Purpose:

* Sepsis is a life-threatening medical emergency caused by your body’s overwhelming response to an infection. It causes extensive inflammation throughout your body that can lead to tissue damage, organ failure and even death.
* Goal of therapy is to recognize Sepsis early and perform interventions to assist with better patient outcomes.

Notes:

* '''Any patient requiring ACLS care should have an ALS intercept if logistically possible.'''

'''''EMR/EMT - EMERGENCY MEDICAL RESPONDER'''''

# Provide routine medical care as indicated.
# Administer oxygen if indicated.
# Assist ventilations if RR < 8/min or > 35/min.
# Assess for hypotension/ shock (HR >130, cap refill > 2 seconds) & follow Medical Hypotension / Shock protocol.
# '''Call for ALS intercept'''

'''''EMT- EMERGENCY MEDICAL TECHNICIAN''''' ''PERFORM/CONFIRM ALL ABOVE INTERVENTIONS''

# Ensure ALS intercept is en route.
# Transport as early as possible
# Measure blood sugar if indicated, follow hypoglycemia protocol
# Reassess VS & lung sounds often during transport
# Apply EtCO2
# Recognize the Presence of Systemic Inflammatory Response Syndrome (SIRS):
## Heart rate > 90
## Respiratory rate > 20
## Temp > 100.4 F or < 96.8 F
# Apply ECG monitor & run strip (if trained, if time allows, and after all other interventions are completed).
# Perform 12-lead ECG (if trained) as indicated.
# '''Contact Medical Control.'''

'''''AEMT – ADVANCED EMERGENCY MEDICINE TECH PERFORM/CONFIRM ALL ABOVE INTERVENTIONS'''''

# Initiate IV (Do not delay transport).
# Administer '''NS fluid bolus''', TKO (Up to 1,000mL).
# Report Lung Sounds.

'''''INTERMEDIATE/PARAMEDIC PERFORM/CONFIRM ALL ABOVE INTERVENTIONS'''''

# Attach cardiac monitor if not already done,
# Administer '''NS fluid bolus''' up to a total of 1000 mL '''-IF-'''
## Symptomatic, no dysrhythmia & lungs are clear
# Reassess VS, lung sounds & rhythm frequently
# Consider Septic Shock when the following criteria are met:
## Presence of Systemic Inflammatory Response Syndrome (SIRS):
### Heart rate > 90
### Respiratory rate > 20
### Temp > 100.4 F or < 96.8 F
## Suspected infection
## Signs of hypoperfusion
### Including EtCO2 <26 on two consecutive readings 5 minutes apart
# If the criteria for Septic Shock are met, consider alerting receiving facility of the concern for aseptic patient. '''CONTACT MEDICAL CONTROL'''
# May administer additional '''NS fluid bolus''', as directed, after a total of 500 mL '''-IF'''
## Symptomatic, no dysrhythmia & lungs are clear.
# May administer '''Push Dose Epinephrine''' to maintain blood pressure / tissue perfusion.
## Push Dose Epi 5-20 mcg IV q5 PRN
## Epi Infusion 1-20mcg/min
# Consistent Hypotension consider 2nd liter of NS if not previously administered
# Confirm all above interventions were completed

2025-06-19T17:19:44Z

Cgabryszek:

5 - Procedures

2024-05-29T19:37:35Z

Cgabryszek:

Notes:

• For patients < 18 years old, contact medical control for management recommendations.

'''EMR/EMT - EMERGENCY MEDICAL RESPONDER'''

# Provide routine medical care as indicated.
# Oxygen – High Flow, assist with ventilations as indicated.
# Treat for signs and symptoms of shock as indicated.
# Control bleeding as indicated.
# Spinal Motion Restriction as indicated.
# If pulseless, treat for cardiac arrest as indicated.

