State of Wisconsin
Emergency Medical Services
Sample Medical Guidelines
Note:
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This protocol may apply to the following conditions:
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Congestive Heart Failure (CHF)
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Asthma/COPD
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Allergy/Anaphylaxis
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Pulmonary Infections
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Spontaneous Pneumothorax
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Upper Airway Obstruction
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Anxiety and Hyperventilation Syndrome
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Acute Coronary Syndromes
Priorities
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Assessment Findings
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Chief Complaint
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“Difficulty breathing,” “Shortness of breath”
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OPQRST
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Assess onset, duration, progression, subjective severity, possible triggering events, and response to treatments before EMS arrival.
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Associated Symptoms/
Pertinent Negatives
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Chest pain (what kind?), fever/chills, productive (of what?) cough
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SAMPLE
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Check for possible exposure to known allergens. Check past history, medications and compliance for clues to cause of present illness.
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Initial Exam
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Check ABCs and correct immediately life-threatening problems.
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Detailed Focused Exam
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General Appearance: Tripod positioning; Purse-lipped breathing.
Neck: JVD?
Skin: Cool, moist and pale? Warm, dry and flushed? Urticaria? Cyanosis?
Respiratory Effort: Using accessory muscles, signs of fatigue; two-word sentences?
Lung Sounds: Wheezes, rales, rhonchi or stridor?
Heart Sounds: Rate, regularity.
Lower Extremities: Pitting edema of the ankles?
Neuro: ALOC, lethargy, somnolence?
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Goals of Therapy
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Improve oxygenation and ventilation, reduce the work of breathing, and treat underlying conditions.
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Monitoring
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BP, HR, RR, EKG, SpO2.
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EMERGENCY MEDICAL RESPONDER (EMR)
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Routine Medical Care
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Allow/assist the patient to assume a position of comfort (usually upright).
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Oxygen as appropriate.
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Support ventilation with BVM if apnea or hypopnea occurs.
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Airway Adjuncts: If there is altered level of consciousness and loss of gag reflex, consider oropharyngeal or advanced airway, if approved.
EMERGENCY MEDICAL TECHNICIAN (EMT)
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Albuterol is indicated for Asthma and COPD, see Asthma & COPD Guidelines.
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If patient is unresponsive with no gag reflex consider advanced airway in not already in place.
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Consider CPAP, if approved.
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IV/IO NS @ TKO, if approved.
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Initiate a 500 ml bolus if hypotension or dehydration is present.
Contact Medical Control for the following:
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Origination August 2007
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