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

Airway Management Comparison

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

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

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

Asthma Comparison

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

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

Suspected Smoke Inhalation Comparison

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

Allergic Reaction Comparison

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

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

Diabetic Emergencies Comparison

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

Seizure Comparison

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

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

Overdose

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

Shock/Hypoperfusion Comparison

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

Adrenal Crisis Comparison

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

Pain / Nausea / Sedation Comparison