SECTION 500 BASIC LIFE SUPPORT TREATMENT PROTOCOLS TABLE OF CONTENTS

Transcription

1 SECTION 500 BASIC LIFE SUPPORT TREATMENT PROTOCOLS TABLE OF CONTENTS TOPIC REFERENCE NUMBER BASIC LIFE SUPPORT TREATMENT PROTOCOLS POLICY CARDIAC ARREST MEDICAL CARDIAC ARREST TRAUMA CARDIAC ARREST EMT-D - AUTOMATIC DEFIBRILLATION (AED) Reference numbers 504 through 509 are reserved for future assignment. MEDICAL TREATMENT ABDOMINAL PAIN AIRWAY OBSTRUCTION ALTERED MENTAL STATUS CHEST PAIN INGESTION POISONING RESPIRATORY DISTRESS SEIZURES STROKE SHOCK (NON-TRAUMATIC) Reference numbers 519 through 529 are reserved for future assignment. TRAUMA TREATMENT ABDOMINAL TRAUMA BURNS CHEST TRAUMA EYE INJURIES HEAD TRAUMA ORTHOPEDIC INJURIES SOFT-TISSUE INJURIES

2 TABLE OF CONTENTS cont d TOPIC REFERENCE NUMBER SPINAL INJURIES SHOCK (TRAUMATIC) Reference numbers 539 through 549 are reserved for future assignment. ENVIRONMENTAL EMERGENCIES ALLERGIC REACTIONS BITES/STINGS COLD RELATED EMERGIENCIES HAZARDOUS MATERIALS HEAT RELATED EMERGENCIES NEAR-DROWNING SNAKEBITE Reference numbers 557 through 559 are reserved for future assignment. OBSTETRICAL EMERGENCIES CHILDBIRTH NEWBORN CARE Reference numbers 562 through 569 are reserved for future assignment. PSYCHIATRIC EMERGENCIES BEHAVIORAL Reference numbers 571 through 579 are reserved for future assignment. PROCEDURES EMT-I USE OF OXYGEN SPINAL IMMOBILIZATION EMT-I MONITORING OF IVs Reference numbers 583 through 589 are reserved for future assignment.

3 SAN LUIS OBISPO COUNTY EMERGENCY MEDICAL SERVICES AGENCY PREHOSPITAL POLICY SUBJECT: BASIC LIFE SUPPORT PROTOCOLS Policy Reference No: 500 Effective Date: 04/01/2010 Supersedes: 03/01/1997 Review Date: 06/01/2012 PURPOSE The Basic Life Support (BLS) protocols provide uniform standards for BLS and ALS personnel to render prehospital medical care when responding to a medical incident. AUTHORITY California Health and Safety Code, Division 2.5, Sections and 1798 (a); California Code of Regulations, Title 22, Social Security, Division 9, Chapter 1.5, Sections and ; Chapter 2, Sections and DEFINITIONS A. Emergency Medical Technician (EMT): An Emergency Medical Technician of any level, certified in the State of California. B. First Responder: EMTs; Paramedics; Flight Nurses and Critical Care Nurses trained in EMS; and Public Safety personnel trained in first aid and CPR, such as firefighters, peace officers, and lifeguards. C. Paramedic: An EMT-P accredited to practice in San Luis Obispo County. POLICY A. All BLS and ALS personnel working in San Luis Obispo County, including Emergency Medical Technicians, Paramedics and First Responders, shall follow the BLS treatment protocols. BLS personnel shall utilize the protocols immediately upon receiving protocol training, while on-duty and rendering medical care. B. BLS and ALS personnel shall utilize principles and skills as indicated in these protocols. C. Deviations from these BLS protocols shall be made only by on-duty Paramedics in conformance with San Luis Obispo County Advanced Life Support Treatment Protocols, or with Base Hospital contact. D. BLS and ALS personnel shall use the protocol that is most closely associated with the patient s condition. Some situations may indicate the use of more than one protocol. BLS personnel shall use their best judgment and consultation with Paramedics to determine which protocol to use. Policy Reference No: 500 Page 1 of 1

4 MEDICAL CARDIAC ARREST Ventilate patient with BVM and supplemental oxygen Do not delay initiation of CPR Follow current CPR guidelines Apply AED if indicated Obtain medical history and gather medications if possible Obtain event history o Down time prior to CPR initiation o Total down time including CPR Special Considerations Cold water drowning and hypothermia patients should have resuscitation performed even with extended down times Refer to Policy 116 for consideration of withholding/terminating resuscitation efforts Policy Reference No. 501

