Protocol or Myth
Protocol or Myth: You're dispatched to a 65 YOF with difficulty breathing. You do not need to perform a 12 lead EKG because oxygenation is priority.
MYTH! Oxygenation is priority, but obtaining an EKG is the standard of care to rule out cardiac involvement (especially with elderly females).
Magnesium (Restrictive Airway) : Dose and Route
2G in 100cc NS over 10 min IV.
Fluids and Diltiazem (0.25mg/kg Max 25mg)
Your patient has deformity to the left forearm with complaint of pain. How would you treat this patient?
Pain control and splint with PMS checks before and after with transport.
Your patient is 25 years old complaining of shortness of breath and history of asthma. Lung sounds result with wheezing. How would you treat this patient?
Duoneb!
Protocol or Myth: You're dispatched to a call by request of law enforcement reference psychiatric emergency with combative behavior. You do not need to reference your BARS score and you must give versed before ketamine to treat your patient.
MYTH! You must reference your BARS score to accurately determine appropriate treatment for your psychiatric emergency patients. You do not have to give versed prior to Ketamine. The protocol is written to give options. Ketamine OR Versed.
EPI 1:1 (Indication ; Dose ; Route)
Your patient is complaining of chest pain. You perform a 12 lead that results with elevation in leads I, V5, V6. What do you suspect is your primary impression and how would you treat this patient.
Lateral STEMI - transport to PCI facility with early notification and EKG transmission. Pad placement, Aspirin, Nitro, IV access.
A 70 YOM experienced a ground level fall at a nursing facility. The patient has dementia and the fall was unwitnessed. His heart rate is slightly elevated and he has a grimace while repeating "neck". Would you be able to clear c-spine?
No- unwitnessed fall on a patient who cannot answer questions appropriately. The patient is showing signs of pain.
45 YOM complaining of hives and airway swelling after being stung by a bee. Upon assessment, you note diffuse wheeze, swollen tongue, hives, tachycardia, and hypotension. How would you treat this patient?
EPI 1:1 , Benadryl, Duoneb, fluids, and potentially an Epi Drip
Protocol or Myth: You are dispatched to a chest pain. You must obtain a 12 lead EKG within the first 5 minutes of patient contact.
PROTOCOL
Droperidol (Indications ; Doses ; Routes)
Nausea/vomiting : 1.25mg IV after attempting Zofran.
Behavioral (BARS 6) : 5mg IM
Your patients heart rate is 40 with a blood pressure of 70/20. How would you treat this patient?
Pace!
Your patient has an open tib/fib fracture. How would you treat this patient?
Ensure PMS ; pain control ; splint ; ancef (2G) ; transport to trauma facility.
33 year old female complaining of shortness of breath and chest pain while on a hike. What should you perform during your assessment?
EKG, vitals, lung sounds and encourage transport.
MYTH: Although the patient has trauma to one side of the chest with retractions and deformity with shortness of breath, you must obtain a set of vital signs first. A patient can have a pneumothorax without it being a tension pneumothorax.
Ancef (Indications ; Dose ; Route)
Open fractures and Amputations
2G in 100cc NS over 10 min IV
Your patient is complaining of weakness with a heart rate of 170 and blood pressure of 110/60. Your patients EKG results with a regular wide complex tachycardia with a pulse. What rhythm do you suspect and how would you treat it?
Monomorphic Ventricular Tachycardia
Lidocaine IVP 1mg/kg max 100mg
Lidocaine Drip 2mg/min
Your patient was involved in a single vehicle roll over. The patients care has significant damage, but the patient was able to self extricate and was ambulatory prior to EMS arrival with complaint of mild pain. Where should I transport this patient?
Trauma Facility! Just because we don't fly for mechanism, doesn't mean we can't transport by ground for mechanism. Heavy damage in a roll over accident - the patient could have significant life threatening internal injury.
78 YOF in the tripod position in respiratory distress. Tachypnea, hypoxia, normotensive, tachycardia, and obvious wheeze. What do you suspect and how would you treat?
COPD Exacerbation - Duonebs, solu-medrol, mag and potentially CPAP.
Protocol or Myth: You have been working a cardiac arrest patient for 45 minutes and have exhausted all treatment efforts. The patient has been defibrillated 3x with 3 doses of Epi 1:10, and 2 doses of Lidocaine. You should mark time of death due to time worked with no improvement.
MYTH : In the termination of CPR protocol, if a patient has received defibrillation at any point during the code, you MUST contact medical control to discontinue CPR.
Ketamine (What are the 3 indications ; doses with max ; routes)
Pain: 0.3mg/kg in 100cc NS over 10 min IV Max 30mg
DAI: 1-2mg/kg IV Max 1 repeat dose
Behavioral (BARS 7): 4mg/kg IM Max 400mg
Your patients EKG results with a p wave that gets progressively longer with a drop in qrs. What rhythm do I suspect?
2nd degree type 1 (Wenckebach)
Your patient was involved in an MVC. He is altered and combative with obvious head injury. How would you treat this patient?
Sedation! Ketamine 4mg/kg IM and prepare for DAI due to impending airway compromise - all while maintaining c-spine and airway.
56 YOM difficulty breathing in the tripod position. The patient is tachypneic, hypertensive, tachycardic, and has 2+ pitting edema. What do you suspect and how would you treat?
CHF Exacerbation - Nitro, CPAP, and transport!