TRAUMA CATCHMENT AREA

GEOGRAPHICAL AREA AROUND TC DEFINED BY

 STREET OR ETA

SECURE TC CATCHMENT AREA

GEOGRAPHIC AREA AROUND TC DEFINED BY

 STREET/FWY/LANDMARKS

OPEN CATCHMENT AREA

30 MIN/CODE 3 TRANSPORT

INCLUDING WEATHER/TRAFFIC

UNDESINATED CATCHMENT

NO CATCMENT AREA

INTERNAL DISASTER

CALL MAC

BOMB THREAT                          FIRE

FLOODING                    LOSS OF H20

HAZ-MAT        OTHER APPROVED MAC

TRAUMA DIVERSION

TC WITH IN 30 MINUTES

DIVERSION

15 MIN TO ALT. RECIEVING OR EDAP

20+10 TC/PTC/SRC

20 - PERINATAL/PMC

WHAT IS ALWAY OPEN CATCHMENT

PEDIATRIC TRAUMA CENTER

WHERE DOES EMT TRANSPORT GO WITH STABLE PT?

MAR 

EXCEPT IF THERE IS INTERNAL DISASTER 

 WHERE DO YOU TAKE A PEDS PT?

MAR IS ALWAYS EDAP

WHERE DO YOU TAKE PERINATAL PT?

MAR IS A PERINATAL CENTER

WHERE DO YOU TAKE A UNMANAGEABLE

AIRWAY PT?

MAR

WHAT DO EMT'S DO IF TIME FOR PARAMEDICS TO ARRIVE IF GREATER THAN TRANSPORT TO FACILITY IN LIFE THREATENING SITUATIONS?

EMTS CAN TAKE PATIENT TO MAR IF IT IS FASTER THAN WAITING FOR PARAMEDICS

WHAT IF PT REQUESTS ANOTHER FACILITY?

CAN TAKE IF NOT TO FAR AND PT IS STABLE.

IF CAN'T THEN PARAMEDICS NEED TO HELP FIND OTHER TRANSPORTATION. IE: PRIVATE AMBULANCE

WHAT ARE THE QUALITIES OF

CAPNOGRAPHY?

SUPERIOR TO COLOR METRIC END TIDAL CO2

BEST METHOD FOR CONTINUOUS MONITORING

IN CPR - DETECTS EARLY ROSC

CAN GIVE FEED BACK - EFFECTIVE CPR

HOW DOES ESPHAGEAL DETECTOR DEVICE

WORK?

PUT ON ET TUBE DEFLATED.

IF REINFLATES BACK TO ORIGINAL SIZE IN

LUNGS

HOW DO YOU VERIFY ET PLACEMENT?

ONE CLINICAL          

VISUALIZE PASSING THROUGH CORDS

EQUAL BREATH SOUNDS

CHEST RISE AND FALL

ONE ADJUNCT

CAPNOGRAPHY

ESOPHAGEAL DETECTOR DEVICE

END CO2 DETECTOR

WHAT IS THE DEFINITION OF HYPERTENSION?

SYS BP EQUAL OR GREATER THAN 140

OR 2 OR MORE TIMES DIAS = OR GREATER THAN

90

WHAT DOES HYPERTENSION DO TO BODY?

DECREASED PERFUSION CAUSING DAMAGE TO ORGANS.

WHAT ARE S/S HYPERTENSION?

ALOC

CHEST PAIN

NEURO

HEADACHE

N/V

SOB

RINGING IN EARS

ABD

VISUAL DISTURBANCES

OTHERS

GCS

WHAT ARE THE CATEGORIES FOR:

EYE OPENING

4 SPONTANEOUS

3 TO VOICE

2 TO PAIN

1 NONE

GCS

WHAT ARE THE CATEGORIES FOR

BEST VERBAL

6             OBEYS

5        LOCALIZES

4    WITHDRAWAL

 3            FLEXION

 2        EXTENSION

1               NONE

GSC

WHAT IS THE CATEGORIES FOR VERBAL?

5              ORIENTED

4             CONFUSED

3      INAPPROPRIATE

 2 INCOMPREHENSABLE

1                     NONE

WHEN CAN YOU USE PACERS?

1ST LINE OF TX

= OR OVER 14

SYMPTOMATIC BRADY LESS THAN 60/MIN

 WITH ONE OR MORE SIGNS:

ALOC

CHEST PAIN

SOB

B/P LESS THAN 90

OTHER S/S SHOCK

CAN YOU USE A PACER IN ASYSTOLE?

NO

HOW WOULD YOU PREMEDICATE FOR

PACER?

VALIUM  2-10 MG (MAX 20)

MS 2-10 MG (MAX 20)

WHAT ARE THE SETTING FOR PACER?

70 BPM/ 0 MA

INCREASE BY 10 UNTIL CAPTURE

NOT MORE THAN 100 MAX

WHAT AGE DO YOU USE ADVANCED AIRWAY?

LESS THAN 12 YRS OR LESS THAN 40 KG

OFF BROWSLO TAPE CAN INTUBATE

WHAT IS SAMPLE?

SECONDARD FOCUSED ASSESSMENT

S = S/S

A= ALLERGIES

M= MEDS

P= HX

L= LAST ORAL INTAKE

E= EVENTS LEADING P TO CURRENT PROBLEM

WHAT IS FIELD TX M9

OVERDOSE/POISONING?

ABC'S

HIGH FLOW O2

IV NS TKO (FC IF LOW BP)

 MONITOR

LT LAT/SHOCK POSITION

NARCAN 0.08 - 2 MG IVP OPIATE OD

D50 1 AMP 50 CC IVP IF BS LESS THAN 80

WHEN DO YOU USE COMBITUBE IN PEDS?

16 AND OVER

4 FT TO 6FT 5 IN

SMALL SIZE COMBITUBE

WHAT AGE IS PEDS CPR?

1-8 YRS

WHAT AGE IS INFANT CPR?

1 - 12 MOS

WHAT AGE IS NEONATE CPR?

0 - 1 MOS

WHAT AGE DO YOU USE INFANT/CHILD

AED PADS?

LESS THAN 8 YRS

WHAT AGE DO YOU USE STANDARD AED PADS?

8 AND OVER

WHAT DOES ALTE STAND FOR?

 APPARENT LIFE THREATENING EVENT

 CHARACTERISTICS OF ALTE?

TWO OF FOLLOWING:

APNEA

COLOR CHANGE (AM. FLAG)

CHANGE IN MUSCLE TONE

DO MEDICS HAVE TO MAKE BASE CONTACT WITH PRONOUNCED DEAD IN FIELD?

NO

WHAT IF MI ARREST OF SCENE?

