EMS Protocol of the Week - Seizures (Pediatric)

The pediatric seizure protocol hits all the same buttons as its adult counterpart, just with a slightly different focus on the medications. There’s a higher emphasis on glucagon for hypoglycemia, given that the IN/IM routes allow for rapid administration without having to get IV access. When it comes to benzodiazepine choice, the pediatric protocol limits Standing Order to midazolam, either IM or (preferably) IN. OLMC can permit a broader array of benzos as Medical Control Options, expanding options to lorazepam and diazepam, as well as adding IV as a route for any of the benzos.  

Remember to double check your math to ensure appropriate weight-based dosages for these meds! And always keep in mind the utility of IN as a route, especially for the kids.

Congrats! You’ve mastered prehospital seizures (again!) Again, other protocols will refer to this one as needed - moreso than in the old formatting. So it’s really like you learned a BUNCH of protocols with just a couple of emails! Aren’t you proud? I am!

www.nycremsco.org or the protocols binder for more!

Dave

EMS Protocol of the Week - Respiratory Distress / Failure / Acute Pulmonary Edema (Adult)

Moving on from the pediatric respiratory distress/failure protocol to its adult counterpart this week, given that adults are just larger versions of kids (PEM colleagues – just kidding! please don’t hit me). Prehospital management of the adult in respiratory distress generally boils down to APE or asthma/COPD, with the occasional interesting obstructed airway case. The latter two instances are given their own distinct protocols to shine, so pulmonary edema gets to bulk of the attention here. As previously discussed with the older version of the protocols, we have the benefit if NYC of having BLS providers trained in the initiation of CPAP. ALS can continue NIPPV management but also obviously have advanced airway capabilities as needed. They’ll also administer nitroglycerin, either as a sublingual tablet or a spray, as SBP allows. As the OLMC doc, you’ll be answering the phone to authorize either a benzodiazepine to assist with anxiolysis or furosemide to initiate diuresis, as the situation demands.  

As a bonus, I’ve also included protocol Appendix P, which provides EMTs and paramedics with inclusion and exclusion criteria for the initiation of CPAP. Interested in more EMS educational nuggets like this? Head to www.nycremsco.org or the North Side OLMC protocol binder for more!

Dave

EMS Protocol of the Week - Respiratory Distress / Failure / Arrest (Pediatric)

The concept of referring out to other protocols is again on display this week, this time in support of pediatric respiratory distress/failure/arrest. This protocol starts with heavy emphasis on the CFR portion, given the importance of respiratory status in pediatrics. Note that there is a separate protocol to refer to in the case of suspected airway obstruction, but following from that, CFRs will administer supplemental oxygen and assist with ventilations if necessary. BLS will call for ALS backup while initiating transport (remember, lots of prehospital pediatric critical care in NYC focuses on rapid transport of the patient to a definitive care facility). If ALS is on scene and suspects overdose, they will administer naloxone as per the new Altered Mental Status protocol. They will also perform advanced airway management and needle decompression as indicated. Again, this is ideally all happening while the patient is already en route to the hospital, so the role for OLMC is limited to discussing vascular access in patients who may need it. Finally, the Key Points/Considerations section provides some reference/terminology info to assist in teasing out the degree of illness severity in these patients. 

That about wraps it up! Some of these protocols appear a bit thinner now that there are portions that refer to other protocols, so don’t forget to refer to them for more info. You can do so at – you guessed it! – www.nycremsco.org and the protocols binder!

Dave