Note: this is not full protocols, this is only meant to describe parts of protocols which are non-obvious, such as medications.
- Nitroglicerin (patient-supplied)
- Cardiac arrest
- If non-traumatic: Three CPR/shock cycles before transport. (no-shock messages are included in "before transport", you don't transport after the first no-shock message.)
- Traumatic: don't apply AED if there is penetrating chest trauma.
- Suspected myocardial infarction
Aspirin: two chewable aspirins. Condition: (Age > 33) OR (age < 33 with diagnosed cardiac history). Exception: aspirin alleregy or hyposensitity.
Nitroglirerin: If chest pain persists after aspirin (don't delay transport or ALS). Must be patient's own, ONE spray or tablet. Requirements: patient perscribed the nitroglicerin, chest pain persists, BP systolic > 120, Exception: patient has used erectile dysfunction meds in the last 72 hours (unless OLMC contacted).
- Albuterol. Up to three doses (third during transport).
- Epinephrine: for very severe distress.
- Under 33: contact OLMC for second dose only.
- Over 33: contact OLMC for both doses.
Adult vs child pen: Adult epi-pen for > 9 years OR > 30kg(=66lb). Otherwise use pediatric pen.
- No RMA without OLMC contact.
- Epinepherine: if severe cardiac OR respiratory distress or arrest.
- Patient has their own epi-pen prescribed: administer one dose (even if you need to use your own pen)
- Pt does not have their own epi-pen:
age < 9:
9 <= age < 33: contact OLMC for second dose only.
age >= 33: contact OLMC for both doses.
Adult vs child pen: Adult epi-pen for > 9 years OR > 30kg(=66lb). Otherwise use pediatric pen. Pediatric patients have same criteria for first/second dose and OLMC.
Can not RMA with BGL < 60 mg/dL or BGL > 300 mg/dL
- Glucose: one tube, AMS+low BGL, or any patient (with AMS, a diagnosed diabetes history and you can't get a BGL on). Counter-indications: head injury, can't swallow.
- CPR protocols
Pulse < 60bpm, non-arrest: 20 breaths/minute for 30 seconds, if pulse !>60 bpm, then full CPR.
Cardiac arrest: Full CPR until pulse > 60bpm, then 20 bpm until pulse>100bpm and breaths>20/min and no central cyanosis
- Infant resuscitation:
Persistent central cyanonis OR breaths < 30/min OR 60<pulse<100: ventelate at 30-60 breaths/min, until criteria not met then use high flow oxygen.
Pulse < 60: full CPR until you can move to the category above.