Quick Reference Guide

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1 Contents Alert Check List... 3 CARDIAC ALERT CHECKLIST-For Inclusion... 3 STROKE ALERT CHECKLIST-For inclusion... 3 SEPSIS ALERT... 3 COOLING CRITERIA-passive cooling only... 4 APGAR... 5 Medications and Doses... 5 Acetaminophen (Tylenol)... 5 ASA... 5 Activated Charcoal... 5 Adenosine... 6 Albuterol... 6 Amiodarone... 6 Ativan... 6 Atropine... 6 Calcium gluconate... 6 Celox... 7 Dextrose... 7 Mixing Guide for D10% (neonate)... 7 Mixing Guide for D25%... 7 Diazepam... 7 Diltiazem... 7 Diphenhydramine... 8 Dopamine... 8 Epinephrine (Adrenalin) Dosing Adult... 8 Dosing Pediatric... 8 Epinephrine Drip chart... 8 Etomidate (Amidate)... 9 Fentanyl(Sublimaze)

2 Glucagon... 9 Haloperidol (Haldol) Insta-Glucose... 9 Hydroxocobalamin(Cyanokit) Ipratropium Bromide/Albuterol(Duo-Neb) Ketamine Lidocaine (Xylocaine) Magnesium Sulfate Methylprednisolone (Solumedrol) Midazolam (Versed) Morphine Sulfate Naloxone (Narcan) Nitroglycerin Ondansetron (Zofran) Oxytocin (Pitocin) waivered medication Phenylephrine (Neo-Synephrine) Promethazine (Phenergan) Sodium Bicarbonate Terbutaline (Brethine) Tetracaine Hydrochloride Rocuronium (Zemuron) Vecuronium (Norcuron) EMS Trauma Bay Report EMS Trauma Radio Report Faces Pain Scale Prehospital Trauma Team Activation Criteria RSI Paralytic Dosing Chart-Revised 07/05/ RSI Sedation and Assisting Medication Dosing Chart-Updated Ventilator Initial Setting Ideal Weight Tidal Volume Chart. 6-8 ml/kg

3 Alert Check List CARDIAC ALERT CHECKLIST-For Inclusion Does not have DNR 90 years old or less Characteristic cardiac presentation Pain less than 12 hours old No LBBB or paced rhythm 1 mm ST elevation in two contiguous limb leads 2 mm ST elevation in two contiguous V-leads Tx per cardiac chest pain protocol. Notify hospital within 5 minutes of identifying alert. Transport to Hospital of choice. Obtain serial 12 leads. Start two IV s. Additional information-nursing home status, Contrast dye allergy, anticoagulant therapy. STROKE ALERT CHECKLIST-For inclusion I.B.F.A.S.T. I.-Eyes. Sudden difficulty seeing or visual field deficits B.-Balance-Sudden dizziness or inability to walk straight F.-Facial droop (have pt. show teeth) Normal-both sides of face move equal. A.-Arm drift-pt closes eyes and hold both arms out. Normal-both arms move the same. S.-Speech-Have the patient say you can t teach an old dog new tricks. Normal-pt uses correct words without slurring. T.-Time-Last known well time within 6 hours Additional information-no Hx of brain tumors. Presence of clotting or bleeding disorder. BGL within Presence of intracranial hemorrhage. Surgery within 14 days. New head trauma. Seizure disorders. No active bleeding. SEPSIS ALERT A. Must have two or more SIRS criteria (the following) 3

4 1. Temp < 96.8 or > Resp rate > HR > WBC < 4000 or > 12, 000 (if lab values are available) Pediatric VS parameters for sepsis Age BP HR Resp < 90 > 110 > < 83 > 130 > < 75 > 140 > 30 < 2 < 75 > 180 > 40 B. Must suspect an infection of some sort. C. Must have one of more of the following. 1. Hypoximia-spO2 < Altered mental status Hypo-perfusion-BP < 90 systolic or a MAP < Lactate > 4 mmol/l (if lab values are available) COOLING CRITERIA-passive cooling only Less than 15 minutes of down time 15 years old or greater Initial temperature is > 34 C ETCO2 > 20 mmhg ROSC Non traumatic cardiac arrest 4