 IF NO ROSC AND NO VIABLE RHYTHM

THEN PRONOUNCEMENT

 OR CAN GO TO SRC

ROSC WITH VIABLE RHYTHM CAN GO TO SRC

WHAT ARE THE EXCEPTIONS TO GOING TO A MAR WITH CARDIAC ARRESTS?

1. TRAUMATIC FULL ARREST WITH PENETRATING TORSO GOES TO TC

2.  DNR/AHCD DOES NOT TRANSPORT

3.  PRONOUCEMENT OF DEAD IN FIELD

POSSIBLE CAUSES ASYSTOLE

1. HYPOTHERMIA
2. HYPOVOLEMIA
3. HYPO/HYPERKALEMIA
4. HYPOXIA
5. HYPOGLYCEMIA

6.  THROMBUS

7.  TAMPONADE

8.  TOXINS

9.  TRAUMA

10.  TENSION PNEUMO

WHAT IS THE PQRST OF PAIN?

O = ONSET

P = PROVOKED

Q = QUALITY

S= SEVERITY

T = TIME/DURATION

WHAT IS THE SEVERITY OF THE PAIN SCALE?

1-2 =  SOME DISCOMFORT

3 - 4 = HAVING DISCOMFORT

5-6 = MILD PAIN

 6-7= MODERATE PAIN

8-9 = SEVERE PAIN

10= MOST SEVERE

IF PUT IN RESTRAINTS IN FIELD HOW OFTEN DO YOU HAVE TO CHECK NEURO/CIRC?

Q 15 MINUTES

IF YOU HAVE A SEVERE COMBATIVE/VIOLENT PATIENT IN FIELD WHAT DO YOU DO?

CALL LAW ENFORCEMENT OFFICERS

CAN YOU TAKE OFF RESTRAINTS ONCE YOU PUT THEM ON?

NOT UNTIL YOU REACH FACILITY

WHAT IS RULE OF 9?

HEAD = 9%

FRONT TORSO = 18%

BACK TORSO = 18 %

ARMS = 9% EACH

LEGS = 9% EACH

WHAT ARE CHARACTERISTIC OF 1,2,3 degree burns?

1. PAIN RED SWELLING (EPIDERMIS)

2.  BLISTERS (DERMIS)

3.  NERVE/BLOOD VESSELS DAMAGE (SUBQ)

HIGH BACTERIA INF. CAUSE OF DEATH

WHAT IS A BURN PT DESTINATION?

IF THEY DO NOT MEET PTC,TC OR PMC CRITERIA

THEN THEY GO TO MAR/EDAP FOR AGE.

THEN CALL MAC FOR TRANSFER

WHAT INFO DO YOU NEED TO GIVE MAC TO TRANSFER BURN PTS?

STATUS OF AIRWAY

% AND LOCATIONS OF BURNS

TYPE OF BURN  (ELECTRICAL, THERMAL OR CHEM)

CIRCULATION STATUS

LOC

OTHER INJURIES

PAIN MED HX

TX IN PROGRESS

WHEN DO YOU TRANSPORT PERINATAL TO MAR?

WHEN IN RESP. DISTRESS

CARDIAC ARREST

CLEARLY NOT RELATED TO PREGNANCY

WHAT ARE THE COMPLICATIONS OF IO'S

COMPARTMENT SYNDROME

GROWTH PLATE INJURY

SKIN/BONE INFECTION

FX/FAT EMBOLISM

LOCAL INFILTRATION OF FLUIDS

WHEN CAN THEY PRONOUNCE IN FIELD?

1. DECAPITATION
2. MASSIVE CRUSH INJURY
3. PENETRATING OR BLUNT INJURY WITH EVISCERATION OF HEART, LUNG, BRAIN
4. DECOMPOSITION
5. INCINERATION
6. PULSELESS WHERE EXTRICATION MORE THAN 15 MIN
7. BLUNT TRAUMA = 0 PULSE/EKG
8. PULSELESS MULTIVICTIMS WITH LIMITED RESOURCES
9. DROWNING MORE THAN 1 HR
10. RIGOR MORTIS
11. POST MORTEM

WHAT ARE THE PHYSICAL ASSESSMENTS FOR PRONOUNCEMENTS?

1. RESP = OPEN AIRWAY, LOOK, LISTEN, FEEL. AUSCULTATE LUNGS 30 SEC
2. FEEL FOR APICAL PULSE FOR 60 SEC 
3.           CAROTID PULSE ADULTS
4.           BRACHIAL PULSE INFANTS
5. NEURO = PENLIGHT - FIXED/DILATED
6. UNRESPONSIVE TO PAIN

WHO DOES PARAMEDICS/EMTS HAVE TO TRANSPORT?

1. ABD PAIN
2. ISOLATED FX SPINE, SKULL, HIP
3. ABN. VAG BLEED
4. ALLERGIC REACTION
5. ASYMP HAZ MAT
6. GI BLEED
7. NEAR DROWNING
8. GRAVELY DISABLED TO SELF/OTHERS

WHAT IS SPECIAL ABOUT 12 MOS OR LESS TRANSPORTS?

SHALL BE TRANSPORTED NO MATTER THE COMPLAINT

WHAT IS THE RULE ABOUT 13-36 MOS. TRANSPORTS

MUST MAKE CONTACT &/OR TRANSPORT TO HOSP

EXCEPTION MINOR EXTREMITY INJURY

IF PARENT REFUSES MUST MAKE BASE CONTACT

WHAT IS PMC CRITERIA?

DYSRYTHMIA

RESPIRATORY DISTRESS

CYANOSIS

PROLONGED AMS

STATUS EPILEPICUS

ALTE LESS THAN 12 MOS.

WHAT PTS DO YOU HAVE TO MAKE BASE CONTACT WITH?

1. S/S SHOCK
2. CARDIAC ARREST
3. CHEST PAIN
4. SOB/TACHYNEA
5. PMC GUIDELINES
6. 5 OR MORE PT NEEDING TRANSPORT
7. ALOC
8. POISON INJECTION/OD
9. HAZMAT WITH C/O
10. ABD PAIN WITH PREGNANCY
11. CHILDBIRTH
12. FX PELVIS/FEMUR
13. FACIAL, NECK  ELECTRICAL, EXTENSIVE BURNS 20% ADULTS, 15% CHILDREN, 10% INFANTS
14. TRAUMA CRITERIA
15. TRAUMA CRUSH
16. SYNCOPE
17. LOC
18. NEURO
19. BLURRED VISION
20. WEAK/DIZZY
21. NUMBNESS
22. AMA TO ABOVE

WHAT PT IN CARDIAC ARREST REQ BASE CONTACT?

PEDS 14 YR AND YOUNGER BLS UNTIL CONTACTED BASE STATION

WHAT IS TRAUMA TRANSPORT CRITERIA?

