EMS Protocol of the Week - Neonatal Care / Resuscitation

The prehospital protocol for neonatal resuscitation is dense, so it doesn't serve to reproduce it all within the email. Read through the attachment for details, and realize that it serves as a reference for stepwise assessment (with target heart and respiratory rates) and interventions (with target compression/ventilation rates and medication dosages) for when our EMTs and paramedics are stuck in a high stress home environment with a neonate in extremis. Not a ton to add from an OLMC perspective, but recognize that this protocol is here for your reference as well, in case a crew calls looking for assistance.

The attached appendix also includes a review of APGAR scores for your review. 

That's RESUSCITATION...BABY.

And with that, hope you all have some wonderful holidays! If you can't wait for more protocol goodness, there's always www.nycremsco.org

Dave

EMS Protocol of the Week - Severe Bradycardia (Pediatric)

Happy EMS Tuesday!

We're going to slow things down from John Su's riveting email about eye emergencies to discuss the EMS protocol for “Severe Bradycardia (Pediatric)”. These are 3 words that no one wants to hear in a sentence together, so let’s get mentally prepared in case this patient comes in!

To use this protocol, patients should have: 1) HR <60 bpm, and 2) signs of shock or AMS. Any provider taking care of this type of patient can begin chest compressions and ventilations as per AHA guidelines. If an EMT is first on scene, they should immediately request ALS assistance and transport if timing makes more sense. 

For paramedics, cardiac monitoring will be started and IV access will be obtained. Standing Order will allow them to perform the following: 

1) Epinephrine 0.01 mg/kg (0.1mL/kg) IV of 1:10,000 concentration (max 1mg) every 3-5 minutes, 

2) Atropine 0.02 mg/kg IV (min 0.1mg, max 0.5mg), 

3) intubation if unable to provide effective BVM ventilations. 

If that does not work, they will call OLMC for one of two options: 

1) administration of a 2nd dose of Atropine 0.02 mg/kg IV 

2) initiation of transcutaneous pacing. Of note, they may also for procedural sedation authorization for pediatric patients if the patient is conscious.

Check out www.nycremsco.org or the protocol binder on North Side for more.

Sincerely,

Joseph Liu, DO

Chief Resident, Emergency Medicine PGY-3

Maimonides Medical Center

EMS Protocol of the Week: Eye Emergencies

Hey all,

This week's protocol looks at eye emergencies that apply to both the adult and pediatric populations.

The prehospital approach starts with CFRs at the most basic level to evaluate and initiate treatments based on these ocular findings:

1) Non-penetrating foreign objects/chemical eye injuries: flush affected eye with NS for 20 minutes

2) Impaled object to eye: use bulky dressings to stabilize object and cover eye to prevent consensual eye movements

3) Avulsed eye: cover eye with saline, sterile dressings and do NOT place eye back into socket

BLS providers provide the additional support of removing contact lenses as needed.

ALS providers provide the additional support of administering proparacaine 0.5% or tetracaine 0.5% drops for chemical eye injuries to assist with irrigation.

Not alot to do on the OLMC side other than to help assist our EMS providers in each ocular scenario.

Check out www.nycremsco.org or the protocol binder on North Side for more.

John Su

PGY-2