5 TRAUMA CARDIAC ARREST Ventilate patient with BVM and supplemental oxygen Do not delay initiation of CPR Follow current CPR guidelines Place patient in full spinal precautions Avoid hyperextension of the neck Control obvious hemorrhage Initiate rapid transport Special Considerations AED is not to be applied unless there are indications that the cardiac arrest preceded the traumatic event Refer to Policy 116 for consideration of withholding/terminating resuscitation efforts Policy Reference No. 502

6 AUTOMATIC EXTERNAL DEFIBRILLATOR (AED) Ventilate patient with BVM and supplemental oxygen Do not delay initiation of CPR Follow current CPR/ manufacturer guidelines for AED use AED is not to be used on traumatic patient unless trauma is suspected secondary to cardiac arrest Policy Reference No. 503

7 ABDOMINAL PAIN Reassure/calm patient Give nothing by mouth Obtain vital signs Obtain medical history or information on traumatic event Treat for shock as necessary Beware of vomiting be prepared to protect airway Patients with abdominal pain should be evaluated in the emergency department Policy Reference No. 510

8 AIRWAY OBSTRUCTION Complete Obstruction Partial Obstruction Follow current guidelines of the American Heart Association, American Red Cross or other approved programs Encourage patient to cough Remove visualized foreign body if possible Monitor patient s airway Do not give fluids Reassure/calm patient Position of comfort Obtain vital signs Obtain medical history Gather medications or list Do not delay transport Policy Reference No. 511

9 ALTERED MENTAL STATUS Known Diabetic Trauma Related If patient able to swallow water and gag reflex intact, administer glucose paste, juice, non diet soda, milk, candy, or other type of glucose Patient not cleared to refuse transport unless A&O X4 and blood glucose reading is above 60 mg/dl Full Spinal Precautions Assess for other injuries Consider medical cause for patient s altered mental status Possible Causes Consider AEIOUTIPS: Alcohol Epilepsy Insulin Overdose Uremia Infection Psychiatric Stroke or Cardiovascular Other Considerations: Hypoxia, Carbon Monoxide or other toxic exposures Policy Reference No. 512

10 CHEST PAIN Reassure/calm patient Position of comfort Obtain vital signs Obtain medical history Gather medications or list If requested by patient, assist with administration of patient s medications Aspirin 162 mg (non-enteric coated) tablets chewed and swallowed Nitroglycerin only if blood pressure remains above 100 systolic. Policy Reference No. 513

11 INGESTION/POISONING Contact with dry substance Brush off substance prior to flushing with large quantities of water Remove all contaminated clothing Decontaminate patient at scene Contact with liquid Remove all contaminated clothing Flush with large quantities of water Decontaminate patient at scene Reassure/calm patient Position of comfort Obtain vital signs Obtain medical history Gather medications or list Special Considerations Consider nerve agent, carbon monoxide, or organophosphate exposure if multiple victims Protect rescuers from poison agent due to contact with substance or secondary exposure from patient If eyes involved, flush for 15 minutes (use normal saline when available ) Policy Reference No. 514

12 RESPIRATORY DISTRESS Possible Medical Causes Possible Traumatic Causes Asthma/Emphysema Bronchitis/Pneumonia Congestive Heart Failure Myocardial Infarction Metabolic imbalance Spontaneous Pneumothorax Pulmonary Embolus Blunt Thoracic Trauma Penetrating Thoracic Trauma Tension Pneumothorax Hemothorax Hypovolemic shock Reassure/calm patient Position of comfort Obtain vital signs Obtain medical history Gather medications or list Special Information Monitor respiratory status closely Transport patient rapidly Consider reversible causes May assist in use of inhaler if one is prescribed to the patient Policy Reference No. 515

13 SEIZURES Do not place anything in patient s mouth while actively seizing Prevent patient from injuring themselves Do not restrain patient Obtain vital signs Obtain medical history Gather medications or list Considerations Insert orophyrangeal airway when seizing has stopped to protect airway if the patient is unconscious and has no gag reflex Utilize spinal precautions if trauma suspected Non-traumatic patients should be placed on their side Patients in status epilepticus should have high flow oxygen and rapid transport initiated Consider hypoglycemia Policy Reference No. 516

14 STROKE (CVA) Thrombotic Stroke Hemorrhagic Stroke Characterized by sudden onset Usually painless Patient s condition may continue to deteriorate rapidly Patient may complain of head pain and have nausea and vomiting Reassure/calm patient Position of comfort Obtain vital signs Obtain medical history Gather medications or list Obtain accurate time of onset and description of event to relay to the emergency department Remember that aphasic CVA patients often understand always communicate with your patient Policy Reference No. 517

