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2012 SOP Update

2012 SOP Update. Region VIII Emergency Medical Services System. Loyola – Good Samaritan – Edward – Central Dupage. 2012 SOP Revision . Over 70 suggestions / submissions from the field and PMDs. Changes New Drugs New Dosaging of old drugs Removal of certain SOP’s

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2012 SOP Update

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  1. 2012 SOP Update Region VIII Emergency Medical Services System Loyola – Good Samaritan – Edward – Central Dupage

  2. 2012 SOP Revision • Over 70 suggestions / submissions from the field and PMDs. • Changes • New Drugs • New Dosaging of old drugs • Removal of certain SOP’s • Verbiage changes • Good News – Not as many changes as last update!

  3. ADULT INITIAL MEDICAL CARE

  4. ADULT INITIAL MEDICAL CARE

  5. Witholding or Withdrawing of Resuscitative Efforts

  6. Cardiac

  7. Adult Suspected Cardiac Patient With Chest Pain

  8. Adult Suspected Cardiac Patient With Chest Pain New 12-lead procedures…

  9. Inferior Wall MI Patient’s are preload dependent… - The danger of NTG and preload That’s great… No Lido?... We don’t give Lido for chest pain… - Ventricular rhythm conversion - Possible block’s - Lidocaine can be lethal

  10. Adult Suspected Cardiac Patient With Chest Pain • NO MORE MORPHINE!!!! • Fentanyl now for pain management • SLOWWWWWW IVP!!! Over 1-2 minutes

  11. Adult Suspected Cardiac Patient With Chest Pain Special considerations: • Avoid more than two IV attempts if patient is a candidate for thrombolytic therapy • If ST-elevation in Leads II, III, aVF(possible Inferior Wall MI), avoidLidocaine and Nitroglycerine • Acute Coronary Syndrome (ACS) in patients < 30 years old is uncommon and judgment should be used in implementing this protocol unless 12-Lead findings consistent with ACS are seen

  12. Adult Bradydysrhythmias *This change is reflected in ALL SOPS that involve versed administration

  13. Amiodarone now preferred medication for ventricular rhythms. AHA recommendation. • If Available!

  14. Once again… Amiodarone

  15. Airway

  16. Drug Assisted Intubation - Etomidate

  17. Drug Assisted Intubation - Versed • DAI using Versed is no longer for adults! • Etomidate is our only avenue for intubation for our ADULT patients. • DAI is still utilized for our pediatric patients

  18. Medical

  19. Adult Syncope/Near Syncope Cont’d • Narcan dose for suspected narcotic ingestion changed. • 0.4mg IV q 2 mins to a total of 2mg PRN.

  20. Adult Stroke

  21. Primary Stroke Centers • Joint Commission Certification • Based on many levels of criteria that must be met • Strokes no longer go to “closest appropriate facility” • Need to go to “Primary Stroke Centers” (PSCs) • All Region VIII Resource hospitals are PSC as well as many of their associate hospitals. • Find out from your system which PSC to transport to!

  22. Primary Stroke Centers

  23. Toxicological Emergencies • Just the simple addition of “suspected” into cyanide poisoning.

  24. Other equivalent kit as available…

  25. Trauma

  26. Field Trauma Guidelines – Cont’d

  27. Adult ITC – cont’d • Again, more generic terminology but in this case for stabilizing pelvic injury.

  28. Adult ITC – Cont’d • The inclusion of a pain scale

  29. Parklund Formula • So… • If you have a patient • Weighing 100kg • With 36% burns • They will need • 14.4 liters of fluid over a 24 hour period… • 100kg x 36% x 4ml = 14,400ml • 4ml is the constant, weight and % are the variables

  30. Pediatrics

  31. Pediatrics • All pediatric SOPs have remained relatively unchanged. • The only difference being for pain control. • Fentanyl • 1mcg/kg not to exceed the adult dose (100mcg) • No repeat dose • May give IV/IM

  32. Review IMC • Interpretation of EKG to be part of VS reassessment q 15 or 5 minutes. • If a DNR is missing information, contact medical control for direction • A photocopy of a DNR IS acceptable • Blunt traumatic arrest now can be “called” from the field with medical control approval.

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