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SNHD Protocols Questions and Answers
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SNHD Manual ✔✔The goal of the manual is to standardize prehospital care in Clark County
If a physician giving on-line medical consultation directs you to provide care not explicitly stated in the protocol manual you must...? ✔✔You and the telemetry physician must immediately notify OEMSTS. In addition, after finishing the call, you as the provider must make all prehospital care documentation/records of your deviation and telemetry physician's name available to OEMSTS. This will then be used for Quality Improvement Review.
If a physicians orders are against protocol, could possibly endanger patient, or there is a lack of resources. What must you do...? ✔✔You must notify telemetry physician why you are not able to carry out the order. Then, indicate the following on prehospital records: the order given, time it was given, and reason the order could not be carried out. Then all documentation/records must be available immediately after the call to OEMSTS and then will be used for Quality Improvement Review.
What is a PATIENT ✔✔1) A person who has a complaint or mechanism suggestive of potential illness or injury;
- A person who has obvious evidence of illness or injury; or
- A person identified by an informed 2nd or 3rd party caller as requiring evaluation for
potential illness or injury.
Pediatric Patient Destination Age ✔✔<
ASA ✔✔Acetylsalicylic Acid
CCC CPR ✔✔Continuous Chest Compression CPR:
Compressions - Push hard (≥2 Inches) Push fast (≥100/min)
BVM - at 8 BPM
DCAP-BTLS ✔✔Deformities; Contusions; Abrasions; Punctures/Penetrations;
Burns; Tenderness; Lacerations; Swelling
M.A.D. ✔✔Mucosal Atomizer Device
Drugs that can be administered through a M.A.D. ✔✔Nalaxone
Patients with evidence of a stroke shall be transported... ✔✔According to Stroke (CVA) protocol
Sexual assault victims <13 y/o shall be transported to ✔✔Sunrise Hospital
Sexual assault victims ≥18 y/o shall be transported to ✔✔UMC
Sexual assault victims between ages 13 and 18 y/o shall be transported to ✔✔Either UMC or Sunrise Hospital
Sexual assault victims outside the 50 mile radius of appropriate facility shall be transported to ✔✔Nearest appropriate facility
Where should stable patients be transported to ✔✔Their hospital of choice or nearest facility
For patients outside of the 50 mile radius of protocol designated transport destination shall be transported to ✔✔Nearest appropriate facility
Waiting Room Placement requisites ✔✔Patient cannot be on a legal psychiatric hold and must meet the following requirements:
HR: 60-
RR: 10-
Systolic: 100-
Diastolic: 60-
Room air SPO2: >94%
A/O x 4
No medication was given except for a single dose of Morphine/Ondansetron
Paramedic opinion states pt. does not need ECG monitoring
No IV fluids are necessary
If a hospital declares an internal disaster that hospital shall be bypassed with the exceptions of ✔✔Cardiac arrest patients or whom adequate ventilation has not been established
In a General Adult Trauma Assessment how do you manage breathing ✔✔Maintain SPO
94%:
Suspected Acute Coronary Syndrome treatment ✔✔+ Obtain vascular access
prescribed; may repeat x 3 (if not contraindicated)
- Telemetry is required for STEMI's
Nitroglycerine Contraindications ✔✔+ BP < 100 systolic
ADULT Allergic Reaction: What is the treatment if no airway obstruction or breathing difficulties are present ✔✔+ Obtain vascular access
- Administer 50 mg IM/IV of Diphenhydramine
ADULT Allergic Reaction: What is the treatment if airway obstruction or breathing difficulties are present ✔✔+ Administer 0.5 mg of 1:1000 IM Epinephrine (may repeat up to 1.5 mg with 15 min in between)
2.5 mg in 3 cc SVN Albuterol (repeat as necessary)
IV access
500 cc NS bolus (may repeat until 2L)
Administer 50 mg IM/IV Diphenhydramine
Notify Receiving Hospital
Epinephrine is a first-line drug that should be used... ✔✔Specifically for ACUTE allergic reactions (signs of airway involvement)
Allergic Reaction Severity levels: ✔✔+ MILD: involves skin rashes, itchy sensations, or hives w/o respiratory involvement
MODERATE: involve skin disorders and may include respiratory involvement such as wheezing, however patient is still able to maintain adequate tidal volume
SEVERE: involve skin disorders, respiratory difficulty, and may include hypotension
CNS (stroke, tumor, seizure, infection)
Cardiac (MI, CHF)
Hypothermia
Infection
Thyroid
Shock (septic, metabolic, traumatic)
Diabetes
Toxicological or ingestion
Acidosis/Alkalosis
Environmental exposure
Hypoxia
Electrolyte abnormality
Psychiatric disorder
Behavior Emergencies: Consider the following medical causes ✔✔1. Hypoxia
- Intoxication / Overdose
- Hypoglycemia / Electrolytes
- Head Injury
- Post-ictal State
- Excited Delirium
What does the pneumonic S.A.F.E.R. stand for in S.A.F.E.R. Model ✔✔+ S-STABILIZE the situation by containing and lowering the stimuli.
