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Terms in this set (1847)

for pts over 1 year of age who are experiencing wheezing or exacerbation of asthma:

1) assess the airway
2) administer oxygen
3) monitor breathing
4) do not permit physical activity
5) place pt in fowler, semi fowler, or position of comfort
6) assess the following PRIOR of first nebulized treatment:
-- vital signs
--pts ability to speak in complete sentences
--accessory muscle use

7) administer albuterol sulfate .083% , one unit dose or 3 cc (cubic centimeter) via nebulizer at a flow rate that will deliver the solution over 5 minutes to 15 minuts. do NOT delay transport to complete medication administration
8) begin transport; for pts with severe resp distress, call for ALS , do not delay transport for any reason, including waiting for a potential second dose of epi.
9) if symptoms persist, albuterol sulfate .083% may be repeated twice for a total of three doses, with the third occuring during transport
10) if pt is having severe resp distress or shock, administer epi (one dose only) via an auto injector

pts 9 years of age or older or weighing more than 30 kg (66 lbs), use adult epi auto injector (.3 mg), pts younger than 9 years of age or weighing less than 30 kg use pediatric epi auto injector (.15mg). Administration of epi via auto injector must be reported to your agencys medical director ASAP

11) contact on line medical control for authorization to administer a second dose of epi, via an auto injector if needed and if available
12) upon completion of pt treatment of trasner of pt care to an ALS provider, reassess teh pt (start again at step 6; vital signs and stuff before nebulizer treatment); medical control must be contacted for any pt refusing medical assistance or transport
emotionally disturbed pts must be presumed to have an underlying medical or traumatic condition causing an AMS

1)assess the situation for potential or actual danger and establish a safe zone, if necessary; pts who attempt suicidal or violent threats should be in police custody if they pose danger to themselves or others
2) if an underlying medical or traumatic condition causing and AMS is not apparent, the pt is fully conscious, alert, and able to communicate, and an emotional disturbance is suspected see protocol for that
3) monitor the airway
5) request ALS
6) if an overdose is strongly suspected, and teh pts respt rate is less than 10/min , administer intra-nasal (IN) Naloxone , if available , via mucosal atomizer device (MAD) as follows:
-- adult pt: 1mg/1ml in each nostril . total of 2mg/2ml
-- pediatric pt : .5mg/.5ml in each nostril. Total of 1mg/1ml


-- cardiopulmonary arrest
--active seizure
--evidence of nasal trauma, nasal obstruction and /or epistaxis (nose bleed)

7) initiate transport
8) if after 5 minutes, the pts resp rate is not greater than 10/min, adminster a second dose of naloxone
9) if the pt is conscious, is able to swallow, and is able to drink without assistance, provide a glucose solution, fruit juice, or non diet soda by mouth
-- do not give oral solutions to unconscious pts
--do not give oral solutions to pt with head injuries
11) assess and monitor the glasgow coma score
-- do not delay transport

for every dosage of naloxone you must report it to the medical director and they have to review it !
1) monitor the airway
2) administer oxygen
3) request ALS for pt with resp distress/failure, or AMS , or if so directed by medical control
4) document the name of substances involved
5) transport

Special Considerations:

Ingested Substances:
-- do not induce (force)vomiting
--do not attempt to neutralize the substance

Inhaled Substances:
-- ensure the scene is safe to enter
-- remove the pt from the contaminated environment
--administer oxygen, especially if carbon monoxide poisoning is suspected

Envenomations venomous bite (adult and pediatric pts):

-- request ALS, do not delay transport
-- move the pt to the ambulance with minimal pt mvmt , on a stretcher or wheeled stair chair
--do not attempt to capture the envenomating animal (snake, scorpion, spider etc.) nor remove the venom with suctioning devices

1) Insect stings:
-- remove stinger by scraping
--cover with a sterile dressing
--apply cold compresses to the site
2) Marine
--remove stinging bristles by patting the area with adhesive tape, then wipe with alcohol
-- remove stinging spine
--cover with a sterile dressing
3) Snakebite:
-- if occured on an extremity, immobilize the extremity and place a constriction band proximal to the bite, make sure pulses are not lost when tightening it, should be tightened to the point wehre 1-2 gloved fingers can be placed between the tourniquet and the skin ; if extremity swelling is extensive and compartment syndrome (limb edema , worsening pain, paresthesias, skin pallor/coolness, or loss of pulses) occurs , remove the tourniquet
-- tranport to venomous bite center

4) Absorptions:

