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ADULT TREATMENT GUIDELINES - CARDIACVENTRICULAR FIBRILLATION - PULSELESS VENTRICULAR
TACHYCARDIA (SJ-AO1) effective 03/01/2002
PRIORITIES ABC's Identify Dysrhythmia
DEFIBRILLATE*: 200 J, 300 J, 360 J; Reassess as Indicated( <200J if Biphasic technology )
INTUBATE: BV & 100% O2IV ACCESS: rate as indicated
DEFIBRILLATE: at last highest Joules
DEFIBRILLATE: at last highest Joules
DEFIBRILLATE: at last highest Joules
BASE CONTACT
EPINEPHRINE IVP: 1.0 mg 1:10,000 Repeat q 3-5 min., Double dose if via ET
LIDOCAINE: 1.5 mg/kg IVP, repeat q 3-5 min x 1Double dose if via ET (single dose, do not repeat)
BRETYLIUM: 5.0 mg/kg IVPrepeat q 5 min at 10 mg/kg (max 35 mg/kg)
MgSO4: 1-2 gm in 10-20 mL IVP over 1-2 min
CONSIDERLIDOCAINE DRIP: 2-4 mg/min if Pt. converts (after bolus or defib)
DEFIBRILLATE: at last highest Joules
REASSESS:Airway,Pulse,ECG,
throughout.
If hyperkalemia suspected, give
Sodium Bicarbonate
early
Revision #5 01/11/02
34
In the case of alternative waveforms (e.g., Biphasic), AHA guidelines will be followed or used after approval of the EMS medical director.
ADULT TREATMENT GUIDELINES - CARDIACPULSELESS ELECTRICAL ACTIVITY (SJ-AO2) effective
05/01/02
PRIORITIES ABC's Identify Dysrhythmia Auscultate Heart Sounds
INTUBATE: BV & 100% O2IV ACCESS: 2 Large bore at wide open
EPINEPHRINE IVP: 1.0 mg 1:10,000; Repeat q 3-5 min., Double dose if via ET
ATROPINE (for Bradycardia): 1.0 mg IVP, Repeat q 3-5 min.Max 3.0 mg (0.04 mg/kg), Double dose if via ET
BASE CONTACT
DOPAMINE DRIP: 5-20 ug/kg/min for hypotensive patients refractory to IV fluidsTitrate to SBP >90 (consider second IV)
San Joaquin EMS Agency
REASSESS:Airway,Pulse,ECG,
throughout.
Revision #4 04/19/02
35
ADULT TREATMENT GUIDELINES - CARDIACASYSTOLE (SJ-AO3) effective 05/01/02
PRIORITIES ABC's Identify Dysrhythmia Define in two (2) leads minimum Consider Causes: Acidosis - adequate ventilation Hypoxia - provide ventilation Hypothermia - refer to guideline A62 Drug Overdose - refer to guidelines A51-A56 Hypokalemia - Hyperkalemia - Sodium Bicarbonate, 1 mEq/kg IVP (after base contact)
INTUBATE: BV & 100% O2IV ACCESS: rate as indicated
BASE CONTACT
EPINEPHRINE IVP: 1.0 mg 1:10,000; Repeat q 3-5 min., Double dose if via ET
ATROPINE: 1.0 mg IVP, Repeat q 3-5 min. to max 3.0 mg (0.04 mg/kg)Double dose if via ET
San Joaquin EMS Agency
REASSESS:Airway,Pulse,ECG,
throughout.
Revision #5 04/19/02
CONSIDERTERMINATION OF EFFORTS (PER BASE PHYSICIAN): if patient
remains in Asystole after intubation and initial medications, if no reversible causes are identified.
36
Consider TCP if patient was witnessed asystolic <8 minutes
Simultaneous
ADULT TREATMENT GUIDELINES - CARDIACBRADYCARDIA (SJ-AO4) effective 03/01/02
PRIORITIES ABC's Identify Dysrhythmia
OXYGEN: high flow via maskIV ACCESS: rate as indicated
BASE CONTACT
ASSESS FOR SYMPTOMS RELATED TO HYPOTENSION:
chest pain, dyspnea, decreased LOC, shock, pulmonary congestion, CHF
DOPAMINE DRIP: 5-20 ug/kg/min for hypotensive patients refractory to IV fluidsTitrate to SBP >90 (consider second IV)
EPINEPHRINE DRIP: 2-10 ug/min Titrate to SBP >90 (consider second IV)
San Joaquin EMS Agency
REASSESS:Airway,Pulse,ECG,
throughout.
