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Comprehensive Review of Intermediate Level Protocols for Cardiac Arrest and Trauma Management

This document outlines new intermediate level protocols for initial care in cardiac arrest, emphasizing rhythm-based approaches, effective Basic Life Support (BLS), and the importance of adequate ventilation. It includes guidance on pediatric cardiac arrest, termination rules in neonatal resuscitation, and trauma transport protocols, particularly for pregnant patients. Key updates cover airway management practices, including the use of supraglottic airways and advancements in diabetic emergencies treatment. The protocols reflect current ITLS/ATLS guidelines to enhance patient outcomes.

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Comprehensive Review of Intermediate Level Protocols for Cardiac Arrest and Trauma Management

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  1. Intermediate Protocol Review Intermediate Level

  2. Cardiac Arrest—Initial Care • NEW PROTOCOL • References rhythm based protocols • Reinforces BLS • Good CPR • Intubation not required if ventilation adequate • Consider supraglottic airway

  3. Post Cardiac Arrest • Therapeutic Hypothermia interventions for all levels of care.

  4. Pediatric Cardiac Arrest • General Approach • Intubation is deemphasized • Understand Termination Rules

  5. Neonatal Resuscitation

  6. Trauma: Transport Guidelines

  7. Trauma: Aeromedical Utilization • Must SIGNIFICANTLY reduce transport time • Signs of life!!! • Don’t wait for the helicopter • <20 mile transport? • Entrapment

  8. Trauma: Pregnant Patients • Adult trauma pt > 20 weeks gestation • Not meeting trauma criteria – ER of their choice • Meeting trauma criteria – Adult trauma center!

  9. Trauma: Chest • Bilateral needle decompression as standing order for Trauma Code with suspected chest injury.

  10. Trauma: Hypoperfusion • Differing fluid goals for compressible injury • Reflects current ITLS/ATLS guidelines

  11. Airway Management • Changes: • CPAP for EMT-I • Must be credentialed • Earlier use of supraglottic airways • Waveform required for intubated patients • Recommended for alternate airways

  12. Airway Management Comparison

  13. Continuous Positive Airway Pressure • Changes • EMT-I allowed* • *If credentialed • Remember indications and contraindications

  14. Diabetic Emergencies • NEW PROTOCOL • Addresses low and high blood sugar • Intermediates use D10 for hypoglycemia

  15. Diabetic Emergencies Comparison

  16. Pain / Nausea /Sedation • A fluid bolus makes almost anyone feel better

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