Medical Information Part 1

Reminder, while based an EMT guide, this is for roleplay, please do not use this as actual medical guidelines.

Critical Care Treatment Procedure Guidelines

Anaphylactic Reaction

1. Airway, breathing, circulation

2. Give Epinephrine 

3. Give oxygen if needed

4. Transport to hospital

Bites and Envenomation

1. Airway, breathing, circulation

2. Give IV fluids

3. Treat for shock and seizures if needed

4. Transport to hospital for antivenom

Stings from jellyfish/lionfish/stingray et

1. Immerse affected body part in hot (not burning) water to reduce pain

2. Pain management

• Do NOT 

• Apply tourniquets, tight Ace®/crepe bandage, or constricting bands above or below the site of the envenomation 

• Incise and/or suction wound to remove toxin 

• Apply cold packs or immerse the effected extremity in ice water (cryotherapy)

Blood Pressure Stabilization

1. Airway, breathing, circulation

2. Give 

• - Epinephrine

• Stabilizes blood pressure

• Opens airway

• Increases heart rate

• Increases blood flow

OR 

• Norepinephrine 

• if you only need to increase bp

• These two drugs can be used together in cases of Septic Shock

1. Watch for confusion, and an altered state of consciousness

2. Use alertness scale

3. Check pupil reaction

4. Check head and neck for signs of trauma

5. Check to see if the patient is drunk, dehydrated, feverish, etc. 

6. Document everything and transport them to the hospital

Burns

1. Airway, breathing, circulation

2. If evidence of possible airway burn, consider aggressive airway management 

1. Stop the burning

• Remove wet clothing if not stuck to patient

• Remove jewelry

• Leave blisters alone

1. Minimize burn wound contamination

• Cover burns with dressings

1. Give oxygen and IV saline

2. Pain management and nausea medication

3. Keep patient warm

Bone Breaks and Fractures

1. Stabilize and splint injury

2. Pain management

3. Transport to hospital

Surgeons evaluate type of injuries and treatment needed

Reminder if removing a plaster cast

• A cast saw uses vibrations to cut through the cast, it is impossible to cut into skin

Crush Injury / Crush Syndrome

A crush injury is where someone has had a body part trapped/crushed under something and has lost circulation for any amount of time. 

1. Airway, breathing, circulation

1. Treat hemorrhage

• Give IV fluids immediately

• Use normal saline, NOT ringer's solution

• crush injury without adequate fluid resuscitation develops into crush syndrome

• If the patient has been trapped for a long time

• Add sodium bicarbonate

1. Monitor vitals

2. Pain control

3. Rush to ER

Determination of Death / Withholding Resuscitative Efforts

Signs resuscitation is useless

• Decapitation

• Decomposition of the body

• Torso cut through all major torso organs (may or may not include spine)

• Burns across 90 percent of the body

• Injuries incompatible with life

• A valid Do Not Resuscitate order

Diabetic Coma

1. Airway, breathing, circulation

2. Give Glucagon shot

• Rapidly raises blood sugar

• An IV with added dextrose does the same thing

Drowning

1. Airway, breathing, circulation

2. CPR will naturally push air out of the lungs

3. Put in c-spine Collar

4. Roll on their side/recovery position to keep from choking if they throw up

5. Give Oxygen

6. Consider CPAP in awake patients with respiratory distress 

7. If needed treat for hypothermia

8. Monitor vital signs

• Transport to hospital and observation for Dry/Secondary Drowning

• This is mandatory if the patient has at any point lost consciousness, even if they have regained consciousness. 

Facial / Dental Trauma

1. Airway, breathing, circulation

• If breathing is at all compromised due to damage, see Respiratory Airway Management and give a surgical airway

1. Administer oxygen

2. If needed give IV

3. Pain control

• Eyes

• If needed place eye shields over the eye or eyes to protect them.

• If the eye is removed, do not put it back into the socket. Cover with saline dressing and transport asap.

• Cover an injured eye with moist saline dressing and place a cup over it, taping it into place. 

