EMS Protocol of the Week - Non-Traumatic Cardiac Arrest (Pediatric)

Not a ton of difference between the prehospital protocol for pediatric non-traumatic arrest when compared to its adult counterpart, at least in terms of the interventions available. The same medications and electricity can be found in the pediatric toolbox as well, albeit with more of an emphasis on age-and-weight-appropriate dosing, which is explicitly described within the protocol for your reference. Similarly to adult arrests, you may encounter OLMC calls requesting orders for calcium, sodium bicarb, or antiarrhythmics like amiodarone. 

Also worth noting is the caveat describing effective BVM use as a "reasonable alternative" to other advanced airways when needed; the point being that, given the predominance of respiratory etiologies in this population, it is likely more beneficial to focus on adequate bagging and mask seal rather than spend multiple attempts trying to intubate a difficult airway. 

Keep this protocol flagged for future use, as it's a great way to offload memorizing doses for some of these critical meds. Not that any of us would have to do that, since clearly these calls are incredibly low-stress (just...kid-ding?).

Ok bye. www.nycremsco.org for more.

Dave


EMS Protocol of the Week: Weapons of Mass Destruction - Nerve Agents

Hey all,

This week's protocol delves into the world of ⚠weapons of mass destruction⚠ with a focus on biochemical warfare -- specifically nerve agents that cause cholinergic toxicities. And I know you're all just foaming at the mouth waiting to hear about it 👅

This protocol can only be activated via a class order by an FDNY Medical Director from the Office of Medical Affairs. Pre-hospital providers must wear the appropriate chemical protective clothing and operate within the hot, warm, and cold zones as directed by the incident commander (throwback to your Orientation HazMat training).

Patients are tagged and triaged based on signs/symptoms of cholinergic toxicity. All "red" and yellow" patients who exhibit SLUDGEM symptoms (salivation, lacrimation, urination, diarrhea, GI upset, emesis, myosis), respiratory distress, or AMS should receive immediate treatment from the nerve agent antidote kit (see image):

 

  • Atropine 2mg IM auto-injector

  • Pralidoxime 600mg IM auto-injector 

Repeat doses of atropine can be given based on secretions and respiratory distress. Don't delay treatment in these patients for decontamination!

Paramedics can also give IM doses of Diazepam or Midazolam for actively seizing patients.

The role of OLMC is to provide additional doses of any of the standing order meds.

Hopefully, we never have to use this one, but if we do -- don't pee your pants -- just stay calm and follow the protocol!

More info at www.nycremsco.org


Best,

Chris Kuhner, MD

PGY-2 Emergency Medicine


EMS Protocol of the Week - Neonatal Care / Resuscitation

The prehospital protocol for neonatal resuscitation is dense, so it doesn't serve to reproduce it all within the email. Read through the attachment for details, and realize that it serves as a reference for stepwise assessment (with target heart and respiratory rates) and interventions (with target compression/ventilation rates and medication dosages) for when our EMTs and paramedics are stuck in a high stress home environment with a neonate in extremis. Not a ton to add from an OLMC perspective, but recognize that this protocol is here for your reference as well, in case a crew calls looking for assistance.

The attached appendix also includes a review of APGAR scores for your review. 

That's RESUSCITATION...BABY.

And with that, hope you all have some wonderful holidays! If you can't wait for more protocol goodness, there's always www.nycremsco.org

Dave