37
ECG Rhythm
Type II second-degree heart block
orThird-degree heart
block
First-degree heart block
orType I second-degree
heart block
Unstable StableUnstable Stable
TCPIf Available
Atropine, 0.5 mg IVP, repeat q 3-5
min to max 3.0 mg (0.04 mg/kg)
Observe Atropine 0.5 mg IVP, repeat q 3-5 min to max
3.0 mg (0.04 mg/kg)
Observe
Valium, 2-5 mg IV, titrate(if available)Versed 2-5
mg IV/IM to max of 10 mg
TCPIf Available
Valium, 2-5 mg IV, titrate (if available)Versed 2-5
mg IV/IM to max of 10 mg
If no response
Simultaneous
If no response
Revision # 4
ADULT TREATMENT GUIDELINES - CARDIACWIDE COMPLEX TACHYCARDIA OF UNCERTAIN TYPE WITH
PULSES (SJ-AO5) effective 03/01/02
PRIORITIES ABC's Identify Dysrhythmia
Secure airway as appropriateOXYGEN: high flow via mask
IV ACCESS: rate as indicated (proximal as possible)
ASSESS FOR UNSTABLE vs. STABLE
UNSTABLE: chest pain, CHF, decreased LOC, dyspnea, hypotension, pulmonary congestion
STABLE: no serious signs or symptoms
FOR UNSTABLE PATIENTS
FOR STABLE PATIENTS
LIDOCAINE: 1-1.5 mg/kg IVPRepeat q 5 min at 1/2 initial dose to
total 3 mg/kg if no conversion
ADENOSINE: 6 mg rapid IVP, repeat q 3 min with 12 mg rapid IVP
x 2 if no conversion
BRETYLIUM: 5 mg/kg IVP over 8-10 min. Repeat at 10 mg/kg to
total dose of 35 mg/kg if no conversion
Avoid in cyclic O.D.
DIAZEPAM: (if available) 2-10 mg titrated for sedation if time allows
Versed 2 mg IV/IM
BASE CONTACT
San Joaquin EMS Agency
REASSESS:Airway,Pulse,ECG,
throughout.
LIDOCAINE: 1-1.5 mg/kg IVPSingle Dose, if condition permits
LIDOCAINE: 1-1.5 mg/kg IVPRepeat q 5 min at 1/2 initial dose to
total 3 mg/kg if no conversion
BASE CONTACT
38
CARDIOVERT: 100J, 200J, 300J, 360JReduce by 1/2 for digitalized patient
Revision# 3
ADULT TREATMENT GUIDELINES - CARDIACVENTRICULAR TACHYCARDIA WITH PULSES (SJ-AO6) effective 03/01/02
PRIORITIES ABC's Identify Dysrhythmia
Secure airway as appropriateOXYGEN: high flow via maskIV ACCESS: rate as indicated
ASSESS FOR UNSTABLE vs. STABLE
UNSTABLE: chest pain, CHF, decreased LOC, dyspnea, hypotension, pulmonary congestion
STABLE: no serious signs or symptoms
FOR UNSTABLE PATIENTS
FOR STABLE PATIENTS
LIDOCAINE: 1-1.5 mg/kg IVPRepeat q 5 min at 1/2 initial dose to
total 3 mg/kg if no conversion
BRETYLIUM: 5 mg/kg IVP over 8-10 min. Repeat at 10
mg/kg to total dose of 35 mg/kg if no conversion
Avoid in cyclic O.D.
DIAZEPAM: (if available) 2-10 mg titrated for sedation if time allows, or
Versed 2 mg IV/IM
San Joaquin EMS Agency
REASSESS:Airway,Pulse,ECG,
throughout.
LIDOCAINE: 1-1.5 mg/kg IVPSingle Dose, if condition permits
LIDOCAINE: 1-1.5 mg/kg IVPRepeat q 5 min at 1/2 initial dose to
total 3 mg/kg if no conversion
BRETYLIUM: 5 mg/kg IVP over 8-10 min. Repeat at 10
mg/kg to total dose of 35 mg/kg if no conversion
Avoid in cyclic O.D.
BASE CONTACT
BASE CONTACT
39
CARDIOVERT: 100J, 200J, 300J, 360JReduce by 1/2 for digitalized patient
Revision# 3
ADULT TREATMENT GUIDELINES - CARDIACPAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA (SJ-AO7) effective 03/01/02
PRIORITIES ABC's Identify Dysrhythmia
Secure airway as appropriateOXYGEN: high flow via mask
IV ACCESS: rate as indicated (proximal as possible)
ASSESS FOR UNSTABLE vs. STABLE
UNSTABLE: chest pain, CHF, decreased LOC, dyspnea, hypotension, pulmonary congestion
STABLE: no serious signs or symptoms
FOR UNSTABLE PATIENTS
FOR STABLE PATIENTS
ADENOSINE: 6 mg rapid IVP, repeat q 3 min with 12 mg rapid IVP
x 2 if no conversion
DIAZEPAM: (if available) 2-10 mg titrated for sedation if time allows, or
VERSED 2 mg IV/IM
BASE CONTACT
Valsalva's Maneuver
BASE CONTACT
San Joaquin EMS Agency
REASSESS:Airway,Pulse,ECG,
throughout.
ADENOSINE: 6 mg rapid IVP, repeat q 3 min with 12 mg rapid IVP
x 2 if no conversion
40
CARDIOVERT: 100J, 200J, 300J, 360JReduce by 1/2 for digitalized patient
Revision# 3
ADULT TREATMENT GUIDELINES - CARDIACATRIAL FIBRILLATION - ATRIAL FLUTTER* (SJ-AO8) effective 03/01/02
PRIORITIES ABC's Identify Dysrhythmia
Secure airway as appropriateOXYGEN: high flow via maskIV ACCESS: rate as indicated
ASSESS FOR UNSTABLE vs. STABLE
UNSTABLE: chest pain, CHF, decreased LOC, dyspnea, hypotension, pulmonary congestion
STABLE: no serious signs or symptoms
FOR UNSTABLE PATIENTS
FOR STABLE PATIENTS
DIAZEPAM: (if available) 2-10 mg titrated for sedation if time allows, or
VERSED 2 mg IV/IM
CARDIOVERT: 100J, 200J, 300J, 360J
Reduce by 1/2 for digitalized patient
OBSERVE and REASSESS as appropriate
BASE CONTACT
San Joaquin EMS Agency
REASSESS:Airway,Pulse,ECG,
throughout.
