Massachusetts EMT-B Protocols

For EMT-Bs who need a review

CPR Protocol

100-120 CPM, Use OPA or NPA, AED as soon as possible, 30:2 Compressions to breaths

Diphenhydramine

Mild distress in allergic reaction, 25-50 mg by capsule, 1 mg/kg for patients 2 years or older up to 50 mg

Epinephrine

anaphylaxis, under 6 months and over 65 call med con, under 25kg weight is 0.15 mg, over 25kg weight is 0.3 mg, administer again after 5 minutes if needed

Oral Glucose

BG less than 70 mg/dL, patient can swallow, if patient is less than 20 kg ½ tube, if patient is over 20 kg 1 tube, second dose can be given after 10 minutes

Behavioral Emergency Protocol

Avoid areas with weapons or a single exit, ask permission to touch before taking vitals, calming body language

Bronchospasm or respiratory distress

Patients own inhaler must be present, they cannot have used maximum dose prior to EMT arrival, Epinephrine may be needed

Hyperthermia

rapid cooling as soon as possible, move to cool area, ice packs to groin and axillae, water for heat cramping if patient can swallow

Hypothermia

Remove wet clothing, move to warm environment, cover with warm blankets

OB Emergencies

Expose as necessary, Fingers may be inserted to manage airway, prolapsed, or nuchal cord, transport on left side

New Born Care

dry, warm, and stimulate, clear secretions if necessary, suction mouth and then nose if needed, clamp and cut cord after it stops pulsating, wrap in blankets

APGAR

Activity: 2 for active, 1 for weak movement, Pulse: 2 for over 100, 1 for below 100, Grimace: 2 for crying, 1 for some movement, Appearance: 2 for all pink, 1 for blue extremities, Respiration: 2 for cry, 1 for irregular breaths.

New Born Resuscitation

40-60 bpm ppv, if heart rate is less than 60 bpm, ppv for 1 minute, than start compressions

Ibuprofen

pain management, 600 mg capsules, no head injury, chest injury, abdominal pain, potential for bleeding, pregnancy

Acetaminophen

Pain management, 650-1000 mg capsules, no liver failure

Septic Shock Criteria

Suspected infection and 2 or more: temp less than 98.6 or more than 100.4, HR above 90 bpm, RR above 22 bpm, systolic BP below 90, altered mental status

FAST-ED stroke scale

Look for facial paralysis, Arm weakness, speech changes, time of last well known, eye deviation, denial of hand

Common blood thinners

Coumadin/warfarin, Pradaxa/dabigatran, Xaralto/rivaroxaban, Eliquis/apixaban

Aspirin

Complaints of chest pain, 324-325 mg, check for allergy, potential for bleeding/blood thinners

Nitroglycerin

Complaints of chest pain, 0.4 mg sublingually every 3-5 minutes, systolic BP must be over 120, no phosphodiesterase inhibitors in last 48 hours: sildenafil, Viagra

Naloxone

Suspected overdose: 0.4-8 mg IN or IM, can give more doses every 2-3 minutes up to 16 mg

Burns Protocol

Stop burns with water or saline, remove clothing and jewelry, cover skin with dry sterile dressing,

Rule of Nines

Each leg 18, Upper and lower torso each 18, head 9, each arm 9, genitals 1

What does head/neck/spinal trauma always suggest the need of?

C-collar

Sucking chest wound

3 sided occlusive dressing, bvm

Flail Chest

bulky dressing, bvm

GCS

Eye opening: 4 spontaneously, 3 to speech, 2 to pain, 1 for nothing, Verbal: 5 oriented to time and place, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 nothing, Motor: 6 obeys commands, 5 moves to localized pain, 4 flex to withdraw from pain, 3 abnormal flexion, 2 abnormal extension, 1 nothing

RTS

GCS: 4 for 13-15, 3 for 9-12, 2 for 6-8, 1 for 4-5, 0 for 3, Systolic BP: 4 for above 90, 3 for 75-90, 2 for 75 - 50, 1 for 50-0, 0 for 0, Respiratory rate: 4 for 10-30, 3 for above 30, 2 for 6-9, 1 for 5-1, 0 for 0