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Lisbon Fire Department Standard Operating Guidelines and Policies


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GUIDELINE/STANDARD OF CARE


Initial Date: 11/01/01

Last Review/Revision: 12/18/08

Guideline Number: 201

Service Director’s Signature




Medical Director’s Signature



The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:



AIRWAY OBSTRUCTION

  • Assure scene safety and observe universal precautions (see guideline #107).
  • Evaluate airway.
  • If the patient is conscious and can speak/cough, encourage efforts but do not interfere.
  • If the patient is conscious but cannot speak or cough, complete the obstructed airway procedures of the American Heart Association:

VICTIM 1 YEAR OF AGE OR OLDER

INFANT
Abdominal thrusts

Repeat until airway clear or patient becomes unconscious

5 Back blows, 5 chest thrusts
Repeat until airway clear or patient becomes unconscious

  • If the foreign body is successfully dislodged:
  • Administer supplemental oxygen (see guideline #105, 2001) with a device and at a rate appropriate for the condition of the patient.
  • Reassess breath sounds. If wheezing or stridor is present, contact medical control for additional orders prior to transport.
  • If the patient is unconscious, perform direct laryngoscopy and attempt to visualize the remove the foreign body with the Magill forceps (see guideline # 2005). If equipment is not immediately available, continue with the obstructed airway procedures of the American Heart Association.

VICTIM 1 YEAR OF AGE OR OLDER

INFANT
Open the airway

Remove the object if
visible

Begin CPR

Visually check airway
before each breath.
Remove the object if
visible
.
Open the airway

Remove the object if
visible

Begin CPR

Visually check airway
before each breath.
Remove the object if
visible
End page
Airway Obstruction (cont.)


  • If unable to remove the foreign body with the Magill forceps, perform the abdominal thrust maneuver and repeat the laryngoscopy.

  • If the airway is cleared, reassess respirations and neurologic status. If the patient continues to have an altered level of consciousness or if wheezing or stridor is present, contact medical control.

  • If unable to clear the airway, continue attempts to remove/ventilate and begin immediate transport to the closest emergency department (overrule diversions).

  • Administer supplemental oxygen (see guideline # 105, 2001) and attempt to ventilate between attempts at removal en route.

  • Consider advanced airway. (See guideline #2008, 2009, 2010).

  • Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.

  • Complete the history and focused physical assessment (see guideline # 103, 1001).

  • Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.

  • Consider intravenous access (see guideline # 3002-3004).

  • Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.

  • Consider 12-lead electrocardiogram (see guideline #3008).

  • Contact medical control for orders as necessary.

  • Reassess and document the patient’s respiratory and cardiovascular systems frequently.

  • Complete a patient care report (see guideline #102) documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.

  • Transport to the closest, most appropriate hospital.

  • Document reasons for any deviation from the preceding Guideline/Standard of care.

END


GUIDELINE/STANDARD OF CARE


Initial Date: 11/01/01

Last Review/Revision: 12/18/08

Guideline Number: 202

Service Director’s Signature




Medical Director’s Signature



The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:



BRONCHIAL ASTHMA


  • Assure scene safety and observe universal precautions (see guideline #107).
  • Assure patent airway.
  • Assure adequate respiratory exchange, ventilate with supplemental oxygen in those patients with inadequate or absent respirations, consider advanced airway (see guideline # 2002-2009).

  • Determine the degree of respiratory distress (mild/moderate/severe).

  • Allow the patient to assume the position of comfort unless contraindicated by medical condition.

  • Administer supplemental oxygen (see guideline # 105, 2001) with a device and at a rate appropriate for the condition of the patient.

  • Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.

  • Complete the history and focused physical assessment (see guideline # 103, 1001).

  • Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.

  • Consider intravenous access (see guideline # 3002-3004)).

  • Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.

  • Monitor oxygen saturation.

  • Consider drug therapy:

  • Albuterol by nebulized inhalation (see drug profile # 002).

  • Consider epinephrine (see drug profile # 009) intramuscular for the patient in severe distress who does not respond to albuterol.

