Hypoglycemia

M406 Glucose level < 70 mg/dL or glucometer reads LOW If patient can swallow, 15g oral glucose or high glucose fluid (juice) If patient cannot swallow, 12.5 – 25g D50W via IV/IO (treatment with D50W through IO should be viewed as a last resort effort) If unable to establish IV/IO, 1mg Glucagon IM

Hyperglycemia

X101 Glucose level > 400mg/dL or glucometer reads HIGH 500-1000ml IV/IO fluid bolus during transport if no pulmonary edema Monitor for dysrhythmias

V-Fib / Pulseless V-Tach

C300 Initiate CPR compressions at 100-120/min rate, 2-2.5 inches in depth, 30 compressions and 2 breaths, and rotate compressors every 2 minutes. Minimize all interruptions to compressions. Attach AED or defibrillator to patient as soon as possible; immediately defibrillate at 360 joules (or biphasic equivalent) Continue CPR for two minutes then perform rhythm check or […]

Traumatic Cardiac Arrest

C308 Do not initiate efforts if injuries are incompatible with life, including decapitation, hemicorporectomy, burned beyond recognition, or obvious signs of prolonged death including rigor mortis (in the absence of hypothermia), decomposition, or lividity For all others, perform CPR and transport to trauma center. Patients under 18 can be transported to a pediatric trauma center. […]

Post-ROSC

C307 Follow protocol for presumptive underlying medical condition Maintain patent airway and give oxygen Ventilate as needed 8-10X/min; do NOT over ventilate Continue cardiac monitoring; obtain and transmit a 12-lead EKG to receiving hospital If cause is suspected cardiac, transport to hospital with 24-hour cardiac cath lab If cause is suspected trauma, follow Trauma Triage […]

Asystole / PEA

C301 Initiate CPR compressions at 100-120/min rate, 2-2.5 inches in depth, 30 compressions and 2 breaths, and rotate compressors every 2 minutes. Minimize all interruptions to compressions. Attach AED or defibrillator to patient as soon as possible and analyze rhythm; recheck every 2 min Attach monitor leads Search for and treat possible causes: Hs & […]

Symptom-Based Respiratory

SB202 Maintain airway and administer Oxygen Allow patient to sit up in a position of comfort Apply cardiac monitor when available Monitor vital signs Consider CPAP If patient has chest pain suggestive of cardiac origin, dyspnea, no evidence of trauma, AND systolic BP <80, OR systolic BP 80-100 and HR>120, skin changes suggestive of shock, […]

Asthma / COPD

M403 Albuterol (Proventil) or Duoneb via HHN. May repeat to a total of 3 treatments For first treatment may add ipratropium bromide or use Duoneb For asthma only, consider Epinephrine 1:1000 0.3 ml IM if patient is unable to breathe in HHN Consider CPAP if available Consider 60 mg Prednisone PO or Solumedrol 125mg IV

Tension Pneumothorax

T701 Expose chest and clean procedure area on skin Use commercial device or long, large bore IV catheter and needle (10-14 gauge; 3 inch 10 gauge preferred) Insert the device or IV needle and catheter over the top of the rib of the second or third intercostal space in the midclavicular line OR Insert the […]

Airway Obstruction

M402 Have victim cough forcefully if possible If victim cannot speak or cough, perform Heimlich maneuver until successful or patient unconscious; If unconscious, perform CPR and attempt BVM ventilations while preparing to intubate Use laryngoscope to visualize airway; if object visible, use Magill forceps or suction to remove If object not visible, intubate the airway; […]