5 APGAR A Sign 0 Points 1 Point 2 Points Activity (Muscle Tone) Absent Arms and Legs Flexed Active Movement P Pulse Absent Below 100 bpm Above 100 bpm G Grimace (Reflex Irritability) No Response Grimace Sneeze, cough, pulls away A Appearance (Skin Color) Blue-gray, pale all over Normal, except for extremities Normal over entire body R Respiration Absent Slow, irregular Good, crying Medications and Doses Acetaminophen (Tylenol)-I = relief of Fever in pediatric patients or adult patients. C=repeated use with anemia, renal, or hepatic diseases. Not recommended in the anti-inflammatory setting. Dose = 15 mg/kg. Dosing Chart < 24 lbs or 2 years old. 15 mg/kg lbs ( kg) or 2-3 years old. 5 ml (1 tsp) equal to 160 mg lbs ( kg) or 4-5 years old. 7.5 ml (1.5 tsp) equal to 240 mg lbs ( kg) or 6-8 years old. 10 ml (2 tsp) equal to 320 mg lbs ( kg) or 9-10 years old ml (2.5 tsp) equal to 400 mg lbs ( kg or 11 years old. 15 ml (3 tsp) equal to 480 mg Adult or greater than 95 lbs (42.75 kg) 15 mg/kg 3. ONSET: Minutes DURATION: 3-4 Hours Doses may be given PO or feeding tube Dosing Chart Supplied 160 mg/5ml(32 mg/ml) ASA-I= suspected AMI. C=Decreased LOC, Dysphagia, Allergy. Dose = mg Activated Charcoal-I= Drug ingestion, OD. C= No absolute contraindications other than oral administration in patient without gag reflex or unconscious. Dose = Adult 50 gram single dose years old 1 gm/kg. 5

6 Adenosine-I = # 1 Med for PSVT, Used diagnostically before amiodarone in Wide complex tachycardias, can be used in the Dig toxic pt. C = 2 nd and 3 rd degree blocks, sick sinus syndrome, hypersensitivity to adenosine, A-fib with WPW. Dose = Pedi 0.1mg/kg IV or IO followed by 20ml bolus. Double once, max 12mg. Adult 6 mg rapid push IV/IO followed by 20ml bolus. Second dose 12 mg to a max of 30mg. Albuterol-I= Acute Asthma and COPD with bronchospasm, Anaphylaxis with bronchospasm with poor response to Epi. Pulmonary Edema, Dyspnea secondary to pneumonia, Hyperkalemia after Calcium and Bicarb. C = Sensitivity to albuterol. Dose = Adult and Pedi-2.5mg (0.5ml) over minutes for resp. issues mg over 15 min for Hyper K+. Amiodarone-I=Refractory VF-pulseless VT when defibrillation fails. Symptomatic A-fib/flutter if diltiazem fails. Stable V-Tach/wide beat tachycardias. Ustable V-Tach refractory to Cardioversion. C= Hypersensitivity, Cardiogenic shock, sinus bradycardia, 2 nd and 3 rd degree heart blocks unless pt. has a functioning internal pacemaker. No ETT administration. P = precipitates with Bicarb. May cause hypotension. Dose = PEDS=5 mg/kg over several minutes for ventricular and supraventricular arrhythmias. Repeat to max of 15mg/kg in 24 hours. Adult = VF/pulseless VT 300 mg rapid IVP with 10ml bolus. Repeat at 150 mg RIVP. VT with pulse/wide complex Tach/Afib/flutter 150mg/100ml over 10 min or slow IVP over 10 min. Ativan-I= Status epilepticus or active SZ. Continued sedation in intubated Pt. Chemical restraint with hysterical or combative pt. FX, dislocations with muscle spasms or contractions. Sedation for cardioversion or pacing. Symptomatic sinus tach (rate > 150) secondary to amphetamine or stimulant abuse in alert patients. C = sensitivity to benzodiazepines or it s vehicle, glaucoma, severe respiratory insufficiency, Breast feeding women. Dose PEDI = 0.1 mg/kg IV/IM/IO max 3 doses. Adult = 2-4 mg IV/IO/IM/ MAD x 3 doses. 1-2 mg for stimulant abuse, muscle spasms, and combative patients. Repeat to 4 mg if needed. Atropine-I=Symptomatic Bradycardia. Pacemaker failure. Pre-treatment in RSI patients with bradycardia. Hypersalivation associated with ketamine use. Antidote for muscarinic effects of organophosphate and carbamate pesticides and nerve gas ezposures. C= A-fib/flutter. Tachycardia. Glaucoma. None when used for exposures. Dose PEDI = 0.02mg/kg IV/IO Minimum of.1mg. Max.5mg. (1mg max for adolescent). ETT dose 3 times IV dose. Adult-(No longer recommended for asystole or PEA). Bradycardia and hypersalivation.5mg IV/IO push q 3-5 min max 3mg while waiting for pacemaker. ETT 2-2 1/2 times IV dose. PEDI = 0.02 mg/kg minimum dose os 0.1mg. 4. Child max is 0.5mg, adolescent is 1.0 mg max. For exposures use 2 mg/kg every minutes until symptoms reverse. Calcium gluconate-i=calcium channel blocker toxicity (OD) with symptomatic shock. Beta blocker toxicity. Hyperkalemia with EKG changes, cardiac arrest with etiology of hyperkalemia (first line choice), Magnesium infusion that fails to respond to fluids, Hydrofluoric acid burns, magnesium toxicity. Hypotension associated with magnesium infusion that does not respond to fluids. Hydrofluoric acid burns. Magnesium toxicity. Pediatrics = hypocalcemia, septic shock, Hyperkalemia, hypermagnesemia, 6