  • Consider Atrovent (See drug profile # 019)

  • Consider 12-lead electrocardiogram (see guideline #3008).

  • Consider CPAP (see guideline #2018).

  • Consider alternative causes for bronchospasm and follow appropriate guide, e.g. anaphylaxis, COPD, CHF, foreign body aspiration.

  • Contact medical control for orders as necessary.

  • Reassess and document the patient’s respiratory and cardiovascular systems frequently.

  • Complete a patient care report (see guideline #102) documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.

  • Transport to the closest, most appropriate hospital.

  • Document reasons for any deviation from the preceding Guideline/Standard of care.

END

GUIDELINE/STANDARD OF CARE




Initial Date: 11/01/01

Last Review/Revision: 12/18/08

Guideline Number: 203

Service Director’s Signature




Medical Director’s Signature



The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:



CHRONIC OBSTRUCTIVE PULMONARY DISEASE



  • Assure scene safety and observe universal precautions (see guideline #107).
  • Assure patent airway. (see guideline # 101,201)
  • Assure adequate respiratory exchange, ventilate with supplemental oxygen in those patients with inadequate or absent respirations, consider advanced airway (see guideline # 2002-2009).

  • Determine the degree of respiratory distress (mild/moderate/severe).

  • Allow the patient to assume the position of comfort unless contraindicated by medical condition.

  • Administer supplemental oxygen (see guideline # 105, 2001) with a device and at a rate appropriate for the condition of the patient. Consider oxygen sensitive patient and monitor respiratory effectiveness. As a general guideline, administer oxygen 2 liters higher than the patient is usually receiving.

  • The bag-valve-mask will be kept immediately available to all patients with a provider assessment of chronic obstructive pulmonary disease who are in moderate/severe respiratory distress.

  • Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.

  • Complete the history and focused physical assessment (see guideline #103, 1001).

  • Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.

  • Consider intravenous access (see guideline # 3002-3004).

  • Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.

  • Consider drug therapy.

  • Albuterol (see drug profile # 002) by nebulized inhalation.

  • Atrovent (See drug profile # 019)

  • Consider 12-lead electrocardiogram (see guideline #3008).

  • Consider CPAP (see guideline #2018).

  • Contact medical control for orders as necessary.

  • Reassess and document the patient’s respiratory and cardiovascular systems frequently.

  • Complete a patient care report (see guideline #102) documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.

  • Transport to the closest, most appropriate hospital.

  • Document reasons for any deviation from the preceding Guideline/Standard of care.

END

GUIDELINE/STANDARD OF CARE




Initial Date: 11/01/01

Last Review/Revision: 12/18/08

Guideline Number: 204

Service Director’s Signature




Medical Director’s Signature



The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:



INHALATION INJURY

  • Assure scene safety and observe universal precautions (see guideline #107).
  • Assure patent airway. Consider potential cervical spine injury during airway maneuver (see guideline # 101,201).
  • Assure adequate respiratory exchange, ventilate with supplemental oxygen in those patients with inadequate or absent respirations, consider advanced airway (see guideline # 2002-2009).

  • Determine the degree of respiratory distress (mild/moderate/severe). Document the potential for inhalation injury as evidenced by the history, burns of the face, chest or mouth, carbonaceous sputum, singed nasal hair, dyspnea, decreased level of consciousness or stridor.

  • Allow the patient to assume the position of comfort unless contraindicated by medical condition.

  • Administer supplemental oxygen (see guideline # 105, 2001) at 100% with a device appropriate for the condition of the patient. Consider humidified oxygen.

  • Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.

  • Complete the history and focused physical assessment (see guideline #103, 1001).

  • Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.

  • Consider concurrent trauma, medication overdose, or toxic exposure (see guidelines #412, 506)

  • Consider intravenous access (see guideline # 3002-3004).

  • Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.

  • Consider drug therapy.

  • Albuterol (see drug profile # 002)

  • Atrovent (see drug profile #019)

  • Consider Positive End Expiratory Pressure (PEEP) (see guideline # 2011).

