Madison Fire Protocols Program

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This program review the Dane County and Madison Fire Department ALS Protocols

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Madison Fire Protocols Program

  1. 6.  No longer prepare Atropine ahead of time  Etomidate replaces Midazolam as the induction medication – no waiting period for effect  Succinylcholine has been increased to 2 mg/kg (up from 1.5 mg/kg currently)  Morphine 3 mg IV AND Midazolam 3 mg IV used for post-intubation sedation.  Vecuronium and Rocuronium may be used for post-intubation sedation if the Morphine and Midazolam are not effective AND transport is going to be greater than 10 minutes.
  2. 7.  Now combined into one protocol.  Peak flow measurement is gone.  3 branches of severity: Mild – Treatment as we are used to Moderate – CPAP, Methylprednisolone Severe – Epi IM, CPAP, Magnesium Sulfate, Methylprednisolone
  3. 9.  Generally is a guide to send you to the correct protocol for treatment, however it does include a treatment pathway for stridor – EPI IM.
  4. 11. NTG is now given if SBP is greater than 100, and can be given as needed, every 2-3 minutes.  CPAP is second course of treatment  MSO4 is third course of treatment  Finally, Lasix is listed as fourth. Emphasis on movement of Lasix to bottom of treatment tree.  Venous tourniquets are no longer listed in protocol
  5. 12.  Note determining factor for decision tree is the presence/absence of adequate bystander CPR.  Good bystander CPR = charge defibrillator  Poor bystander CPR = compressions at 100/min x 2 minutes
  6. 13.  General CCR information.
  7. 14.  Epi and Vasopressin given together at start of protocol  Followed by EPI 1 mg every 3-5 minutes  No longer have all of the other pressor options (i.e. high dose, infusion, Norepi)
  8. 15.  Epi and Vasopressin given together at start of protocol  Followed by EPI 1 mg every 3-5 minutes  No longer have all of the other pressor options (i.e. high dose, infusion, Norepi)
  9. 16.  Fentanyl AND Midazolam used together for pre-medication with TCP  Guidelines for TCP are a heart rate <60 AND SBP <90 AND symptomatic  If using an EPI drip, titrate to a heart rate of 60.
  10. 17.  2 branches of treatment: Stable and Unstable  Stable: May give a repeat dose of Amiodarone  Unstable: Now using Etomidate for pre-medication with Synchronized Cardioversion.
  11. 18.  2 branches of treatment: Stable and Unstable  Stable: May give a repeat dose of Amiodarone  Unstable: Now using Etomidate for pre-medication with Synchronized Cardioversion.
  12. 19.  2 branches of treatment: Stable and Unstable  Stable: Diltiazem now given over 5 minutes  Unstable: Etomidate now used for pre-medication with synchronized cardioversion.
  13. 20.  NTG now given if SBP >100  Morphine is now 2- 5 mg IV  Ondansetron is available for nausea  Lorazepam is now available for anxiety.
  14. 21.  If Blood Glucose is less than 60 and the pt is malnourished, the Thiamine is given along with Dextrose.
  15. 22.  ASA now given  2 branches of treatment: Stable and Unstable  Stable: Fentanyl AND Midazolam provided together for pain control.  Unstable: Magnet now applied without Medical Control.
  16. 23.  ASA now given  2 branches of treatment: Stable and Unstable  Stable: Defined as SBP >100  Unstable: Defined as SBP <100. May now place magnet without Medical Control.
  17. 24.  Treatment based on SBP <100  If SBP<100 then provide bolus to maintain SBP of 100, consider reduction of long bone fractures, consider needle chest decompressions.  If SBP >100, and GCS is 15, then may use pain control protocol
  18. 25.  Provide 2-liter bolus  Epi given every 3 to 5 minutes  Consider chest decompression and reduction of long bone fractures
  19. 26.  2 branches for treatment: GCS <8 or GCS >8.  If GCS>8, monitor, maintain SPO2 of 92%  If GCS<8, then evaluate for Gag  If gag, then RSI  If no gag, then Lidocaine, intubate, sedate with Morphine and Midazolam, maintain ETCO2 of 40.
  20. 27.  Guides care to the pain control protocol, and also provides directions on care for amputations.
  21. 29.  10 % burn surface is determinate for treatment  If <10%, then cool with Saline  If >10%, then treat with dry dressings  Fentanyl used for pain control  Ondansetron available for nausea
  22. 31.  Now able to provide pain control to abdominal pain  Ondansetron available for nausea  500 cc Fluid bolus if orthostatic – may repeat to 2000 cc.
  23. 32.  3 branches for treatment: Hives/rash only, respiratory distress, and Impending respiratory arrest/shock.  Methylprednisolone available
  24. 33.  3 branches for treatment: Glucose <60, Glucose 60-350, Glucose >350  Narcan now given as 0.5 mg IV, and repeated every 1 minute to effect. Max of 4 mg.
  25. 34.  If non-traumatic and orthostatic, then will provide 1000 cc bolus.
  26. 35.  Reference to restraint procedure SP-35.  Haloperidol AND Lorazepam given together as IM injection, with Medical Control.  Followed with 2 liters NSS.
  27. 42.  Hypotension is SBP <100.  Provide fluid bolus in 500 cc doses, to a max of 20 cc/kg.  If no improvement after 20 cc/kg, or if pulmonary edema develops, then Dopamine 5-20 mcg/kg/min.
  28. 43.  500 to 2000 ml bolus  If Cocaine overdose suspected, provide Lorazepam with Medical Control.
  29. 44.  2 important temperature determinates: 95 F, and 88 F.
  30. 45.  Criteria for Induced Hypothermia: Witness arrest & ROSC, Significant ALOC, Not following commands, No purposeful movement, Incomprehensible speech, No known surgery < 2 weeks, No history of bleeding disorder, Not pregnant, Age > 18 years, No evidence of trauma  Review Steps of procedure
  31. 46.  Defined as DBP >130 or SBP >200.  Labetolol or NTG given with Medical Control
  32. 48.  Acetaminophen available if pain severity does not warrant IV/IM access  2 branches for treatment: Abdominal pain, and other  Abdominal pain = Fentanyl  Other = Morphine or Fentanyl
  33. 50.  2 branches for treatment: Status, and post-ictal  If status, then Lorazepam 1-2 mg IV OR IM. May repeat every 2 minutes to 6 mg max.  If post-ictal, then measure blood glucose  If glucose >60, and seizure recurs, then Lorazepam as above.  If glucose <60, then go to AMS protocol.
  34. 52.  If orthostatic, 500 cc bolus  Ondansetron available
  35. 55.  Magnesium Sulfate given to pregnant seizing patient.
  36. 59.  2 branches for treatment: Mild or Moderate/Severe  If Moderate/Severe, then Hydroxocobalamin, unless in arrest – contact Medical Control first

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