EMS Protocol of the Week - Hyperglycemia (Adult and Pediatric)

We're not quite at the point yet where EMS will initiate insulin therapy in the field, so for the time being, the prehospital approach to hyperglycemia mainly involves the recognition oh hyperglycemic emergencies. This means that, in addition to checking for an elevated glucometer reading, EMTs and paramedics will assess for altered mental status, dehydration, or tachypnea (ie, Kussmaul breathing compensating for DKA). ALS units will likely obtain vascular access and start fluid resuscitation on these patients, so be sure to confirm how much crystalloid was given during transport (if any) when calculating your own fluid repletion strategies. From there, the rest is up to you!

Have fun closing the gap! www.nycremsco.org and the protocol binder for more.

Dave

EMS Protocol of the Week - Asthma/COPD/Wheezing (Adult and Pediatric)

I’ll be one of the first to admit that these protocols can be pretty densely packed with text, which is why I always support finding a way to simplify or consolidate protocols without sacrificing medical care. Previously, steps were taken to combine approaches to asthma and COPD into one document, and this year, it’s been taken a step further by having protocols for your wheezy adult and pediatric patients all in one place. You all know how to take care of your asthmatics/puffers/bloaters, but reading through this week’s protocol serves both as a good refresher and as a good example of the graduated responsibilities from CFR, to EMT, to paramedic, depending on who is on the scene.

Give it a skim – it’ll…take your breath away?

I think I might be starting to repeat some of these bits.

www.nycremsco.org or the protocol binder for more.

Dave

EMS Protocol of the Week - Abdominal Pain / Severe Nausea / Severe Vomiting (Adult and Pediatric)

Belly problems? Have we got a protocol for you! 

Not a ton to this week’s protocol – patients in severe abdominal pain will be kept NPO at all EMS provider levels, and paramedics can give a dose of ondansetron by Standing Order as needed – with a reminder to check an EKG, both for QT prolongation and for possible cardiac etiologies of the abdominal pain. Remember that there is a separate pain management protocol available for patients requiring prehospital analgesia.

That’s it for this week, hope you were all able to…stomach it?

www.nycremsco.org and the protocol binder for more

Dave