Eye and Dental Trauma

Stabilize impaled objects in place and cover both eyes Cover puncture wound with protective devices over both eyes Irrigate chemicals or non-penetrating foreign matter from eye with copious amounts of water or normal saline Instill Proparacaine into affected eye and repeat every 5 minutes as needed Dental avulsions should be placed in an obviously labeled […]

Burns

Scene safety; remove patient from burn source, including clothing Maintain airway and administer oxygen In burns over 10% BSA, use dry dressings and insulate patient to prevent hypothermia In burns under 10% BSA, use moist dressings Initiate IV fluids 0.9% NaCl or Lactated Ringers

Toxicological

Be sure the scene is safe Absorbed poison: Remove clothing and fully decontaminate. If eye(s) involved, irrigate ≥20 minutes Inhaled/ingested poison: Administer high-flow O2. Pulse oximetry may be inaccurate Ingested poison: Contact Poison Control Review circumstances with Medical Control and Poison Control Envenomations: Immobilize extremity in dependent position; consider ice pack for bee stings

Stroke

Obtain glucose reading via glucometer Administer high concentration oxygen, and be prepared to assist ventilations if necessary Assess patient with Cincinnati Stroke Scale Facial droop (big smile) Pronator drift (extend arms, palms up, eyes closed: one arm drift = positive; both = unclear) Speech (“The sky is blue in Cincinnati”) Assess and record the exact […]

Seizure

If generalized seizure activity is present, consider: Lorazepam 1-2 mg IV or IM repeated every 5 min to a total of 4 mg OR Diazepam 5 mg IV(then 2.5 mg every 5 minutes to a total of 10 mg Midazolam 1-2.5 mg IV/IM/IO repeated every 5 minutes to a total of 5 mg or until […]

Pain Management

Systolic BP >90 mmHg, no altered level of mental status, multi-system trauma, or abdominal pain Ketorolac 15 mg IVP or 30 mg IM (no repeat); avoid in patients likely to go to OR, NSAID allergy, aspirin sensitive asthma, known peptic ulcer disease, pregnant, or nursing Morphine 1-5 mg IV/IM every 10 min, max total 15 […]

Obstetrical

Assist with normal delivery If cord is prolapsed, relieve pressure on cord, elevate hips, keep cord moist, transport If buttocks presents first, give oxygen and attempt to open path in birth canal to infant’s mouth w/ sterile gloved fingers. Transport immediately! If massive bleeding or newborn distress, proceed to nearest appropriate hospital

Nausea/Vomiting

Proclorperazine 2.5 mg IV or 5 mg IM OR Promethazine (Phenergan) 6.25 mg IV diluted in 10 ml of 0.9% NaCl, which is administered over 2 mins via the furthest port from the vein May repeat either medication x1 in 10 mins if symptoms persist Ondanestron ((Zofran) 4 mg IV administered over 30 seconds. May […]

Hyperthermia

Remove patient to cool area If patient temperature >104F or >40C or if altered mental status, begin active cooling IV fluids 0.9% NaCl to maintain SBP ≥90 mm Hg or >minimum for age and signs of adequate perfusion If uncontrolled shivering occurs during cooling—ADULTS ONLY, lorazepam 0.5-1.0 mg IV/IM or diazepam 2 mg IV or […]

Tachycardia (Unstable)

Hypotension, altered mental status, signs of poor perfusion Synchronized cardioversion V-tach, A-fib, PSVT: 100j, 200j, 300j, 360j A-flutter: 50j, 100j, 200j, 300j, 360j Polymorphic V-tach: 200j, 300j, 360j or biphasic equivalents, based on manufacturers recommendations Consider procedural sedation if practical (Midazolam 2.5 mg IV or Diazepam 5 mg IV)