advanced & primary care paramedic changes to medical directives fall 2005
TRANSCRIPT
Advanced & Primary Care Paramedic
Changes to Medical Directives
Fall 2005
“The Power of 7” Base Hospital Programs
Cambridge Grey Bruce Hamilton Lambton London Niagara Windsor
SouthWestEducationCommittee
History ?? In past medical directives varied
between Base Hospital Programs. This year, implementation of
standardized protocols approved by the Provincial Medical Advisory Committee (MAC) have been released for all Base Hospitals to follow.
“New Look”
General changes includeAn introduction which clearly outlines guidelines for:
Use of the protocols and patching to the Base Hospital PhysiciansConsent to treatment and capacity assessmentRefusal of treatmentCardiac monitoring and oxygen administration
Not New H
ere!
“New Look”
Adult and Pediatric protocols are not combined – but will be in the future.
Auxiliary Protocols.
Personal Protective Equipment use for paramedics is clearly outlined within the appropriate directive, specifically nebulized medication administration.
SOB/Respiratory Distress Protocol
The new medical directives indicates that salbutamol administration will not exceed 3 doses…
previously…maximum administration was 2 doses
SOB/Respiratory Distress Protocol
Contraindications for nebulization of salbutamol now include:
Patient has a suspected or known fever (> 38.0 C)
ORIn the case of a declared outbreak of a severe respiratory illness by the local Medical Officer of Health
SOB/Respiratory Distress Protocol
Procedure changes:
Salbutamol should be administered via MDI ifavailable
If MDI not available or the patient not able to use the MDI/spacer properly then administersalbutamol via nebulizer
SOB/Respiratory DistressProtocol
Procedure changes:
Salbutamol via spacer dosePatients <30 kg = total of 6 puffsPatients > 30 kg = total of 9 puffs
Salbutamol via nebulizerPatients < 30kg = 2.5 mgPatients > 30 kg = 5.0 mg
No longer 1.25 mg for pediatric patients
Moderate to Severe AsthmaExacerbation Protocol
This protocol can now be applied to patients where nebulized salbutamol is contraindicated and MDI/spacer is unavailable.
Indications for application of this protocol has been expanded to include patient presentationof severe agitation, confusion, and cyanosis.
Moderate to Severe AsthmaExacerbation Protocol
Epinephrine can be administered either subcutaneously OR intramuscularly
Moderate to Severe AsthmaExacerbation Protocol
Procedure changes:
Caution!!!
A BHP patch must be attempted prior to a second dose of epinephrine for patients that are < 10 kg or patients with a history of ischemic heart disease.
Anaphylaxis/Allergic Reaction Protocol
Epinephrine can be administered either subcutaneously OR intramuscularly
Caution!!!A BHP patch must be attempted prior to a second dose of epinephrine for patients that are < 10 kg or patients with a history of ischemic heart disease.
Epipen standing orders are now included for Ambulance Services that utilize them!
Suspected Cardiac Ischemia Chest Pain Protocol
Contraindications for nitroglycerin administration:
Prescription medication for erectile dysfunction within the last 48 hours
Suspected Cardiac Ischemia Chest Pain Protocol
ASA can now be administered to patients even if chest pain has resolved on paramedic arrival
Acute Cardiogenic Pulmonary Edema Protocol
Contraindications for nitroglycerin administration:
Prescription medication for erectile dysfunction within the last 48 hours
Altered LOC- Suspected Hypoglycemia Protocol
Glucagon now can be administered either subcutaneously OR intramuscularly
Blood glucose tests can be done when:a glucose problem is suspected; either hypoglycemic or hyperglycemic
The patient can receive oral glucose if signs and symptoms consistent with hypoglycemia are present
Altered LOC- Suspected Hypoglycemia Protocol
Caution! patients that are on oral hypoglycemics are at a high risk for recurrent episodes of hypoglycemia
Hypotension
Changes to hypotension require the paramedic to only fluid bolus a hypotensive patient when a known or suspected causes exists.
IO infusions
The age for IO insertion has been increased to 12 years.
Lasix
Not part of any standing order for CHF but drug may be used in consultation with a BHP during a patch for management of a severe CHF patient.
Lidocaine
Lidocaine for intubation to prevent the spike in ICP requires………
Arrest Protocols
Cardiac Arrest General Protocol
Paramedics, where available, should select the lowest energy
level available for each shock for patients between the ages of
8 and 12 years.
The EndQuestions?