1.  TRAUMA WITH B/P LESS THAN 90
2.  TRAUMA WITH B/P LESS THAN 70
3.  PENETRATING CRANIAL INJURY
4.  BLUNT WITH GCS <14, SEIZURE, UNEQUAL PUPILS, NEURO DEFICITS
5.  PENETRATING NECK INJURY
6.  BLUNT TRAUMA WITH FLAIL CHEST
7.  CARDIAC ARREST WITH PENETRATING TORSO
8.  FALL >15 FT
9.  GSW TO TORSO
10.  PENETRATING TORACIC BETWEEN MID CLAVICULAR LINES
11. DIFFUSE ABD
12. PASSENGER SPACE INTRUSION
13.  OPEN/CLOSED INJURY TO SPINAL CORD WITH DEFICITS TO EXTREMITIES

WHAT ARE THE TRAUMA GUIDELINES?

1. SURVIVOR OR SAME VEHICLE FATAL ACCIDENT
2. PEDS VS AUTO
3. EJECTED FROM VEHICLE
4. REQUIRED EXTRICATION
5. VERY YOUNG AND VERY OLD

WHAT IS DONE WITH TRAMA EXTREMIS PT?

IMMEDIATE TRANSPORT TO MAR IF OBSTRUCTED AIRWAY, HEMORRHAGE, UNMANAGABLE AIRWAY, AND OTHER

WHAT IS CPR TO CHILD?

1. SHAKE AND SHOUT
2. AIRWAY/LISTEN FOR BREATHS
3. 2 BREATHS
4. COMPRESSION 1/3 DEPTH OF CHEST 30:2 CENTER OF CHEST X 2 MINUTES
5. 911

WHAT IS INFANT (< 1 YRS) CPR?

1. SHOUT
2. OPEN AIRWAY
3. LISTEN FOR BREATH
4. 2 BREATH
5. COMPRESSION 30:2 X 2 MINUTES

ADULT & CHILD > 1 YRS

FOREIGN BODY AIRWAY OBSTRUCTION

1. 911
2. ABD THRUST (SITTING OR STANDING)
3. CHEST THRUST (OBESE/PREGNANT)

ADULT UNRESPONSIVE

FOREIGN BODY OBSTRUCTED AIRWAY

1. TONGUE/JAW LIFT LOOK FOR OBJECT
2. CPR
3. LOOK WHEN GIVE 2 BREATHS
4. USE MAGILL FORCEPS

BLS

CHILD/INFANT

NO ADVANCED AIRWAY

1. 30:2 (1 RESCUER)
2. COMPRESSION 100 RATE
3. 15:2 (2 RESCUER)
4. 1/3 - 1/2 DEPTH OF CHEST

ADULT BLS

ADVANCED AIRWAY

1. COMPRESSION 100/MIN
2. NONSYCHRONIZED BREATHS q 6-8 (8-10 MIN)

WHAT DOES REDDNET STAND FOR?

RAPID EMERGENCY DIGITAL DATA INPUT NETWORK

WHAT ARE THE 3 BODY FLUIDS AND WHAT IS THE % OF FLUIDS IN BODY?

1. INTRAVACULAR   7-10%
2. INTERSTITUAL    18-25%
3. INTRACELLULAR  65-75%

WHAT IS CA++ MOST RESPONSIBLE FOR?

MUSCLE

WHAT IS OSMOSIS?

LESSER CONCENTRATION TO HIGHER CONCENTRATION

EXAMPLES OF HYPERTONIC SOLUTIONS

D50

PULLS WATER TO VASCULAR

HYPOTONIC SOLUTION

D5W

WHAT IS NEROTRANSMITTER ACETYLCHOLINE?

PARASYMPATHETIC 

 WHAT IS CATECHOLAMINE?

NEUROTRANSMITTER

SYMPATHETIC

NOREPINEPHRINE

EPINEPHRINE

DOPAMINE

WHAT BODY FUNCTIONS IS THE MEDULLA OBLONGATA RESPONSIBLE?

1. RETICULAR ACTIVATING SYSTEM (RAS)
2. VASCULAR CENTER (PVR)
3. CARDIAC CENTER (INOTROPHY, CHRONOTROPY, AV CINDUCTION, EXCITABILITY
4. RESPIRATORY CENTER
5. ALL RESPOND TO CHEMORECEPTOR

WHAT ARE THE BARORECEPTORS?

1. IN CAROTID AND AORTIC ARCH
2. MEASURES STRETCH OF VESSELS
3. DETECTS CHANGES IN B/P
4. VALSALVA STIMLANTS BAROREPTORS

WHAT DOES THE HYPOTHALMUS REGULATE?

1. BODY TEMP
2. HUNGER
3. THRIST
4. SEX DRIVE
5. EMOTIONS (ANGER, FEAR, PAIN, & PLEASURE)
6. VOMIT REFLEX

WHAT DO THE CENTRAL CHEMORECEPTORS DO?

1. LOCATED IN BRAINSTEM
2. RESPONDS TO CSF - CO2 LEVELS
3. HIGH CO2 - CAUSES RESP/TV TO GO UP
4. LOW CO2 - CAUSES RESP/TV TO GO DOWN

WHAT DOES PHERIPHERAL CHEMORECEPTORS DO?

1. LOCATED IN CAROTID/AORTIC BODIES
2. RESPONDS TO 02 LEVELS IN BLOOD
3. HIGH 02 - DECREASES RR/TV
4. LOW 02 - INCREASE RR/TV

WHAT ARE THE S/S INCREASE ICP FOR

 BRAINSTEM INJURIES?

1. ALTERED MENTAL STATUS
2. PROJECTILE VOMITING
3. DECELEBRATE POSTURING
4. DECORTICATE POSTURING 
5. ABN. RESPIRATION PATTERN
6. HIGH SYSTEMIC BLOOD PRESSURE*
7. WIDENING PULSE PRESSURE*
8. BRADY*

WHAT IS THE S/S INCREASED ICP IN CEREBRAL INJURIES?

1. SEIZURES
2. DILATED PUPILS
3. PERSONALITY CHANGES
4. AMNESIA

WHAT IS CUSHING'S TRIAD?

1. HIGH SYSTOLIC B/P
2. WIDENING PULSE PRESSURE
3. BRADY

WHAT ARE THE EFFECTS OF HYPERCAPNIA (INCREASE CO2)?

1. VASODILATION
2. LETHARGY/ALOC
3. SEIZURES
4. INCREASE INTRACRANIAL PRESSURE

WHAT ARE THE S/S OF HYPOXIA?

(DECREASED O2 TO TISSUES)

1. RESTLESSNESS/ANXIETY/ALOC
2. SEIZURES
3. INCREASE RESPIRATIONS
4. ALTERED MENTAL STATUS
5. CYANOSIS
6. TACHYCARDIA

MOST IMPORTANT CRANIAL NERVES?