*Due to high incidence of chronic Atrial Fibrillation, cardiovert only if patient in extremis.
41
Revision# 3
ADULT TREATMENT GUIDELINES - CARDIACCORONARY ISCHEMIC CHEST DISCOMFORT (SJ-AO9) effective 09/01/00
PRIORITIES ABC's Identify Dysrhythmia
Secure airway as appropriateAPPLY OXYGEN TO PATIENT
NITROGLYCERINE: 1/150 gr.(0.4 MG) sublingual
(if SBP >90) Repeat q 5 min
San Joaquin EMS Agency
REASSESS:Airway,Pulse,
3 Lead ECG,throughout.
ASPIRIN: 320mg P.O. (four 80 mg chewable tablets)if myocardial infarction suspected. Check for history of
allergy.
Revision #7 04/17/2000
42
If available: 12 Lead ECG
CONTACT WITHRECEIVING FACILITY
MANDATORY
Consider the following treatments:
IV ACCESS: rate as indicated1 Large Bore IV
CONSIDERLIDOCAINE: 1.0 mg/kg IVP for frequent, multifocal PVC's with
hypotension
MORPHINE: 2-5 mg increments, slow IVP(if SBP > 90)
Repeat as needed; max 20 mg
BASE CONTACT
ADULT TREATMENT GUIDELINES - RESPIRATORYAIRWAY OBSTRUCTION - STRIDOR (SJ-A21) effective 09/01/95
PRIORITIES ABC's Pulse Oximetry Determine degree of distress:
Unstablevs.
Stable
Stable
Unstable
OXYGEN: flow as indicated or tolerated
ECG: treat dysrhythmia as appropriate
CONSIDER IV ACCESS:rate as indicated
ConsiderCauses
Foreign Body Croup/Epiglottitis
Trauma/Burns Anaphylaxsis
Abdominal thrusts/finger
sweeps
Direct Laryngoscopy
Position of Comfort
Consider humidified
oxygen
Avoid Visualization/
OPA
Consider Intubation
if ventilationinadequate
Intubate and suction as
appropriate
Refer to allergic reaction
guideline A43
BASE CONTACT
NEEDLE CRICOTHYROTOMY: followed by 50 psi transtracheal oxygen ventilation
San Joaquin EMS Agency
REASSESS:Frequently
Revision #202/02/95
43
ADULT TREATMENT GUIDELINES - RESPIRATORYCHRONIC OBSTRUCTIVE PULMONARY DISEASEASTHMA - BRONCHOSPASM (SJ-A22) effective 09/01/95
PRIORITIES ABC's Pulse Oximetry Determine degree of distress
Secure airway as appropriateOXYGEN: low flow via nasal cannula,
increase as appropriate
ECG: treat dysrhythmia as appropriate
CONSIDER IV ACCESS: rate as indicated
ALBUTEROL: 2.5 mg via Hand Held Nebulizer (or inline)
Repeat as needed
Reassess frequently
BASE CONTACT
EPINEPHRINE: 0.01 mg/kg of 1:1,000 sub-q (max 0.5 mg)Repeat q 20 min.
(Caution with history coronary artery disease, hypertension, age > 35)
San Joaquin EMS Agency
REASSESS:Frequently
Consider Intubation
Revision #303/08/95
44
ADULT TREATMENT GUIDELINES - RESPIRATORYACUTE PULMONARY EDEMA (SJ-A23) effective 09/01/95
PRIORITIES ABC's Pulse Oximetry Determine degree of distress
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
IV ACCESS: rate as indicated
NITROGLYCERINE: 1/150 gr. (0.4 mg) suglingual (if SBP >90)
Repeat q 5 min
MORPHINE: 2-5 mg increments, slow IVP(if SBP > 90)
Repeat as needed; max 20 mg
BASE CONTACT
FUROSEMIDE: 20-80 mg IV over 2-4 min.(if SBP > 90)
DOPAMINE DRIP: 5-20 ug/kg/min for hypotensionTitrate to SBP of 90 (consider second IV)
San Joaquin EMS Agency
REASSESS:Frequently
CONSIDER INTUBATION
Revision #4 02/02/95
45
ADULT TREATMENT GUIDELINES - RESPIRATORYTENSION PNEUMOTHORAX (SJ-A24) effective 09/01/95
PRIORITIES ABC's Determine degree of distress Pulse Oximetry
NEEDLE THORACOSTOMY:on affected side(s)
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
IV ACCESS: rate as indicated
REASSESS and observe frequently
San Joaquin EMS Agency
REASSESS:Frequently
BASE CONTACT
Revision #202/02/95
46
ADULT TREATMENT GUIDELINES - NEUROLOGICALTERED LEVEL OF CONSCIOUSNESS (SJ-A31) effective 09/01/95
PRIORITIES ABC's Pulse Oximetry
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
IV ACCESS: rate as indicated
Test for glucose
DEXTROSE: 25 gm IVPif serum glucose < 75Repeat x1 if needed
NALOXONE: 2-4 mg IVP/IM or ET for depressed respirations or altered level of consciousness.