--take precaution to avoid contamination of yourself and others
-- remove all contaminated clothing
--brush away any dry agents or blot away any excess liquids from the skin
--flush teh area with sterile saline, sterile water, or plain water for at least 10 minutes
--bandage any contact burns with a saline moistened, sterile dressing
1) monitor the airway
2) observe spinal injury precautions
3) administer oxygen (its with inhalation injury should receive humidified oxygen if available and receive ALS)
4) stop the burning process
5) prevent contamination of the wound; avoid making contact with non sterile materials if possible; do not remove clothing adherent to the wound
6) monitor breathing for adequacy
7) assess for shock and treat
8) calculate the % and degree of affected areas
9) for burns less than 10% BSA , cover the affected areas with saline-moistened , sterile dressings , then wrap in dry sterile sheets. for burns greater than 10% BSA, cover the affected areas with dry, sterile dressings , then wrap in dry sterile sheets
10) maintain body temp
11) transport

Special Considerations:

1) Thermal burns
-- cool hot or smoldering skin (up to 20% of the body surface area at a time) with cool water or normal saline (.9%)

2) Chemical burns:
-- obtain the name of the product
--remove any contaminated clothing or personal articles
--brush dry agents off the skin, then flush with water or at least 10 minutes
--blot any excessive liquids from the skin, then flush liquid chemical agents with water:

- from the skin for at least 10 minutes
- from the eyes or at least 20 minutes

3) Electrical Burns:

--be alert for cervical spine and other skeletal injuries
--begin basic cardiac life support procedures if necessary
--observe spinal injury precautions
--request ALS
--locate and bandage the obvious entrance and exit wounds
--treat skeletal injuries if necessary
1) assess the mother for shock and treat if necessary
2) if the mother is in active labor, perform a visual inspection of the perineum for bulging or crowning
3) if delivery has begun, proceed as follows:
-- request ALS
4) if any of the following are present, refer to special conditions:
-- prolapsed umbilical cord (cord is protruding through vaginal opening)
-- umbilical cord (cord wrapped around neonate's neck)
-- breech (buttocks comes out first)
-- limb presentation
-- multiple births
-- premature births
-- amniotic sac not ruptured
--amniotic fluid that is meconium stained
(ALS MUST be requested for premature or multiple births, or if amniotic fluid is meconium stained)
5) apply gentle pressure against neonate's head to prevent tearing of the perineum (do NOT apply pressure to the fontanels (soft spots))
6) as the head presents, clear the airway of secretions (first clear the mouth , inserting a bulb syringe no more than 1 1/2 inches, then the nose, inserting the bulb no more than 1/2 inch . depress the bulb prior to insertion in to the neonatal's mouth and nose)
7) support the head and thorax as it delivers (momentarily position the head lower than the body to allow for drainage. repeat suctioning as necessary prior to spontaneous or stimulated respirations)
8) thoroughly but rapidly dry the newborn with a clean, dry towel
9) monitor the neonate's airway (to stimulate breathing, first rub the lower back, then gently snap the sole of the feet; spontaneous resp should begin within 30 seconds after birth
10) resuscitate if necessary
11) place the first clamp 8-10 inches from the neonate and the second clamp 4 finger widths from the neonate . cut between the clamps and immediately check both ends for bleeding
12) if continuous bleeding is seen from either end of the old, lead the clamps already applied and add a second clamp to the end that is bleeding
13) cover the neonate with clean, dry towel or blanket, then wrap in silver swaddled, exposing only the neonate's face (neonates are subject to rapid heat loss and must be kept warm and dry)
14) administer oxygen to mother
15) re-assess the mother for shock and treat if necessary ; if post part hemorrhage occurs, follow protocol for that
16) care for the neonate and follow those protocols
17) transport ; do NOT delay transport waiting for the placenta to deliver (if miscarriage or stillbirth occurs,bring all expelled material to the hospital with the mother)

Special Considerations:

1) abnormal presentation:
a) breech:
--support the thorax of the neonate as it delivers (a full delivery may occur)
-- if the head does not deliver immediately, play sterile, gloved fingers between the neonate's face and the wall of the birth canal to establish an air passageway. this position must be maintained until the head delivers
b) limb presentation:
-- elevate the mother's hips and legs
c) prolapsed cord:
-- elevate the mothers hips and legs
-- if the cord is not pulsatile, place sterile, gloved fingers into the birth canal and push the head back 1-2 inches toward the cervix until the cord begins to pulsate
-- wrap saline-moistened , sterile dressings around the cord ( do NOT attempt to insert the cord back into the uterus. the cord should be continuously monitored for the presence of a pulse)