EMS Protocol of the Week - Suspected Myocardial Infarction (Adult)

Diaphoretic? Clutching your chest? Might just be your excitement for another EMS-PoW, but it might also be a heart attack! Hard to tell, I know, so it’s probably just safer to call 911.

When dealing with a suspected MI, EMS will administer 324mg of aspirin orally, starting at the CFR level. BLS providers will immediately request ALS backup, but importantly, if the nearest ALS unit is farther away than the nearest appropriate hospital, BLS will instead transport the patient for further evaluation. If the patient is already prescribed nitroglycerin, BLS can help the patient to take it (assuming no erectile dysfunction meds have been given in the preceding 72 hours), but they do not have their own to give. 

Once ALS is on scene, they will perform and interpret a 12-lead EKG – this will assist in determining whether it is more appropriate to bring the patient to the nearest hospital or to bypass said hospital for the nearest STEMI/PCI center. En route, they can also administer their own nitroglycerin for persistent chest pain (again, assuming no ED meds, as well as a systolic BP > 100mmHg).

Not a lot for you all to do on the OLMC phone, but keep in mind that the decision for closer hospital vs longer transport to STEMI center is the main reason behind EMS calling for these sorts of cases. Listen closely to the case details, as well as the paramedic’s description of the EKG (if they have not sent it electronically) to help answer that question.

See you all next week for more! www.nycremsco.org or the protocols binder to tide you all over until then!

 Dave

EMS Protocol of the Week - Anaphylaxis (Pediatric)

Lots of suspense from last week’s cliffhanger, I know, but basically, the pediatric anaphylaxis protocol plays out largely the same as its adult counterpart, just with peds-relevant dosing, along with a predilection for dexamethasone over methylprednisolone, particularly for kids less than 2 years of age.

Double check your dosages! Need a reference? That’s what www.nycremsco.org and the protocols binder are for!

Dave

EMS Protocol of the Week - Anaphylaxis (Adult)

Anaphylaxis is one of the rare protocols where you will actually find medication administration as early as the CFR (FDNY firefighter) level. In this protocol, if CFRs are the first on scene and recognize a patient in anaphylaxis, they will administer epinephrine via auto-injector while awaiting EMS backup. 

BLS will also administer IM epi, either by auto-injector or – in some instances – manually drawn up into a premarked syringe. However, EMTs require OLMC approval to give a second dose, regardless if they themselves gave the first epi or the CFRs did. This highlights the importance of checking with crews which meds were given, and by whom. BLS is also equipped to administer albuterol for any wheezing noted.

ALS providers on scene will do all manner of ALS stuff – advanced airway management if needed, IV fluids, steroids, diphenhydramine, ipratropium, and repeat epi if instructed by OLMC. Any further issues with respiratory or hemodynamic status are referred to appropriate protocols for additional management.

That’s it for this week, but I bet you’re all…itching…to find out what happens for pediatric patients in anaphylaxis? Stay tuned, faithful readers!

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

 Dave