1. 3RD CRANIAL NERVE - OCULAR MOTOR
2. 10TH CRANIAL NERVE - VAGUS (LONGEST)

WHAT IS THE PURPOSE OF THE AUTONOMIC

NERVOUS SYSTEM?

1. CONTROLS SMOOTH MUSCLES
2. HEART MUSCLE   
3. BLOOD VESSELS
4. VITAL ORGANS
5. BRONCHIALS
6. MAINTAINS HOMEOSTASIS

WHAT IS ATROPINE?

PARASYMPATHETIC BLOCKER

CHOLINGERGIC BLOCKING AGENT

ANTIDYSRHYTHIC AGENT

DECREASES VAGAL TONE RESULTING INCREASED HEART RATE AND AV CONDUCTION

DECREASES GI SECRETIONS

WHAT IS THE PROTEIN RECEPTOR BETA1

(LOCATED IN THE HEART)?

ONE HEART

TWO LUNGS

FUNCTIONS ARE: 

1. CHRONOTROPIC (HEART RATE)
2. INOTROPIC (CONTRACTIBILITY)
3. AV CONDUCTION
4. IRRITABILITY

WHAT DO PROTEIN RECEPTORS BETA 2 DO?

1. LOCATED IN SMOOTH MUSCLE OF BRONCHIOLES
2. VASODILATION OF ARTERIES
3. DIALATION OF BRONCHIOLES

WHAT DO THE PROTEIN RECEPTOR ALPHA DO?

1. LOCATED IN ARTERILES OF SKIN/GI TRACT/AORTA
2. FUNCTION: ARTERIAL CONSTRICTION

WHAT IS IS PNEUMONIC?

A    /  B

 C  /  D

ALPHA = CONSTRICTS

BETA = DILATES

WHAT DOES LOW DOSE OF DOPAMINE DO?

DILATIONS OF RENAL/MESTENTERIC ARTERIES

WHAT DOES MODERATE DOSE OF DOPAMINE DO?

1. DILATE RENAL
2. BETA 1 INCREASE INOTROPY WITHOUT CHRONOTROPY
3. INCREASE B/P BY INCREASE C.O.
4. USED FOR CARDIAC SHOCK
5.                DISTRIBUTIVE SHOCK

WHAT DOES HIGH DOSE DOPAMINE DO?

1. ALPHA - CONSTRICTS BLOOD VESSEL WHICH INCREASE PVR
2. BETA1 - INCREASES INOTROPY/CHRNOTROPY
3.             INCREASE B/P = VASCONSTRICTION +
4.                                      C.O.

WHAT ARE THE DOSAGES LOW, MOD, HIGH DOPAMINE?

1.  LOW = 6 -12 MGTTS/DOPAMINE RECEPTORS
2.  MOD = 12-60 MGTTS/ DOP/BETA
3.  HIGH = > 60 MGTTS/DOP/BETA/ALPHA

WHAT IS AFTERLOAD?

AFTERLOAD IS THE RESISTANCE AGAINST WHICH THE BLOOD MUST BE PUMP.

WHAT IS DIASYSTOLE?

TIME MYOCARDIUM RELAXES

CARDIAC FILLING TAKES PLACE

WHAT IS RESP DIFFUSION?

GASES GO TO PULMONARY CAPALLARIES

WHAT IS PERFUSION?

BLOOD GOES TO LUNG/PULMONARY BED

S/S

1. BRAIN - ANXIOUS/ALOC
2. HEART - TACHY - EARLY
3. B/P     - LOW B/P - LATE
4. GI      -  N/V
5. SKIN   - COOL/CLAMMY
6. PUPILS DILATE
7. RESP   - TACHYNEA

WHAT IS THE % OF BLOOD LOSS?

• 10-15%-----------500-750 cc  O SYMP
• 20-25%-----------1000-1250cc - INCREASE HR
• 30-35%-----------1500-1750cc - SKIN COOL BP
•                                                NORMAL
• 40-45%-----------2

1. HR - THREADY, WEAK, INCREASED
2. BP - LOW
3. ALOC
4. THRIST
5. SKIN CYANOSIS
6. ALT RESP PATTERN

HYPOVOLEMIC SHOCK

• LOSS OF VOLUME CIRCULATING
• FLUID IN INTRAVASCULAR SPACE
• DECREASE STROKE

1. HEMORRAGE
2. LOSS OF PLASMA (BURNS)
3. 3RD SPACING
4. LOSS OF BODY FLUID (VOMITING/DIARRHEA)

1. DECREASE HR OR STROKE VOLUME
2. DECREASE CO
3. 40% INFARTED
4. GOAL TO INCREASE CONTRACTIBITY AND DECREASE WORKLOAD
5. DECREASE PVR
6. INCREASE DIASYSTOLIC FILLING
7. INCREASE CORONARY PERFUSION

OBSTRUCTIVE SHOCK

1. OBSTRUCTS NORMAL BLOOD FLOW
2. TENSION PNEUMOTHORAX - VENA CAVA
3. CARDIAC TAMPONADE - ERICARDIUM
4. PULMONARY EMBOLUS - PULMONARY ARTERY
5. AORTIC ANEURYM - AORTA

DISTRIBUTIVE SHOCK

1. DEFECT BLOOD VESSELS CAUSES MASSIVE VASODILATION AND/OR INCREASE CAP PERMEABILITY
2. NEROGENIC - SPINAL CORD, DECREASE REFLEX DIALATION
3. DRUGS - MASSIVE VASODILATION
4. SEPSIS - BACTERIA END TOXIN REACTION
5. ANAPHYLAXIS - ANTIGEN/ANTIBODY
6. CRUSH SYNDROME - TOXINS/ACIDS INCREASE

AIR EMBOLUS WHILE USING EXTERNAL IV CATHETHER

1. SOB
2. DECREASE IN BP
3. WEAK PULSE
4. SUDDEN LOC
5. TREATMENT: LT LATERAL TRENDELBERG
6.                   CLAMP CATHETHER

NITROGYCERIN

1. AVOID SYSTOLIC BP <100
2. AVOID IF TAKEN SEX ENHANCING DRUG
3. REASSESS 5 MIN
4.        B/P
5.        PULSE
6.        LOC
7.        RESPONSE TO MED
8.        SKIN SIGNS

TREATMENT OF DECOMPRESSION EMERGENCY

1.  LEFT LATERAL POSITION
2. AIRWAY
3. MONITOR
4. IF LOW BP FLUID
5. HYPOTENSION UNRESPONSIVE TO FC - DOPAMINE
6. SEIZURES - DIAZEPAM 5-10 MG
7. CONTACT MAC FOR ONCALL HYPERARIC MD AND DETERMINATION FO PT DESTINATION