'''EMT- EMERGENCY MEDICAL TECHNICIAN'''

''PERFORM/CONFIRM ALL ABOVE INTERVENTIONS''

# Assure ALS intercept is en route.
# Apply ECG monitor & run strip (if trained, if time allows, and after all other interventions are completed).
# Perform 12-lead ECG (if trained) as indicated.
# Monitor for signs of hyperkalemia:

# Peaked T-waves
# Widened QRS complex
# Lengthening QT interval
# Absent P-waves

'''AEMT – ADVANCED EMERGENCY MEDICINE TECH'''

''PERFORM/CONFIRM ALL ABOVE INTERVENTIONS''

# Initiate IV/IO.
# Administer NS fluid bolus, 1,000 mL wide open (do not delay transport).

'''INTERMEDIATE/PARAMEDIC'''

''PERFORM/CONFIRM ALL ABOVE INTERVENTIONS''

# Address pain per Pain Management and/or Trauma-Prolonged Extrication Guidelines.
# For crush injuries lasting GREATER THAN 2 HOURS, and with EKG/monitor evidence for HYPERKALEMIA (Peaked T-waves, Absent P-waves, Widened QRS complex), administer:
## Albuterol 5mg in 6ml normal saline via nebulizer
## Sodium Bicarbonate 1mEq/kg IV, delivered over sixty (60) seconds
## Calcium Chloride 1gm IV
## NOTE: Flush the IV tubing well between injections when administering Calcium Chloride and Sodium Bicarbonate in sequence. When these drugs are mixed, a milky precipitate (calcium carbonate) may result.
# Special Considerations:
##Monitor for signs of Compartment Syndrome (severe swelling/tightness of an extremity with loss of pulses/sensation).
###Usually requires compression for 6+ hours.
##Tourniquets should only be used for hemorrhage control.

'''''Contact Medical Control if a physician is needed at the scene for surgical extrication.'''''

3-11 CRUSH INJURY

2024-05-29T19:36:01Z

Cgabryszek: Created page with "Notes: • For patients < 18 years old, contact medical control for management recommendations. '''EMR/EMT - EMERGENCY MEDICAL RESPONDER''' # Provide routine medical care as indicated. # Oxygen – High Flow, assist with ventilations as indicated. # Treat for signs and symptoms of shock as indicated. # Control bleeding as indicated. # Spinal Motion Restriction as indicated. # If pulseless, treat for cardiac arrest as indicated. EMT- EMERGENCY MEDICAL TECHNICIAN PERFO..."

Notes:

• For patients < 18 years old, contact medical control for management recommendations.

'''EMR/EMT - EMERGENCY MEDICAL RESPONDER'''

# Provide routine medical care as indicated.
# Oxygen – High Flow, assist with ventilations as indicated.
# Treat for signs and symptoms of shock as indicated.
# Control bleeding as indicated.
# Spinal Motion Restriction as indicated.
# If pulseless, treat for cardiac arrest as indicated.

EMT- EMERGENCY MEDICAL TECHNICIAN PERFORM/CONFIRM ALL ABOVE INTERVENTIONS

# Assure ALS intercept is en route.
# Apply ECG monitor & run strip (if trained, if time allows, and after all other interventions are completed).
# Perform 12-lead ECG (if trained) as indicated.
# Monitor for signs of hyperkalemia:

# Peaked T-waves
# Widened QRS complex
# Lengthening QT interval
# Absent P-waves

AEMT – ADVANCED EMERGENCY MEDICINE TECH

PERFORM/CONFIRM ALL ABOVE INTERVENTIONS

# Initiate IV/IO.
# Administer NS fluid bolus, 1,000 mL wide open (do not delay transport).

INTERMEDIATE/PARAMEDIC PERFORM/CONFIRM ALL ABOVE INTERVENTIONS

# Address pain per Pain Management and/or Trauma-Prolonged Extrication Guidelines.
# For crush injuries lasting GREATER THAN 2 HOURS, and with EKG/monitor evidence for HYPERKALEMIA (Peaked T-waves, Absent P-waves, Widened QRS complex), administer:
## Albuterol 5mg in 6ml normal saline via nebulizer
## Sodium Bicarbonate 1mEq/kg IV, delivered over sixty (60) seconds
## Calcium Chloride 1gm IV
## NOTE: Flush the IV tubing well between injections when administering Calcium Chloride and Sodium Bicarbonate in sequence. When these drugs are mixed, a milky precipitate (calcium carbonate) may result.
# Special Considerations:

A. Monitor for signs of Compartment Syndrome (severe swelling/tightness of an extremity with

loss of pulses/sensation).

