Intermediate Protocol Review Intermediate Level

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

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

Pediatric Cardiac Arrest General Approach Intubation is deemphasized Understand Termination Rules

Neonatal Resuscitation

Trauma: Transport Guidelines

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

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

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

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

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

Airway Management Comparison

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

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

Diabetic Emergencies Comparison

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