GUIDELINE/STANDARD OF CARE
Initial Date: 11/01/01
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Last Review/Revision: 12/18/08
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Guideline Number: 201
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Service Director’s Signature
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Medical Director’s Signature
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The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:
AIRWAY OBSTRUCTION
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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:
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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.
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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.)
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If unable to remove the foreign body with the Magill forceps, perform the abdominal thrust maneuver and repeat the laryngoscopy.
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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.
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If unable to clear the airway, continue attempts to remove/ventilate and begin immediate transport to the closest emergency department (overrule diversions).
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Administer supplemental oxygen (see guideline # 105, 2001) and attempt to ventilate between attempts at removal en route.
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Consider advanced airway. (See guideline #2008, 2009, 2010).
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Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.
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Complete the history and focused physical assessment (see guideline # 103, 1001).
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Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.
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Consider intravenous access (see guideline # 3002-3004).
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Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.
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Consider 12-lead electrocardiogram (see guideline #3008).
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Contact medical control for orders as necessary.
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Reassess and document the patient’s respiratory and cardiovascular systems frequently.
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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.
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Transport to the closest, most appropriate hospital.
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Document reasons for any deviation from the preceding Guideline/Standard of care.
END
GUIDELINE/STANDARD OF CARE
Initial Date: 11/01/01
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Last Review/Revision: 12/18/08
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Guideline Number: 202
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Service Director’s Signature
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Medical Director’s Signature
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The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:
BRONCHIAL ASTHMA
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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).
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Determine the degree of respiratory distress (mild/moderate/severe).
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Allow the patient to assume the position of comfort unless contraindicated by medical condition.
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Administer supplemental oxygen (see guideline # 105, 2001) with a device and at a rate appropriate for the condition of the patient.
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Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.
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Complete the history and focused physical assessment (see guideline # 103, 1001).
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Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.
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Consider intravenous access (see guideline # 3002-3004)).
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Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.
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Monitor oxygen saturation.
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Albuterol by nebulized inhalation (see drug profile # 002).
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Consider epinephrine (see drug profile # 009) intramuscular for the patient in severe distress who does not respond to albuterol.
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Consider Atrovent (See drug profile # 019)
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Consider 12-lead electrocardiogram (see guideline #3008).
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Consider CPAP (see guideline #2018).
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Consider alternative causes for bronchospasm and follow appropriate guide, e.g. anaphylaxis, COPD, CHF, foreign body aspiration.
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Contact medical control for orders as necessary.
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Reassess and document the patient’s respiratory and cardiovascular systems frequently.
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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.
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Transport to the closest, most appropriate hospital.
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Document reasons for any deviation from the preceding Guideline/Standard of care.
END
GUIDELINE/STANDARD OF CARE
Initial Date: 11/01/01
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Last Review/Revision: 12/18/08
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Guideline Number: 203
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Service Director’s Signature
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Medical Director’s Signature
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The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
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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).
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Determine the degree of respiratory distress (mild/moderate/severe).
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Allow the patient to assume the position of comfort unless contraindicated by medical condition.
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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.
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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.
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Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.
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Complete the history and focused physical assessment (see guideline #103, 1001).
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Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.
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Consider intravenous access (see guideline # 3002-3004).
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Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.
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Albuterol (see drug profile # 002) by nebulized inhalation.
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Atrovent (See drug profile # 019)
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Consider 12-lead electrocardiogram (see guideline #3008).
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Consider CPAP (see guideline #2018).
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Contact medical control for orders as necessary.
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Reassess and document the patient’s respiratory and cardiovascular systems frequently.
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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.
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Transport to the closest, most appropriate hospital.
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Document reasons for any deviation from the preceding Guideline/Standard of care.
END
GUIDELINE/STANDARD OF CARE
Initial Date: 11/01/01
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Last Review/Revision: 12/18/08
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Guideline Number: 204
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Service Director’s Signature
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Medical Director’s Signature
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The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:
INHALATION INJURY
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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).
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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.
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Allow the patient to assume the position of comfort unless contraindicated by medical condition.
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Administer supplemental oxygen (see guideline # 105, 2001) at 100% with a device appropriate for the condition of the patient. Consider humidified oxygen.
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Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.
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Complete the history and focused physical assessment (see guideline #103, 1001).
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Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.
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Consider concurrent trauma, medication overdose, or toxic exposure (see guidelines #412, 506)
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Consider intravenous access (see guideline # 3002-3004).
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Consider electrocardiograph monitoring (see guideline #3009). See appropriate dysrhythmia guidelines.
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Consider drug therapy.
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Albuterol (see drug profile # 002)
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Atrovent (see drug profile #019)
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Consider Positive End Expiratory Pressure (PEEP) (see guideline # 2011).
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Consider 12-lead electrocardiogram (see guideline #3008).
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For patients with suspected carbon monoxide poisoning:
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Rescue safely.
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Administer high flow oxygen via nonrebreather mask.
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Provide appropriate medical care based on patient assessment.
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Consider transport to facility with hyperbaric capabilities.
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Contact medical control for orders as necessary.
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Reassess and document the patient’s respiratory, cardiovascular and nervous systems frequently.
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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.
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Document the time of removal from the toxic environment, the circumstances and duration of exposure, and the time started on oxygen.
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Document the history of loss of consciousness.
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Transport to the closest, most appropriate hospital.
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Document reasons for any deviation from the preceding Guideline/Standard of care.
END
GUIDELINE/STANDARD OF CARE
Initial Date: 11/01/01
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Last Review/Revision: 12/18/08
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Guideline Number: 205
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Service Director’s Signature
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Medical Director’s Signature
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The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:
RESPIRATORY ARREST
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Assure scene safety and observe universal precautions (see guideline #107).
- Assure patent airway. Utilize airway obstruction maneuvers as appropriate (see guideline # 101,201).
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Assure adequate respiratory exchange, ventilate with supplemental oxygen, consider advanced airway. (see guideline # 2002-2009)
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Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.
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Complete the history and focused physical assessment (see guideline #103, 1001).
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Obtain initial vital signs (see guideline #1002) and repeat at a minimum of 15-minute intervals. Critical patients may need more frequent monitoring.
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Consider causes for respiratory arrest and treat with the appropriate guidelines.
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Consider intravenous access (see guideline # 3002-3004).
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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
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Guideline Number: 206
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Service Director’s Signature
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|
Medical Director’s Signature
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The following content will be considered the Guideline/Standard of care for the patient with a provider impression of:
RESPIRATORY DISTRESS
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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.
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Assess for adequate circulation to perfuse the vital organs. Begin CPR as appropriate.
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Complete the history and focused physical assessment (see guideline #103, 1001). Consider both medical and traumatic causes of respiratory distress. Follow appropriate treatment guideline.
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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.
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Consider CPAP (see guideline #2017)
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Albuterol (asthma, COPD) (see drug profile # 002).
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Atrovent (asthma, COPD)(See drug profile # 019)
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Epinephrine (anaphylaxis) (see drug profile # 009)
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Nitroglycerin (CHF) (see drug profile # 015)
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Consider 12-lead electrocardiogram (see guideline #3008).
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Contact medical control for orders as necessary.
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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.
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Transport to the closest, most appropriate hospital.
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Document reasons for any deviation from the preceding Guideline/Standard of care.
END
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