1) Usually requires compression for 6+ hours.

B. Tourniquets should only be used for hemorrhage control.

Contact Medical Control if a physician is needed at the scene for surgical extrication.

3 - Adult Trauma

2024-05-29T19:35:34Z

Cgabryszek:

[[3-1 INITIAL TRAUMA CARE]]

[[3-2 SELECTIVE SPINAL PROTECTION]]

[[3-3 TRAUMA-CARDIAC ARREST]]

[[3-4 TRAUMA-CHEST]]

[[3-5 TRAUMA-ABDOMINAL PAIN]]

[[3-6 TRAUMA-BURNS]]

[[3-7 TRAUMA-NEAR DROWNING]]

[[3-8 TRAUMA-EXTREMITY]]

[[3-9 TRAUMA-EYE INJURY]]

[[3-10 TRAUMA-PROLONGED EXTRICATION-PAIN]]

[[3-11 CRUSH INJURY]]

4-2 PEDIATRIC ALTERED MENTAL STATUS-HYPOGLYCEMIA

2024-04-30T14:53:23Z

Cgabryszek:

{| class="wikitable"
|'''EMR - Emergency Medical Responder'''
|}

# Establish patient responsiveness. If cervical spine trauma is suspected, manually stabilize the spine.
# Assess the patient’s airway of patency, protective reflexes and the possible need for advanced airway management. Look for signs of airway obstruction and if present proceed as per airway obstruction protocol.
# Open the airway via chin lift or modified jaw thrust.
# Suction as necessary
# Consider placing an oropharyngeal or nasopharyngeal airway adjunct if the airway cannot be maintained with positioning and the patient is unconscious.
# Assess patient breathing, including mental status rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
# If signs of respiratory arrest or respiratory failure with inadequate breathing are present, assist ventilation using a B-V-M device with 100% oxygen.
# If breathing is adequate, place the child in a position of comfort and administer high-flow 100% oxygen as tolerated.
# Assess circulation and perfusion.
# '''Call for ALS intercept'''

{| class="wikitable"
|'''EMT - Emergency Medical Technician''' ''Perform/Confirm All Above Interventions''
|}

# Assess patient breathing, including mental status, rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
# Check blood glucose and if less than 60 mg/dL, administer '''Glucagon''' 0.1 mg/kg IM (Max dose 1 mg if weight >20kg and 0.5 mg if weight < 20 kg).
# Initiate transport and '''Contact MEDICAL CONTROL''' to request ALS intercept.

{| class="wikitable"
|'''AEMT – Advanced Emergency Medicine Tech ''' ''Perform/Confirm All Above Interventions''
|}

# Assess patient breathing, including rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
# Consider need for vascular access and administer NS at a TKO rate if indicated. If IV access unlikely or cannot be obtained in 2 attempts in a child less than 6 do not attempt further IV placement.
# If vascular access obtained, recheck blood glucose and if less than 60, administer Dextrose according to the following:
##Administer 5mL/kg of D10 up to 125mL
### This dose is for all ages (newborn - adult size)
### If blood glucose remains <60, a repeat does may be administered.
## If vascular access unavailable, consider glucagon administration as above.
# '''Contact MEDICAL CONTROL''' '''to request ALS intercept''' and for orders regarding rate of fluid administration or further medication order, including consideration for administration of '''naloxone (Narcan),''' 0.1 mg/kg (max dose 2 mg total).

{| class="wikitable"
|'''Intermediate -''' ''Perform/Confirm All Above Interventions''
|}

# Consider alternate causes of altered mental status, including dehydration, head trauma, seizures and drug intoxication and treat appropriately.
# Evaluate for need for endotracheal intubation.
# Initiate transport.
# '''Contact MEDICAL CONTROL''' for further orders.

{| class="wikitable"
|'''Paramedic -''' ''Perform/Confirm All Above Interventions''
|}

2-16 ADULT HYPOGLYCEMIA

2024-04-30T14:51:54Z

Cgabryszek:

The true diabetic emergency is that of hypoglycemia (low blood sugar). This can cause seizures and be fatal if not rapidly recognized and treated. In the field, when a known diabetic patient is unresponsive and no means to obtain a blood sugar level is available, assume the patient is hypoglycemic.

