2006 protocol update
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2006 Protocol Update. Central New York EMS 50 Presidential Plaza Jefferson Tower, Suite LL1 Syracuse, New York 13202 Click mouse anywhere on slide to continue…. Overview. Format Readjustments Adult Protocol Changes Pediatric Protocol Changes Special Protocols and Charts Review.

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2006 Protocol Update

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2006 protocol update

2006 Protocol Update

Central New York EMS

50 Presidential Plaza

Jefferson Tower, Suite LL1

Syracuse, New York 13202

Click mouse anywhere on slide to continue….


Overview

Overview

  • Format Readjustments

  • Adult Protocol Changes

  • Pediatric Protocol Changes

  • Special Protocols and Charts

  • Review


Format changes

Format Changes

  • Index

    • Easier to read and quickly locate protocols

  • Pages

    • Laminated for durability and longevity

  • Section tabs

    • Indicate the protocol section on the side of the page

    • Sections are no longer designated at the top of the page


Format changes1

Format Changes

  • Fonts

    • Though it may still seem small, font size has been maximized without compromising the size of the book

  • Clinical judgment boxes

    • Protocol sections that require clinical judgment are:

  • black with white letters


Format changes2

Format Changes

  • Cardiac Protocol Titles

    • Titles are based on subject and the word “cardiac” has been removed from the titles

      • Asystole

      • Bradycardia, Symptomatic

      • Cardiogenic Shock

      • Chest Pain

      • PEA

      • Tachycardia, Unstable

      • Tachycardia, Stable

      • V-Fib / Pulseless V-Tach


Adult protocol changes

Adult Protocol Changes

  • Pain – Non-Cardiac (page 29)

EMT-CC/EMT-P

Routine Medical or Trauma Care

Assess with Visual Analog Pain Scale (page 71) or equivalent

Minor Pain

Major Pain

Nubain 10 mg IV

OR

Morphine up to 5 mg IV

May repeat every 5 min.

up to 20 mg

Acetaminophen PO 15 mg/kg (maximum dose 1000mg) if patient can tolerate oral medication

* For pain of 6 and below via the Visual Analog Pain Scale (page 71) consider treatment via the Minor Pain pathway only, and care may be transferred to BLS.


Adult protocol changes1

Adult Protocol Changes

  • Pain – Non-Cardiac

    • Agencies will carry 325 mg and/or 500 mg tablets of acetaminophen and potable water.

    • While available under standing order and not technically a controlled substance, the storage, use, distribution and record-keeping shall be the same for nalbuphine (Nubain) as is currently utilized for ALL controlled substances.


Adult protocol changes2

Adult Protocol Changes

  • Facilitated Intubation (page 5)

    • Etomidate 0.3 mg/kg

Etomidate 20 mg IV over 30 to 60 seconds

Repeat Etomidate dose after 1-2 minutes if desired effect is not achieved

After successful intubation

Consider Diazepam 5.0 mg or Versed 2.0 mg for continued sedation*

To reverse effects of diazepam (Valium ) or midazolam (Versed ) due to complications arising from unsuccessful intubation (for example: hypotension or inability to maintain an airway) flumazenil (Romazicon ) 0.2 mg IV may be given.


Adult protocol changes3

Adult Protocol Changes

  • Allergic Reaction/Anaphylaxis (page 10)

Systolic BP <90 mmHg or severe respiratory compromise

Epi 1:1000 0.3 mg SC

Benadryl 50 mg slow IV/IM

If patient does not improve

Epi 1:1000 0.3 mg SC

If patient does not improve

Epi 1:10,000 0.3mg IV slow over 5 minutes or 2 mg ET

Epi 1:10,000 0.5 –1.0 mg IV or 2 mg ET

Fluid Challenge (page 7)

Transport


Adult protocol changes4

Adult Protocol Changes

  • Pulmonary Edema (page 13)

Nitroglycerin 0.4 mg SL

May repeat every 5 min. x 2

Nitroglycerin 0.4 mg SL

May repeat every 5 min. x 2

Furosemide 80 mg IV over 1 min.