7 calcium channel OD. C= VF. Precipitates with Bicarb. Dose-Not for IM or SQ administration. PEDI= 2-5mL slow IV/IO repeated once in 10 min. Pedi max is 5mL and infant max is 2 ml. Adult = 5-20 ml over 2-5 min. repeated q 10. For Hydrofluoric acid burns mix with a water based lubricant and apply liberally to burn area then cover with adaptic dressing, celaphane, or exam glove. Celox-I + Animal use only- arterial or venous bleeding after direct pressure and CAT tourniquet. Pour package contents into wound and pack tightly with guaze. Apply pressure for 5 minutes. Dextrose (D-50)-I= BS < 70 (<40 in neonate) with signs and symptoms. Hypoglycemia with diabetes. Unconscious hypothermic patients with focal or partial neurologic deficits or altered states of consciousness if glucometer is not available. C = questionable IV or know brain injury (trauma or CVA) if glucose levels are above 60. Dose NEONATE = 0.5 to 1gm/kg D-10 (5:1mix with NS) IV/IO/Rectal. PEDI= 0.5 to 1 gm/kg of D-25(dilute to 1:1 with NS) IV/IO/rectal. Adult = g IV/IO/rectal. Mixing Guide for D10% (neonate) 1 Draw up 6g (12 ml) of Dextrose 50 % into 60 ml syringe 2 Add 48 ml of saline to bring the total to 60 ml in the syringe 3 Administer 2-4 ml/kg IV bolus Mixing Guide for D25% 1 Draw up 15g (30 ml) of Dextrose 50 % into 60 ml syringe 2 Add 30 ml of saline to bring the total to 60 ml in syringe 3 Administer 2-4 ml/kg IV bolus Dextrose (D-10)-Indicated to treat hypoglycemia when D-50 is not available. Same indications and contraindications. Diazepam-I= Active SZ, sedation for pacing or carcioversion, continued sedation for RSI, uncontrollable patients needing intubation, excited delirium, in pulseless arrest when trismus is present to facilitate ventilation and intubation. C = recent ETOH intake, patients with resp depression or hypotension, glaucoma, induction for RSI. Dose PEDI = 0.2 mg/kg over 1 min. Double in ETT administration. Rectal dose 0.5mg/kg via small feeding tube. Adult = 5-10 mg slow IV/IO push mg for continued sedation in the intubated pt. 5. Diltiazem-I= symptomatic A-fib/flutter with rapid ventricular response. Stable PSVT refractory to adenosine and vagal maneuvers. C = Sic sinus syndrome except in the presence of a functioning pacemaker. Hypersensitivity. Severe hypotension or CHF, in the presence of Asystole, 1 st 2 nd and 3 rd degree blocks, junctional rhythms. VF, VT, bradycardia. Do not use in the same line as lasix, diazepam, 7