1. APPLY COLD PACK

JELLYFISH TX

1. RINSE SITE WITH STERILE SALINE

1. SCRAPE STINGER OFF SKIN
2. APPLY COLD PACK
3. DO NOT SQUEEZE POISON SAC

SNAKE TX

1. IMMOBILIZE AS MUCH AS POSSIBLE
2. KEEP AFFECTED EXTREMITY BELOW LEVELOF THE HEART

ADMINISTER AMYL NITRATE 1 AMPULE IN CONJUNCTION WITH DECONTAMINATION

CRUSH AMPULE

USE NEW AMPULE Q 2-3 MINUTES

TAPE TO INSIDE OF BVM MASK

VENTILATE FOR 60 SECONDS

REMOVE AMPULE

CONTINUE TO VENTILATE FOR 15 SEC

REPEAT STEPS INTL IV CYANIDE ANTIDOTE AVAILABLE

NERVE AGENTS TX

MILD EXPOSURE

1. MILD EXPOSURE: MIOSIS, RHINORRHEA & SOB    
2. MARK I KIT
3. ATROPINE 2MG
4. PRALIDOXIME CHLORIDE 600MG IM         
5. IF SOB PERSISTS ATROPINE 2 MG IM OR IV
6. GIVE ATROPINE Q 5 MINUTES UNTIL NOT SOB

MIOSIS

CONSTRICTIONS OF PUPIL OF EYE

MODERATE SYSTOMS

NERVE AGENTS

1. MIOSIS, RHINORRHEA, SEVERE SOB AND VOMITING, DIARRHEA
2. 2 MARK I KITS IM ONE AFTER THE OTHER
3. IF SYMPTOMS PERSISTS ATROPINE 2 MG IM OR IV
4. MR ATROPINE Q 5 MIN UNTIL SOB AND GI SYMPTOMS IMPROVE

NERVE AGENT

SEVERE EXPOSURE

• RESP DISTRESS,CYANOSIS, EXTREME SLUDGE, SEIZURES, UNCONSCIOUSNESS
• 3 MARK I KITS IM ONE AFTER THE OTHER VALIUM 10 MG IM OR 5-10 IV
• IF PERSISTS ATROPINE Q 5 MIN

   TOTAL OF 3 MARK I KITS

PULMONARY IRRITANTS

PHOSGENE

1. LIMIT PT EXERTION TO PREVENT ACCELERATION OF LUNG DAMAGE (DO NOT USE LASIX TO TX PUL EDEMA)

PULMONARY IRRITANTS

AMMONIA

FLUSH SKIN AND EYES WITH COPIOUS AMTS OF WATER AND IRRIGATE EYES CONTINUOUSLY PRM

CHLORIDE TX

FLUSH SKIN AND EYES WITH COPIOUS AMT OF WATER PRM

HYPERTHERMIA

PERFUSING

1. ENCOURAGE PO FLUIDS
2. FLUID CHALLENGE

HYPERTHERMIA

POOR PERFUSION

1. IF ALOC CHECK BS
2. FLUID RESUSCITATION
3. MOVE TO COOL ENVIRNMENT
4. REMOVE CLOTHING
5. WET WITH WATER AND PROMOTE COOLING BY FANNING

SVT

TX

PERFUSING

1. VASALVA
2. ADENOSINE 6 MG
3. ADENOSINE 12MG IN 1-2 MIN

SVT

NARROW COMPLEX

TX

POOR PERFUSION

1. IF CONSCIOUS: ADENOSINE 6 MG
2. SEDATION FOR AWAKE: VALIUM TO 10 MG
3. SYNCHRONIZED CARDIOVERSION UP TO 4X

VENTRICULAR TACH

WIDE COMPLEX

WITH PULSES

PERFUSING

TX

1. MONITOR

VENTRICULAR TACH

WIDE COMPLEX

WITH PULSES

TX

1. SEDATION IN AWAKE PT
2. SYNCHRONIZED CARDIOVERSION UP TO 4 X

ALLERGIC REACTION

MILD RESPIRATORY DISTRESS PERFUSING

TX

1. EPINEPHRINE (1:1000) 0.3 MG SQ
2. IF WHEEZING ALBUTEROL 5 MG HHN
3. BENEDRYL 50 - 100 MG IVP

ALLERGIC REACTION

SEVERE RESP. DISTRESS

POOR PERFUSION

TREATMENT

1. SHOCK POSITON PRN
2. EPINEPHRINE 1:10,000 0.1 MG IVP
3. MAY REPEAT Q 3 MINUTES
4. HYPOTENSIVE - FC
5. IF FC UNSUCCESSFUL - DOPAMINE 400/500 START AT 30 MCGTTS/MIN

HYPERTENSIVE

TREATMENT

• FOWLERS POSITION
• IV

  ALOC

  CP

  EPISTAXIS

  FOCAL NEUROLOGIC DEFICITS

  HEADACHE

  N/V

  PARESTHESIA

  SOB

  VISUAL DISTURBANCES

  DIZZINESS/VERTIGO

EMERGENCY CHILDBIRTH

PULSE > 60 MIN

1. ASSIST DELIVERY,IF AMNIOTIC SAC INTACT, PINCH AND TWIST THE MEMBRANE TO RUPTURE CHECK CORD
2. SUCTION MOUTH, THEN NOSE
3. CLAMP  AND CUT CORD
4. STIMULATE BY VIRGOUSLY DRYING NEWBORN WITH TOWEL
5. WRAP IN THERMAL BLANKET, DRY TOWEL, KEEP WARM
6. REASSESS RESPIRATIONS AND PULSES FREQ
7. IF PULSE 60-100 AND NOT RISING, BVM FOR 30 SECONDS
8. CHECK PULSES

EMERGENCY CHILDBIRTH

PULSE LESS THAN 60

TREATMENT

1. ASSIST DELIVERY
2. IF AMNIOTIC SAC INTACT, PINCH AND TWIST THE MEMBRANE TO RUPTURE
3. SUCTION MOUTH THEN NOSTRIL
4. CLAMP AND CUT CORD
5. STIMULATE BY VIGOROUSLY DRYING NEW BORN WITH TOWEL
6. OXYGEN
7. IF PULSE LESS THAN 60/MIN BVM VENTILATION FOR 30 SEC./CHECK PULSES
8. IF PULSE REMAINS <60/MIN AND NOT RISING BEGIN CHEST COMPRESSION AT 120/MIN
9. BVM USED "SQUEEZE-RELEASE-RELEASE" TECHNIQUE.