• Mouth and Nose

• Have suction available if the patient can’t use their mouth

• Put protective sterile dressings over major lacerations

• Transport sitting upright if possible

• Any dislocated tissues

• Wrap in dry sterile gauze 

• Put in a plastic bag

• Put that bag in another bag of ice to transport

Head Injury

1. Airway, breathing, circulation

2. Maintain cervical stabilization 

3. Give oxygen

4. Maintain airway

5. Control bleeding

6. Give IV with Ringers Solution 

7. Evaluate mental state

8. Transport to hospital

1. Patients with penetrating injury to the neck should not be placed in a cervical collar or other spinal precautions regardless of whether they are exhibiting neurologic symptoms or not. Doing so can lead to delayed identification of injury or airway compromise and has been associated with increased mortality 

Heart Attack

1. Airway, breathing, circulation

2. Have the patient chew 2 tablets of aspirin

3. Give nitroglycerin

4. Transport to the hospital while maintaining vitals and treating as needed

Hemorrhage control

1. Manage the bleeding

2. Expose the wound and apply direct pressure 

3. If needed apply a tourniquet 

4. If bleeding continues, place a second tourniquet proximal to the first

• For thigh wounds, consider the placement of two tourniquets, side-by-side, and tighten them sequentially 

5. Wound packing:

• pack tightly and fully to the depth of the wound until bleeding stops (may require significant packing for deep, large wounds), then apply direct pressure and/or pressure dressing; do not remove packing to assess bleeding 1. Pack around (do not remove) bone fragments or foreign objects 

6. Manage pain

• Pain management should be strongly considered for patients with tourniquets and suspected fractures 

• Do not loosen the tourniquet to relieve pain

7. Stabilize suspected fractures/dislocations:

• Remove wet or blood-soaked clothing and use measures to prevent heat loss 

• Remove jewelry and potentially constricting clothing from the injured limb

• Do not remove impaled foreign bodies (if needed, stabilize them in place)

8. IV Fluid Resuscitation

• Tourniquets

• Combat Application Tourniquet(C-A-T)\

• Jett Junctional Emergency Treatment Tool 

• Hemostatic infused items

• Applicators for gunshot and stab wounds

• Bandages

• Gauze

• Granules

•  Nasal Plug

•  Plunger applicators

•  Sponges

•  Sprays

•  Wound Dressing

• Surgical Hemostatics

• Hemospray® Endoscopic Hemostat (for GI tract)

• OMNI-STAT®

• TISSEEL

• SURGIFLO® Hemostatic Matrix

• EVICEL® Fibrin Sealant (Human)

• Alternate - Sucking Chest Wound 

• Chest Vent Seals

Lung Collapse / Pneumothorax

1. Airway, breathing, circulation

2. The easiest indicator is to check breathing, if one side of the chest is rising normally, and the other is not, that is an immediately visible indication of a collapsed or collapsing lung.

1. If applicable use:

• Needle decompression 

• Tension Pneumothorax Access Kits (TPAK)

• Multiple kinds

1. AFTER emergency needle decompression, follow Chest Tube Procedure

Alternate - Sucking Chest Wound (from gunshots)

• Chest Vent Seals

Pain Management

1. Airway, breathing, circulation

Non-medicinal

1. Get patient in a comfortable position

2. Ice packs/splints, etc

3. Verbal reassurance to control anxiety

Medicinal

1. Acetaminophen or Ibuprofen (nonsteroidal anti-inflammatories)

2. Can administer nitrous oxide via oxygen

1. For moderate to severe pain

• Morphine sulfate

• Fentanyl

• Ketamine

• Add Ondansetron for nausea

Respiratory Airway Management

1. Airway, breathing, circulation

2. Open and maintain airway

3. Determine type of airway needed (oxygen, NIV, surgical)

• Surgical Intubation is mandatory if there has been extensive trauma to the face. This bypasses the nose/mouth entirely via using the throat. 

• Bleeding in the airway

• This is a major myth that someone is dying.

• This can only happen if there is internal damage to the mouth, throat, or airway. It is vital to find where the bleeding is coming from, why, and to stop it.

