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Region VII BLS SMO Revision. 2011. 2011 BLS SMO. This presentation will highlight changes in the SMO’s and also cover information that is on the 2011 SMO study booklet. Code 2: Respiratory Distress. Added reference to Failed Adult Airway Code 75 for inadequate breathing.

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2011 bls smo
2011 BLS SMO

This presentation will highlight changes in the SMO’s and also cover information that is on the 2011 SMO study booklet.


Code 2 respiratory distress
Code 2: Respiratory Distress

  • Added reference to Failed Adult Airway Code 75 for inadequate breathing.

  • Code 75 – BLS providers now allowed to use King Airway for patients who are not getting good ventilations with BVM alone.


Code 3
Code 3

  • The Airway Obstruction code, in the past, referred to infant situations.

  • The pediatric portion (less than one year) was eliminated in this revision and now Code 3 only refers to patients that are over 1 year old.


Code 4 cardiac arrest
Code 4 – Cardiac Arrest

  • Codes 6, 9 and 11 now all refer back to this code (Vfib, Vtach, PEA, asystole)

  • BLS treatment for all is the same anyway.

  • Includes suggestion that King Airway be considered.

  • Encourages minimal interruptions of chest compressions per new AHA guidelines.


Code 12 suspected cardiac patient
Code 12 – Suspected Cardiac Patient

  • Have added “perform 12 lead EKG and transmit if available” to BLS cardiac SMO.

  • Have added box that includes times 12-lead use should be considered:

    • Chest pain/discomfort/pressure

    • Arm pain

    • Jaw pain

    • Upper back pain

    • Unexplained diaphoresis

    • Vomiting without fever or diarrhea

    • Shortness of breath

    • Dizzy/syncope

    • Epigastric pain

    • Unexplained fall in elderly

    • Weakness/fatigue

    • Bradycardia or tachycardia


Bls and 12 leads
BLS and 12-leads

  • BLS providers will not be asked to interpret 12-lead EKG’s.

  • But it will be within their scope of practice to apply electrodes if trained, and transmit the results to the ER.

  • Will make the EMT-B of even greater assistance to their EMT-P partner, and to the ER.


Code 13 pulmonary edema due to heart failure
Code 13 – Pulmonary Edema Due to Heart Failure

  • Adds “consider CPAP en route, if available” for patients with a BP > 90.

  • CPAP an exciting new addition to the BLS toolbox for patients with trouble breathing due to pulmonary edema/CHF.

  • Also referred to in Code 30 (Asthma, COPD, Wheezing) with approval of medical control.


Trauma codes
Trauma Codes

  • Codes 16 and 21 (trauma and extremity injuries) now allow for use of hemostatic agents by BLS providers.

  • These are powders or chemicals that are applied to wounds to stop bleeding.

  • Your EMS coordinator will have more information on whether your department has purchased hemostatic agents.


Code 21

ISOLATED EXTREMITY INJURY AND/OR

AMPUTATED AND AVULSED PARTS

INITIAL TRAUMA CARE

(ABCs always take priority over the severed part)

  • Control bleeding with direct pressure and elevation

  • For uncontrolled hemorrhage:

    • Consider use of a hemostatic agent

    • Use a tourniquet if needed

      • Note time of placement

      • Apply as close to the injury as possible

      • DO NOT release once applied

NITROUS OXIDE (optional)

  • Wrap part in sterile gauze, sheet or towel.

  • Place part in waterproof bag or container and seal.

  • DO NOT immerse part in any solutions.

  • Place this container in a second one filled

  • with ice, cold water or cold pack.

Transport part to hospital with patient

TRANSPORT

NOTE TO PREHOSPITAL PROVIDER:

MORPHINE SULFATE 5-10mg slow IV in 5mg

increments every 5 minutes as necessary for pain.

Reviewed 10/01/11

Effective 05/01/98

ALS


Code 24 trauma in pregnancy
Code 24 – Trauma in Pregnancy

  • Added F – “Manually displace uterus to the left side during CPR.”

  • Left uterine displacement increases cardiac output by 30% and restores circulation.


Intranasal medications
Intranasal Medications

  • Codes 32, 33, 34 and 35 now allow for BLS use of Intranasal Narcan and Glucagon.

  • Fast-acting through the nasal mucosa.

  • Allows for effective BLS treatment of diabetics, drug OD’s, comas of unknown origin and seizures


Code 18

SUSPECTED SPINAL CORD INJURY

SPINAL IMMOBILIZATION

Mechanism:

Suspected Deceleration Injuries,

Motor Vehicle Crashes, Falls, etc.

Yes

Spine pain/tenderness or

complaint of neck/spine pain

No

Yes

Physical findings suggesting neck and/or back injury

No

Yes

Other painful injury identified

(Distracting Injury)

No

Yes

Decreased or altered level of consciousness

No

Abnormal?

Motor/Sensory Exam

Patient is

  • Calm

  • Cooperative

  • Alert

  • Ambulatory without pain

  • No apparent distress

  • No suspected intoxication

  • Having an acute stress reaction

  • Suspected of being intoxicated

  • Have symptoms of brain injury

  • Acting inappropriately

  • Having difficulty communicating,

  • such as, speaks a foreign language, deaf, etc.

Reliable patient exam

IMMOBILIZE

Reviewed 10/01/11

Effective 05/01/98

ALS

NO IMMOBILIZATION NEEDED


Code 38 suspected stroke
Code 38 – Suspected Stroke

  • “Hypertensive Crisis” code is gone.

  • Replaced with “Suspected Stroke” code.

  • Includes possible use of 12-lead EKG

  • Also includes performance of Cincinnati Stroke Scale and checking of glucose.


Code 45 emergency childbirth
Code 45 – Emergency Childbirth

  • Removes “involuntary pushing with contractions” and “contractions less than 2 minutes apart” from criteria to prepare for immediate delivery.

  • Bulging perineum or crowning are most important things to look for… the rest may still allow you transport time.


Some other minor changes
Some other minor changes

  • Code 55 and 56, pediatric respiratory distress and arrest, now refer to “back slaps” instead of “back blows”.

  • Code 61, pediatric toxic exposure, now says simply “do not induce vomiting” instead of going into detail about caustic substances.

  • Code 68, Behavioral Emergencies, now reminds you to first “maintain situational awareness and scene safety”.



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