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Updates in Airway Management and Protocol Changes for EMT-I Credentialing in Respiratory Care

This document outlines significant updates in airway management protocols, including the introduction of CPAP for EMT-I personnel (with credentialing), earlier use of supraglottic airways, and the implementation of waveform analysis for intubated patients. Key changes also include new age parameters for medication facilitated intubation, revised medication lists, and updated protocols for conditions such as asthma, acute pulmonary edema, smoke inhalation, allergic reactions, diabetic emergencies, seizures, overdose management, shock, and pain sedation.

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Updates in Airway Management and Protocol Changes for EMT-I Credentialing in Respiratory Care

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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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