May repeat or increase initial dose

Furosemide 40 mg IV over 1 min.

Morphine up to 5 mg IV for adults

May repeat every 5 min. up to 10 mg

Morphine 2 mg IV

May repeat every 5 min. up to 10 mg

If patient does not improve

Furosemide 80 mg IV over 1 min.


Adult protocol changes5

Adult Protocol Changes

  • Morphine initial dose change to range, still requires orders for all providers

    • “Up to 5 mg” for adults

      • Pulmonary Edema (page 13)

      • Chest Pain (page 17)


Pediatric protocol changes

Pediatric Protocol Changes

  • All pediatric protocols:

    • Use of Broselow Tape for adjunct sizes and drug dosages is required.


Pediatric protocol changes1

Pediatric Protocol Changes

  • Acute Respiratory Distress

    • Atrovent 500 mcg in 2.5 milliliters normal saline

Wheezing or history of

Asthma or Bronchiolitis

Albuterol (2.5 mg in 3 ml NS) and

Atrovent (500 micrograms in 2.5ml NS)

Administer via nebulizer*

Albuterol 2.5 mg in 3 ml via nebulizer

or

Epi 1:1000 0.01 mg/kg SC

to a total of 0.3 mg

May repeat in 20 min.


Pediatric protocol changes2

Pediatric Protocol Changes

  • Seizures (page 52)

    • Added “Maximum Total Doses” of Diazepam and Versed

Diazepam 0.1 mg/kg IV

May repeat X 1

Maximum total Dose

5 mg

OR

Diazepam 0.5 mg/kg PR*

May repeat X 1

Maximum total Dose

10 mg

OR

Versed 0.07 mg/kg IM

May repeat X 1

Maximum total Dose 5 mg


Special protocols

Special Protocols

  • Trauma Triage Criteria added (page 64)

Major trauma is present if the mechanism of injury or patient’s physical findings meet any one of the following criteria:

  • Physical Findings

    • -Pulse <50/min or >120/min

    • -Systolic blood pressure of 90 mmHg or less

    • -Respiratory rate <10/min or >28/min

    • - Glasgow Coma Scale <14

    • - Penetrating injuries of the trunk, head, neck, chest, abdomen or groin

    • - Two or more proximal long bone fractures

    • - Flail chest

    • - Burns that involve 15% or more of the body surface or facial/airway burns

    • - Combined system trauma that involves two or more body systems

    • - Spinal cord injury or limb paralysis

    • - Amputation (except digits)

  • Mechanism of Injury

  • -Death in the same passenger compartment

  • -Fall >20 feet

  • -Vehicle-pedestrian collision

  • -Patient ejected from the vehicle

  • -Vehicle collision >20 mph resulting in 12 inches of deformity to the vehicle

  • -Vehicle rollover

  • -Motorcycle crash

  • -Vehicle vs. bicycle collision >5 mph


Special protocols1

I

Lateral

aVR

V1

Septal

V4

Anterior

II

Inferior

AVL

Lateral

V2

Septal

V5

Lateral

III

Inferior

AVF

Inferior

V3

Anterior

V6

Lateral

Special Protocols

  • 12 Lead EKG (page 65)

    • Criteria

    • Frequency

    • Considerations for suspected MI

    • Reminders


Charts

Charts

  • Visual Analog Pain Scale (page 71)

    • This scale is designed to be used as a tool to subjectively determine pain level.

    • Refer to the Pain — Non-Cardiac protocol (page 29)


Review

Review

  • Provider-friendlier format

  • Adult protocol changes to:

    • Pain – Non-Cardiac

    • Facilitated Intubation

    • Allergic Reaction/Anaphylaxis

    • Pulmonary Edema

    • Chest Pain


Review1

Review

  • Pediatric Protocol changes to:

    • Acute Respiratory Distress

  • Special Protocol Additions:

    • Trauma Triage Criteria

    • 12 Lead EKG

  • Charts Additions:

    • Visual Analog Pain Scale


Evaluation

Evaluation

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