Repeat as needed.
BASE CONTACT
San Joaquin EMS Agency
REASSESS:Frequently
Revision #6 09/15/95
ORAL DEXTROSE: for suspected hypoglycemia with intact gag reflex
47
ADULT TREATMENT GUIDELINES - NEUROLOGICACUTE CEREBROVASCULAR ACCIDENT (SJ-A32) effective 09/01/95
PRIORITIES ABC's Identify and document neurologic deficits - progressive vs. non-progressive Pulse Oximetry
Secure airway as appropriatePrevent Aspiration
OXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
IV ACCESS: rate as indicated
Test for glucose
DEXTROSE: 25 gm IVPif serum glucose < 75Repeat x1 if needed
REASSESS neurologic findings
BASE CONTACT
TRANSPORT: code 3 if progressive neurologic deficit evident
San Joaquin EMS Agency
REASSESS:Frequently
Revision #7 09/15/95
CONSIDERFUROSEMIDE: 20-80 mg slow IVP if
SBP > 190 and DBP > 110 mmHg
48
ADULT TREATMENT GUIDELINES - NEUROLOGICSEIZURES (SJ-A33) effective 03/01/02
PRIORITIES ABC's Prevent injury
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
CONSIDER IV ACCESS: rate as indicated
DIAZEPAM: (if available) 2-10 mg slow IVP Titrate in 2 mg increments to max 20 mg or VERSED: 1-2 mg IV/IM, max 10
mg, for active seizure control
Test for glucose
DEXTROSE: 25 gm IVPif serum glucose < 75Repeat x1 if needed
San Joaquin EMS Agency
REASSESS:Frequently
BASE CONTACT
49
Revision# 6
ADULT TREATMENT GUIDELINES - NEUROLOGICALTERED LEVEL OF CONSCIOUSNESS (SJ-A31) effective 09/01/95
PRIORITIES ABC's Pulse Oximetry
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
IV ACCESS: rate as indicated
Test for glucose
DEXTROSE: 25 gm IVPif serum glucose < 75Repeat x1 if needed
NALOXONE: 2-4 mg IVP/IM or ET for depressed respirations or altered level of consciousness.
Repeat as needed.
BASE CONTACT
San Joaquin EMS Agency
REASSESS:Frequently
Revision #6 09/15/95
ORAL DEXTROSE: for suspected hypoglycemia with intact gag reflex
47
ADULT TREATMENT GUIDELINES - MEDICALSHOCK, NON-TRAUMATIC (SJ-A41) effective 09/01/95
PRIORITIES ABC's Attempt to determine cause of shock Pulse Oximetry
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
IV ACCESS: 2 - large bore250cc fluid challenges to SBP of 90
If no signs/symptoms of pulmonary edema
REASSESS as indicated
BASE CONTACT
DOPAMINE DRIP: 5-20 ug/kg/min for hypotensionTitrate to SBP of 90 (consider second IV)
San Joaquin EMS Agency
REASSESS:Frequently
Revision #4 02/02/95
51
ADULT TREATMENT GUIDELINES - MEDICALDIABETIC KETOACIDOSIS (SJ-A42) effective 09/01/95
PRIORITIES ABC's Pulse Oximetry
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
IV ACCESS: 250cc boluses, max 2 liters
Test for glucose
BASE CONTACT
San Joaquin EMS Agency
REASSESS:Frequently
Revision #4 02/02/95
52
ADULT TREATMENT GUIDELINES - MEDICALALLERGIC REACTION (SJ-A43) effective 09/01/95
PRIORITIES ABC's Determine type of allergen if possible Determine severity of reaction Pulse Oximetry
Severevs.
Mild/ModSevere
REMOVE ALLERGEN: if possible
Secure airway as appropriateOXYGEN: high flow via mask
EPINEPHRINE: 0.01 mg/kg sub-Q of 1:1,000Max dose 0.5 mg. Caution with age > 35, hx: HTN
IV ACCESS: 2 - large bore. 250cc fluid challenges as indicated
DIPHENHYDRAMINE: 25-50 mg IVP or IM
BASE CONTACT
EPINEPHRINE: 0.1 mg of 1:10,000 slow IVP if SBP < 80. Repeat every 1-2 min.
EPINEPHRINE DRIP: 2-10 ug/min Titrate to SBP >90 (consider second IV)
DOPAMINE DRIP: 5-20 ug/kg/min for hypotensive patients refractory to IV fluidsTitrate to SBP >90 (consider second IV)
San Joaquin EMS Agency
CONSIDER ALBUTEROL: 2.5 mg via Hand Held Nebulizer (or inline) for persistent respiratory distress
CONSIDER INTUBATION
(OR)
Secure airway as appropriateOXYGEN: high flow via mask
CONSIDER IV ACCESS: rate as indicated
Mild/Moderate
REMOVE ALLERGEN: if possible
CONSIDER DIPHENHYDRAMINE: 25-50 mg IVP or IM
CONSIDER ALBUTEROL: 2.5 mg via Hand Held Nebulizer
CONSIDER EPINEPHRINE: 0.01 mg/kg sub-Q of 1:1,000. Max dose 0.5 mg.
