Slide 1

Respiratory & Medical Critical Care and Paramedic Levels

Slide 2

Airway Management Changes: CPAP for EMT-I Must be credentialed Earlier use of supraglottic airways Waveform required for intubated patients

Slide 3

Airway Management (cont) Second page Very few protocols go to second page

Slide 4

Airway Management Comparison

Slide 5

Medication Facilitated Intubation Changes Age now 14* Lidocaine removed Only Etomidate for induction Weight based dosing Only 2 total attempts

Slide 6

Continuous Positive Airway Pressure Changes EMT-I allowed* *If credentialed Remember indications and contraindications

Slide 7

Asthma/COPD Replaces Respiratory Signs and Symptoms Clinical judgment Includes CPAP EMT-I (if credentialed) Changes: No albuterol alone Magnesium in standing orders

Slide 8

Asthma Comparison

Slide 9

Acute Pulmonary Edema Replaces Respiratory Signs and Symptoms Clinical judgment Includes CPAP EMT-I (if credentialed) Changes: NTG SL based on BP Lasix removed from standing orders

Slide 10

Suspected Smoke Inhalation Changes: Cyanokit may be used in place of Sodium Thiosulfate if approved by Medical Director Will affect labs for 48 hours Attempt to draw blood samples prior to administration

Slide 11

Suspected Smoke Inhalation Comparison

Slide 12

Allergic Reaction/Anaphylaxis Changes: Essentially none Caution administering Epinephrine if patient is over 55 years old

Slide 13

Allergic Reaction Comparison

Slide 14

Altered Mental Status Changes: Separate from Stroke protocol Meant as reminder follow other protocols that cause altered mental status

Slide 15

Diabetic Emergencies NEW PROTOCOL Addresses low and high blood sugar Thiamine only if KNOWN chronic ETOH Other Hypoglycemic treatments unchanged

Slide 16

Diabetic Emergencies Comparison

Slide 17

Seizures Changes: Magnesium now standing order if known pregnant or within 6 weeks post-partum without seizure history Thiamine removed

Slide 18

Seizure Comparison

Slide 19

Stroke Changes: No longer combined with Altered Mental Status protocol Key point: Confirm time last known NORMAL

Slide 20

Overdose or Toxic Exposure NEW PROTOCOL Exposure specific treatments Opiate Organophosphate Dystonic reaction Physician Options for Calcium channel and beta blockers Tricyclic, sympathomimetic

Slide 21

Overdose

Slide 22

Shock/Hypoperfusion Changes: More aggressive fluid resuscitation with sepsis 12 lead EKG for possible STEMI Remember: Shock and hypoperfusion are signs of another disease process

Slide 23

Shock/Hypoperfusion Comparison

Slide 24

Adrenal Crisis NEW PROTOCOL Fairly rare diagnosis If CONFIRMED diagnosis by patient or family, steroids can be lifesaving in presence of shock

Slide 25

Adrenal Crisis Comparison

Slide 26

Pain / Nausea /Sedation A fluid bolus makes almost anyone feel better Morphine standing orders are under utilized in WNY Sedation standing orders are not intended for chemical restrains

Slide 27

Pain / Nausea / Sedation Comparison