BLS Seizure Management

Seizures - Adult

• Indications: involuntary, repetitive muscle movements, observed seizure activity, decreased mental status, unconsciousness, incontinence, and head injury
• Post-seizure management:
  • Identify and treat injuries
  • Check blood glucose and treat per Hypoglycemia protocol if necessary
  • Administer oral glucose paste (10-15 grams) between the gum and cheek if blood glucose is less than 70 mg/dL
  • Administer a single additional dose of oral glucose if not improved after 10 minutes
• Active seizure management:
  • Do not restrain the patient or place any device into the patient's mouth
  • Protect the patient from injury
  • Identify and treat potential underlying causes of seizure: epilepsy, head injury, hypoxia, hypoglycemia, hypoperfusion, infection, stroke, alcohol or drug abuse or withdrawal, and head injury

Seizures - Pediatric

• Indications: same as adult, plus pediatric-specific considerations
• Post-seizure management:
  • Same as adult, plus pediatric-specific considerations
• Active seizure management:
  • Same as adult, plus pediatric-specific considerations

Sepsis - Adult

• Indications: adult patients (18 years of age and older) with a suspected source of infection and present with at least two of the following criteria:
  • Temperature greater than 100.4°F (38°C) or less than 95.9°F (35.5°C)
  • Heart rate greater than 100 bpm
  • Respiratory rate greater than 25 (or ETCO2 less than or equal to 32 mmHg)
  • Hypotension (systolic BP less than 90 mmHg)
• Management:
  • Place patient in position of comfort, or supine if hypotension is present
  • Monitor airway and respiratory status, manage as required using the appropriate respiratory distress protocol
  • Rendezvous with ALS or transport to the closest appropriate facility
  • Use the term "sepsis alert" during hospital notification
• Priority 1 patients: those with suspected sepsis and either altered mental status or hypotension

Sepsis - Pediatric

• Indications: pediatric patients (less than 18 years of age) with a suspected source of infection and present with at least three of the Pediatric Sepsis Rule-In Criteria by Age
• Management:
  • Place patient in position of comfort, or supine if hypotension is present
  • Monitor airway and respiratory status, manage as required using the appropriate respiratory distress protocol
  • Transport to the closest appropriate facility
  • Use the term "sepsis alert" in consultation with the receiving facility
• Priority 1 patients: those with suspected sepsis and either altered mental status or hypotension

Shock/Hypoperfusion - Adult

• Indications: shock is a state of inadequate blood flow to meet the oxygen demands of the cells
• Symptoms:
  • Altered mental status
  • Cool, clammy skin
  • Diaphoresis
  • Hypotension
  • Tachycardia or weak pulses
  • Shallow, labored respirations
  • General weakness
  • Decreasing pulse pressure
• Management:
  • Place patient in supine position with legs elevated
  • Closely monitor airway and vital signs every 5 minutes
  • Pregnancy: for pregnant patients greater than 20 weeks gestation with hypotension, provide constant left lateral uterine displacement

Shock/Hypoperfusion - Pediatric

• Indications: same as adult
• Symptoms:
  • Same as adult, plus pediatric-specific considerations
• Management:
  • Same as adult, plus pediatric-specific considerations

Stroke - Adult & Pediatric

• Indications:
  • Blurred vision
  • Difficulty speaking
  • Numbness or weakness
  • Sudden onset of dizziness or loss of balance
  • Severe, unexplained headache
• Management:
  • Position patient with head elevated at 30 degrees
  • Check blood glucose level; if less than 70 mg/dL, treat per Hypoglycemia protocol
  • Perform Cincinnati Prehospital Stroke Scale (any abnormality is positive for stroke)
  • Perform Posterior Cerebellar Assessment (any abnormality is positive for stroke)
  • If either the Cincinnati Prehospital Stroke Scale or Posterior Cerebellar Assessment is positive, then calculate the suspected stroke patient's Los Angeles Motor Scale (LAMS) score
  • Destination determination for a suspected stroke patient who can be delivered to the appropriate stroke center within 30 minutes from when the patient was last known well
  • Notify the receiving stroke center or hospital as soon as possible

Syncope - Adult & Pediatric

• Indications:
  • Transient loss of consciousness with an inability to maintain postural tone
  • Symptoms may resolve without intervention or prior to EMS arrival
  • Patients who "feel like they are going to pass out" (near-syncope)
  • For children less than 24 months of age, refer to ALTE/BRUE protocol
• Management:
  • Place patient in the supine position, with feet elevated
  • Check blood glucose
  • If less than 70 mg/dL, refer to Hypoglycemia protocol
  • Perform Cincinnati Stroke Scale
  • If any abnormal findings are present, refer to Stroke protocol

Obstetrics/Gynecological Emergencies: Childbirth Algorithm

• Indications: labor, fetal distress, or other obstetric emergencies
• Management:
  • Follow the Childbirth Algorithm
  • Perform uterine massage
  • ALS administer TXA (e)