15 SHOCK NON TRAUMATIC Place patient supine with legs elevated* Keep patient warm Do not delay transport Obtain vital signs Obtain medical history Gather medications or list * Patients in cardiogenic shock or with respiratory compromise may need to be placed in a semi-fowlers position. Consider possible causes Respiratory Hemorrhagic Anaphylactic Cardiogenic Septic Metabolic Neurological Policy Reference No. 518

16 ABDOMINAL TRAUMA Blunt Trauma Penetrating Trauma Repeat abdominal exam frequently for changes Do not delay transport Stop bleeding /apply dressing Stabilize impaled objects with bulky dressing Eviscerations - cover area with large moist dressing. Do not replace intestines. Do not delay transport Reassure/calm patient Give nothing by mouth Obtain vital signs frequently Obtain medical history or information on traumatic event Treat for shock as necessary Spinal precautions as indicated Monitor for vomiting be prepared to protect airway Policy Reference No. 530

17 BURNS Small Burns < 15% TBSA Cover with moist sterile dressings using normal saline or a commercial water gel burn dressing Large Burns > 15% TBSA Cover with moist sterile dressings using normal saline or a commercial water gel burn dressing and then cover with dry dressings to prevent hypothermia Reassure/calm patient Position of comfort Obtain vital signs Assess/ treat other injuries (radiation/electrical) Treat for shock Monitor airway closely for swelling Special Considerations Chemical Burns o Remove patient s clothing o Remove contaminants with large quantities of water except for lime, metallic sodium, or lithium exposure Consider carbon monoxide or other toxic exposures Policy Reference No. 531

18 CHEST TRAUMA Penetrating Trauma Blunt Trauma Open Chest Wound Cover wound with chest seal device or Vaseline impregnated gauze and tape loosely on three sides Monitor patient closely for development of tension pneumothorax. If this occurs, remove dressing to allow the air to escape Flail Chest Support flail section with pillow or other supportive device to provide patient comfort Monitor patient closely for respiratory or cardiac deterioration Impaled objects - stabilize with bulky dressings do not remove object Position of comfort if not contraindicated Consider spinal precautions Obtain vital signs Provide respiratory support as indicated Do not delay transport Reassure/calm patient Position of comfort if not contraindicated Consider spinal precautions Obtain vital signs Provide respiratory support as indicated Do not delay transport Policy Reference No. 532

19 EYE INJURIES Chemical Contamination Trauma/Foreign Body Avoid contamination of unaffected eye Flush continuously with water or normal saline for at least 15 min or until patient arrives at hospital Bandage both eyes to prevent eye movement Do not remove foreign body or impaled objects stabilize with bulky dressings Consider need for spinal immobilization Reassure/calm patient Position semi-fowlers if possible Obtain vital signs Obtain medical history Gather medications or list Policy Reference No. 533

20 HEAD TRAUMA Spinal precautions as indicated Monitor airway closely Assess Level of Consciousness and obtain initial Glasgow Coma Scale Score Assess for secondary injuries Obtain vital signs Obtain medical history Gather medications or list Monitor patient s mental status for changes and document sequential Glasgow Coma Scale scores Policy Reference No. 534

21 ORTHOPEDIC INJURIES If indicated, Administer Oxygen per Policy 580 Closed Fractures Open Fractures Confirm and mark distal pulses Immobilize joints above and below fracture with well padded splint Apply traction splint to femur fractures only Apply cooling packs to reduce swelling and relieve pain Confirm and mark distal pulses Immobilize joints above and below fracture with well padded splint Apply moist dressings and bandages to stop bleeding and reduce contamination Do not apply traction splint to open femur fractures Do not attempt to reduce an open fracture Reassure/calm patient Position of comfort Obtain vital signs Consider spinal precautions Do not delay transport if neurovascular compromise noted Policy Reference No. 535

22 SOFT TISSUE INJURIES If indicated, Administer Oxygen per Policy 580 Stop bleeding o Direct pressure o Elevation o Pressure Points o Tourniquet if bleeding not controlled Apply moist sterile dressings Check distal neurovascular status Special Considerations Amputations Wrap amputated part in a dry dressing and place in a waterproof container or plastic bag Place the container or plastic bag on ice/cooling pack to keep cool, but not frozen Transport the amputated part with the patient to the hospital, if possible but do not delay patient transport to locate part Avulsed tissue should be returned to a normal position and secured with a moist sterile dressing Policy Reference No. 536