{| class="wikitable"
|'''EMR - Emergency Medical Responder'''
|}

# Initial assessment
## Last oral intake
## Assess if the patient is on diabetic medications, and if so, when was the last dose.
## Symptoms onset
## Is there a history of recent infections, poor food intake and/or vomiting?
# If the patient is awake with intact gag reflex, administer one tube of glucose. '''NEVER PUT ANYTHING IN THE MOUTH OF A PATIENT WHO HAS A SIGNIFICANT DECREASE IN LEVEL OF CONSCIOUSNESS.'''

{| class="wikitable"
|'''EMT - Emergency Medical Technician''' ''Perform/Confirm All Above Interventions''
|}

# Perform glucometry
## If greater than 60 assess for other causes of altered mental status.
## If less than 60, or known diabetic with symptoms of hypoglycemia and unable to obtain glucose measurement, treat as hypoglycemic.
# '''Consult Medical Control''' for order to administer 1 mg of glucagon IM. Hypoglycemia should resolve within several minutes. Consider ALS intercept if patient does not respond.
# Initiate transfer and perform ongoing assessment.
# Hypoglycemic patients may refuse transport once back to usual mental status, but are at risk to become symptomatic again, and transport should be advised. '''Consult Medical Control''' prior to transport refusal.

{| class="wikitable"
|'''AEMT – Advanced Emergency Medicine Tech ''' ''Perform/Confirm All Above Interventions''
|}

# Establish IV.
# Administer 250 mL of D10 IV if blood glucose less than 60. (D10 is 25g of dextrose in 250mL.)
# If unable to establish and IV and glucagon has not been administered, administer 1 mg glucagon IM and consider ALS intercept if patient does not respond.
# Initiate transfer and perform ongoing assessment
# Hypoglycemic patients May refuse transport once back to usual mental status, but are at risk to become symptomatic again, and transport should be advised. '''Consult Medical Control''' prior to transport refusal.

{| class="wikitable"
|'''Intermediate -''' ''Perform/Confirm All Above Interventions''
|}

# If an IV cannot be established in a reasonable time frame and patient is critical:
## Establish an I/O and administer 250mL of D10. (D10 is 25g of dextrose in 250mL.)
### May repeat X1 if patient remains symptomatic after 5 minutes.
### I/O D50 can be performed before, after, or as an alternative to IM Glucagon.
# Hypoglycemic patients may refuse transport once back to usual mental status, but are at risk to become symptomatic again. Consideration should be given to transport, especially if patient does not have someone to watch them nor has higher risk factors for recurrence such as oral medications. If there is any question regarding need for transport, '''consult Medical Control.'''

{| class="wikitable"
|'''Paramedic -''' ''Perform/Confirm All Above Interventions''
|}

4 - Pediatrics

2022-04-04T19:48:18Z

Cgabryszek:

[[PEDS RESUSCITATION GUIDE]]

[[4-1 PEDIATRIC FOREIGN BODY-AIRWAY OBSTRUCTION]]

[[4-2 PEDIATRIC ALTERED MENTAL STATUS-HYPOGLYCEMIA]]

[[4-3 PEDIATRIC ANAPHYLACTIC-ALLERGIC REACTION]]

[[4-4 PEDIATRIC BRADYCARDIA]]

[[4-5 PEDIATRIC NEAR DROWNING]]

[[4-6 PEDIATRIC NON-TRAUMATIC CARDIAC ARREST]]

[[4-7 PEDIATRIC NON-TRAUMATIC HYPOPERFUSION]]

[[4-8 PEDIATRIC PAIN MANAGEMENT]]

[[4-9 PEDIATRIC RESPIRATORY DISTRESS]]

[[4-10 PEDIATRIC SEIZURES]]

[[4-11 PEDIATRIC TACHYCARDIA]]

[[4-12 PEDIATRIC TOXIC EXPOSURE]]

[[4-13 PEDIATRIC TRAUMA]]

[[4-14 PEDIATRIC BURNS]]

2022-04-04T04:58:04Z

Cgabryszek:

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