8 or bicarb. Caution with beta-blockers. Dose Adult = 0.25 mg/kg over 2 min. repeat at0.35 mg/kg after 15 min. Diphenhydramine-I= Anaphylaxis, Dystonic reactions, Simple allergic reactions with itching or hives. C = Lower respiratory tract symptoms. Dose PEDI = -1-2 mg/kg IV/IO/IM repeat as needed. Adult = mg slow IV/IO/IM repeat as needed. Dopamine-I= Cardiogenic shock (BP with signs and symptoms of shock) not responding to fluid. Any hypotension after hypovolemia has been treated. Symptomatic Bradycardia refractory to atropine, Hypotension post ROSC. C = Hypovolemic shock, uncorrected tachyarrhythmias or VF. Dose PEDI =mix 200 mg in 250 ml NS ( 800 mcg/ml) infuse at mcg/kg/min. Adult = 400mg in 250 ml (1600 mcg/ml)(26.6mcg/gtt) infuse at 2-20 mcg/kg/min Duo-Dote-I = Suspected nerve agent or organophosphate exposure with signs and symptoms of poisoning. C = none in acute setting. Dose-One to Three auto injector doses depending on severity. Epinephrine (Adrenalin)-I =Pulseless VT, VF, Asystole, PEA, Anaphylaxis, Severe croup, Symptomatic bradycardia. C = In non-arrest situations. HTN, hyperthyroidism, Ischemic heart disease, cerebrovascular insufficiency, and childbirth. Dosing Adult Arrest 1mg q 3-5min 1:10,000 IV/IO Double down ETT Anaphylaxis/asthma-mild 0.3mg q 3-5min 1:000 IM Anaphylaxis/asthma-severe 0.3mg q 3-5min 1:10,000 IV/IO-slow push Bradycardia 2-10mcg/min 2mg/250ml IVD Dosing Pediatric Bradycardia 0.01 mg.kg 1:10,000 IV/IO Arrest 0.01 mg/kg 1:10,000 IV/IO Arrest 0.1/mg/kg 1:1000 ETT Anaphylaxis/asthma 0.01mg/kg 1:1000 IM Croup 0.5 ml/kg max of 5 ml 1:1000 Nebulize 6. Epinephrine Drip chart 2 mg in 250 ml = 8 mcg/ml 8

9 mcg/min ml/hr drops per minute 1 7.5ml/hr or 7.5 drops per minute ml/hr or 15 drops per minute ml/hr or 22.5 drops per minute ml/hr or 30 drops per minute ml/hour or 37.5 drops per minute ml/hr or 45 drops per minute ml/hr or 52.5 drops per minute ml/hr or 60 drops per minute ml/hr or 67.5 drops per minute ml/hr or 75 drops per minute Etomidate (Amidate) wavered medication-i-for initial sedation during RSI. C= Hypersensivitity. Dose = mg/kg IV/IO Fentanyl(Sublimaze)-I=Sedation, Pain relief, Sever chest pain during suspected MI, continued sedation in RSI, Shivering associated with cooling therapy. C= uncorrected respiratory insufficiency, hypersensitivity, Head injuries except during RSI, Not used for induction in RSI. Dose Adult and PEDS = 1-2 mcg/kg IV/IO/IM/MAD q 10 minutes. For RSI 1-3 mcg/kg IV/IO/IM. May nebulizer at 0.75mcg/kg if IV/IO cannot be obtained. Glucagon-I= Hypoglycemia when IV cannot be obtained, Beta Blocker OD, Calcium Channel Blocker OD, Esophageal spasm or obstruction. C = None with listed indications. Dose Adult = 1mg IM. 1mg slow IV/IM/IO. 2 mg for OD. PEDS (<8y/o or 3-18 kg) = 0.5mg kg = 1 mg. Haloperidol (Haldol)-I = psychotic disorders, chemical restraint for uncontrollable, violent, acutely agitated patients, restraint of combative head injury. C = severe toxic CNS depression, coma, allergies to butyrophenone family, parkinson s disease, patients on lithum, patients taking anit-convulsants, severe cardiovascular disorders because of hypotension or angina pain, patients receiving anticoagulant medications. Dose-Adult only- 2-5 mg IV/IM. Insta-Glucose-I = hypoglycemia. C = unconscious patients, patients who cannot control their airway, neonates. Dose-entire contents of tube. Repeat after 10 minutes if no response. 9

