patient care guidelines PDF
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2015 Bell Ambulance, Inc. Keith Rader M.D. – Medical Director 1 | P a ge 2 | P a ge Bell Ambulance Inc. 2013 Protocols, Skills, Policies, Procedures Keith Rader M.D. – Medical Director 549 E Wilson St. Milwaukee, WI 53207 Original 12/2012 Version 1.2 REVISED 12/31/12 This Manual remains property of Bell Ambulance Inc. Unauthorized reproduction is prohibited including electronic file copying and sharing. 3 | P a ge [GENERAL MEDICAL GUIDELINES] ................................................................. 11 ABDOMINAL PAIN..……………………….……………………………………………………………………………………………………….12 ACLS - ASYSTOLE/PEA…………………………………………………………………………………………………………………………….13 ACLS - BRADYCARDIA .................................................................................................................................. 15 ACLS – CARDIOGENIC SHOCK (ADULT) ....................................................................................................... 16 ACLS TACHYCARDIA .................................................................................................................................... 18 ACLS – VFIB / PULSELESS VTACH ................................................................................................................. 21 ADULT ALLERGY/ANAPHLAXIS……………………………………………………………………………………………………………….23 AED GUIDELINES…………………………………………………………………………………………………………………………………...26 AGITATED AND COMBATIVE ....................................................................................................................... 28 AIRWAY/OXYGEN MANAGEMENT .............................................................................................................. 29 ALTERED LEVEL OF CONSCIOUSNESS .......................................................................................................... 30 CHEST PAIN – SUSPECTED CARDIAC ........................................................................................................... 31 CHEST PAIN – PRESUMED NONCARDIAC .................................................................................................... 33 DETERMINATION OF DEATH ....................................................................................................................... 34 DO NOT RESUSCITATE ................................................................................................................................. 37 HYPERGLYCEMIA ......................................................................................................................................... 38 HYPERKALEMIA ........................................................................................................................................... 39 HYPERTENSIVE CRISIS…………………………………………………………………………………………………………………………….41 HYPERTHERMIA .......................................................................................................................................... 42 HYPOGLYCEMIA .......................................................................................................................................... 43 HYPOKALEMIA............................................................................................................................................. 44 HYPOTENSION & SHOCK ............................................................................................................................. 45 HYPOTHERMIA ............................................................................................................................................ 47 INITIAL MEDICAL CARE ................................................................................................................................ 49 NAUSEA / VOMITING .................................................................................................................................. 50 OBSTETRICAL EMERGENCIES & CHILDBIRTH .............................................................................................. 51 PAIN MANAGEMENT ................................................................................................................................... 53 POISONING & OVERDOSE ........................................................................................................................... 55 RESPIRATORY EMERGENCIES ...................................................................................................................... 56 SEDATION / PARALYSIS ............................................................................................................................... 62 4 | P a ge SEIZURE ....................................................................................................................................................... 64 STROKE ........................................................................................................................................................ 66 TRACHEOSTOMY CARE................................................................................................................................ 68 [TRAUMA GUIDELINES] ................................................................................................ 70 INITIAL TRAUMA CARE ................................................................................................................................ 71 SELECTIVE SPINAL IMMOBILIZATION……………………………………………………………………………………………………..74 TRAUMA - ABDOMEN ................................................................................................................................. 76 TRAUMA- ABUSE SUSPECTED ..................................................................................................................... 77 TRAUMA - AMPUTATION ............................................................................................................................ 78 TRAUMA - BURNS ....................................................................................................................................... 79 TRAUMA - CHEST ........................................................................................................................................ 80 TRAUMA - DROWNING ............................................................................................................................... 81 TRAUMA – ELECTRICAL INJURY ................................................................................................................... 82 TRAUMA - EPISTAXIS ................................................................................................................................... 83 TRAUMA - EXTREMITY ................................................................................................................................ 84 TRAUMA - EYE ............................................................................................................................................. 85 TRAUMA - FACIAL ....................................................................................................................................... 86 TRAUMA – HEAD OR SPINAL INJURY .......................................................................................................... 87 TRAUMA - PREGNANT ................................................................................................................................. 88 TRAUMA – SEXUAL ASSAULT ...................................................................................................................... 89 [PEDIATRIC MEDICAL GUIDELINES] ..................................................... 90 ACLS – PEDIATRIC BRADYCARDIA ............................................................................................................... 