services

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G3–GENERAL BEHAVIORAL EMERGENCY • A behavioral emergency is defined as combative or irrational behavior not caused by medical illnesses such as hypoxia, shock, hypoglycemia, head trauma, drug withdrawal, intoxicated states or other conditions • Combative or irrational behavior may be caused by psychiatric or other behavioral disorder • History of event and past history are important in patient evaluation • Past history of psychiatric condition does not eliminate need to assess for other illnesses SCENE SAFETY ASSESS PATIENT • Many patients merit a weapons search by law enforcement • Physical restraints may be needed if patient exhibits behavior that presents a danger to him/herself or others • Assess for evidence of hypoxia, hypoglycemia, trauma • Consider other medical causes for behavioral symptoms VITAL SIGNS Obtain vital signs as possible CONSIDER OXYGEN BLS: Low flow unless ALOC / respiratory distress / shock ALS: Titrate to sPO of at least 94% 2 CARDIAC MONITOR Place as possible / safe consider BLOOD GLUCOSE Obtain as possible / safe
CONSIDER CHEMICAL RESTRAINT MONITOR PATIENT BASE ORDER REQUIRED Despite verbal de-escalation and physical restraint, if adult patient (15 years or older) remains extremely combative and struggling against restraints, consider: • MIDAZOLAM 5 mg IM. Lower doses should be considered in elderly or small patients (under 50 kg). • MIDAZOLAM 1-5 IV mg in 1 mg increments if IV established and patent Monitor closely for respiratory compromise. Assess and document mental status, vital signs, and extremity exams (if restrained) at least every 15 minutes. Related guidelines: Altered Level of Consciousness (G2), Trauma (G16) Key Treatment Considerations • Calming measures may be effective and may preclude need for restraint in some circumstances • Utilize a single person to establish rapport. Separate patient from crowd and seek quiet environment if possible, but maintain contact with other personnel and ability to exit rapidly. • Avoid violating patient’s personal space, making direct eye contact or sudden movements. Frequent reassurance and calm demeanor of personnel are important. • Enlist assistance of law enforcement if restraint needed. Never transport patient in prone position. • Assure adequate resources available to manage patient’s needs. Restraint may require up to five persons to safely control patient. • Patients with past history of violent behavior are more likely to exhibit recurrent violent behavior • In pediatric patients, consider child’s developmental level when providing care • Sedation with Midazolam intended for adult patients only (age 15 and over) • Not all patients will respond to Midazolam. Repeat dosage is not recommended.
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 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: Key Treatment Considerations • Na
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
Page 70 and 71: P1-PEDIATRIC PEDIATRIC PATIENT CARE
Page 72 and 73: P2-PEDIATRIC CARDIAC ARREST - INITI
Page 74 and 75: P3-PEDIATRIC NEONATAL CARE AND RESU
Page 76 and 77: P4-PEDIATRIC VENTRICULAR FIBRILLATI
Page 78 and 79: P5-PEDIATRIC PULSELESS ELECTRICAL A
Page 80: P6-PEDIATRIC SYMPTOMATIC BRADYCARDI
Page 83 and 84: UNSTABLE SUPRAVENTRICULAR TACHYCARD
Page 85: 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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