Emergency Medical Response: Agitation Management

Correct hypoxia quickly, prevent desaturation, and maintain adequate oxygenation.

Using supplemental oxygen and proper positioning to restore adequate oxygen levels.

Administer 650mg PO Tylenol if recent use/contraindicated hx is absent.

Establish IV access, draw blood, and aggressively fluid resuscitate (0.9% NS or LR) up to 30ml/kg IBW.

If hypotension persists after fluid, initiate vasopressors (e.g., Norepinephrine) aiming for a systolic BP of 90mmHg or MAP of 65mmHg.

Prioritize patient comfort during pre-hospital care, considering injuries like extremity injuries, burns, chest pain, trauma, abdominal pain, severe back/flank pain. Non-traumatic pain (myalgias, muscle spasms) should use a non-opioid strategy.

Consider Cryotherapy, Tylenol (650mg), Toradol (IV or IM), or Ativan (for severe radicular muscle spasms).

Fever considerations for patients older than 18 years include: heart rate > 90 bpm, respiratory rate > 22 breaths per minute, and EtCO2 less than 25 mmHg. Pediatric patients use age-appropriate criteria.

Initiate vasopressor therapy (Norepinephrine or Epinephrine) if fluid resuscitation fails to restore blood pressure to target levels (90 mmHg systolic or 65 mmHg MAP).

Patient showing signs of alteration due to psychosis, drugs, or alcohol, lacking decision-making capacity, or displaying aggression towards EMS personnel.

Approach calmly, clarify choices, assess capacity and suicidal/homicidal ideation, and prioritize patient assessment and management if transferred by law enforcement.

If law enforcement requested assistance, clarify patient transfer, focus on assessment and management by EMS, and avoid delays in vital checks.

Evaluate the patient's ability to understand decisions and their consequences.

Assess if the patient expresses thoughts, feelings or intent regarding harming themselves or others.

Ativan 1 mg IVP (Intravenous Push) is commonly used to relieve anxiety in a patient

Haldol 2.5 mg IVP (Intravenous Push) is used for a patient who has trouble organizing thoughts, is self-conscious, or has hallucinations.

Capnography, SpO2 (pulse oximetry), and blood pressure monitoring are necessary for all benzodiazepine, opiate, or ketamine usage, along with other interventions.

Protocol to follow if a patient shows signs of airway obstruction like stridor, airway swelling, or altered mental status

Closely observe stable patients with EtCO2, SpO2, cardiac monitor, vital rechecks, and reassessments.

Do not use succinylcholine on patients with burns older than 72 hours.

Criteria for transfer to a burn unit by aircraft: Combined burns (partial and full thickness), >10% in <10 or >50 years old, >20% in other age groups, full thickness >5%, burns to specific areas (hands, face, eyes, ears, feet, perineum, major joints), inhalation, electrical, or chemical injuries, major trauma or pre-existing disease.

If aircraft unavailable or delayed, transport by ground to nearest trauma center within 45 minutes, per Indiana Trauma Code.

Initial management followed Trauma Protocol. Differentiate isolated head injuries from those with hemorrhage due to other trauma.

Check and correct patient's blood glucose levels.

Hypoxemia, Hypotension, Hyperventilation. Aggressively prevent and treat these in head injury management.

NRB (non-rebreather) 100% oxygen for spontaneously breathing patients with altered mental status, or FiO2 of 100% on ventilator. NC 4-6L titrating to 100% SpO2 for non-altered patients. NRB as needed, immediately.

For patients with head injuries, give IV fluids to maintain a systolic blood pressure (SBP) above 110 mmHg. Start fluid boluses before hypotension occurs, and repeat as needed with 500 mL boluses. Avoid vasopressors as they can increase intracranial pressure (ICP).

Monitor end-tidal carbon dioxide (ETCO2) continuously in all traumatic brain injury (TBI) patients. Maintain ETCO2 between 35-45 mmHg by adjusting ventilator settings (volume/rate). Avoid hypocapnia (low ETCO2).

Patients with unconsciousness or altered mental status, neurological deficits, or newly appearing midline deformities, resulting from traumatic events, require a cervical collar and a scoop stretcher, vacuum splint, or similar device for safe transport.

Avoid undue flexion, extension, or rotation during patient transfers, especially with suspected spinal injuries. Use vacuum mattresses for transfers involving injured spines.

Transport pregnant patients in the third trimester in the left lateral recumbent position, secured on a vacuum mattress.

Use sedatives with caution for TBI, considering doses at half of normal dosages. Do not give sedatives if SBP is low or actively decreasing. Consider Ketamine in case of precaution for hypotension.

For intubated patients, initiate mechanical ventilation promptly, and aim for a tidal volume of 5-6 ml/kg of ideal body weight and a respiratory rate of 10 breaths per minute; maintain ETCO2 at or between 35 and 45 mmHg using gentle volume/rate adjustments.

The umbilical cord slips down and blocks the baby's birth path during labor.

Lying on back with feet elevated, a way to elevate the uterus.

Baby's shoulders get stuck after the head is delivered.

Pulling the mother's legs towards her chest to flatten the pelvis.

Tucking the baby's head with two fingers to aid childbirth.

Pressure applied above the pubic bone to aid head rotation during childbirth.

A bony part of the baby's skull, crucial for the maneuver.

Opening up the baby's breathing passage when the head isn't delivering.

Pulling gently downward to bring out the baby's shoulders and head.

Increased intracranial pressure, a dangerous condition in head injuries.

Blood flow to the brain. Low flow is significant.

A neck brace used to stabilize the cervical spine.

Sores from prolonged pressure on skin.

Initial steps in trauma care, covering airway, breathing, circulation, and disability/exposure.

Low blood pressure.

Slow heart rate.

Raising the head of the bed to aid blood flow to the brain (for unconscious or increased ICP patients).

Using drugs to help open and maintain an airway.

Monitoring carbon dioxide levels in exhaled air.

Abnormally low body temperature.

Using external heat sources to raise body temperature gently.

Using external heat packs and warmed fluids to increase body temperature.

Cardiopulmonary Resuscitation. A life-saving procedure to restart the heart.

Cerebrospinal Fluid. Fluid surrounding the brain and spinal cord.