10 7. Hydroxocobalamin(Cyanokit)-I= known or suspected cyanide poisoning with unstable vital signs, patients in cardiac arrest or unconscious who were in an enclosed space smoke inhalation or fire. C = None. Dose Adult = 5 g over 15 minutes IVD. Pedi = 70 mg/kg over 15 min. Ipratropium Bromide/Albuterol(Duo-Neb)-I=Acute asthma or COPD with bronchospasm, Anaphylaxis with bronchospasm and poor response to epinephrine, Pulmonary Edema, Dyspnea secondary to pneumonia. C = none with nebulized solution. Supplied.5 mg atropine and 3 mg albuterol per 3 ml. Dose Adult and Adolescent = 0.5mg nebulized. Peds = 0.25 mg nebulized. Ketamine-Waivered Medication-I-Adult patients showing signs of excited delirium and extreme agitation where the safety of the patient and/or provider is of substantial concern. Analgesia after morphine or fentanyl, when longer lasting effects are desired, or in situations when opiates are not desired (addiction, allergy). As an induction agent during RSI. C = relative contraindications for penetrating trauma to the eye and patients with known cardiovascular disease. Dosing. Agitation and excited delirium (adult only) 5 mg/kg IM. Pain control (adult and pedi) 0.3 mg/kg IV/IO up to 3 doses. M.A.D. 0.5 mg/kg up to 3 times. Rapid Sequence Intubation > 12 years old mg/kg IV/IO Lidocaine (Xylocaine)-I= Active or preventative laryngospasm during intubation, pre-treatment for ETT or NG tube if ICP is suspected or patient has a head injury, Analgesia bolus for IO patients who are conscious. C= Bundle branch blocks, AV blocks, A-fib/flutter, SVT with WPW, hypersensitivity. Dose Adult = 1-1.5mg/kg IV/IO for ICP, head injury, or laryngospasm (may spray needed amount on cords as well). 0.5mg/kg slow bolus for IO analgesia. Max adult dose is 3 mg/kg. PEDS mg/kg IV/IO for ICP or head injury. Magnesium Sulfate-I= Torsades de Pointes, A-Fib with rapid ventricular response after diltiazem or amiodarone, eclampsia or pre-eclampsia if > 20 seeks gestation, Asthma with moderate or severe presentation after nebulized medications. Uterine tetany pre partum. C= heart blocks. Dose Adult = 1-2 gm slow IV/IO push for asthma, A-fib, Torsades. 2-4 gm over min for eclampsia. May be given IM for seizing eclamptic patients at a dose of 2 grams, repeat in 5 minutes if needed. PEDS = 50 /kg over 1-3 min for asthma. Methylprednisolone (Solumedrol)-I=Anaphylaxis, severe asthma, or COPD with accessory muscle use, poor airflow, or severe wheezing refractory to Beta agonist use. C = hypersensitivity. Dose Adult = 125 mg IVP over several min. PEDS = 2mg/kg IVP over several minutes Midazolam (Versed)-I= status epilepticus or active SZ, chemical restraint, uncontrollable patients with possible spinal injuries, Sedation for RSI or cardioversion or pacing, Significant FX with contractions or spasm, muscle spasms for chronic back pain, shivering associated with cooling therapy, excited delirium, and pulseless arrest if trismus is present to facilitate ventilation and intubation. C = Glaucoma. Dose Adult = Muscle spasms = mg. SZ, chem. Restraint, uncontrollable or hysterical patients, cardioversion, pacing, shivering = 2-5 mg to a max of 10 mg. RSI initial and re-sedation = mg/kg. May be given IV, IO, IM, and MAD> Pedi = 0.1 mg/kg repeat once if needed to mg/kg. 10

