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Respiratory & Medical

Respiratory & Medical. Critical Care and Paramedic Levels. Airway Management. Changes: CPAP for EMT-I Must be credentialed Earlier use of supraglottic airways Waveform required for intubated patients. Airway Management ( cont ). Second page Very few protocols go to second page.

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Respiratory & Medical

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  1. Respiratory & Medical Critical Care and Paramedic Levels

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

  3. Airway Management (cont) • Second page • Very few protocols go to second page

  4. Airway Management Comparison

  5. Medication Facilitated Intubation • Changes • Age now 14* • Lidocaine removed • Only Etomidate for induction • Weight based dosing • Only 2 total attempts

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

  7. Asthma/COPD • Replaces “Respiratory Signs and Symptoms” • Clinical judgment • Includes CPAP • EMT-I (if credentialed) • Changes: • No albuterol alone • Magnesium in standing orders

  8. Asthma Comparison

  9. Acute Pulmonary Edema • Replaces “Respiratory Signs and Symptoms” • Clinical judgment • Includes CPAP • EMT-I (if credentialed) • Changes: • NTG SL based on BP • Lasix removed from standing orders

  10. Suspected Smoke Inhalation • Changes: • Cyanokit may be used in place of Sodium Thiosulfate if approved by Medical Director • Will affect labs for 48 hours • Attempt to draw blood samples prior to administration

  11. Suspected Smoke Inhalation Comparison

  12. Allergic Reaction/Anaphylaxis • Changes: • Essentially none • Caution administering Epinephrine if patient is over 55 years old

  13. Allergic Reaction Comparison

  14. Altered Mental Status • Changes: • Separate from “Stroke” protocol • Meant as reminder follow other protocols that cause altered mental status

  15. Diabetic Emergencies • NEW PROTOCOL • Addresses low and high blood sugar • Thiamine only if KNOWN chronic ETOH • Other Hypoglycemic treatments unchanged

  16. Diabetic Emergencies Comparison

  17. Seizures • Changes: • Magnesium now standing order if known pregnant or within 6 weeks post-partum without seizure history • Thiamine removed

  18. Seizure Comparison

  19. Stroke • Changes: • No longer combined with “Altered Mental Status” protocol • Key point: • Confirm time last known “NORMAL”

  20. Overdose or Toxic Exposure • NEW PROTOCOL • Exposure specific treatments • Opiate • Organophosphate • Dystonic reaction • Physician Options for • Calcium channel and beta blockers • Tricyclic, sympathomimetic

  21. Overdose

  22. Shock/Hypoperfusion • Changes: • More aggressive fluid resuscitation with sepsis • 12 lead EKG for possible STEMI • Remember: • Shock and hypoperfusion are signs of another disease process

  23. Shock/Hypoperfusion Comparison

  24. Adrenal Crisis • NEW PROTOCOL • Fairly rare diagnosis • If CONFIRMED diagnosis by patient or family, steroids can be lifesaving in presence of shock

  25. Adrenal Crisis Comparison

  26. Pain / Nausea /Sedation • A fluid bolus makes almost anyone feel better • Morphine standing orders are under utilized in WNY • Sedation standing orders are not intended for chemical restrains

  27. Pain / Nausea / Sedation Comparison

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