Errata and Stickers- Pocketbook 2019

Transcription

1 Errata and Stickers- Pocketbook 2019 Pocketbook Stickers for ALSPCS.5 Emergency Childbirth: Emergency Childbirth: Nuchal Cord: Attempt to slip over head (or shoulder) If tight, leave in situ and somersault baby out LAST resort: clamp and cut Shoulder Dystocia: ALARM x 2 Ask for help Lift legs Adduct shoulder (suprapubic pressure) Roll over (hands and knees) Manual delivery of posterior arm BuBum, Bum, Bum Limb Presentation: DO NOT push limb back in Cover limb with dry sheet Discourage pushing Tum, Tum, Tum Breech Birth: Position patient HANDS OFF THE BREECH Assist with legs and arms if needed 3 MINUTES: umbilicus to hairline Mauriceau Smellie Veit manoevre Cord Prolapse: Knee to chest position Manually reinsert cord and elevate presenting part off cord Postpartum Hemorrhage: Placenta Delivered Fundal Massage External bimanual compression Placenta not Delivered External bimanual compression

2 Analgesia (ACP) Version.5 Indications: Pain Clinical Parameters: Acetaophen and Ibuprofen: Ketorolac: Normotension Restricted to those who cannot tolerate oral medication Fentanyl and Morphine: 1 year old Normotensive Severe pain Contraindications: Ibuprofen / Ketorolac: NSAID / Ibuprofen use within 6 hours Allergy / sensitivity to ASA or NSAIDs Patient on anticoagulation therapy Current active bleeding Hx of peptic ulcer disease or GI bleed Pregnant If asthmatic, no prior use of ASA or NSAIDs CVA or TBI in previous 2 hours Known renal impairment Ibuprofen only active vomiting / unable to tolerate oral medication Contraindications continued: Acetaophen: Use within previous hours Allergy / sensitivity Hx of liver disease Active vomiting Unable to tolerate oral medications Morphine: Allergy / sensitivity to Morphine Treatment of headache Treatment of chronic pain SBP drops by 1/3 initial value after Morphine adistered * Fentanyl: Allergy / sensitivity to Fentanyl Treatment of headache Treatment of chronic pain SBP drops by 1/3 initial value after Fentanyl adistered *Refer to the Cardiac Ischemia medical directive for suspected cardiac ischemia Acetaophen PO 12 yrs to mg N/A N/A 1 dose 18 yrs mg N/A N/A 1 dose Ibuprofen PO 12 yrs 00 mg N/A N/A 1 dose Ketorolac IM / IV 12 yrs mg N/A N/A 1 dose

3 Morphine IV / SC Age 1 yr to Dose mg/kg single 5 mg 18 yrs 2-10 mg 10 mg Fentanyl IV / IN Age 1 yr to 18 yrs Dose Up to 1 mcg/kg mcg (Mandatory Patch < 12 years) single Q Q (Mandatory Patch < 12 years) 75 mcg 75 mcg 5 5 total 10 mg 20 mg total 225 mcg 225 mcg Notes: Consider co-adistration of Acetaophen and Ibuprofen. Suspected renal colic patients should be considered for Ketorolac and Morphine or Fentanyl. Fentanyl should not be used in combination with morphine unless authorized by BHP. volume of Fentanyl via IN is 1 ml / nare. Exercise caution when using narcotics in opioid naive patients and 65 years old Consider lower of Morphine or Fentanyl IV. When using higher consider aliquots q3 utes until desired effect or max single dose is reached. The end of medication delivery is when the clock starts to time the medication interval for additional.

4 Indications: Pain Clinical Parameters: Acetaophen and Ibuprofen: Ketorolac: Normotension Restricted to those who cannot tolerate oral medication Contraindications: Ibuprofen / Ketorolac: NSAID / Ibuprofen use within 6 hours Allergy / sensitivity to ASA or NSAIDs Patient on anticoagulation therapy Current active bleeding Hx of peptic ulcer disease or GI bleeds Pregnant If asthmatic, no prior use of ASA or NSAIDs CVA or TBI in previous 2 hours Known renal impairment Ibuprofen only active vomiting unable to tolerate oral medication Contraindications continued: Acetaophen: Use within previous hours Allergy / sensitivity Hx of liver disease Active vomiting Unable to tolerate oral medications Acetaophen PO 12 yrs to mg N/A N/A 1 dose 18 yrs mg N/A N/A 1 dose Ibuprofen PO 12 yrs 00 mg N/A N/A 1 dose Ketorolac IM / IV 12 yrs mg N/A N/A 1 dose Notes Consider co-adistration of Acetaophen / Ibuprofen Suspected renal colic patients should be considered for ketorolac

5 PCP page 18/ ACP page 22 The age for the Opioid Toxicity Medical Directive is now 12 years old General Note Regarding Epinephrine: Recently manufacturers have changed labelling regarding the concentrations of supplied epinephrine in ampoules. Ampoules previously labeled as Epinephrine 1 mg/ml 1:1000 no longer list the 1:1000 on the label. All references to 1:1000 in the pocketbook refer to the concentration of epinephrine provided as 1 mg/ml. Similarly Epinephrine 0.1 mg/ml 1:10000 pre-load will be known only as Epinephrine 0.1 mg/ml. And again references to 1:10000 refer to Epinephrine 1 mg/ 10 ml should refer to Epinephrine provided as a concentration as 0.1 mg/ml. Pictures are provided below to show the changes:

6 ACP page 6 Epinephrine table at the bottom of the algorithm incorrectly states ETT Epinephrine 1:1,000. This should read ETT Epinephrine 1:10,000. The algorithm flowchart above this has the correct dosing. ACP page Lidocaine < (less than), should be (greater than or equal to) 100 mmhg 2. Repeat dosing is listed as 0.75 mg/kg to a maximum of 75 mg, this should read: 0.75 mg/kg to a maximum of 150 mg PCP page 7 Medical Cardiac Arrest number of interpretations for any age is Pediatric Doses (in pink) -Epinephrine-IM (for suspected anaphylaxis) should have a imum dose listed as 0.5 mg Shared reference page R-2 The Acute Stroke Protocol Prompt Card: The reference provided shows a.5 hour time from onset within the indications. As per the current guidelines, that should read 3.5 hours. The.5 hour window comes into effect with the new BLS standards on Dec 11, Shared reference page R-2 Balil typo Shared reference page R-39 Provincial STEMI guideline should also read: Once a STEMI is confirmed, the paramedic should apply defibrillation pads due to the potential for lethal cardiac arrhythmias.