Intermediate Protocol ReviewIntermediate Level

Cardiac Arrest—Initial Care

• NEW PROTOCOL• References rhythm

based protocols• Reinforces BLS– Good CPR– Intubation not required

if ventilation adequate– Consider supraglottic

airway

Post Cardiac Arrest

• Therapeutic Hypothermia interventions for all levels of care.

Pediatric Cardiac Arrest

• General Approach• Intubation is

deemphasized• Understand

Termination Rules

Neonatal Resuscitation

Trauma: Transport Guidelines

Trauma: Aeromedical Utilization

• Must SIGNIFICANTLY reduce transport time

• Signs of life!!!• Don’t wait for the

helicopter • <20 mile transport?• Entrapment

Trauma: Pregnant Patients

• Adult trauma pt > 20 weeks gestation– Not meeting trauma criteria – ER of their choice– Meeting trauma criteria – Adult trauma center!

Trauma: Chest

• Bilateral needle decompression as standing order for Trauma Code with suspected chest injury.

Trauma: Hypoperfusion

• Differing fluid goals for compressible injury

• Reflects current ITLS/ATLS guidelines

Airway Management

• Changes:– CPAP for EMT-I– Must be credentialed– Earlier use of

supraglottic airways• Waveform required

for intubated patients• Recommended for

alternate airways

Airway Management Comparison

Continuous Positive Airway Pressure

• Changes– EMT-I allowed*• *If credentialed

• Remember indications and contraindications

Diabetic Emergencies

• NEW PROTOCOL• Addresses low and high

blood sugar• Intermediates use D10

for hypoglycemia

Diabetic Emergencies Comparison

Pain / Nausea /Sedation

• A fluid bolus makes almost anyone feel better