Caution with age > 35, hx: HTN
BASE CONTACT
REASSESS:Frequently
Revision #5 03/08/95
53
ADULT TREATMENT GUIDELINES - MEDICALHYPERTENSION (SJ-A44) effective 09/01/95
PRIORITIES ABC's
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
CONSIDER IV ACCESS: rate as indicated
TREAT ASSOCIATED SYNDROMES
Acute Cerebrovascular Accident - refer to guideline A32Coronary Ischemic Chest Discomfort - refer to guideline A09
Pregnancy - if seizing, refer to guideline A75Pulmonary Edema - refer to guideline A23
BASE CONTACT
San Joaquin EMS Agency
REASSESS:Frequently
Revision #3 02/02/95
54
ADULT TREATMENT GUIDELINES - POISONINGSBETA BLOCKER OVERDOSE (SJ-A51) effective 09/01/95
PRIORITIES ABC's Determine type, amount, and when ingestion occurred Severity of distress
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
IV ACCESS: rate as indicated
ATROPINE: 0.5 mg IVP every 3-5 min to max 3 mg (0.04 mg/kg). For symptomatic bradycardia.
DEXTROSE: 25 gm IVP if serum glucose < 75Repeat x1 if needed
DIAZEPAM: 2-10 mg slow IVP. Titrate in 2 mg increments to max. 20 mg for active seizure control.
ALBUTEROL: 2.5 mg via Hand Held Nebulizer(or inline). Repeat as needed.
ACTIVATED CHARCOAL: 25-50 gm P.O.
Test for glucose
BASE CONTACT
EPINEPHRINE DRIP: 2-10 ug/min. Titrate to SBP >90(consider second IV)
DOPAMINE DRIP: 5-20 ug/kg/min for hypotensive patients refractory to IV fluids. Titrate to SBP >90 (consider second IV)
San Joaquin EMS Agency
REASSESS:Frequently
Revision #5 09/15/95
55
ADULT TREATMENT GUIDELINES - POISONINGSCALCIUM CHANNEL BLOCKER OVERDOSE (SJ-A52) effective 09/01/95
PRIORITIES ABC's Determine type, amount, and when ingestion occurred
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
IV ACCESS: rate as indicated
ATROPINE: 0.5 mg IVP every 3-5 min to max 3 mg (0.04 mg/kg). For symptomatic bradycardia.
ACTIVATED CHARCOAL: 25-50 gm P.O.
BASE CONTACT
EPINEPHRINE DRIP: 2-10 ug/min. Titrate to SBP >90(consider second IV)
DOPAMINE DRIP: 5-20 ug/kg/min for hypotensive patients refractory to IV fluids. Titrate to SBP >90 (consider second IV)
San Joaquin EMS Agency
Revision #3 02/02/95
REASSESS:Frequently
56
ADULT TREATMENT GUIDELINES - POISONINGSCAUSTICS - CORROSIVES (SJ-A53) effective 09/01/95
PRIORITIES Scene Safety - HAZMAT ABC's Determine type, amount, and when exposure occurred
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
IV ACCESS: rate as indicated
REMOVE AGENT: brush then flush
DO NOT INDUCE VOMITING: if ingestion occurred
BURN or SHOCK GUIDELINES:as indicatedBurn = A81Shock = A41
BASE CONTACT
WATER or MILK: p.o. if ingestion occurred
San Joaquin EMS Agency
Revision #4 02/02/95
REASSESS:Frequently
CONSIDER: early intubation if respiratory burn likely
57
ADULT TREATMENT GUIDELINES - POISONINGSCYCLIC ANTIDEPRESSANTS (SJ-A54) effective 03/01/02
PRIORITIES ABC's Determine type, amount, and when ingestion occurred Pulse Oximetry
Secure airway as appropriateOXYGEN: high flow via mask
ECG
IV ACCESS: rate as indicated. Caution with fluid boluses due to high incidence of pulmonary edema
SODIUM BICARBONATE: 1 mEq/kg slow IVP for dysrhythmias, altered mental status, or QRS > 0.10 sec. Max dose 2 mEq/kg.
Treatment of choice for cardio-respiratory and neurologic dysfunction.
ACTIVATED CHARCOAL: 50-100 gms via NG Tube after intubation. Early administration encouraged.
DIAZEPAM: (if available) 2-10 mg slow IVP Titrate in 2 mg increments to max 20 mg or VERSED: 2-5 mg,IV/IM
max of 10mg
BASE CONTACT
SODIUM BICARBONATE DRIP: 100 mEq/1000mL for dysrhythmias or QRS > 0.10 sec. (consider second IV)
EPINEPHRINE DRIP: 2-10 ug/min. Titrate to SBP >90(consider second IV)
San Joaquin EMS Agency
REASSESS:Frequently
MgSO4: 1-2 gm in 10-20 mL IVP over 1-2 minFor Torsades de Pointes refractory to Sodium Bicarbonate
ECG: treat dysrhythmia as appropriate if refractory to Sodium Bicarbonate
58
Revision# 6
ADULT TREATMENT GUIDELINES - POISONINGSPHENOTHIAZINE REACTIONS (SJ-A55) effective 09/01/95
(DYSTONIC REACTIONS)
PRIORITIES ABC's Determine type, amount, and when ingestion occurred
Secure airway as appropriateOXYGEN: high flow via mask
CONSIDER IV ACCESS: rate as indicated
DIPHENHYDRAMINE: 25-50 mg IVP or IMMay repeat x1.
