Allegheny General Hospital LifeFlight

Allegheny General Hospital

LifeFlight

Adult Protocols

Version 2016

Allegheny General Hospital LifeFlight Protocols Adult Protocols Version 2016

Table of Contents

GENERAL PATIENT PROTOCOL....................................................................4 AIRWAY/KING LTSD PROCEDURE................................................................6 AIRWAY ? FOREIGN BODY OBSTRUCTION.....................................................8 AIRWAY/HYPOXIA.......................................................................................9 AIRWAY/RAPID SEQUENCE INTUBATION......................................................10 AIRWAY/SURGICAL CRICOTHYROIDOTOMY PROCEDURE..............................11 ALTERED MENTALSTATUS..........................................................................12 AMPUTATION............................................................................................13 ANAPHYLAXIS..........................................................................................14 AORTIC DISSECTION...................................................................................15 AORTIC RUPTURE......................................................................................16 ADMINISTRATION OF BLOOD......................................................................17 BURNS......................................................................................................18 CARDIOGENIC SHOCK................................................................................20 CHF/PULMONARY EDEMA...........................................................................22 CHEST PAIN..............................................................................................23 PREHOSPITAL STEMI..................................................................................25 COMBATIVE PATIENT.................................................................................26 DETERMINATION OF DEATH IN FIELD..........................................................27 DIABETIC KETOACIDOSIS...........................................................................29 ASYSTOLE................................................................................................30 BRADYCARDIA..........................................................................................31 PULSELESS ELECTRICAL ACTIVITY (PEA).....................................................33 ROSC / Induced Hypothermia...........................................................................34 TACHYCARDIA: ATRIAL FIBRILLATION OR FLUTTER.....................................35 TACHYCARDIA: PSVT.................................................................................36 TACHYCARDIA: UNSTABLE (Cardioversion Protocol)...........................................37 TACHYCARDIA: VT....................................................................................38 VENTRICULAR FIBRILLATION & PULSELESS VENTRICULAR TACHYCARDIA.....39 WIDE COMPLEX TACHYCARDIA OF UNCERTAIN ORIGIN.................................41 HEMORRHAGIC SHOCK.............................................................................42 HYPER-REACTIVE AIRWAY.........................................................................43 HYPERTENSIVE EMERGENCY (Associated with Angina or MI)................................44 PREHOSPITAL ACUTE CVA.........................................................................45

2

Allegheny General Hospital LifeFlight Protocols Adult Protocols Version 2016

INTERHOSPITAL ACUTE CVA......................................................................47 INTERHOSPITAL CONFIRMED INTRACRANIAL HEMORRHAGE.........................53 HYPERTHERMIA.......................................................................................54 HYPOTHERMIA..........................................................................................56 IABP Systolic Hypertension..............................................................................58 IABP ? Ruptured Balloon.................................................................................59 REMOVAL OF INTRA-AORTIC BALLOON (IAB) CATHETERS BY LIFEFLIGHT NURSES....................................................................................................60 ALTERED MENTAL STATUS WITH S&S OF BRAINSTEM HERNIATION...............62 NAUSEA/VOMITING...................................................................................63 NEAR DROWNING.....................................................................................64 NEUROGENIC SHOCK.................................................................................65 OCULAR INJURIES.....................................................................................66 PACING, TRANSCUTANEOUS.......................................................................67 PAIN RELIEF.............................................................................................68 PARALYTICS.............................................................................................70 POISONINGS/INGESTIONS...........................................................................71 GENERAL HIGH-RISK OB ASSESSMENT AND DOCUMENTATION......................72 PREGNANCY INDUCED HTN........................................................................74 THIRD-TRIMESTER VAGINAL BLEEDING......................................................75 TOCOLYTIC PROTOCOL...............................................................................76 TRAUMA IN PREGNANCY...........................................................................78 SEDATION PROTOCOL................................................................................79 SEDATION PROTOCOL/DIPROVAN (PROPOFOL) INFUSIONS.............................80 SEIZURES.(ADULT)....................................................................................84 SEPTIC SHOCK..........................................................................................85 THROMBOLYTIC THERAPY, DISCONTINUATION OF.......................................86 TRAUMA/SPINE IMMOBILIZATION.................................................................87 TRAUMA-MULTIPLE SYSTEM......................................................................88 TRAUMATIC ARREST PROTOCOL.................................................................91 VENTRICULAR ASSIST DEVICES...................................................................92 ECMO TRANSPORTS....................................................................................94 EMERGENCY PERICARDIOCENTESIS PROCEDURE.........................................102 ABIOMED IMPELLA VENTRICULAR ASSIST DEVICE TRANSPORT...................104 MECHANICAL VENTILATION.....................................................................108 BOUSSIGNAC CPAP...................................................................................111 PIG-TAIL CHEST TUBE THORACOSTOMY.....................................................112 EZ-IO PROCEDURE....................................................................................114 NEEDLE THORACENTESIS PROCEDURE......................................................116 HEMOSTATIC DRESSING PROTOCOL..........................................................119 MAD PROTOCOL:INTRANASAL MEDICATION ADMINSTATION.......................121 INTRANASAL MEDICATION DOSAGE TABLES..............................................123 EXTERNAL VENTRICULAR DRAIN (EVD)......................................................125 SAM PELVIC SPLINT II..............................................................................126

3

Allegheny General Hospital LifeFlight Protocols Adult Protocols Version 2016

Protocol:

GENERAL PATIENT PROTOCOL

1. Oxygen saturation will be monitored on all patients.

2. Optimally, O2 saturations should be maintained >95%. Provide for a Patent airway and administer supplemental oxygen as necessary to maintain this level.

3. If the patient is peripherally vasoconstricted and pulse oximetry is unable to be obtained, then at minimum, a non-rebreather facemask with high flow oxygen will be applied. Monitor ETC02.

4. Orotracheal intubation is the definitive airway of choice if the patient is unable to be adequately oxygenated or ventilated, if the airway is at risk for aspiration and/or obstruction, or if there is significant head injury. Use c-spine precautions as indicated.

5. The Rapid Sequence Intubation protocol will be used to facilitate orotracheal intubation.

6. Endotracheal intubation will be confirmed by at least auscultation and either capnometry or capnography.

7. Capnography is the method of choice for airway intubation confirmation and monitoring. All intubated transports will have capnography initiated and a waveform printout placed on the patient's record.

8. If airway control proves extremely challenging, notify Medical Command of your need for airway assistance upon landing. The Attending Physician/Designee will be available to assist with additional advanced airway control methods.

9. Initiate 2 IV lines, 18g or greater in the trauma patient. Transport should not be delayed to initiate IV access unless necessary to establish airway via RSI. Keep attempts limited to 2 per crewmember prior to transport. If peripheral IV not possible, consider IO, Femoral access, or ETT (for initial resuscitation meds only).

10. All medications that can be administered by IV can also be administered via the IO route. (Note: IO Adenosine will be more effective if administered at the humeral head site).

11. Provide for continuous cardiac monitoring.

4

Allegheny General Hospital LifeFlight Protocols Adult Protocols Version 2016

12. Vital signs including pulse ox reading every 15 minutes x6, then every 30 minutes throughout transport if normal and stable. When titrating vasoactive medications, monitor BP both before and after titration.

13. If invasive lines in place, monitor during transport if patient on IABP or transport time >45 minutes.

14. Soft restraints should be applied when safety is a concern for crew and patient.

15. Document reevaluations according to patient care standards.

Reviewed 1/16 PSM Top

5

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download