BLS TREATMENT GUIDELINES - CARDIAC
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1 BLS TREATMENT GUIDELINES - CARDIAC CARDIOPULMONARY ARREST - NON-TRAUMATIC (SJ-B101) effective 07/01/99 Defibrillation CPR Apply S-AED and assess rhythm as trained. Defib as indicated Simultaneous OXYGEN: BVM & 100% O 2 CPR Adequacy of efforts frequently Transport Code 3 Special Notes: Near Drowning - People who have been submerged in cold water are salvageable for a long period of time. All drowning victims should be resuscitated. Hypothermia - These patients often look dead when they are still salvageable. 7
2 BLS TREATMENT GUIDELINES - CARDIAC CORONARY ISCHEMIC CHEST DISCOMFORT (SJ-B102) effective 07/01/99 Obtain Good History May allow Pt's own: NITROGLYCERINE: 1/150 gr. (0.4 MG) sublingual (only if SBP >110) Airway, Pulse, throughout. Code 3 Transport if Pt in shock Consider applying S-AED pads on patient for rapid defibrillation as indicated, if available 8
3 BLS TREATMENT GUIDELINES - RESPIRATORY AIRWAY OBSTRUCTION - STRIDOR (SJ-B201) effective 07/01/99 Determine degree of distress Unstable Unstable vs. Stable Frequently Consider Causes Stable Foreign Body Croup/ Epiglottitis Trauma/ Burns OXYGEN: flow as indicated or tolerated Position of Comfort Abdominal thrusts/finger sweeps Consider humidified oxygen Monitor for swelling or closure of airway Avoid Visualization/ OPA OXYGEN: flow as indicated or tolerated 9
4 BLS TREATMENT GUIDELINES - RESPIRATORY RESPIRATORY DISTRESS (SJ-B202) effective 07/01/99 Determine degree of distress OXYGEN: low flow via nasal cannula, increase as appropriate Frequently Position of Comfort Assist respirations as indicated Immediate Transport as indicated 10
5 BLS TREATMENT GUIDELINES - NEUROLOGIC ALTERED LEVEL OF CONSCIOUSNESS (SJ-B301) effective 07/01/99 Determine Cause OXYGEN: low flow via nasal cannula, increase as appropriate Frequently ORAL DEXTROSE: for suspected hypoglycemia, with intact gag reflex Position of comfort if conscious 11
6 BLS TREATMENT GUIDELINES - NEUROLOGIC ACUTE CEREBROVASCULAR ACCIDENT (SJ-B302) effective 07/01/99 Identify and document neurologic deficits - progressive vs. non-progressive Prevent Aspiration OXYGEN: High flow via mask, Assist ventilations as indicated Frequently Transport with Pt's head in neutral position REASSESS and DOCUMENT neurologic findings frequently TRANSPORT: code 3 if progressive neurologic deficit evident 12
7 BLS TREATMENT GUIDELINES - NEUROLOGIC SEIZURES (SJ-B303) effective 07/01/99 Prevent injury OXYGEN: High flow via mask Position on side if no trauma Airway Heart Rate Frequently 13
8 BLS TREATMENT GUIDELINES - NEUROLOGIC SYNCOPE (SJ-B304) effective 07/01/99 Prevent injury OXYGEN: High flow via mask Frequently Position on side if no trauma 14
9 BLS TREATMENT GUIDELINES - MEDICAL SHOCK, NON-TRAUMATIC (SJ-B401) effective 07/01/99 Attempt to determine cause of shock Assist respirations as necessary Frequently Consider placing in Trendelenburg Position REASSESS as indicated Consider Code 3 Transport if unstable 15
10 BLS TREATMENT GUIDELINES - MEDICAL ABDOMINAL EMERGENCIES - NON-TRAUMATIC (SJ-B402) effective 07/01/99 Attempt to determine cause of shock Nothing by mouth Position of Comfort Anticipate Vomiting (save sample) 16
11 BLS TREATMENT GUIDELINES - MEDICAL HYPERTENSION (SJ-B403) effective 07/01/99 Place Pt in upright position with Pt's head in neutral position Frequently TREAT ASSOCIATED SYNDROMES Acute Cerebrovascular Accident - refer to guideline B302 Coronary Ischemic Chest Discomfort - refer to guideline B102 Pregnancy, if seizing - refer to guideline B303 Pulmonary Edema - refer to guideline B202 17
12 BLS TREATMENT GUIDELINES - MEDICAL POISONINGS (SJ-B404) effective 07/01/99 Determine degree of distress Determine/Identify Type of Agent, Amount, and when Ingested (Support respirations as necessary) Locate, Identify, (and if safe) bring substance to Hospital Immediate Transport Anticipate Vomiting (save sample) 18
13 BLS TREATMENT GUIDELINES - ENVIRONMENTAL ENVENOMATION (SJ-B501) effective 07/01/99 Determine type and time of exposure Frequently Identify Cause Bee/Wasp Spider/ Scorpion Snake Scrape stinger away Scrape stinger away Avoid movement Keep extremity below heart Cold packs for pain Cold packs for pain Circle swelling and note time Measure proximal circumference and note time Apply loose restricting band 19
14 BLS TREATMENT GUIDELINES - ENVIRONMENTAL HEAT ILLNESS (SJ-B502) effective 07/01/99 Frequently Determine severity of distress Heat Stroke Heat Cramps/ Heat Exhaustion COOLING MEASURES COOLING MEASURES Rapid Transport 20
15 BLS TREATMENT GUIDELINES - ENVIRONMENTAL HYPOTHERMIA - FROSTBITE (SJ-B503) effective 07/01/99 Determine time and duration of exposure Determine severity of distress Frequently Severe Hypothermia Mild/Moderate Hypothermia Frostbite PREVENT FURTHER HEAT LOSS: remove wet clothing and cover with dry blankets (move Pt gently) PREVENT FURTHER HEAT LOSS: remove wet clothing and cover with dry blankets (move Pt gently) PREVENT FURTHER HEAT LOSS: remove wet clothing and cover with dry blankets (move Pt gently) Assist ventilations as indicated Rapid Transport in a preheated patient compartment 21
