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Diabetic Emergencies ABC’S - secure as needed OXYGEN - as needed - Nasal Cannula 1-6 lpm - NRBM 15 lpm - Signs and Symptoms - •Disorientation ASSESSMENT - medical alert tags - vitals - other injuries/illnesses - •Unconsciousness - history - blood glucose level - •Altered mentation - physical - blood glucose level - •Combativeness TRANSPORT SYMPTOMATIC? - move to unit - glucose < 60 No - begin transport - contact receiving facility Yes LOC ORAL - alert Yes GLUCOSE - oriented No EMT-B EMT-I Paramedic TRANSPORT TRANSPORT TRANSPORT - move to unit - move to unit - move to unit - begin transport - begin transport - begin transport - contact receiving - contact receiving - contact receiving facility facility facility BG > 400 mg % IV Titrate IV to a IV - .9 % NACL rate of - .9 % NACL - TKO - TKO 150 – 250 cc/hr Pediatric Considerations - 15 grams oral glucose as tolerated Considerations - Amp D50 @ 25g - 1 gram/kg Dextrose IV This form supersedes no other KBEMS Form 30 063 090801 Shock ABC’S - secure as needed OXYGEN - as needed - Nasal Cannula 1-6 lpm - NRBM 15 lpm Bolus IV fluids should ASSESSMENT - Lung sounds be used with caution for - vitals - O2 Sat Patients with known - history - Temperature pulmonary history or - physical - Recent infection presents with rales - Recent illness EMT-B EMT -I Paramedic TRANSPORT TRANSPORT TRANSPORT - move to unit - move to unit - move to unit - begin transport - begin transport - begin transport - contact receiving - contact receiving - contact receiving facility facility facility IV Consider 2 IV Consider 2 Large bore large bore .9 % NACL - .9% NACL Maintain B/P - Maintain B/P Considerations - Contact medical control and - cover patient with blankets to maintain body heat - administer Dopamine 5mcg/kg/min - hypothermia is frequently associated with shock titrated to effect or max dose of - Monitor LOC during transport 20mcg/kg/min. if warranted - Contact medical control and - administer Dopamine 5mcg/kg/min titrated - to effect or max dose of 20mcg/kg/min. This form supersedes no other KBEMS Form 30 065 090801 Hyperthermia ABC’S - secure as needed OXYGEN - as needed - Nasal Cannula 1-6 lpm - NRBM 15 lpm ASSESSMENT - Include skin temp., - vitals character and color - history - O2 saturation - Rate of onset - physical MOVE PATIENT Symptomatic for Heat Stroke - cooler environment - ice packs over groin and under - begin cooling if indicated armpits - cool with wet towels or blankets EMT-B EMT-I Paramedic TRANSPORT TRANSPORT TRANSPORT - move to unit - move to unit - move to unit - begin transport - begin transport - begin transport - contact receiving - contact receiving - contact receiving facility facility facility IV ECG - .9 % NACL - monitor - Maintain B/P IV - .9 % NACL - Maintain B/P See next page for specific treatment This form supersedes no other KBEMS Form 30 067 090801 Specific types of Heat Injury Management (in addition to the above) Heat Cramps Heat Exhaustion Heat Stroke Rapid body cooling, move Replace fluids but try to avoid Fan & cool the pt. to cool environment, remove plain water (use sports drinks) but avoid chilling. all possible clothing, rinse with cold water if possible or use whatever means are available Replace fluids with sports drinks & (i.e.; ice packs) COOL RAPIDLY avoid fluids by mouth if pt. is nauseated. Do not massage muscle cramps Calm, quiet, and reassure pt. Transport to appropriate facility This form supersedes no other KBEMS Form 30 067 090801 Hypothermia ABC’S - secure as needed OXYGEN - Nasal Cannula 1-6 lpm ASSESSMENT - Vitals may be much lower - vitals - history - Monitor for full minute - physical EMT-B EMT -I Paramedic TRANSPORT TRANSPORT TRANSPORT - move to unit - move to unit - move to unit - begin transport - begin transport - begin transport - contact receiving - contact receiving - contact receiving facility facility facility IV ECG - LR or NS - monitor - TKO Precautions IV - move patient to warm environment as soon as possible - LR or NS - remove all wet clothing - TKO Protect the patient from further exposure - handle patient with extreme care, rough handling can cause ventricular fibrillation - high flow oxygen is contraindicated due to possibility causing ventricular fibrillation See next page for localized injury This form supersedes no other KBEMS Form 30 067A 090801 Local Cooling and Frostbite ABC’S - secure as needed OXYGEN - as needed - Nasal Cannula 1-6 lpm - NRBM 15 lpm - Remove items covering injured part(s) ASSESSMENT - Protect injured area from - vitals pressure, trauma, friction - history - Do not break blisters - physical TRANSPORT APPLY DRESSING - move to unit - Loose, light dressing - begin transport - Do not use tape or other - contact receiving facility circumferential bandages Mild MODERATE SEVERE HYPOTHERMIA