23 SPINAL INJURIES Place patient in full spinal precautions Administer oxygen per Policy 580 Full Spinal Precautions Establish manual spinal stabilization Apply properly-sized cervical collar maintaining manual c-spine stabilization Secure Patient to long spine board o Ensure adequate strapping to prevent patient movement o Secure head last, maintaining manual c-spine stabilization until patent s head is secured Monitor airway closely, be prepared to log roll patient in the event of vomiting Reassure/calm patient Assess for secondary injuries Obtain vital signs Monitor for changes in neurological status Policy Reference No. 537

24 ALLERGIC REACTIONS Administer oxygen per Policy 580 Respiratory Distress No Respiratory Distress Administer oxygen 15 liters/minute by nonrebreather mask Do not delay transport Administer oxygen 4-6 liters/minute by cannula Reassure/calm patient Position of comfort Obtain vital signs Monitor respiratory status Obtain medical history Gather medications or list May assist with administration of patient s own medication Epi Auto-injector - Only to be used if prescribed to patient Policy Reference No. 550

25 BITES AND STINGS Administer oxygen per Policy 580 Insect Stings Animal Bites Remove stinger if visible by scraping. Do not pinch using tweezers or other instruments Apply ice to the sting site Monitor patient for signs of allergic reaction. If present, refer to Policy 550 Administer oxygen 4-6 liters/minute by cannula. Treat wounds as appropriate Reassure/calm patient Position of comfort Obtain vital signs Obtain medical history Gather medications or list Policy Reference No. 551

26 COLD EMERGENCIES Remove patient from cold environment Prevent further heat loss or injury Check vital signs, especially pulse, for at least seconds a hypothermic patient may have a slow, weak pulse Remove wet clothing and jewelry as appropriate Rewarm hypothermic patient with blankets, warm environment. Avoid rough handling of patient which may precipitate arrhythmias Rewarming of Frostbitten extremities consider only if evacuation not possible for 6-12 hours o If patient is not hypothermic, sufficient supply of warm water is available, and there is no risk of refreezing: Use degree water, immerse until limb is soft, pink, pliable and painful o After re-warming, place gauze between digits and dress extremity, splint as needed Transport as soon as possible Policy Reference No. 552

27 HAZARDOUS MATERIALS Do not approach patient Isolate and deny entry to hazardous area Request immediate Fire Department response Treatment Area should be established uphill and upwind from hazardous area All patients should be decontaminated by rescue personnel prior to medical treatment After decontamination, treat patient based on their chief complaint Early notification of receiving facility Transport to appropriate facility Consider need for unit decontamination Refer to Weapons of Mass Destruction Guidelines in SLOEMSA Policies and Procedures Policy Reference No. 553

28 HEAT RELATED EMERGENCIES Remove patient from environment and place in a cool area Patients with environmental heat exposure and ALOC that feel hot and are not sweating should be treated for hyperthermia / heat stroke Initiate transport/cool enroute (remove clothing / cool with water and use fans/air conditioning) Considerations Alert patients may receive up to 1 Liter of water or sport drink (50/50 mix with water) in small sips. Discontinue if patient experiences nausea or vomiting Seizures may occur with heat stroke. Adjunctive Measures - Ice packs to neck, armpits and groin Policy Reference No. 554

29 NEAR DROWNING Initiate water rescue only if trained to do so Consider need for spinal precautions Consider possibility of hypothermia Consider possible preceding medical event (Seizure, hypoglycemia, CVA) Treat injuries appropriately All patients should be evaluated at a medical facility Policy Reference No. 555

30 SNAKEBITE Calm/Reassure patient Do not delay transport Remove constricting items around area of bite or swelling Mark area of swelling and record time Irrigate and treat wound site o Splint injured extremity and keep below level of heart o Do not apply ice o Do not incise wound or attempt suction of venom Transport patient to hospital Some of the following may occur with envenomation: Pain/Edema/bleeding at wound site Numbness/tingling Involuntary twitching Metallic taste in mouth Exotic snakes/mojave Rattlesnakes may cause neurologic and respiratory depression Policy Reference No. 556