92 ACLS – PEDIATRIC CARDIAC ARREST ........................................................................................................... 94 ACLS – PEDIATRIC TACHYCARDIA ................................................................................................................ 97 PEDIATRIC ALLERGY & ANAPHYLAXIS ....................................................................................................... 100 PEDIATRIC ASTHMA .................................................................................................................................. 102 PEDIATRIC HYPERGLYCEMIA ..................................................................................................................... 103 PEDIATRIC HYPOGLYCEMIA ...................................................................................................................... 104 PEDIATRIC HYPOVOLEMIA / SHOCK .......................................................................................................... 105 PEDIATRIC RESPIRATORY DISTRESS .......................................................................................................... 106 5 | P a ge PEDIATRIC SEIZURES…………………………………………………………………………………………………………………………….107 PEDIATRIC TOXIC EXPOSURE / OVERDOSE ............................................................................................... 108 [MEDICATION GUIDELINES] .......................................................................... 112 ADENOSINE (ADENOCARD) ....................................................................................................................... 114 ALBUTEROL (PROVENTIL) .......................................................................................................................... 115 AMIODARONE (CORDARONE) ................................................................................................................... 116 ASPIRIN ..................................................................................................................................................... 117 ATROPINE .................................................................................................................................................. 118 ATROVENT (IPRATROPIUM) ...................................................................................................................... 119 BENADRYL / DIPHENHYDRAMINE ............................................................................................................. 120 CALCIUM CHLORIDE .................................................................................................................................. 121 DEXTROSE ................................................................................................................................................. 122 DIAZEPAM (VALIUM) ................................................................................................................................ 123 DILTIAZEM ................................................................................................................................................. 124 DOBUTAMINE ........................................................................................................................................... 125 DOPAMINE ................................................................................................................................................ 126 EPINEPHRINE IM ....................................................................................................................................... 127 EPINEPHRINE INFUSION ............................................................................................................................ 128 EPINEPHRINE IVP/ET ................................................................................................................................. 129 FENTANYL .................................................................................................................................................. 130 GLUCAGON ............................................................................................................................................... 131 GLUCOSE ................................................................................................................................................... 132 KETAMINE ................................................................................................................................................. 133 LABETALOL ................................................................................................................................................ 134 LIDOCAINE ................................................................................................................................................. 135 LORAZEPAM (ATIVAN) .............................................................................................................................. 136 MAGNESIUM SULFATE .............................................................................................................................. 137 METHYLPREDISOLONE .............................................................................................................................. 138 METOCLOPRAMIDE ................................................................................................................................... 139 METOPROLOL ............................................................................................................................................ 140 MIDAZOLAM (VERSED) ............................................................................................................................. 141 6 | P a ge MORPHINE ................................................................................................................................................ 142 NARCAN .................................................................................................................................................... 143 NICARDIPINE ............................................................................................................................................. 144 NITROGLYCERIN - ADMINISTERED ............................................................................................................ 145 NITROGLYCERIN – ASSISTED [EMT]........................................................................................................... 146 NITROPRUSSIDE ........................................................................................................................................ 148 NOREPINEPHRINE ..................................................................................................................................... 149 ONDANSETRON (ZOFRAN)………………………………………………………………………………………………………………….150 PHENYLEPHRINE (NEOSYNEPHRINE) ........................................................................................................ 151 PROCAINAMIDE ........................................................................................................................................ 152 PROPOFOL (DIPRIVAN) ............................................................................................................................. 153 SODIUM BICARBONATE ............................................................................................................................ 154 VECURONIUM ........................................................................................................................................... 155 [SKILLS GUIDELINES] ................................................................................................ 157 12 LEAD EKG .............................................................................................................................................. 