4.11 Traumatic Cardiac Arrest—Adult & Pediatric EMT STANDING ORDERS 1.0 Routine Patient Care If direct pressure and other methods cannot stop bleeding, apply an appropriate tourniquet. Document the exact time of tourniquet application and notify receiving hospital staff. Provide appropriate management for identified injuries: 4.4 Head Trauma/Injuries 4.9 Thoracic Injuries Treat according to appropriate Cardiac Arrest Protocol. ADVANCED EMT STANDING ORDERS Provide advanced airway management only if patient is not adequately oxygenating or ventilating and not corrected by BVM. Obtain 1-2 points of vascular access (IV) while en route to the hospital. ADVANCED EMT STANDING ORDERS Obtain 1-2 points of vascular access (IO) while en route to the hospital. MEDICAL CONTROL MAY ORDER Additional fluid boluses. PARAMEDIC STANDING ORDERS For medication facilitated intubation, see 5.2 Difficult Airway Protocol. Needle Decompression, if indicated. SECTION 5:
The patient and their family are experts on this device. Listen to what they have to say about any problems with the LVAD. 5. FEEL: Feel the control unit. A hot control unit indicates the pump is working harder than it should and indicates a pump problem such as a thrombosis (clot) in the pump. The use of pulse and blood pressure to assess stability can be unreliable in an LVAD patient, even if they are very stable. 6. VITALS: Pulse: generally, you will be unable to feel a pulse. Pressure: you may or may not be able to obtain one, standard readings are unreliable and may vary from attempt to attempt. If NIBP machine can detect a blood pressure, adjust it to display Mean Arterial Pressure (MAP). This is a more reliable measure of perfusion and the calculation for MAP can overcome variations in standard readings. A MAP of 60-70 is normal. Pulse-oximetry: readings seem to be fairly accurate and consistent, according to data, despite the manufacturer stating that pulse oximetry often doesn’t work. Quantitative Continuous Waveform Capnography: This should remain accurate, as it relies on respiration, not Normal (printed) waveform shape with a normal respiratory rate and low CO2 readings (<30) can indicate low perfusion = poor pump function. Temperature: infection and sepsis are common, temperatures! 7.9 Process for Changes to the Statewide Treatment Protocols All changes (any addition, deletion, or any other type of amendment) to the Massachusetts Statewide Treatment Protocols require statewide dissemination and often require training of EMTs and Medical Control physicians prior to implementation. Therefore, to ensure a thorough review and orderly implementation, all protocol changes shall be approved and implemented on an ANNUAL basis, with the exception of those arising out of procedures described in Part B below. Any protocol change must be approved pursuant to the following procedures. PART A Procedures for ANNUAL Protocol Changes 1. All requests for protocol changes shall be submitted by at least one Regional Medical Director to the Medical Services subcommittee by October 1 of the preceding year. The request for a protocol change shall include the following: a. A detailed description of the proposed change;
Calcium Chloride 10% solution Indications: For calcium channel blocker overdose. Bradycardia 2-4mg/kg slow IV over 5 minutes, maximum 1g. Avoid use if pt is taking digoxin. Cyanide Antidote Kit Amyl Nitrite, Sodium Nitrite and Sodium Thiosulfate Indications: Antidote for Cyanide Posioning Poisoning: Amyl Nitrite: (2) Inhalants Sodium Nitrite: 3%, 10mL slow IV/IO over 2-4 minutes. Sodium Thiosulfate: 25% 50mL IV/IO bolus Cyanokit (Hydroxocobalamin) Indications: Antidote for Cyanide Posioning Poisoning: 5gm IV/IO over 15 minutes. Dextrose Glucose solutions Indications: Symptomatic hypoglycemia. Diabetic Emergencies 12.5 g to 25 g IV/IO Diazepam (Valium ®) Benzodiazepine Indications: Seizure control. Sedation. Anti-anxiety (anxiolytic) Nerve Agent 10 mg IM via auto-injector
Epinephrine 1:10,000 Indications: Vasopressor used in cardiac arrest. Cardiac Arrest 1 mg IV/IO Repeat every 3 – 5 minutes per AHA guidelines Epinephrine (Racemic, for Inhalation) Indications: Croup Croup 11.25mg in 2.5mL solution Fentanyl (Sublimaze ®) Indications: Opioid analgesic Pain 1 mcg/kg up to 150 mcg slow IV/IO/IM/IN Therapeutic Hypothermia, Shivering 50mcg every 5 minutes, maximum 200mcg IV/IO/IM/IN Furosemide (Lasix ®) Indications: Congestive Heart Failure, Pulmonary Edema, Hypertensive Emergencies, Toxicology Congestive Failure, Pulmonary Edema 20-40mg IV/IO Hypertensive Emergencies 0.5-1mg/kg IV/IO Toxicology 40mg IV/IO Glucagon Indications: Hypoglycemia Beta Blocker or Calcium Channel Blocker Overdose Diabetic Emergencies 1 mg IV/IO/IM/IN/SC Beta Blocker/Calcium Channel Blocker Overdose 1-5mg IV/IO/IM/IN/SC Bradycardia 1-5 mg IV/IO/IM/IN/SC Glucose Oral Glucose Solutions Indications: Use in conscious hypoglycemic states. Diabetic Emergencies Administer 1-2 of commercially prepared glucose gel or equivalent.