A-ASSESS and acknowledge the crisis.
F-FACILITATE the identification and activation of resources (chaplain, family, friends or police).
E-ENCOURAGE patient to use resources and take actions in his/her best interest.
R-RECOVERY or referral - leave patient in care of responsible person or professional, or
transport to appropriate facility.
In a behavior emergency if patient is a harm to self you should ✔✔Apply 2 point restraints; consider law enforcement; use a 4 point restraint if needed
In a behavior emergency if a patient is a harm to others ✔✔4-point restraints; hood
if indicated; NO PRONE
POSITION
- Remove smoldering clothing (DO NOT REMOVE STUCK CLOTHING)
- ONLY apply a dry sterile dressing
- Administer 500 cc fluid bolus if signs of hypoperfusion or > 10 %BSA present
- Repeat step 4 up to 2L if patient condition improvement is not visible
- Consider inhalation injury and transport to UMC
What should you do for a ELECTRICAL/CHEMICAL burn ✔✔1. If eyes are involved flush eyes with NS for 10-15 minutes
- Remove all and any jewelery, constricting items, and expose the burned area
- For electrical burns identify entrance/exit wounds and cover with dry sterile dressing
- Administer 500 cc fluid bolus if signs of hypoperfusion or > 10 %BSA present
- Repeat step 4 up to 2L if patient condition improvement is not visible
- Transport to UMC
Burn differentials ✔✔· Superficial (1st degree) - red and painful
· Partial Thickness (2nd degree) - blistering
· Full Thickness (3rd degree) - painless/charred
or leathery skin
What happens and should occur if CO inhalation is suspected ✔✔If CO inhalation has occurred SPO2 will read high (even 100%) not because of oxygen but because of the CO. These patients are to be given 100% oxygen
Which patients shall be transported to the UMC Burn Center via the Adult or Pediatric Trauma Center: ✔✔1. Second and/or third degree burns >20% body surface area (BSA).
- Second and/or third degree burns >10% body surface area (BSA) in patients under 10 years old or
over 50 years old.
- Burns that involve the face, hands, feet, genitalia, perineum or major joints.
- Electrical burns, including lightning injury.
- Chemical burns.
- Circumferential burns.
- Inhalational injury.
In case of a chemical burn and no NS or sterile water is present what should be used. ✔✔Use to cleanest and immediate water source (tap)
· Hypothermia - Warming
· Tension pneumothorax - Needle decompression
· Tamponade, cardiac - Volume infusion
· Toxins - Agent specific antidote
· Thrombosis, pulmonary - Volume infusion
· Thrombosis, coronary - Emergent PCI
Non-Specific Chest Pain treatment ✔✔+ Ensure SPO2 is >94%
for constricted airways
Suspected Aortic Dissection treatment ✔✔+ Ensure SPO2 is >94%
2L in order to treat hypoperfusion
Normal Presentation Birth/Labor ✔✔1. Puncture amniotic sac if not already bursted
- Facilitate delivery of the head
- Suction the MOUTH 1st THEN THE NOSE
- Deliver upper shoulder then lower shoulder
- Deliver remainder of the baby
- Clamp and cut
- Repeat if multiple births
- Deliver placenta
- Obtain Vascular Access
Limb Presentation Birth/Labor ✔✔1. Place patient in left lateral recumbent position
- Obtain IV
- Transport
Breech Presentation Birth/Labor ✔✔1. Support body of the baby during delivery of the head
- IV access
Cord Presentation Birth/Labor ✔✔1. Position patient on elbows and knees with hips elevated
- Wrap cord and keep it moist
Drowning Patients ✔✔If airway is not protected BVM
If patient breathing on their own 15L NRB
If BVM do not stop to suction foam simply BVM past it
Consider administering Albuterol at 2.5 mg/3cc SVN; repeat until improvement
If drowned victim is in cardiac arrest focus on oxygenation/ventilation and perform tradition 30:2 CPR
For drowning patients what form must be submitted ✔✔SNHD Submersion Incident Form
Suspected Hyperkalemia ✔✔THIS PROTOCOL IS FOR PATIENTS WITH CHRONIC KIDNEY DISEASE AND SUSPECTED HYPERKALEMIA
administer 2.5 mg/3cc SVN Albuterol
Heat Cramps ✔✔Consist of benign muscle cramping caused by dehydration and is not associated with an
elevated temperature.
Heat Exhaustion ✔✔Elevated body temp,
cool, moist skin, weakness, anxious tachypnea
Consists of dehydration, salt depletion, dizziness, fever, AMS, headache, cramping,
N/V. Vital signs usually consist of tachycardia, hypotension and elevated temperature.
Heat Stroke ✔✔High body temp >104,
hot, dry skin
hypotension, AMS/coma
Hypethermia treatment ✔✔Remove from ambient heat, remove tight clothing, and use passive cooling measures
HEAT CRAMPS: PO fluids if tolerated