31 CHILDBIRTH If indicated, Administer Oxygen per Policy 580 Normal Delivery Complications Patient assessment with visual exam of perineum Control head and speed of delivery Suction mouth first, then nose Check for cord around neck Deliver upper, then lower shoulder Dry, stimulate, and wrap baby Cut and clamp cord 6 from newborn s umbilicus Healthy infant to mother s breast Prepare for delivery of placenta Hypertension B/P> 180/110 Seizures-follow seizure protocol Placenta abruptio/previa = vaginal bleeding in last trimester not associated with labor Breech/Limb presentation Prolapsed cord - Place mother in Trendelenberg or knee-chest position. Feel cord for pulse. With gloved hand, push baby into vagina slightly to take pressure off cord. Maintain this position. Do not attempt to push cord back Initiate Rapid Transport ASAP! Postpartum Hemorrhage Perform visual exam to determine site of bleeding For perineal tear, apply direct pressure Firmly massage fundus Policy Reference No. 560

32 NEWBORN CARE Assess vital signs then dry thoroughly and cover head and body to maintain body heat Position infant on back and suction mouth then nose with bulb syringe Stimulate infant by rubbing the back or flicking the soles of the feet Consider BVM assist if indicated. Or blow by O2 at 100% HR < 60BPM = chest compressions X 1 Minute HR=60-100, 40/min with 100% O2 Initiate Rapid Transport Asphyxiation/respiratory distress is most common cause of neonatal arrest Prompt warming, suctioning and O2 are the key to a successful resuscitation Make sure to use proper sized equipment Heat loss is critical and all measures to minimize heat loss should be taken Determine APGAR at delivery and after 5 minutes, and after interventions Policy Reference No. 561

33 BEHAVIORAL EMERGENCIES Consider Need for Law Enforcement Safety is the first priority - Consider retreat or need for Law Enforcement if patient is violent or threatening. If necessary, restrain patient per San Luis Obispo Policy No. 118 to protect patient or first responders. (Restraints are to be used only in situations where the patient is potentially violent and is exhibiting behavior that is a danger to self or others) Aggressive or violent behavior may be a symptom of medical conditions such as head trauma, alcohol, drug-related problems, metabolic disorders, psychiatric disorders, or stress Assessment Setting/History of event, Trauma, drug/alcohol ingestion, Past Medical History, Neuro deficits, Temperature Treat injuries as appropriate Transport Considerations Differential Diagnosis Mnemonic: AEIOUTIPS - for causes of ALOC Medical Emergencies including CVA, Diabetic Problem, Seizure, Syncope, Brain Tumors; Environmental factors, Emotional states Address patient in a calm, quiet manner Complete, thorough documentation in PCR Policy Reference No. 570

34 OXYGEN ADMINISTRATION Significant Respiratory Distress Mild Respiratory Distress Administer Oxygen 15 liters/minute by non-rebreather mask Monitor patient closely for possible vomiting/airway compromise Administer Oxygen 4-6 liters/minute by nasal cannula Consider using cannula for patient with nausea or who will not tolerate a mask Patients requiring Oxygen Administration Altered mental status or acute neurological symptoms (to include syncope, seizure, stroke, numbness, cardiac, medical, or trauma related problems) Shortness of breath, cyanosis, or an elevated respiratory rate Chest pain Irregular pulse rate, or pulse rate over 120/minute Shock of any cause Other conditions where Oxygen is called for in the Basic Life Support Protocols Use BVM with supplemental oxygen (10-15 liters/min) when: o Patient is not breathing o Patient is breathing too slowly or too shallowly to provide adequate ventilations Policy Reference No. 580

35 SPINAL IMMOBILIZATION Indications Patients with a history of significant trauma or mechanism of injury resulting in blunt trauma, head trauma or axial spine trauma Trauma patients with ALOC Trauma patients with distracting injuries Trauma patients with a history of alcohol/drug impairment Trauma patients complaining of neck or spine pain Considerations Children injured in MVA may be immobilized and transported in their car seats provided assessment and treatment can be rendered If in doubt, transport patient with spinal immobilization Paramedic may release patient from spinal immobilization per Policy # 615 Policy Reference No. 581

36 EMT MONITORING OF IVS The Emergency Medical Technician may monitor peripheral IV lines delivering intravenous fluids under the following conditions: A stable patient undergoing Interfacility transport who is deemed stable by transferring physician No medication or electrolyte additives have been added to the IV fluids The patient has no other ALS procedures in progress There are no IV pumps attached The EMT may only monitor and turn off the flow of IV fluid Patients that have IV therapy initiated in field by a Paramedic, must be accompanied to the hospital by a Paramedic. The patient may not be turned over to an EMT except in the case of a Multi-Casualty Incident. (Policy # 126) Policy Reference No. 582