EMS Protocol of the Week: Obstetric Emergencies!

 ·   · 

Hi all, 

This week we will be focusing on Obstetric Emergencies!

The prehospital approach exists as a progression of care based on the provider’s level of training. CFRs start with ABCS and monitoring vital signs for shock. They will check for crowning and if present prepare for imminent delivery. If delivery has not begun, they will place the patient in a left lateral recumbent position. 

BLS crews can address vaginal bleeding in pregnancy by placing dressing over the vagina to help estimate quantity of blood loss. If immediately postpartum, they can massage the mother’s abdomen over the uterus. 

If the on-scene team is ALS-trained, they can obtain IV access for patients with severe pre-eclampsia, eclampsia or postpartum hemorrhage. For patients with eclampsia, they can administer Magnesium Sulfate 4 g IV over 10 minutes. 

From an OLMC standpoint, providers can authorize 2g Magnesium Sulfate over 10 minutes for patients with concern for pre-eclampsia. 

KEY POINTS: 

  • Consider supine hypotension syndrome as a cause of shock 

  • Severe pre-eclampsia is when pregnant patients have BOTH of the following conditions: 

    • Systolic blood pressure ≥ 160 mm Hg OR a diastolic blood pressure ≥ 110 mm Hg 

    • Symptoms of a headache, visual disturbances, pulmonary edema or lower extremity edema 

  • Eclampsia and pre-eclampsia do not occur prior to 20 weeks of gestation 

  • Eclampsia and pre-eclampsia may occur up to one (1) month post-partum 


More words to read at www.nycremsco.org

EMS Protocol of the Week!!! - Stridor/croup/epiglottitis (Peds)

 ·   · 

It’s that time of year! All the children have been coming in with respiratory distress. These days, most often it’s a child with bronchiolitis. But it’s also important not to forget about the kids coming in with croup, anaphylaxis, airway obstruction, and the rare but scary epiglottitis.

 

 

Management?

 

As always…ABC’s.

 

1.     Administer high flow O2 via NC or face mask

2.     Consider obstructed airway vs. anaphylaxis as causes of respiratory distress

3.     Stridor at rest? Think croup.

a.     Epi 3mg nebulized OR racemic epi nebulized

4.     Get IV access (in real life, depending on age of the child I feel like this doesn’t always happen, but it’s important for children in respiratory distress who can decompensate quickly)

5.     STEROIDS!! (ONLY if 2 years or older)

a.     Dex 0.6mg/kg to max of 12mg or methylpred 1mg/kg to max of 60mg

 

If EMS suspects Epiglottitis, EMS will NOT attempt advanced airway – will only ventilate with bag valve mask and transport ASAP

 

Last but not least, OLMC (which we are all experts on now after Vic’s great emails the other week)

-       EMS must call if kid is <2 y/o in respiratory distress and wants to give steroids

 

KEY POINTS:

-       Croup = stridor + retractions + barking cough

-       Epiglottitis = stridor + retractions + muffled voice + high fever (TOXIC APPEARING)

-       Unvaccinated = high risk for epiglottitis

-       Airway obstruction (foreign body, mass) = biphasic stridor

-       Don’t agitate a child already in respiratory distress

-       Dex > methylpred in kids

And if you want more... www.nycremsco.org

 

Jennifer Wolin, MD

Emergency Medicine PGY-2 Resident Physician

Maimonides Medical Center

EMS Protocol of the Week - Adult Respiratory Distress

 ·   · 

Hi EM friends,


Time to take your breath away with another EMS protocol of the week. This week's focus will be on adult respiratory distress and how our prehospital counterparts initiate patient care prior to handing them off to us. A few months ago, we discussed the respiratory distress protocol for pediatric patients - a lot of overlap here except EMS providers have a couple more tricks up their sleeves when it comes to adults.


The prehospital approach to respiratory distress exists as a progression of care based on the provider's level of training. CFRs start with ABCs and monitoring vital signs. If needed, these providers can implement airway adjuncts and administer supplemental O2. All patients will be started off on a NRB unless the mask is not tolerated in which case O2 will be given via NC. At this level of training, CFRs can then address potential drug overdose. 


BLS crews can address all of the above and will then transport these patients to the hospital. They can additionally request ALS backup while en route. If available, CPAP therapy can be utilized for patients with persistent distress. 


If the on-scene team is ALS-trained, they can perform advanced airway management as necessary. From here, ALS providers will start cardiac monitoring, EKG interpretation, and establish IV access during transport. They can even assess and treat for a tension pneumothorax or administer Nitroglycerin for suspected flash pulmonary edema.


There is not a lot to be aware of from an OLMC standpoint, but providers have the option of authorizing Lasix to be given to patients that may benefit.

Also important to note, ALL patients who are received by EMS crews in respiratory arrest MUST receive ventilatory assistance unless an official DNR order and/or MOLST form is provided to the crew.

More words to read at www.nycremsco.org.

Best,

Zachary Kim, MD

PGY-2 Emergency Medicine