NEW MEXICO EMERGENCY MEDICAL SERVICES GUIDELINES PROCEDURES FIRST RESPONDER EMT- BASIC EMT- INTERMEDIATE (EMT-I) EMT-PARAMEDIC Updated September 2018 TABLE OF CONTENTS Contents ACUPRESSURE ....................................................................................................................................... 1 AIRWAY MANAGEMENT ......................................................................................................................... 2 GENERAL GUIDELINES ...................................................................................................................... 2 OROPHARYNGEAL SUCTIONING ...................................................................................................... 3 ENDOTRACHEAL SUCTIONING ......................................................................................................... 4 OROPHARYNGEAL AIRWAY .............................................................................................................. 6 NASOPHARANGEAL AIRWAY ............................................................................................................ 7 COMBITUBE® ...................................................................................................................................... 8 LARYNGEAL and SUPRAGLOTTIC AIRWAY DEVICES ................................................................... 11 KING AIRWAY ................................................................................................................................................................. 11 LMA® ............................................................................................................................................................................... 13 INTUBATION – ENDOTRACHEAL (for patients 13 years of age and older) ...................................... 16 INTUBATION - NASOTRACHEAL (for patients 13 years of age and older) ....................................... 18 CRICOTHYROTOMY .......................................................................................................................... 21 AEROMEDICAL REQUEST ....................................................................................................................23 CAPNOGRAPHY .................................................................................................................................... 25 CAPNOMETRY ....................................................................................................................................... 26 CARDIAC MONITORING ........................................................................................................................27 CARDIAC PACING-TRANSCUTANEOUS ............................................................................................. 29 CARDIOVERSION .................................................................................................................................. 30 CHEST TUBE MONITORING ................................................................................................................. 31 COMMUNICATIONS - HOSPITAL ..........................................................................................................34 CPAP - CONTINUOUS POSITIVE AIRWAY PRESSURE ..................................................................... 35 DEFIBRILLATION - MANUAL ................................................................................................................. 36 DEFIBRILLATION – SEMI-AUTOMATIC ................................................................................................ 37 ENDOTRACHEAL MEDICATION ADMINISTRATION ........................................................................... 38 HEMOSTATIC GAUZE ........................................................................................................................... 39 INJECTIONS ........................................................................................................................................... 40 SQ & IM............................................................................................................................................... 40 AUTO-INJECTORS ............................................................................................................................. 41 INTRANASAL DRUG ADMINISTRATION ..............................................................................................42 INTRAOSSEOUS INFUSION ................................................................................................................. 43 TIBIAL ................................................................................................................................................. 43 HUMERAL ........................................................................................................................................... 46 IV THERAPY ........................................................................................................................................... 48 EXTREMITIES .................................................................................................................................... 48 EXTERNAL JUGULAR ....................................................................................................................... 49 NASOGASTRIC TUBES ......................................................................................................................... 51 NEBULIZED DRUG ADMINISTRATION ................................................................................................. 53 OXYGEN ADMINISTRATION ................................................................................................................. 54 PATIENT ASSESSMENT ....................................................................................................................... 56 SCENE SIZE UP ................................................................................................................................. 56 PRIMARY ASSESSMENT .................................................................................................................. 60 HISTORY AND PHYSICAL EXAM (H&P) ........................................................................................... 62 PLEURAL (THORACIC) DECOMPRESSION ......................................................................................... 63 POINT OF CARE TESTING ....................................................................................................................64 GLUCOMETRY ................................................................................................................................... 64 SERUM LACTATE .............................................................................................................................. 65 POSITIVE PRESSURE VENTILATION .................................................................................................. 67 SPINAL MOTION RESTRICTION ...........................................................................................................68 SPLINTING ............................................................................................................................................. 71 EXTREMITY ........................................................................................................................................ 71 TRACTION SPLINT ............................................................................................................................ 72 TASER® BARB REMOVAL .................................................................................................................... 73 TOURNIQUETS ...................................................................................................................................... 75 WILDERNESS PROTOCOLS ................................................................................................................. 76 New Mexico EMS Procedure Guidelines Sept 2018 ACUPRESSURE LEVEL OF AUTHORIZATION EMT-Basic, EMT-Intermediate & EMT-Paramedic RATIONALE Traditional Chinese medicine suggests that acupressure therapy may reduce nausea and vomiting in certain ailments. DESIRED EFFECT Temporary relief of nausea INDICATIONS 1. Mild nausea CONTRAINDICATIONS 1. None PROCEDURE 1. Using the middle and index fingers, firmly press down on the groove between the two large tendons on the wrist. 1 New Mexico EMS Procedure Guidelines Sept 2018 AIRWAY MANAGEMENT GENERAL GUIDELINES LEVEL OF AUTHORIZATION First Responder, EMT-Basic, EMT-Intermediate & EMT-Paramedic RATIONALE An adequate patent airway is the HIGHEST PRIORITY WITH EVERY PATIENT. All First Responder and EMTs must be skilled and practiced in all approved airway management techniques at their level, and use careful judgment in the selection of a technique. DESIRED EFFECT When properly performed the patient will have a patent airway and be able to receive adequate oxygen by breathing on-their-own or by assisted ventilations. INDICATIONS 1. All patients CONTRAINDICATIONS 1. None PROCEDURES 1. Approved airway management for all levels a. Jaw thrust and chin lift b. Visual inspection, auscultation, and feeling for air exchange c. Oropharyngeal suction d. Nasopharyngeal “trumpet” e. Oropharyngeal airway f. Laryngeal & supraglottic airway devices (LMA, King Airway) 2. Additional adjuncts for EMT-Basic, EMT-Intermediate & EMT-Paramedic only a. Multi-lumen airway (i.e. Combitube, PTL) 3. Additional adjuncts for EMT-Paramedic