11 Morphine Sulfate-I= Chest pain and anxiety in suspected AMI, Pain associated with FX or burns, Chronic back pain or spasms, General Pain relief. C= shock, hypotension, head injuries, altered mental status, Acute respiratory distress if not associated with pulmonary edema, chest injuries, abdominal injuries. Dose Adult = 2-15 mg slow IVP/IM/IO/<AD/. PEDS = mg/kg Naloxone (Narcan)-I=Coma unknown etiology, reversal of narcotic effects in overdose. C = None. Dose Adult mg IV/IO/ETT/IM/MAD. PEDI = 0.1mg/kg same routes as adult. 8. Nitroglycerin-I= Chest, arm, shoulder, or neck pain or pressure related to possible coronary ischemia. HTN with suspected aortic aneurism or cardiac chest pain, Pulmonary edema, Suspected silent AMI, Esophageal spasms. C= Shock, BP < 90 systolic, patients who have taken erectile dysfunction meds within previous 24 hour period. Dose Adult-0.4 mg spray SL every 3-5 minutes. Do not exceed 3 doses unless patient has showed marked improvement of symptoms. Transdermal Past-When patient needs CPAP but condition warrants nitro apply ½ inch of nitro paste as a single dose. Ondansetron (Zofran)-I= Control of nausea and vomiting, and control of nausea and vomiting with administration of analgesics when further sedation is undesirable. C = Hypersensitivity. Dose Adult = 4 mg IV/IO once. PEDI =.15 mg/kg IV/IO/IM max 4 mg. Oxytocin (Pitocin) waivered medication-i = Postpartum hemorrhage > 1000 ml. C = Hypersensitivity, Potential additional Fetus, prior to delivery of placenta. Dose = 20 units in 1000ml NS wide open IV/IO. If IV is unobtainable may be given 10 units IM. Phenylephrine (Neo-Synephrine)-I= Prior to nasal intubation, during epistaxis to control bleeding. C = HTN. Dose = two sprays to desired nares. Promethazine (Phenergan)-I= Nausea and vomiting, control of nausea and vomiting associated with the administration of analgesics, allergic reactions to blood or plasma administration. C = ETOH or sedative ingestion, Allergies to phenothiazines, glaucoma, urinary obstruction, Coma, Children under 2 y/o. Dose Adult or = 12.5mg IM/IV/IO. PEDS = mg.kg QuickClot-I = control of severe bleeding. Do not remove packing once wound is packed Sodium Bicarbonate-I= Prolonged cardiac arrest, Tricyclic OD, Hyperkalemia with EKG changes after calcium, crush injuries with prolonged extrication. C = None under previous incidations. Dose Adult 1mEq/kg IV/IOfor suspected or known hyperkalemia. 50 meq IV/IO for arrest. PEDS = 1mEq/kg IV/IO. Second dose ½ if needed. Neonates = 1 meq/kg with a 4.2% solution over 10 min. Terbutaline (Brethine)-I= Asthma, Bronchitis, or COPD. Patients > 40 y/o when epinephrine is not advisable. C = Sensitivity. Dose Adult = 0.25mg IM/SQ. PEDI = 0.01mg/kg SQ max.5mg. 11

12 Tetracaine Hydrochloride-I = Pain relief in eye, to assist with eye irrigation. C = allergies, non intact globe. Dose Adult/PEDS = 1-2 gtts in affected eye. Rocuronium (Zemuron) waivered medication-i= Initial paralytic in RSI C = anaphylaxis, Pediatric patients, Cesarean patients who are in labor. Not for continued muscle relaxation. Use vecuronium. Dose Adult > 12 y/o = mg/kg IV/IO. Defasiculating dose is 1/10 th of standard dose. Vecuronium (Norcuron) waivdred medication-i-for neuro blockade with continuous muscle relaxation is required (long transports). C-patients with hypersensitivity. Dose. 0.1 to 0.15 mg/kg NOTES and Equations 1. Equation for determining Medication dosage. Desired dose in mg divided by supplied concentration = dose in ml. EX: Morphine-supplied as 10mg/ml-you want to give 6 mg mg (desired dose) divided by 10 mg (supplied concentration of 10 mg/ml) =.6 ml 2. MAP calculation-systolic BP minus Diastolic BP. Multiply the result by.33 and add that to the diastolic BP to get the MAP. EX: 120/ = x.33 = = round it to 93 12

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14 EMS Trauma Bay Report *Approximate Age *Gender *Mechanism of injury *VS *Suspected injuries *Changes from pre hospital report

15 Any other information EMS feels is important to patient care should be relayed to the Scribe nurse in the trauma Bay. EMS Trauma Radio Report *Approximate Age *Gender *Mechanism of injury *VS *Suspected injuries *Airway status *Neurologic status 12. *Meds/Procedures performed (including IV access *ETA The purpose of the Bullet is to give clear, actionable information regarding a trauma patient with the least amount of extraneous information that is not immediately important to their care. The Radio bullet contains information from the scene: The trauma Bay bullet is the information given at patient off-load. It is 15

16 suggested that whoever is giving the bullet report should look at the appropriate outline and give information in that order. Using this system, high quality information can be conveyed in less than 30 seconds