DNR

1. SPECIFIES RESUSCITATIVE MEASURES AND SUPPORTIVE MEASURES WHEN DEATH APPEARS IMMINENT.
2. FAMILY CAN REVERSE.
3. PATIENTS SIGNATURE
4. PHYSICIANS SIGNATURE

AHCD

1. SPECIFIES RESUSCITATIVE MEASURES AND SUPPORTIVE MEASURES WHENPT IS INCAPACITATED.
2. FAMILY MAY NOT REVERSE.
3. MAY NAME AN AGENT TO MAKE HEALTH CARE DECISIONS IN CASE PT IS INCAPACITATED.
4. PATIENT'S SIGNATURE
5. TWO WITNESSES SIGNATURES OR NOTARY PUBLIC

ATROPINE ADVERSE REACTIONS

1. TACHYCARDIA
2. INCREASE MYOCARDIAL O2 DEMAND
3. SEIZURES
4. DIZZINESS
5. CONFUSION DILATED PUPILS
6. BLURRED VISION
7. DIFFICULTY SWALLOWING
8. DRY MOUTH

 DO NOT GIVE ATROPINE TO NEONATES

ET PLACEMENT USING EID

ALLOW BULB TO SELF EXPAND; IF BULB EXPANDS IN <= 5 SEC IN THE TRACHEA

PVAD

MEDICATION ADMINSTRATION

1. STERILE GLOVES
2. PORT WITH ALCOHOL
3. UNCLAMP CATHETER
4. USING 10 CC SYRINGE ---INJECT 5 ML OF NS, IF MEET RESISTANCE, DONT USE.
5. ASPIRATE FOR BLOOD RETURN. IF NO BLOOD RETURN, RECLAMP CATHETER AND DONT USE.

ALTERED LEVEL OF CONSCIOUSNESS/WEAKNESS/DIZZINESS/SYNCOPE

CAUSES

1. A    ALCOHOL, ANOXIA, ALLERGIC REACTION
2. E    EPILEPSY, ELECTROLYTE IMBALANCE
3. I    INSULIN (HYPO/HYPERGLYCEMIA)
4. O   OVERDOSE
5. U   UREMIA, UNDER-DOSE
6. T   TRAUMA
7. I    INFECTION
8. P   PSYCHIATRIC, POST-ICTAL,POISONING, (INGESTION,INHALATION) PALPITATION (DYSRHYTHMIA)
9. S   STROKE

NORMAL PULSE RATE

ADULT

CHILD

INFANT

ADULT 60 -100

CHILD 80 - 120

INFANT 90 -160

1. RADIAL APPROX > 80 SYS
2. BRANCHIAL        >70 SYS
3. FEMORAL           >70 SYS
4. CAROTID           >60 SYS

TREAT

MILD

ALLERGIC RX

1. AIRWAY
2. 02
3. MONITOR
4. IV
5. EPINEPHRINE 1:1,000 0.3 MG SQ  MAY REPEAT X2 EVERY 20 MINUTES
6. IF WHEEZING, ALBUTEROL 5 MG
7. BENADRYL 50-100 MG SLOW IVP
8. SIMPLE HIVES ARE NOT TREATED IN FIELD

TREAT

ALLERGY/ANAPHYLAXIS

SEVERE RESP. DISTRESS

POOR PERFUSION

1. AIRWAY
2. O2
3. SHOCK PRN
4. MONITOR
5. IV
6. EPINEPHRINE 1:10,000 0.1 MG IVP*** MRX3!!!
7. IF B/P LOW, FLUID CHALLENGE (RALES?)
8. IF FAILS, DOPAMINE 400 MG/500CC START AT 30 MGTTS/MIN
9. WHEEZES? ALBUTEROL 5 MG MR PRN

TREAT

BRADYCARDIA

POOR PERFUSION

1. AIRWAY/O2/MONITOR/IV
2. GET PACER
3. IF 2ND  II OR 3RD DEGREE HB DONOT DELAY FOR IV.
4. IF AWAKE VALIUM OR MORPHINE UP TO 10 MG IVP
5. ATROPINE 0.5 MG IVP WHILE WAITING FOR PACER ( Q 3-5 MIN. MAX DOSE 3 MG )
6. EKG IF POSSIBLE CARDIAC EVENT
7. CONSIDER FLUID CHALLENGE/ RALES?
8. CONSIDER DOPAMINE 400MG/500CC START AT 30 MGTT/MIN

SVT

PERFUSING

1. PROCEDURES PRIOR TO BASE CONTACT
2. UNCONSCIOUS CARDIOVERT IMMEDIATELY
3. VALSALVA
4. ADENOSINE 6 MG IVP RAPID IVP FOLLOWED BY 10-20 ML RAPID FLUSH NS
5. ADENOSINE 12 MG IN 1-2 MINUTES

SVT

POOR PERFUSION

1. PROCEDURES PRIOR TO BASE CONTACT
2. UNCONSCIOUS CARDIOVERT IMMEDIATELY
3. IF CONSCIOUS ADENOSINE 6 MG RAPID IVP
4. CONSIDER SEDATION IN AWAKE PT - VALIUM UP TO 10 MG TO SEDATION (MAX 20 MG)
5. SYNCHRONIZED CARDIOVERSION UP TO 4X (100, 200, 300, 360 WS)
6. ADENOSINE CONTRAINDICATIONS:  2ND OR 3RD DEGREE HEART BLOCK. TAKING PERSANTINE OR TEGRETOL, HX OF SSS.

V TACH WITH PULSES

PERFUSING

MONITOR

VTACH WITH PULSES

POOR PERFUSION

1. SEDATION WITH AWAKE PT - VALIUM UP TO 10 MG (20MG MAX)
2. SYCHONIZED CARDIOVERSION UP TO 4X:  100, 200, 300, 360j BIPHASIC
3. MONITOR DOES NOT DISCHARGE ON "SYNC" TURN OFF SYNCH AND DEFIBRILLATE.

1. HYPOGLYCEMIA
2. HYPOVOLEMIA
3. HYPO/HYPERKALEMIA
4. HYPOTHERMIA
5. HYDROGEN ION
6. HYPOXIA
7. TRAUMA
8. TOXINS
9. THROMBUS
10. TENSION PNEUMO
11. TAMPONADE

1. AIRWAY/CPR/MONITOR
2. CONFIRM IN TWO LEADS IF ASYSTOLE
3. IF DOUBT - TX FINE VFIB
4. IV
5. EPINEPHRINE 1 MG IV/IO Q 3-5 MIN 1:10,000
6. NO IV/IO ---ET 2MG
7. ATROPINE 1 MG Q 3-5 MIN MAX 3 MG -----2 MG ET
8. CONSIDER CAUSE
9. CONSIDER D50, CAL CHLORIDE 1 GM IV/IO, NARCAN 0.8-2MG IV/IO 2-4 MG ET
10. RESUSCITATE ON SCENE UNTIL ROSC
11. CONSIDER PRONOUNCEMENT OR TRANSPORT PER BASE ORDERS