San Joaquin EMS Agency
Revision #3 02/02/95
REASSESS:Frequently
BASE CONTACT
59
ADULT TREATMENT GUIDELINES - POISONINGSNARCOTICS - SEDATIVES (SJ-A56) effective 09/01/95
PRIORITIES ABC's Determine type, amount, and Time taken
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
CONSIDER IV ACCESS: rate as indicated
NALOXONE: 2-4 mg IVP/IM or ET for depressed respirations or L.O.C.
Repeat as needed
ACTIVATED CHARCOAL: 25-50 gms for history of oral ingestion.
San Joaquin EMS Agency
Revision #3 02/02/95
REASSESS:Frequently
BASE CONTACT
60
ADULT TREATMENT GUIDELINES - POISONINGSORGANOPHOSPHATES (SJ-A57) effective 03/01/02
PRIORITIES Scene Safety - HAZMAT ABC's Determine type, amount, and time of exposure
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
IV ACCESS: rate as indicated
REMOVE AGENT: brush then flush
ATROPINE: 2.0 - 5.0 mg slow IVP, or 2.0 mg IM, or 4.0 mg ETRepeat q 5 min as needed to control secretions, bronchorrhea, or
dysrhythmias. NOTE: large amounts may be needed.
DIAZEPAM: (if available) 2-10 mg slow IVP Titrate in 2 mg increments to max 20 mg or
VERSED: 2-5 mg IV/IM, max of 10mg
ACTIVATED CHARCOAL: 25-50 gms p.o. for oral ingestion
BASE CONTACTEarly Notification for Hospital Preparation
San Joaquin EMS Agency
REASSESS:Frequently
61
Revision# 5
ADULT TREATMENT GUIDELINES - POISONINGSPETROLEUM DISTILLATES (SJ-A58) effective 09/01/95
PRIORITIES ABC's Determine type, amount, and time of exposure
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
CONSIDER IV ACCESS: rate as indicated
REMOVE AGENT: brush then flush
DO NOT INDUCE VOMITING: if ingestion occurred
San Joaquin EMS Agency
Revision #3 02/02/95
REASSESS:Frequently
Monitor forAspiration
CONSIDER EARLY INTUBATION
BASE CONTACT
62
ADULT TREATMENT GUIDELINES - ENVIRONMENTALENVENOMATION (SJ-A61) effective 09/01/95
PRIORITIES ABC's Determine type and time of exposure
Secure airway as appropriateOXYGEN: high flow via mask
ECG: treat dysrhythmia as appropriate
CONSIDER IV ACCESS: rate as indicated
Identify Cause
Bee/Wasp Spider/Scorpion Snake
Scrape stinger away
Cold packs for pain
Refer to Allergic Reaction Guideline A43
Scrape stinger away
Cold packs for pain
Avoid movementKeep extremity below heart
Circle swelling and note time
Measure proximal circumference and note time
Apply loose restricting band
San Joaquin EMS Agency
Revision #5 09/15/95
REASSESS:Frequently
BASE CONTACT63
ADULT TREATMENT GUIDELINES - ENVIRONMENTALHYPOTHERMIA - FROSTBITE (SJ-A62) effective 09/01/95
PRIORITIES ABC's Determine time and duration of exposure
Determine severity of exposure
FrostbiteSevere Hypothermia
Mild/ModerateHypothermia
PREVENT FURTHER HEAT LOSS: remove wet clothing and cover
with dry blankets(move gently)
PREVENT FURTHER HEAT LOSS: remove wet clothing and cover
with dry blankets(move gently)
PREVENT FURTHER HEAT LOSS: remove wet clothing and cover
with dry blankets(move gently)
IV ACCESS: rate as indicated with warm
fluids
IV ACCESS: rate as indicated with warm
fluids
IV ACCESS: rate as indicated with warm
fluids
Secure airway as appropriateOXYGEN: high flow via mask
ECG: observe rhythm/pulse for one minute for organized rhythm. Treat dysrhythmia as appropriate
MORPHINE: 2-5 mg increments, slow IVP (if SBP > 90). Repeat as needed. Max 20 mg.
