Airway Management/Respiratory Arrest - ANS-- BLS Airway Management
- BLS foreign body obstruction techniques as appropriate
- Oxygen with pulse oximetry, to maintain saturation of >94%
- Establish IV access
- Naloxone up to 2.0 mg IV/IO/IN for suspected narcotics OD
- Supraglottic airway
...
- Initiate CPAP for spontaneously breathing patient, if credentialed by medical director
- Indications for use (must have all three)
(- Age > 10 years old)
(- Signs of severe respiratory distress defined as the patient does not improve after
oxygen administration and at least TWO of the following:)
[- Respiratory rate of >24/min]
[- SaO2 < 92%]
[- Significantly decreased air movement]
[- Pulmonary edema or frothy sputum, rales or severe wheezes all fields]
[- Significantly increased work of breathing e.g. tripling, mottled skin, pallor, or
cyanosis]
(- Awake patient who can cooperate with CPAP)
- Contraindications fo use, any one
[- Altered mental status, GCS < 14]
[- Systolic BP < 90]
[- Respiratory arrest or atonal respirations]
[- Blunt or penetrating trauma]
[- Suspected pneumothorax]
[- Subcutaneous emphysema]
[- Facial trauma inhibiting mask seal]
[- High risk of vomiting or aspiration]
[- Tracheostomy]
[- Stridor or suspected airway obstruction]
- If indications are present and contraindications are absent:
,(- Position patient in semi-fowler position and apply a proper fitting CPAP mask at 10
cm H2O pressure)
- May increase by 5 cm H2O every 5 minutes if no improvement, as long as the patient
tolerates the increased pressure (max 15 cm H2O). May decrease by 5 cm H2O
immediately if patient is unable to tolerate pressure.
MEDICAL CONTROL OPTIONS
- Increased CPAP pressure
Medication Facilitated Intubation - ANS-PARAMEDIC ONLY
- BLS Airway management
- Obtain vascular access as appropriate
- Cardiac monitor as appropriate
- Pre-oxygenate, position the patient appropriately
- Contact Medical Control for sedation medications
- Post ET intubation
(- monitor waveform capnography)
(- use a colorimetric CO2 detector as a secondary device)
- Diazepam (Valium) 5mg IV/IO for continued sedation
Vascular Access/ Fluid and Medication Management - ANS-- Saline lock or KVO IV line
with normal saline may be used
- Patients that require rapid IV volume drip, at least one (1) large bore IV line with
normal saline should be established
- Peripheral veins should be used as a primary site. The external jugular vein (EJ) may
be used in extremis for adult patients if no other site is accessible
- An intraosseous (IO) device may be used for patients in complete vascular collapse
via proximal tibia or proximal humerous.. Drug administration via this route utilizes
doses identical to those used for IV administration
- In the absence of IV access, intranasal (IN) with an appropriate atomizer device may
be used if available
- The only AEMT drugs approved for this route are Naloxone and Glucagon
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