  • Consider 12-lead electrocardiogram (see guideline #3008).

  • For patients with suspected carbon monoxide poisoning:

  • Rescue safely.

  • Administer high flow oxygen via nonrebreather mask.

  • Provide appropriate medical care based on patient assessment.

  • Consider transport to facility with hyperbaric capabilities.

  • Contact medical control for orders as necessary.

  • Reassess and document the patient’s respiratory, cardiovascular and nervous systems frequently.

  • Complete a patient care report (see guideline #102) documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.

  • Document the time of removal from the toxic environment, the circumstances and duration of exposure, and the time started on oxygen.

  • Document the history of loss of consciousness.

  • Transport to the closest, most appropriate hospital.

  • Document reasons for any deviation from the preceding Guideline/Standard of care.

END

GUIDELINE/STANDARD OF CARE




Initial Date: 11/01/01

Last Review/Revision: 12/18/08

Guideline Number: 205

Service Director’s Signature




Medical Director’s Signature



The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:



RESPIRATORY ARREST

  • Assure scene safety and observe universal precautions (see guideline #107).
  • Assure patent airway. Utilize airway obstruction maneuvers as appropriate (see guideline # 101,201).

  • Assure adequate respiratory exchange, ventilate with supplemental oxygen, consider advanced airway. (see guideline # 2002-2009)

  • Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.

  • Complete the history and focused physical assessment (see guideline #103, 1001).

  • Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.

  • Consider causes for respiratory arrest and treat with the appropriate guidelines.

  • Consider intravenous access (see guideline # 3002-3004).

  • Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.

  • Consider 12-lead electrocardiogram (see guideline #3008).

  • Contact medical control for orders as necessary.

  • Reassess and document the patient’s respiratory and cardiovascular systems frequently.

  • Complete a patient care report (see guideline #102) documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.

  • Transport to the closest, most appropriate hospital.

  • Document reasons for any deviation from the preceding Guideline/Standard of care.

END

GUIDELINE/STANDARD OF CARE




Initial Date: 11/01/01

Last Review/Revision: 12/18/08

Guideline Number: 206

Service Director’s Signature




Medical Director’s Signature



The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:



RESPIRATORY DISTRESS



  • Assure scene safety and observe universal precautions (see guideline #107).
  • Assure patent airway. Consider potential for cervical spine injury during airway maneuvers. (see guideline # 101,201).
  • Assure adequate respiratory exchange, ventilate with supplemental oxygen in those patients with inadequate or absent respirations, consider advanced airway (see guideline # 2002-2009).

  • Determine the degree of respiratory distress (mild/moderate/severe).

  • Allow the patient to assume the position of comfort unless contraindicated by medical condition.

  • Administer supplemental oxygen (see guideline # 105, 2001) with a device and at a rate appropriate for the condition of the patient.

  • The bag-valve-mask will be kept immediately available to all patients with a provider assessment of respiratory distress who are in moderate or severe respiratory distress.

  • Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.

  • Complete the history and focused physical assessment (see guideline #103, 1001). Consider both medical and traumatic causes of respiratory distress. Follow appropriate treatment guideline.

  • Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.

  • Consider intravenous access (see guideline # 3002-3004).

  • Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.

  • Consider CPAP (see guideline #2017)

  • Consider drug therapy.

  • Albuterol (asthma, COPD) (see drug profile # 002).

  • Atrovent (asthma, COPD)(See drug profile # 019)

  • Epinephrine (anaphylaxis) (see drug profile # 009)

  • Nitroglycerin (CHF) (see drug profile # 015)

  • Consider 12-lead electrocardiogram (see guideline #3008).

  • Contact medical control for orders as necessary.

  • Reassess and document the patient’s respiratory and cardiovascular systems frequently.

  • Complete a patient care report (see guideline #102) documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition.

  • Transport to the closest, most appropriate hospital.

  • Document reasons for any deviation from the preceding Guideline/Standard of care.

END

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