158 AIRWAY -COLORMETRIC ETCO2 ................................................................................................................ 160 AIRWAY - COMBITUBE .............................................................................................................................. 161 AIRWAY - CPAP.......................................................................................................................................... 163 AIRWAY – CRICOTHYROTOMY - SURGICAL ............................................................................................... 164 AIRWAY – ORAL INTUBATION ................................................................................................................... 166 AIRWAY – FOREIGN BODY AIRWAY OBSTRUCTION .................................................................................. 168 AIRWAY – NASOTRACHEAL INTUBATION ................................................................................................. 169 AIRWAY - NEBULIZER ................................................................................................................................ 171 AIRWAY - S.A.L.T. ...................................................................................................................................... 172 AIRWAY – ADVANCED SUCTIONING ......................................................................................................... 175 AIRWAY – TRACH CHANGE ....................................................................................................................... 176 AIRWAY - SUCTIONING ............................................................................................................................. 177 BLOOD GLUCOSE MEASUREMENT ............................................................................................................ 178 BLOOD PRODUCT INFUSION ..................................................................................................................... 179 ET INTRODUCER (BOUGIE) ........................................................................................................................ 182 CAPNOGRAPHY ......................................................................................................................................... 184 7 | P a ge CHEST DECOMPRESSION .......................................................................................................................... 185 CHEST TUBE MAINTENANCE ..................................................................................................................... 186 CHILDBIRTH ............................................................................................................................................... 190 CARDIOPULMONARY RESUSCITATION ...................................................................................................... 191 DEFIBRILLATION - MANUAL ...................................................................................................................... 193 GASTRIC TUBE INSERTION ........................................................................................................................ 194 INJECTIONS – SQ AND IM .......................................................................................................................... 195 INTRANASAL MEDICATIONS...................................................................................................................... 196 INVASIVE PRESSURE MONITORING- COMPATIBLE TRANSDUCER ............................................................ 198 INVASIVE PRESSURE MONITORING- INCOMPATIBLE TRANSDUCER ........................................................ 200 IV INFUSION MONITORING ....................................................................................................................... 202 ORTHOSTATIC BLOOD PRESSURE ............................................................................................................. 204 PAIN ASSESSMENT .................................................................................................................................... 205 PULSE OXIMETRY ...................................................................................................................................... 207 PUSH DOSE PRESSORS .............................................................................................................................. 208 RESTRAINTS ............................................................................................................................................... 209 SELECTIVE SPINAL IMMOBILIZATION……………………………………………………………………………………………………210 SPINAL IMMOBILIZATION ......................................................................................................................... 213 SPLINTING ................................................................................................................................................. 214 SWAN-GANZ CATHETER MAINTENANCE .................................................................................................. 216 SYNCHRONIZED CARDIOVERSION ............................................................................................................. 217 TRANSCUTANEOUS PACING ...................................................................................................................... 219 TRANSVENOUS PACEMAKER .................................................................................................................... 220 VENOUS ACCESS – CENTRAL LINE MAINTENANCE ................................................................................... 222 VENOUS ACCESS – EXISTING CATHETERS ................................................................................................. 223 VENOUS ACCESS – EXTERNAL JUGULAR ................................................................................................... 224 VENOUS ACCESS - EXTREMITY .................................................................................................................. 225 VENOUS ACCESS - INTRAOSSEOUS ........................................................................................................... 227 MECHANICAL VENTILATOR - ADJUSTABLE ................................................................................................ 229 WOUND CARE ........................................................................................................................................... 236 8 | P a ge [PATIENT CARE POLICY / PROCEDURES] .................................... 238 BELL ALS WITH MCEMS INTERFACE .......................................................................................................... 239 CANCELLED ENROUTE ............................................................................................................................... 240 DESTINATION DETERMINATION ............................................................................................................... 241 BLS “LOAD AND GO” ................................................................................................................................. 245 OUT ON CALL TIME ................................................................................................................................... 246 PARAMEDIC REQUEST GUIDELINES .......................................................................................................... 247 ALS BLS TRANSFER OF CARE (TURNDOWN) ......................................................................................... 252 VEHICLE OPERATION ................................................................................................................................. 254 9 | P a ge 10 | P a ge
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