Central Shenandoah EMS Council Prehospital Standard Patient Treatment Protocols 2312 W. Beverley Street Staunton, VA 24401 Phone 540-886-3676 • Fax 540-886-3735 www.csems.org [email protected] Revised October 1, 2017 / Effective November 1, 2017 © 2017 CSEMS Prehospital Standard Patient Treatment Protocols – Revised10/3/17 1 TABLE OF CONTENTS SECTION 1 – PATIENT ASSESSMENT INTRODUCTION .......................................................................................................................... 6 AUTHORIZATION ......................................................................................................................... 7 SAFE MEDICATION ADMINISTRATION PRACTICES ................................................................ 8 BLS LOCAL PROTOCOL PROGRAM .......................................................................................... 9 PATIENT MANAGEMENT – GENERAL ..................................................................................... 10 PATIENT MANAGEMENT – SCENE SIZE-UP .......................................................................... 10 PATIENT MANAGEMENT – PRIMARY SURVEY ...................................................................... 11 PATIENT MANAGEMENT – SECONDARY SURVEY ............................................................... 12 PATIENT MANAGEMENT – REASSESSMENT ........................................................................ 14 SECTION 2 – DYSRHYTHMIA MANAGEMENT (ADULT) CARDIAC ARREST (ADULT) ..................................................................................................... 15 BASIC LIFE SUPPORT – ALL AGES ......................................................................................... 19 CARDIAC ARREST – ASYSTOLE / PEA (ADULT) .................................................................... 20 CARDIAC ARREST – V-FIB/PULSELESS V-TACH (ADULT) .................................................... 21 BRADYCARDIA (ADULT) ........................................................................................................... 23 TACHYCARDIA (ADULT) ........................................................................................................... 25 POST RESUSCITAITON CARE (ADULT) .................................................................................. 27 DEATH DETERMINATION – ALL AGES .................................................................................... 28 SPECIAL RESUSCITATION CIRCUMSTANCES - ALL AGES .................................................. 29 SECTION 3 – DYSRHYTHMIA MANAGEMENT (PEDIATRIC) CARDIAC ARREST (PEDIATRIC) .............................................................................................. 31 ASYSTOLE / PEA (PEDIATRIC) ................................................................................................ 33 V-FIB/PULSELESS V-TACH (PEDIATRIC) ................................................................................ 34 CARDIAC ARREST (GENERAL) – PEDIATRIC ........................................................................ 35 BRADYCARDIA (PEDIATRIC) ................................................................................................... 36 SUPRAVENTRICULAR TACHYCARDIA (PEDIATRIC) ............................................................. 38 VENTRICULAR TACHYCARDIA W/PULSE (PEDIATRIC) ........................................................ 40 SECTION 4 – MEDICAL AND TRAUMA ALTERED MENTAL STATUS ..................................................................................................... 42 ALLERGIC REACTION/ANAPHYLAXIS ..................................................................................... 43 BURNS ....................................................................................................................................... 44 BURNS - RULE OF NINES ......................................................................................................... 47 CHEST PAIN (NON-TRAUMATIC) ............................................................................................. 48 COMBATIVE PATIENT (NON-TRAUMATIC) ............................................................................. 50 ENVIRONMENTAL – HYPERTHERMIA .................................................................................... 51 ENVIRONMENTAL – HYPOTHERMIA ....................................................................................... 54 ENVIRONMENTAL – SNAKE BITE ............................................................................................ 56 HYPERGLYCEMIA ..................................................................................................................... 57 HYPOGLYCEMIA ....................................................................................................................... 58 NAUSEA – VOMITING ............................................................................................................... 59 © 2017 CSEMS Prehospital Standard Patient Treatment Protocols – Revised10/3/17 2 OBSTETRICS – NORMAL DELIVERY ....................................................................................... 60 OBSTETRICS – CARE OF THE NEWBORN ............................................................................. 62 OBSTETRICS - APGAR SCORE ............................................................................................... 62 OBSTETRICS – NEWBORN / NEONATAL RESUSCITATION .................................................. 63 PROLAPSED UMBILICAL CORD .......................................................................................................... 66 BREECH PRESENTATION .................................................................................................................... 66 LIMB PRESENTATION .......................................................................................................................... 67 GENERAL – PAIN CONTROL .................................................................................................... 68 RESPIRATORY DISTRESS – AIRWAY OBSTRUCTION .......................................................... 69 RESPIRATORY DISTRESS – ASTHMA/COPD ......................................................................... 71 RESPIRATORY DISTRESS – CROUP / EPIGLOTTITIS ........................................................... 73 PULMONARY EDEMA / CHF ..................................................................................................... 74 SEIZURES .................................................................................................................................. 76 SHOCK – HYPOVOLEMIA ......................................................................................................... 78 SHOCK – NON-HYPOVOLEMIA (CARDIOGENIC) ................................................................... 80 SEPTIC SHOCK ......................................................................................................................... 82 SPINAL IMMOBILIZATION ......................................................................................................... 83 SPINAL IMMOBILIZATION/CLEARANCE .................................................................................. 84 ST–ELEVATION MYOCARDIAL INFARCTION (STEMI) TRIAGE ............................................. 85 STROKE / CVA ........................................................................................................................... 87 CINCINNATI PREHOSPITAL STROKE SCALE......................................................................................... 88 VAN STROKE ASSESSMENT ................................................................................................................... 88 OVERDOSE/POISONING/TOXIC INGESTION ......................................................................... 90 GENERAL ............................................................................................................................................... 90 ALCOHOL WITHDRAWAL ..................................................................................................................... 91 NARCOTICS / OPIATES ........................................................................................................................ 92 ORAL HYPOGLYCEMIC AGENTS ........................................................................................................ 92 TRICYCLIC ANTIDEPRESSANTS ......................................................................................................... 93 CHOLINERGICS .................................................................................................................................... 94 CALCIUM CHANNEL BLOCKERS ......................................................................................................... 95 STIMULANTS ......................................................................................................................................... 96 CYANIDE POISONING .......................................................................................................................... 97 TRAUMA – CONTROL OF EXTERNAL BLEEDING .................................................................. 98 TRAUMA – CRUSH SYNDROME .............................................................................................. 99 TRAUMA TRIAGE & MANAGEMENT ...................................................................................... 100 SECTION 5 – PROCEDURES 12 LEAD ECG ..........................................................................................................................