DECOMPRESSION

EMERGENCY

1. AIRWAY/IMMOBILIZATION
2. HIGH FLOW 02
3. LT LATERAL TRENDELBERG POSITION
4. ADVANCED AIRWAY/MONITOR
5. IV - IF HYPOTENSION FLUID CHALLENGE
6. DOPAMINE 200 MG/250CC NS AT 30 MCGTTS/MIN
7. IF ACTIVE SEIZURE WITH ALOC - VALIUM 5-10 MG ( MAX 20 MG)

BEE STINGS

1. SCRAPE STINGER OFF SKIN (USE CREDIT CARD)
2. APPLY COLD PACK.
3. DO NOT SQUEEZE POISON SAC.

JELLY FISH

1. RINSE SITE WITH STERILE SALINE

1. IMMOBILIZE AS MUCH AS POSSIBLE

1. KEEP AFFECTED EXTREMITY BELOW LEVEL OF THE HEART.

1. COLD PACK

STINGRAY/SCULPIN

HYPOTHERMIA

FROSTBITE

1. HANDLE AFFECTED AREA GENTLY
2. REMOVE CONSTRICTIVE JEWELRY
3. COVER AD PROTECT AFFECTED AREA
4. DO NOT ALLOW AFFECTED AREA TO THAW AND THEN REFREEZE.

Pulmonary Irritates

PHOSGENE

1. CONTACT HAZMAT RESOURCES
2. SECURE AREA AND ESTABLISH INCIDENT SITE
3. ENSURE DECONTAMINATION PROCEDURES ARE COMPLETED BEFORE TX OR TRANSPORT TO FACILITY
4. AIRWAY/02/MONITOR/IV
5. HYPOTENSION - FLUID CHALLENGE
6. WHEEZING - ALBUTEROL
7. LIMIT PT EXDERTION TO PREVENT ACCELERATION OF LUNG DAMAGE.
8. DO NOT USE LASIX FOR TREATING PULMONARY EDEMA.
9. CONTINUOUS FLUSHING C NS DURING TRANSPORT.
10. LIMIT PT EXERTION TO PREVENT ACCELERATION OF LUNG DAMAGE
11. DO NOT USE LASIX FOR PULMONARY EDEMA

PULMONARY

IRRITANT

 AMMONIA

1. CONTACT HAZMAT
2. SECURE AREA AND ESTABLISH INCIDENT SITE
3. AIRWAY/IMM/02/MONITOR/IV
4. HYPOTENSIVE - FLUID CHALLENGE
5. WHEEZING - ALBUTEROL
6. FLUSH SKIN/EYES WITH COPIOUS AMTS OF WATER
7. IRRIGATE EYE CONTINUOUS DURING TRANSPORT.

PULMONARY IRRITATE

AMMONIA

1. CONTACT HAZMAT RESOURCES
2. SECURE AREA AND ESTABLIHS INCIDENT SITE
3. WEAR PROTECGTIE EQUIPENT/GEAR
4. ENSURE DECONTAMINATION PROCEDURES ARE COMPLEDTED BEFORE TREATMENT OF TRANSPORT TO FACILITY
5. CONTINUOUS FLUSHING OF EYE WITH NS DURING TRANSPORT/ REMOVE CONTACTS
6. DYSRTHYMIAS COMMON WITH TOXIC INHALATION - SEE GUIDELINES

PULMONARY

IRRITATE

CHLORINE

1. CONTACT HAZMAT
2. SECURE AREA AND ESTABLISH INCIDENT SITE
3. AIRWAY/IMM/O2/ MONITOR/IV PRN
4. HYPOTENSION - FC
5. WHEEZING - ALBUTEROL
6. FLUSH SKIN AND EYES WIT COPIOUS AMTS OF WATER
7. DYSHYTHMIAS - GUIDELINES PRN

NERVE AGENT

  MILD

MIOSIS, RHORRHEA, SOB

SARIN

SOMAN

TABUN

VX

OTHERS

1. CONTACT HAZMAT
2. SECURE AREA AND ESTABLISH INCIDENT SITE
3. AIRWAY/02/MONITOR/IV PRN
4. HYPOTENSIVE? - FC
5. WHEEZING? - ALBUTEROL
6. 1 MARK I KIT (ATROPINE 2 MG & PRALIDOXIME CHLORIDE 600 MG IM
7. IF SOB PERSISTS ATROPINE 2MG IM OR IV
8. MAY REPEAT ATROPINE EVERY 5 MIN UNTIL SOB RESOLVED
11. IF SOB PRESISTS ATROPINE 2MG IM/IV
12. MAY REPEAT ATROPINE Q 5 MIN UNTIL NO LONGER SOB

NERVE AGENT

MODERATE

MIOSIS, RHINORRHEA, SEVERE SOB, N/V, DIARRHEA

1. CONTACT HAZMAT
2. SECURE AREA
3. AIRWAY/02/MONITOR/IV PRN
4. 2 MARK I KITS IM, ONE AFTER THE OTHER.
5. IF SYMPTOMS PERSIST, ATROPINE 2 MG IM/IV.
6. ATROPINE 2 MG EVERY 5 MIN UNTIL SOB, DIARRHEA.

NERVE AGENT

 SEVERE

SOB, CYANOSIS, EXTREME SLUDGE, SEIZURE, UNCONSCIOUS

SALVATION

LACRIMATION

URINATION

DYSPNEA/WHEEZING

DIARRHEA

EMESIS

1. CALL HAZMAT
2. SECURE AREA
3. 02/MONITOR/IV PRN
4. HYPOTENSION? - FC
5. WHEEZING? - ALBUTEROL
6. 3 MARK I KITS ONE AFTER THE OTHER-TOTAL3
7. VALIUM 10 MG IM OR 5-10MG IVP
8. IF PERSISTS ATROPINE 2 MG IVP MR Q 5MIN.

