EMS Protocol of the Week - Avulsed Tooth (Adult and Pediatric)

Tooth Fairy? NOT IF EMS HAS ANYTHING TO SAY ABOUT IT.

Kidding. The prehospital protocol for the avulsed tooth applies solely to permanent teeth. If encountered, EMTs and paramedics will gently clean the tooth with saline and reimplant it within the socket (assuming the patient isn’t at risk for aspirating the tooth – see the Key Points section). If the patient is not eligible for reimplantation, EMS will prevent the tooth from drying out by placing it in an storage medium – remember that preference is “commercial tooth preservation media” (generic term for Hank’s Balanced Salt Solution) > milk > saliva > saline. 

That’s all there is to it! All neatly packaged for you to manage in the ED! Or, more likely, to have the dentist manage! High five!

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

 Dave

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

Despite the broad-sounding title, the prehospital protocol for respiratory distress/failure and pulmonary edema serves mostly to describe the pulmonary edema aspect of care.  As we’ve seen, there are separate, more specific protocols of obstructed airways and COPD/asthma exacerbations, leaving this protocol to mostly focus on fluid overload.

Of note, this protocol also refers to Appendix P (attached), which describes indications for prehospital CPAP use. Remember that CPAP can be applied at either the BLS or ALS level, which has been of tremendous utility in caring for these patients.

At the ALS level, paramedics will administer nitroglycerin (either via tablet or spray) as indicated. You may receive OLMC calls from them requesting to give a benzodiazepine (for CPAP-related anxiety) or furosemide (to get a jumpstart on diuresis). Approve or deny the request as you choose; just remember to confirm dosages and routes!

That’s it for this week, gang! One more protocol to…take your breath away!

Goodbye!

www.nycremsco.org or the protocol binder for more

Dave

EMS Protocol of the Week - Amputation (Adult and Pediatric)

Another trauma protocol this week, which means relatively low complexity in terms of prehospital interventions. In approaching amputation, the bulk of care can be administered at the CFR level, with BLS and ALS levels of training offering not much more beyond transport. 

The relevance for OLMC comes in understanding questions on hospital destination. Generally, only amputations proximal to the wrist or ankle require transport to a trauma center (which, remember, often means bypassing a closer, non-trauma center ED), but be sure to listen to the EMT or paramedic’s full presentation on the case. Use your discretion in determining what feels appropriate for patient care, but just like with other transportation decisions, remember that your orders (extending the transport time of a unit, adding patient load to a particular hospital, etc.) may impact the community and overarching EMS system at large.

Reach out with any questions, www.nycremsco.org or the protocols binder for more, and I’ll see you next week!

Dave