Test for glucose
DEXTROSE: 25 gms IVPfor serum glucose < 75
Repeat x1 if needed
NALOXONE: 2-4 mg IVP/IM or ET for suspected
narcotic O.D. Repeat as needed
BASE CONTACT
San Joaquin EMS Agency
Revision #5 09/15/95
REASSESS:Frequently
64
ADULT TREATMENT GUIDELINES - ENVIRONMENTALHEAT ILLNESS (SJ-A63) effective 03/01/02
PRIORITIES ABC's
Determine severity of
distress
Heat Stroke
COOLING MEASURES
Secure airway as appropriateOXYGEN: high flow via mask
IV ACCESS: 250cc fluid challenges to SBP of 90
CONSIDER
Test for glucose
DEXTROSE: 25 gms IVPif serum glucose < 75Repeat x1 if needed
DIAZEPAM: (if available) 2-10 mg slow IVP Titrate in 2 mg increments to max 20 mg or
VERSED: 2-5 mg IV/IM, max of 10mg
San Joaquin EMS Agency
REASSESS:Frequently
BASE CONTACT
Heat Cramps/Heat Exhaustion
COOLING MEASURES
Secure airway as appropriateOXYGEN: high flow via mask
CONSIDER IV ACCESS: rate as indicated
BASE CONTACT
65
Revision# 6
ADULT TREATMENT GUIDELINES - OBSTETRICSVAGINAL HEMORRHAGE WITH SHOCK (SJ-A71) effective 09/01/95
PRIORITIES ABC's Determine trimester of pregnancy Estimate blood loss (EBL) Early transport
San Joaquin EMS Agency
Secure airway as appropriateOXYGEN: high flow via mask
IV ACCESS: two large bore, 250cc fluid challenges as needed to SBP of 90
POSITION: left lateral decubitus if 3rd trimester pregnancy
BASE CONTACT
Revision #3 02/02/95
REASSESS:Frequently
66
ADULT TREATMENT GUIDELINES - OBSTETRICSVAGINAL HEMORRHAGE WITHOUT SHOCK (SJ-A72) effective 09/01/95
PRIORITIES ABC's Determine trimester of pregnancy Estimate blood loss (EBL) Early transport
San Joaquin EMS Agency
Secure airway as appropriateOXYGEN: high flow via mask
CONSIDER IV ACCESS: rate as indicated
POSITION: left lateral decubitus if 3rd trimester pregnancy
BASE CONTACT
Revision #3 02/02/95
REASSESS:Frequently
67
ADULT TREATMENT GUIDELINES - OBSTETRICSIMMINENT DELIVERY - NORMAL (SJ-A73) effective 09/01/95
PRIORITIES ABC's Determine trimester of pregnancy Estimate blood loss (EBL)
San Joaquin EMS Agency
Secure airway as appropriateOXYGEN: high flow via mask
IV ACCESS: consider if time allows, rate as indicated
DELIVER HEAD: suction mouth/nose
BASE CONTACT
CHECK NECK: for wrapped cord; if present- loosen and slip over infants head, if unable
- double clamp and cut between clamps
PROCEED WITH DELIVERY:
WRAP: in warm, dry, cloth or place on mom and cover
CUT & CLAMP: six (6) inches from baby
APGAR's: at one (1) & five (5) min.
NEONATAL RESUSCITATION FORMAT: per guideline N01
ALLOW DELIVERY OF PLACENTA
Revision #3 02/02/95
REASSESS:Frequently
DRY INFANT
68
ADULT TREATMENT GUIDELINES - OBSTETRICSIMMINENT DELIVERY - COMPLICATED (SJ-A74) effective 09/01/95
PRIORITIES ABC's Determine trimester of pregnancy Estimate blood loss (EBL)
San Joaquin EMS Agency
Secure airway as appropriateOXYGEN: high flow via mask
IV ACCESS: if time allows, rate as indicated
BASE CONTACT Early if possible
Type of abnormal
presentation
Breech or Footling Prolapsed cord
Early Transport
Allow delivery to proceed to
waist
ROTATE: infant to
face-down
If head does not deliver, insert gloved hand into vaginal opening and create air passage for infant
Insert gloved hand into vagina, gently push presenting part off cord
Place mom into Trendelenburg position with hips elevated
Transport
BASE CONTACTEarly if possible
Revision #3 02/02/95
REASSESS:Frequently
Transport according to
specialty triage criteria
69
ADULT TREATMENT GUIDELINES - OBSTETRICSPRE-ECLAMPSIA, ECLAMPSIA (SJ-A75) effective 09/01/95
PRIORITIES ABC's Determine trimester of pregnancy Early transport Determine degree of distress
San Joaquin EMS Agency
Secure airway as appropriateOXYGEN: high flow via mask
IV ACCESS: rate as indicated
POSITION: left lateral decubitus if 3rd trimester pregnancy
BASE CONTACT
EARLY TRANSPORT: quiet, non-stimulating environment
Revision #4 03/08/95
REASSESS:Frequently
Transport according to
specialty triage criteria
MgSO4: 2-4 gm in 20-40 mL slow IVP over 1-2 min. for active seizure control.
FOR SEIZURES: refractory to MgSO4, proceed to Guideline A33
70
ADULT TREATMENT GUIDELINES - TRAUMABURNS (SJ-A81) effective 09/01/95
PRIORITIES ABC's Determine time, type, and severity of burn
MOVE PATIENT: to safe environment
STOP THE BURNING PROCESS: brush then flush
Secure airway as appropriateOXYGEN: high flow via mask
CONSIDER: early intubation if respiratory burn likely
IV ACCESS: large bore, wide open for 2nd & 3rd Degree Burns
ECG: treat dysrhythmia as appropriate
DRESS BURNS: with sterile drapes
MORPHINE: 2-5 mg increments, slow IVP (SBP > 90) Repeat as needed. Max 20 mg.
BASE CONTACT
San Joaquin EMS Agency
Revision #302/02/95
REASSESS: airway
frequently
CONSIDER: second IV, large bore
71
ADULT TREATMENT GUIDELINES - TRAUMATRAUMATIC SHOCK (SJ-A82) effective 09/01/95
PRIORITIES ABC's Determine mechanism of injury Load and Go: to appropriate facility by best method available Early base notification for surgical mobilization
Secure airway as appropriateOXYGEN: high flow via mask
C-SPINE: as indicated
BLEEDING CONTROL: as indicated
IV ACCESS: 2 large bore, 250 cc fluid challenges as needed until SBP of 100
DRESS & SPLINT: as needed. Return extremities to anatomical position. Reassess neurovascular frequently.