HYPOTHERMIA HYPOTHERMIA Core temperature 93-97 Core temperature 86-97 Core temperature less than degrees fahrenheit active degrees fahrenheit active 86 degrees fahrenheit external rewarming rewarming of truncal areas only -active internal rewarming •warm IV fluids (109° F) •warm, humid oxygen Asses the pt. for ABC's presence or absence of -secure as needed -blood pressure pulse or respirations -respirations -pulse Assesment -pupils Core Temp less than -neuro function 97 degrees fahrenheit -skin (core temperature) indicates hypothermia OXYGEN as needed -Nasal Cannula 1-6 lpm If possible, oxygen & IV -Non Rebreather Mask 10-15 lpm Treat the pt. very gently. fluids should be heated. Rough handling can If possible, obtain core precipitate ventricular fibrillation. temperature. Prevent further heat loss. Insulate from the ground, protect from the wind, eliminate evaporate heat loss by removing wet clothing or by covering pt. with vapor barrier (such as a plastic bag), cover the head & neck. Move the pt. to a warm environment. This form supersedes no other KBEMS Form 30 067A 090801 Chest Pain ABC’S - secure as needed OXYGEN - Nasal Cannula 1-6 lpm - NRBM 15 lpm ASSESSMENT - Note pt. allergies - vitals - Does pt. take Nitro? - history - Does pt. take Aspirin daily - physical - O2 Saturation - Is the patient on ED medication? EMT-B EMT-I Paramedic - check TRANSPORT TRANSPORT ASPIRIN allergy - move to unit - move to unit - 325 mg P.O. - If pt. takes - begin transport - begin transport - chew tablets daily, check with - contact receiving - contact receiving facility facility provider NITRO - B/P > 100 systolic AED AED - 0.4 mg SL - 3 lead - 3 lead - repeat X 2 every 5 - obtain strip(s) - obtain strip(s) min. if needed for E.R. for E.R. TRANSPORT EMT – B and EMT – I Considerations IV - move to unit - Assist patient with personal nitro .9 % - begin transport - B/P must be > 100 systolic NACL - contact receiving - Repeat in 5 min. if needed, not to facility exceed three total ECG - monitor PARAMEDIC CONSIDERATIONS ACLS - Atropine 0.5 mg IV bolus per ACLS - contact medical direction IV Guidelines for bradycardia - .9 % NACL - PEA per ACLS Guidelines for V-Fib, for approval - TKO pulseless V-Tach, or Asystole - initiate current ACLS Morphine Sulfate 1-3 mg Guidelines every 3-5 mins titrated to effect or systolic BP less than 100mmHg This form supersedes no other KBEMS Form 30 069 090801 Abdominal Pain ABC’S - secure as needed OXYGEN - as needed - Nasal Cannula 1-6 lpm - NRBM 15 lpm - O2 Saturation ASSESSMENT - Use “OPQRS” to evaluate - vitals pain - history - Follow appropriate protocols - physical for hypo or hypertension SYMPTOMATIC? REFERENCE - injury related pain Yes - Refer to appropriate protocol No EMT-B EMT-I Paramedic TRANSPORT TRANSPORT TRANSPORT - move to unit - move to unit - move to unit - begin transport - begin transport - begin transport - contact receiving - contact receiving - contact receiving facility facility facility IV IV - .9% NACL - .9% NACL Considerations - TKO - TKO - Give nothing by mouth - Be alert of vomiting - Avoid analgesics ECG - Consider ectopic pregnancy for - Monitor women of child bearing years This form supersedes no other KBEMS Form 30 071 090801 Respiratory Distress / Dyspnea ABC’S - Be prepared to assist respiration’s - secure as needed - Note use of accessory muscles - Note respiratory pattern OXYGEN - Nasal Cannula 1-6 lpm - NRBM 15 lpm - BVM 15 lpm - Resp. rate ASSESSMENT - Lung sounds - vitals - Edema - O2 Saturation - history - physical - Leave pt. in position of comfort TRANSPORT SYMPTOMATIC? No - move to unit - severe resp. distress? - begin transport Yes - contact receiving facility EMT-B EMT-I Paramedic TRANSPORT TRANSPORT TRANSPORT CHF use - move to unit - move to unit - move to unit CPAP - begin transport - begin transport - begin transport - contact receiving - contact receiving - contact receiving facility facility facility CONSIDER STATUS COPD? No No - 2.5 mg Albuterol Solution ASTHMATICUS @ 10 – 15 lpm Yes Yes - 0.5 mg Atrovent Solution @ 10 – 15 lpm IV .9 % NACL IV - TKO .9 % NACL TKO CONSIDER Pediatric Considerations CONSIDER - contact medical direction - Epinephrine 0.3-0.5 - Epinephrine 0.1 mg 1:1000 SQ; - 2.5 mg Albuterol Solution @ 10 – 15 lpm mg 1:1000 SQ repeat in 5 minutes not to exceed 0.5 - Epinephrine 0.3-0.5 - 0.5 mg Atrovent Solution @ 10 – 15 lpm mg 1:10,000 IV if hypotensive This form supersedes no other KBEMS Form 30 073 090801 Obstetrical Emergencies Childbirth ABC’S - secure as needed OXYGEN - as needed - Nasal Cannula 1-6 lpm - NRBM 15 lpm - chronic illness ASSESSMENT - # of pregnancies - vitals - prenatal care? - history - baby’s expected birth date - physical - last menstrual cycle - time MONITOR - frequency CONTRACTIONS - duration - strength - bleeding
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