16 BLS TREATMENT GUIDELINES - OBSTETRICS IMMINENT DELIVERY - NORMAL (SJ-B601) effective 07/01/99 Determine trimester of pregnancy Estimate blood loss (EBL) DELIVER HEAD: suction mouth/nose Frequently CHECK NECK: for wrapped cord; if present - loosen and slip over infant's head, if unable - double clamp and cut between clamps PROCEED WITH DELIVERY: DRY INFANT WRAP: in warm, dry, cloth or place on mom and cover CUT & CLAMP: six (6) inches from baby APGAR's: at one (1) & five (5) min. ALLOW DELIVERY OF PLACENTA 22
17 BLS TREATMENT GUIDELINES - OBSTETRICS IMMINENT DELIVERY - COMPLICATED (SJ-B602) effective 07/01/99 Determine trimester of pregnancy Estimate blood loss (EBL) Type of abnormal presentation frequently Transport according to specialty triage criteria Breech or Footling Prolapsed cord Early Transport Insert gloved hand into vagina, gently push presenting part off cord Allow delivery to proceed to waist Place mom into Trendelenburg position with hips elevated ROTATE: infant to face-down If head does not deliver, insert gloved hand into vaginal opening and create air passage for infant Transport Special Note: If mother is toxemic and/or actively seizing, reduce stimuli (e.g., no sirens, etc.) 23
18 BLS TREATMENT GUIDELINES - TRAUMA BURNS (SJ-B701) effective 07/01/99 Determine time, type, and severity of burn MOVE PATIENT: to safe environment frequently Transport according to specialty triage criteria STOP THE BURNING PROCESS: brush then flush CONSIDER: Preparation for early intubation if respiratory burn likely DRESS BURNS: with sterile drapes 24
19 BLS TREATMENT GUIDELINES - TRAUMA TRAUMATIC SHOCK (SJ-B702) effective 07/01/99 Determine mechanism of injury Load and Go: to appropriate facility by best method available Early Base notification for surgical mobilization C-SPINE: as indicated frequently BLEEDING CONTROL: as indicated DRESS & SPLINT: as needed. Return extremities to anatomical position. Reassess neurovascular frequently HOSPITAL CONTACT 25
20 BLS TREATMENT GUIDELINES - TRAUMA TRAUMATIC ARREST (SJ-B703) effective 07/01/99 Determine mechanism of injury Load and Go: to appropriate facility by best method available Early HOSPITAL notification for surgical mobilization VENTILATE: BVM & 100% O2 (Use OPA/NPA) CPR airway, rhythm and pulse frequently C-SPINE: as indicated BLEEDING CONTROL: as indicated DRESS & SPLINT: as needed. Return extremities to anatomical position. Reassess neurovascular frequently 26
21 BLS TREATMENT GUIDELINES - TRAUMA HEAD - NECK - FACIAL TRAUMA (SJ-B704) effective 07/01/99 Determine mechanism of injury Consider Load and Go: to appropriate facility by best method available Early Base notification for surgical mobilization OXYGEN: High flow via mask Prepare for ALS intubation C-SPINE: as indicated frequently Transport according to specialty triage criteria BLEEDING CONTROL: as indicated POSITION: head injured patients with head of board elevated degrees (if normotensive) DRESS & SPLINT: as needed 27
22 BLS TREATMENT GUIDELINES - TRAUMA CHEST TRAUMA (SJ-B705) effective 07/01/99 Determine mechanism of injury Load and Go: to appropriate facility by best method available Early Base notification for surgical mobilization OXYGEN: High flow via mask C-SPINE: as indicated frequently Transport according to specialty triage criteria BLEEDING CONTROL: as indicated DRESS & SPLINT: as needed. Vaseline impregnated gauze for open chest wounds. Thick padding dressing or pillow splint for flail chest. 28
23 BLS TREATMENT GUIDELINES - TRAUMA ABDOMINAL TRAUMA (SJ-B706) effective 07/01/99 Determine mechanism of injury Load and Go: to appropriate facility by best method available Early Base notification for surgical mobilization OXYGEN: High flow via mask C-SPINE: as indicated frequently Transport according to specialty triage criteria BLEEDING CONTROL: as indicated DRESS & SPLINT: as needed. Return extremities to anatomical position. Reassess neurovascular frequently. 29
24 BLS TREATMENT GUIDELINES - TRAUMA EXTREMITY TRAUMA (SJ-B707) effective 07/01/99 Determine mechanism of injury Load and Go: to appropriate facility by best method available Early Base notification for surgical mobilization OXYGEN: High flow via mask C-SPINE: as indicated frequently Transport according to specialty triage criteria BLEEDING CONTROL: as indicated DRESS & SPLINT: as needed. Return extremities to anatomical position. Reassess neurovascular frequently. Cover exposed bone with saline soaked gauze. AMPUTATIONS: partial, dress and splint in anatomical position; complete, place part in sterile container and place container on ice 30
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