CONSIDER
NEEDLE THORACOSTOMY: for tension pneumothorax on affected side(s)
BASE CONTACT
San Joaquin EMS Agency
Revision #302/02/95
REASSESS: frequently
72
ADULT TREATMENT GUIDELINES - TRAUMATRAUMATIC ARREST (SJ-A83) effective 09/01/95
PRIORITIES ABC's Determine mechanism of injury Load and Go: to appropriate facility by best method available Early base notification for surgical mobilization
INTUBATE: BV & 100% O2
C-SPINE: as indicated
BLEEDING CONTROL: as indicated
IV ACCESS: 2 large bore, 250 cc fluid challenges as needed until SBP of 100
CONSIDER
NEEDLE THORACOSTOMY: for tension pneumothorax on affected side(s)
ECG: treat dysrhythmia as appropriate
BASE CONTACT
DRESS & SPLINT: as needed. Return extremities to anatomical position. Reassess neurovascular frequently.
San Joaquin EMS Agency
Revision #403/08/95
REASSESS:airway, rhythm
and pulse frequently
CONSIDERTERMINATION OF EFFORTS (PER BASE PHYSICIAN): if patient remains in Asystole after intubation and initial medications, if no reversible causes are identified
73
ADULT TREATMENT GUIDELINES - TRAUMAHEAD - NECK - FACIAL TRAUMA (SJ-A84) effective 09/01/95
PRIORITIES ABC's Determine mechanism of injury Consider Load and Go: to appropriate facility by best method available Early base notification for surgical mobilization
Secure airway as appropriateOXYGEN: high flow via mask
Hyperventilate via ET to decrease ICPNOTE: medicate head injured patients with Lidocaine 1.5
mg/kg IV prior to intubation as time allows
C-SPINE: as indicated
BLEEDING CONTROL: as indicated
IV ACCESS: rate as indicated
DRESS & SPLINT: as needed
POSITION: head injured patients with head of board elevated 15 - 20 degrees
(if normotensive)
CONSIDER
MORPHINE: 2-5 mg increments, slow IVP(if SBP > 90) for severe pain. Repeat as needed. Max dose 20 mg
LASIX: 40 mg slow IVP if SBP > 90
BASE CONTACT
San Joaquin EMS Agency
Revision #409/15/95
REASSESS: airway
frequently
Transport according to
specialty triage criteria
74
ADULT TREATMENT GUIDELINES - TRAUMACHEST TRAUMA (SJ-A85) effective 09/01/95
PRIORITIES ABC's Determine mechanism of injury Load and Go: to appropriate facility by best method available Early base notification for surgical mobilization
Secure airway as appropriateOXYGEN: high flow via mask
C-SPINE: as indicated
BLEEDING CONTROL: as indicated
IV ACCESS: 2 large bore, 250 cc fluid challenges as needed until SBP of 100
DRESS & SPLINT: as needed. Return extremities to anatomical position. Reassess neurovascular frequently.
BASE CONTACT
MORPHINE: 2-5 mg increments, slow IVP(if SBP > 90) for severe pain. Repeat as needed. Max dose 20 mg
San Joaquin EMS Agency
Revision #409/15/95
REASSESS: airway
frequently
NEEDLE THORACOSTOMY: for tension pneumothorax on affected side(s)
75
ECG: treat dysrhythmia as appropriate
ADULT TREATMENT GUIDELINES - TRAUMAABDOMINAL TRAUMA (SJ-A86) effective 09/01/95
PRIORITIES ABC's Determine mechanism of injury Load and Go: to appropriate facility by best method available Early base notification for surgical mobilization
Secure airway as appropriateOXYGEN: high flow via mask
C-SPINE: as indicated
BLEEDING CONTROL: as indicated
IV ACCESS: 2 large bore, 250 cc fluid challenges as needed until SBP of 100
DRESS & SPLINT: as needed. Return extremities to anatomical position. Reassess neurovascular frequently.
BASE CONTACT
MORPHINE: 2-5 mg increments, slow IVP (if SBP > 90) for severe pain. Repeat as needed. Max dose 20 mg
San Joaquin EMS Agency
Revision #302/02/95
REASSESS: frequently
76
ADULT TREATMENT GUIDELINES - TRAUMAEXTREMITY TRAUMA (SJ-A87) effective 09/01/95
PRIORITIES ABC's Determine mechanism of injury Consider Load and Go: to appropriate facility by best method available Early base notification for surgical mobilization
Secure airway as appropriateOXYGEN: high flow via mask
C-SPINE: as indicated
BLEEDING CONTROL: as indicated
IV ACCESS: 2 large bore, 250 cc fluid challenges as needed until SBP of 100
DRESS & SPLINT: as needed. Return extremities to anatomical position. Reassess neurovascular frequently.
Cover exposed bone with saline soaked gauze.
BASE CONTACT
MORPHINE: 2-5 mg increments, slow IVP (if SBP > 90) for severe pain. Repeat as needed. Max dose 20 mg
San Joaquin EMS Agency
Revision #403/08/95
REASSESS: frequently
AMPUTATIONS: partial, dress and splint in anatomical position; complete, place part in sterile container and place container on ice
77