Hypotension / Shock History Blood loss - vaginal or gastrointestinal bleeding, AAA, ectopic Fluid loss - vomiting, diarrhea, fever nfection Cardiac ischemia (M, CHF) Medications Allergic reaction regnancy History of poor oral intake Signs and Symptoms Restlessness, confusion Weakness, dizziness Weak, rapid pulse ale, cool, clammy skin Delayed capillary refill Hypotension Coffee-ground emesis Tarry stools Differential Shock Hypovolemic Cardiogenic Septic Neurogenic Anaphylactic Ectopic pregnancy Dysrhythmias ulmonary embolus Tension pneumothorax Medication effect / overdose Vasovagal hysiologic (pregnancy) Diabetic rotocol B Blood Glucose Analysis rocedure 12 Lead ECG rocedure V rocedure O rocedure Cardiac / Arrhythmia rotocol(s) as indicated Cardiac Monitor Airway rotocol(s) History, Exam and Circumstances Suggest Type of Shock Hypovolemic Cardiogenic Distributive Obstructive Spinal mmobilization rocedure Trauma Wound Care rocedures as indicated Control Hemorrhage Revised 10/20/2015 Exit to Multiple Trauma rotocol Consider TXA rotocol - 42TXA Right Sided M tify Destination or Contact Medical Control Spinal mmobilization rocedure Trauma Exit to Multiple Trauma rotocol rotocol 30 Any local EMS System changes to this document must follow the NC OEMS rotocol Change olicy and be approved by OEMS Spinal mmobilization rocedure Chest Decompression- Needle rocedure Trauma Exit to Multiple Trauma rotocol Adult Medical Section rotocols
Hypotension / Shock Adult Medical Section rotocols earls Recommended Exam: Mental Status, Skin, Heart, Lungs, Abdomen, Back, Extremities, Neuro Hypotension can be defined as a systolic blood pressure of less than 90. This is not always reliable and should be interpreted in context and patients typical B if known. Shock may be present with a normal blood pressure initially. Shock often is present with normal vital signs and may develop insidiously. Tachycardia may be the only manifestation. Consider all possible causes of shock and treat per appropriate protocol. Hypovolemic Shock; Hemorrhage, trauma, G bleeding, ruptured aortic aneurysm or pregnancy-related bleeding. Cardiogenic Shock: Heart failure: M, Cardiomyopathy, Myocardial contusion, Ruptured ventrical / septum / valve / toxins. Distributive Shock: Sepsis Anaphylactic Neurogenic: Hallmark is warm, dry, pink skin with normal capillary refill time and typically alert. Toxins Obstructive Shock: ericardial tamponade. ulmonary embolus. Tension pneumothorax. Signs may include hypotension with distended neck veins, tachycardia, unilateral decreased breath sounds or muffled heart sounds. Acute Adrenal nsufficiency: State where body cannot produce enough steroids (glucocorticoids / mineralocorticoids.) May have primary adrenal disease or more commonly have stopped a steroid like prednisone. Usually hypotensive with nausea, vomiting, dehydration and / or abdominal pain. f suspected EMT- should give Methylprednisolone 125 mg V / O or Dexamethasone 10 mg V / O. May use steroid agent specific to your drug list. For non-cardiac, non-trauma hypotension, Dopamine should only be started after 2 liters of NS have been given. Revised 10/20/2015 rotocol 30 Any local EMS System changes to this document must follow the NC OEMS rotocol Change olicy and be approved by OEMS
Multiple Trauma History Time and mechanism of injury Damage to structure or vehicle Location in structure or vehicle Others injured or dead Speed and details of MVC Restraints / protective equipment ast medical history Medications Signs and Symptoms ain, swelling Deformity, lesions, bleeding Altered mental status or unconscious Hypotension or shock Arrest Differential (Life threatening) Chest: Tension pneumothorax Flail chest ericardial tamponade Open chest wound Hemothorax ntra-abdominal bleeding elvis / Femur fracture Spine fracture / Cord injury Head injury (see Head Trauma) Extremity fracture / Dislocation HEENT (Airway obstruction) Hypothermia Assessment of Serious Signs / Symptoms ABC and LOC Airway rotocol(s) Spinal mmobilization rocedure V rocedure O rocedure rmal Repeat Assessment Adult rocedure Splint Suspected Fractures Consider elvic Binding Control External Hemorrhage Monitor and Reassess Transport to appropriate destination using Trauma and Burn: EMS Triage and Destination lan Cardiac Monitor VS / erfusion / GCS Abnormal Rapid Transport to appropriate destination using Trauma and Burn: EMS Triage and Destination lan Limit Scene Time 10 minutes rovide Early tification Head njury rotocol Spli nt Suspected Fractures Consider elvic Binding Control External Hemorrhage Adult Trauma and Burn Section rotocols Chest Decompression-Needle rocedure Monitor and Reassess tify Destination or Contact Medical Control rotocol 42 Any local EMS System changes to this document must follow the NC OEMS rotocol Change olicy and be approved by OEMS
Tranexamic Acid (TXA) Assessment of Serious Signs / Symptoms ABC and LOC Airway rotocol(s) Multi Trauma rotocol Age > 16 years old and < 3 hours from time of injury Contraindication for TXA: Recent E / DVT History Evidence of DC Yes Scene Any of the following: Obvious significant bleeding enetrating trauma Multiple trauma (e.g.: suspected intraperitoneal hemorrhage, multiple long bone fracture) SB < 90 mmhg Or Tachycardia (> 120 bpm) Yes Multi Trauma rotocol nterfacility Any of the following: Obvious significant bleeding enetration trauma Multiple trauma (e.g.: suspected intraperitoneal hemorrhage, multiple long bone fracture) ositive FAST ositive CT for bleeding NR >1.5 Adult Trauma and Burn Section rotocols 1 gram TXA over 10 min 1 gram TXA over 10 min tify Destination or Contact Medical Control rotocol 42TXA This protocol has been altered from the original 2012 NCCE rotocol by the local EMS Medical Director 2015
Multiple Trauma Adult Trauma and Burn Section rotocols earls Recommended Exam: Mental Status, Skin, HEENT, Heart, Lung, Abdomen, Extremities, Back, Neuro tems in Red Text are key performance measures used in the EMS Acute Trauma Care Toolkit Transport Destination is chosen based on the EMS System Trauma lan with EMS pre-arrival notification. Scene times should not be delayed for procedures. These should be performed en route when possible. Rapid transport of the unstable trauma patient to the appropriate facility is the goal. Bag valve mask is an acceptable method of managing the airway if pulse oximetry can be maintained 90% Geriatric patients should be evaluated with a high index of suspicion. Often occult injuries are more difficult to recognize and patients can decompensate unexpectedly with little warning. Mechanism is the most reliable indicator of serious injury. n prolonged extrications or serious trauma, consider air transportation for transport times and the ability to give blood. Do not overlook the possibility of associated domestic violence or abuse. rotocol 42 Any local EMS System changes to this document must follow the NC OEMS rotocol Change olicy and be approved by OEMS