17 Faces Pain Scale

18 Prehospital Trauma Team Activation Criteria FULL Trauma Team Criteria Persons who sustain injury with any of the following: PRIMARY SURVEY: PHYSIOLOGIC Adult (15+ yrs) Child (0-14 yrs) Airway Unable to Adequately Ventilate Unable to Adequately Ventilate Intubated or Assisted Ventilation Intubated or Assisted Ventilation Breathing Resp Rate < 10 or > 30/min Any sign of resp insufficiency (hypoxia, acc musc use, grunting) Circulation Systolic BP < 90 mm/hg Any sign of abnormal perfusion (cap refill>2sec, BP low for age) Age SBP (mm/hg) < 1 yr < yrs < 70 +2x age > 10 yrs < 90 Deficit GCS Motor Score 5 AVPU Resp to Pain or Unresp Deterioration of Previously Stable Patient Transfers Requiring Blood Transfusion SECONDARY SURVEY: ANATOMIC Penetrating injuries to the Head, Neck, Torso or Extremities proximal to elbow/knee Open or Depressed Skull Fracture Paralysis or Suspected Spinal Cord Injury Flail Chest Unstable Pelvic Fracture Amputation proximal to the wrist or ankle Two or more Proximal Long Bone Fractures (humerus or femur) Crushed, Degloved or Mangled Extremity LIMITED Trauma Team Criteria Persons who sustain injury with any of the following: 18

19 15. MECHANISM OF INJURY Falls (Adult): > 20 ft; (Child): > 15 ft or 3x ht High Risk auto crash, with: Intrusion of vehicle > 12 in occupant compartment; > 18 other site Ejection (partial or complete) from automobile Death in same passenger compartment Auto vs Ped/Cyclist thrown, run over, or with sig (> 20 mph) impact Motorcycle Crash > 20 mph High Energy Dissipation or Rapid Decelerating Incidents, ie: Ejection from motorcycle, ATV, animal, etc Striking fixed object with momentum Blast or explosion High Energy Electrical Injury Burns > 10% TBSA (2 or 3 ) and/or Inhalation Injury Suspected Non-Accidental Trauma EMS Provider Judgment *Anticoagulated patients require an anticoagulation alert, not a LTTA 19

20 16. RSI Paralytic Dosing Chart-Revised 07/05/14 Zemuron/Rocuronium Initial Paralytic 10 mg/ml 0.6-1mg/kg LBS KG.6-1 mg/kg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg Calculation-(Dose in mg to be delivered) divided by (mg/ml) = dose in ml 20

21 RSI Sedation and Assisting Medication Dosing Chart-Updated LBS KG Atropine Etomidate Fentanyl Lidocaine Valium Versed 17. Brady-Adult Initial Sedation Cont. Sedation Susp. Head Inj. Cont. Sedation Initial Sedation 1mg/ml 2mg/ml 50mcg/ml 20mg/ml 5mg/ml 1mg/ml 5mg/mL mg/kg mg/kg 1-3mcg/kg 1-1.5mg/kg 5-15mg mg/kg mg 8-24mg mcg 40-60mg 5-15mg 1.2-4mg mg 9-27mg mcg mg 5-15mg mg mg 10-30mg mcg 50-75mg 5-15mg 1.5-5mg mg 11-33mg mcg mg 5-15mg mg mg 12-36mg mcg 60-90mg 5-15mg 1.8-6mg mg 13-39mg mcg mg 5-15mg mg mg 14-42mg mcg mg 5-15mg 2.1-7mg mg 15-45mg mcg mg 5-15mg mg mg 16-48mg mcg mg 5-15mg 2.4-8mg mg 17-51mg mcg mg 5-15mg mg mg 18-54mg mcg mg 5-15mg 2.7-9mg mg 19-57mg mcg mg 5-15mg mg mg 20-60mg mcg mg 5-15mg 3-10mg mg 21-63mg mcg mg 5-15mg mg mg 22-66mg mcg mg 5-15mg mg mg 23-69mg mcg mg mg mg 24-72mg mcg mg 5-15mg mg Right Drug-Right Dose-Right Indication-Right Patient Calculation- (Dose to Administer in mg) divided by (mg/ml) equals dose in ml. 21

22 Ventilator Initial Setting 18. Tidal Volume: 6-8cc/kg: max of 10cc/kg Ideal Wt. Men-50kg kg/inch above 5 feet Women-45.5 kg kg/inch above 5 feet Resp. Rate: Adult: Peds: 20 and up PIP: Normal Range Adult: Peds: PEEP: Normal is 5 cmh2o Call in > than 10. FiO2 Adjustments Start at 100%. May decrease to 50% depending on pt. need. Allow pt. to adjust to settings before making changes. Ideal Weight Tidal Volume Chart. 6-8 ml/kg Male Female Height Ideal Wt. (kg) Vt Ideal Wt. (kg) Vt

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