• In cases where there is a lot of blood, use suction to clear the airway to the best of your ability. 

If needed

• Tilt the head and chin, or use a jaw thrust 

• Suction airway

• Administer oxygen 

• If oxygen is not available use a bag-valve-mask (BVM)

Surgical Intubation

Surgical airways should take a maximum of 100 seconds to perform from incision to ventilation

1. Give patient several deep breaths of oxygen

2. Spray lidocaine down throat

3. Via IV give etomidate and succinylcholine

• Etomidate is a sedative that produces rapid onset of anesthesia with little effects on both heart rate and blood pressure. 

• Succinylcholine acts within a minute and is a paralytic agent to keep the body from fighting back while being intubated

1. Continue with whatever surgical airway is needed

2. Once done get patient immediate ventilation 

Difference between tracheostomy and cricothyrotomy;

• Cricothyrotomy (also known as cricothyroidotomy), on the other hand, can be performed quickly to give a person immediate access to oxygen. It’s sometimes called “emergency tracheostomy.”

• Tracheostomy is a surgical technique performed in a hospital under anesthesia or sedation that helps people who require long-term respiratory support.

Surgical Airways

• TacMed™ Surgical Airway Kit

Cricothyrotomy

• CONTROL CRIC™

• Simplified Cric Kit

• TACTICAL CRICKIT

Tracheostomy

• Tracheostomy Kit

Non-invasive Airway Support

Non-invasive ventilation (NIV)

• continuous positive airway pressure (CPAP)

• bilevel positive airway pressure (BiPAP), 

• bilevel nasal CPAP, and high flow oxygen by nasal cannula (HFNC)

Nasal Airway

• A nasal airway should not be used with significant facial injury or possible skull fracture

• Oropharyngeal airways (OPA) used for a patient without a gag reflex

• Nasopharyngeal airways (NPA) Used for a patient with a gag reflex

Resuscitation / Cardiac Arrest

1. Circulation, Airway, Breathing

• In this situation, the airway takes secondary importance to circulation. 

• If the mouth/nose/throat is obstructed use alternate respiratory methods.

If the heart has stopped completely

1. Start and continue chest compressions to physically pump the heart and keep blood pumping through the body

2. Do NOT use a AED/defib to ‘restart the heart’

The use of a defibrillator or AED to ‘shock’ a stopped heart is an extremely dangerous myth and media trope. A defib ONLY has an effect if there is a heart rhythm (is beating on its own).  

1. Administer epinephrine and amiodarone (antiarrhythmic)

2. Check airway and treat as needed

3. Rush to ER

If the heartbeat is low or has an irregular rhythm 

1. Set an aed/defib up and assess if the heart needs to be shocked

2. Start and continue administering chest compressions, stopping only to administer shock if needed

3. Check for a pulse every 2 min, regardless if a heart rhythm is shown

4. If possible get an IV going

5. Administer epinephrine and amiodarone (antiarrhythmic)

6. Rush to ER

Seizures

1. Airway, breathing, circulation

2. Roll the patient on their side and wait for convulsions to stop.

3. NEVER put anything in a patient’s mouth when they are having a seizure.

4. Administer oxygen

5. Give IV, add Diazepam

• If the patient is in the third trimester of pregnancy

• Give magnesium sulfate
  

Spinal Care

1. Airway, breathing, circulation

1. Assess injury

2. Determine if the patient needs either a cervical collar, or full restriction

• Patients with penetrating injury to the neck should not be placed in a cervical collar or other spinal precautions regardless of whether they are exhibiting neurologic symptoms or not. Doing so can lead to delayed identification of injury or airway compromise and has been associated with increased mortality 

• Cervical collar

• Midline neck or spine pain or tenderness

• Altered mental status

• Alcohol or drug intoxication

• Another severe or painful distracting injury

• Full restriction 

• Unable to move fingers/toes, or feel body

• High-risk injuries

• Falls greater than 10 feet 

• Motor vehicle crashes, especially via a motorcycle, or off-road vehicle