1. AMYL NITRATE 1 AMPULE
2. CRUSH AMPULE
3. NEW AMPULE Q 2-3 MINUTES
4. INSIDE BVM VENTILATE 60 SEC
5. REMOVE AMPULE
6. CONTINUE TO VENTILATE FOR 15 SEC
7. REPEAT CYANIDE IV ANTIDOTE AVAILABLE
8. DYSRTHYMIA? GUIDELINE

1. PENETRATING CRANIAL
2. BLUNT CRANIAL ASS WITH ALOC(GSC =<14,EXCLUDING PT <1YR), SEIZURE, UNEQUAL PUPILS, OR FOCAL NEROLOGICAL DEFICIT
3. PENETRATING NECK
4. BLUNT THORARIC WITH FLAIL CHEST
5. PENETRATING TORSO WITH CARDIAC ARREST
6. GSW TO TRUNK
7. DIFFUSE ABD TENDERNESS
8. FALL >15 FT
9. PSI
10. SPINAL INJURY WITH SENSORY DEFICIT OR WEAKNESS TO ONE OR MORE EXTREMITY
11. EXTREMITY INJURY C NEURO/CIRC COMPROMISE EXCLUDING FEET/HANDS
12. PENETRATINGTHORARIC BETWEEN MID CLAVICULAR LINES
13. BP <90 ADULTS, BP < 70 PED

TRIAGE GUIDELINES

MECHANISM OF INJURY

1. SURVIVOR OF FATAL ACCIDENT C/O INJURY
2. PEDESTRIANS STRUCK BY AUTOMOBILE
3. EJECTED FROM VEHICLE
4. REQUIRING EXTRICATION
5. VERY YOUNG AND VERY OLD

EXTREMIS PATIENTS

1. IMMEDIATE TRANSPORT TO MAR
2. OBSTRUCTED AIRWAY
3. AS DETERMINED BY THE BASE HOSPITAL WHOSE LIVES WOULD BE JEOPARDIZED OTHERWISE NOT GOING TO MAR

DETERMINATION OF DEATH

NO BASE CONTACT REQUIRED

1. DECAPITATION
2. MASSIVE CRUSH INJURY
3. PENETRATING OR BLUNT INJURY WITH EVISCERATION OF HEART, LUNG OR BRAIN
4. DECOMPOSITION
5. INCINERATION
6. PULSELESS, NON-BREATHING VICTIMS WITH EXTRICATION TIME GREATER THAN 15 MIN WHERE NO RESUSCITATIVE MEASURES CAN BE PERFORMED PRIOR TO EXTRICATION.
7. BLUNT TRAUMA PTS WHO BASED ON PARAMEDICS THOROUGH PTS ASSESSMENT  ARE FOUND APNEIC, PULDSELESS, AND WITHOUT ORGANIZED EKG ACTIVITY UPON THE ARRIVAL OF EMS AT THE SCENE.
8. PULSELESS, NON-BREATHING VICTIMS OF A MULT VICTIM INCIDENT WHERE INSUFFICIENT MEDICAL RESOURCES PRECLUDE INITIATNG RESUSCITATIVE MEASURES.
9. RIGOR MORTIS
10. POST-MORTEM LIVIDITY

1. has an open airway
2. look listen and feel for respirations.
3. AUSCULTATE LUNGS 30 SEC FOR APNEA
4. AUSCULTATE APICAL 60 SEC ADULTS
5. PALPATE CAROTID PULSE 60 SEC PEDS
6. PALPATE BRANCHIAL PULSE 60 SEC INFANTS
7. CHECK PUPILLARY RESPONSE
8. RESPOND TO PAIN STIMULI

NONTRAUMATIC FULL ARREST

REQUIRES BLS UNTIL ONE OF FOLLOWING MET

THEN PT DETERMINED DEAD

1. VALID DNR
2. AHCD WITH WRITTEN DNR
3. AGENT IDENTIFIED IN AHCD REQUESTING DNR
4. WITHOUT SAID DOCUMENT OTHER FAMILY MEMBERS IN AGREEMENT
5. PARENTS AT SCENE OF CHILD UNDER 18 TO DISCONTINUE CPR
6. IN ASYSTOLE AND TIME HAS BEEN >10 MIN ACCORDING TO BYSTANDING

WHICH CAN A FAMILY REVERSE?

DNR VS. AHCD

1. SPECIFIES RESUSCITATIVE MEASURE AND SUPPORTIVE MEASURES WHEN DEATH APPEARS IMMINENT.
2.  FAMILY CAN REVERSE.
3. PTS SIGNATURE
4. MD SIGNATURE

1. SPECIFIES RESUSCITATIVE MEASURES AND SUPPORTIV E MEASURES WHEN PT IS INCAPACITATED.
2. FAMILY MAY NOT REVERSE.
3. PT SIGNATURE
4. 2 WITNESSES SIGNATURE OR NOTARY PUBLIC

1. CHILDREN UNDER 12 YRS OR < 40 KG SHALL BE MANAGED WITH BVM VENTILATION, NASOPHARYNGEAL (NP), OR OROPHARYNGEAL (OP) AIRWAY
2. ECT MAY BE USED ON PT =>16 YRS  WHO ARE >4FT - <6FT 5IN (SM SIZE)
3. CANT USE NP IN INFANTS
4. CAN ONLY USE OP IF NOT GAG

FIELD PROTOCOL M9

OVERDOSE/POISONING

1. ABC
2. 02 15L
3. IV - NS TKO (FC LOW BP)
4. MONITOR
5. LEFT LATERAL/SHOCK POSITION
6. NARCAN 0.8-2MG FOR OPIATE OVERDOSE
7. D50 1 AMP 50CC IVP SLOW PRNB IF BL SUGAR <80

1. MORPHINE SULFATE
2. DILAUDID
3. HEROIN
4. CODEINE

1. Adapin (doxepin)
2. Anafranil (clomipramine)
3. Elavil (amitriptyline)
4. Endep (amitriptyline)
5. Ludiomil (maprotiline)
6. Norpramin (desipramine)
7. Pamelor (nortryptyline)
8. Pertofrane (desipramine)
9. Sinequan (doxepin)
10. Surmontil (trimipramine)
11. Tofranil (imipramine)
12. Vivactil (protriptyl)

1. S - S+S
2. A - ALLERGIES
3. M - MEDS
4. P - PAST MED HX
5. L - LAST ORAL INTAKE
6. E - EVENTS LEADING UP TO CURRENT PROBLEMS

WHAT CONDITIONS COULD BE

RESP DISTRESS

NONCARDIAC

RALES?

1. OVERDOSE
2. PNEUMONIA
3. NEAR DROWNING
4. INHALATION INJURIES

WHAT IS THE TREATMENT OF

RESPIRATORY?

1. AIRWAY/02/MONITOR/IV PRN
2. NO NTG

RESP DISTRESS

WHEEZES

1. AIRWAY/02/MONITOR/IV
2. ALBUTEROL 5 MG HHN
3. MAY REPEAT PRN
4. CONSIDER EPINEPHRINE 1:1,000 0.3MG SQ
5. REPEAT Q 20 MIN X2

1. WHEEZING MAY BE AN INITIAL SIGN OF PULMONARY EDEMA, THATEFORE. REASSESS BREATH SOUND FREQUENTLY.

ACUTE STOKE/NEURO DEFICITS

PROTOCOL

1. AIRWAY/02/MONITOR/IV
2. BLOOD GLUCOSE TEST
3. FAST MG MD?

1. AIRWAY/02/MONITOR/IV
2. BLOOD GLUCOSE PRN
3. DEXTROSE MAY REPEAT X1
4. DYSRHYTHMIA?