Professional Responder Cheat Sheet PDF

PROFESSIONAL RESPONDER CHEAT SHEET Medi-Pro Response Solutions 778-724-9054 [email protected] mediprofirstaid.com Medi-Pro Response Solutions Professional Responder Cheat Sheet Table of Contents Assessment Model......................

PROFESSIONAL RESPONDER CHEAT SHEET Medi-Pro Response Solutions 778-724-9054 [email protected] mediprofirstaid.com Medi-Pro Response Solutions Professional Responder Cheat Sheet Table of Contents Assessment Model................................................................................................................................................................................................ 2 CPR Compression to Ventilation Ratios................................................................................................................................................................. 3 High Performance “Pit Crew” CPR......................................................................................................................................................................... 3 CPR in transport - Treatable CPR........................................................................................................................................................................... 3 Oxygen Cylinder Calculations................................................................................................................................................................................ 3 Oxygen Flow Rates................................................................................................................................................................................................ 4 Glasgow Coma Scale.............................................................................................................................................................................................. 4 APGAR................................................................................................................................................................................................................... 4 Administration of Medications vs Assisting with Medications............................................................................................................................... 5 6-Rights of Medication.......................................................................................................................................................................................... 5 RTC Critical Interventions Requiring History and/or Vital Signs.............................................................................................................................. 5 Common Units of Measurement............................................................................................................................................................................ 6 Assisted Ventilations............................................................................................................................................................................................. 6 Weight Estimation for Pediatric Patients............................................................................................................................................................... 6 A-T-M-I-S-T A-M-B-O............................................................................................................................................................................................ 6 PAC National Occupational Skill Competency Profiles............................................................................................................................................ 7 Critical Findings..................................................................................................................................................................................................... 7 Head to Toe Assessment Mnemonics.................................................................................................................................................................... 8 Relevant S-A-M-P-L-E and Mechanism of Injury Information................................................................................................................................. 8 Average Vital Signs................................................................................................................................................................................................ 9 T-POD/Pelvic Binder Application..........................................................................................................................................................................10 Naloxone (Narcan) Administration.......................................................................................................................................................................11 Terminology.........................................................................................................................................................................................................12 Chest Auscultation Points.....................................................................................................................................................................................12 EMALB NEXUS SMR Decision Matrix for Injuries with Spinal Mechanism..............................................................................................................13 Epinephrine Administration – Auto-Injector (Epi-Pen)..........................................................................................................................................15 Acetaminophen Administration...........................................................................................................................................................................16 Ibuprofen Administration.....................................................................................................................................................................................17 Glucagon Administration – Intramuscular (IM).....................................................................................................................................................18 Glucagon Administration – Intranasal (IN)............................................................................................................................................................19 Glucogel Administration - Parenteral....................................................................................................................................................................20 Salbutamol (Ventolin) Administration – Nebulizing Mask.....................................................................................................................................21 Salbutamol (Ventolin) Administration – Metered Dose Inhaler (MDI)...................................................................................................................22 Epinephrine Administration – Intramuscular Injection (IM)..................................................................................................................................23 IV Drip Set Calculations........................................................................................................................................................................................24 Common IV Solutions...........................................................................................................................................................................................24 Common IV Complications...................................................................................................................................................................................24 Entonox................................................................................................................................................................................................................25 Sager Traction Splint............................................................................................................................................................................................26 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 1 of 26  Medi-Pro Response Solutions Professional Responder Cheat Sheet Assessment Model Scene Assessment Hazards – BSI/PPE Environment Mechanism # Patients Additional Resources Are there any hazards? What are your What is going on? How many people Are more people or Are you wearing Body surroundings? How did it happen? require assistance? equipment Substance Isolation PPE? Is it safe to stay? Likely Injuries? Bystanders? needed? Primary Assessment General Impression What appears to be going on? What is bothering the patient the most right now? Precautionary SMR? Are Spinal Motion Restriction measures needed as you conduct your assessment? (based on Mechanism) LOR A B C RBS Critical Level of Responsiveness Airway Breathing Circulation Rapid Body Survey Interventions A (fully alert) Manage life- Airway clear? Adequate? Radial Pulse present? Skin condition V (responds to verbal) threatening OPA/NPA if O2 needed? (Carotid if Unresponsive) Major Bleeding P (responds to pain) problems Unresponsive Assisted Vents? Cap Refill & SpO2 Obvious Injuries U (unresponsive) Treat for shock Decision Point Chief Complaint What is the patient’s main concern? What are your most urgent considerations? Initial Transport Decision Urgent/Rapid Transport Category (RTC) or Delayed (Non-Urgent) Transport? Continue/Discontinue SMR? Pre-Hospital Report Update receiving medical center. Call Medical Oversight as needed. Check ABCs after any movement. Secondary Assessment Interview S A M P L E Signs & Symptoms Allergies Medications Past Medical Hx Last Oral Intake Events Leading Up Chief Complaint Allergic to Take Relevant medical What and when did What were you doing Pain/Discomfort anything? medication? incidents or you last eat/drink? when this started? Recent Wrong dose? conditions exposures? New med/dose? Ie…Diabetes O P Q R S T Onset Provoke/Palliate Quality Region/Radiate Severity Timing Did this happen What makes the Type of pain? Does the pain radiate Scale of 1-10 When did it start? suddenly or pain better or (ie…squeezing, dull, from one region to Is it constant or does it gradually? worse? sharp, throbbing) another? come and go? Vital Signs (every 5 minutes if Urgent or 15 minutes if Non-Urgent) Responsiveness Blood Pressure Respiration Pulse SpO2 Pupils CapBgl Glasgow Palpation Rate/Rhythm/Character Rate Pulse Pupils equal and Glucometer if Coma or Auscultate Chest Rhythm Oximeter reactive to light? relevant Scale Auscultation (6 points) Character (PEARL) Head to Toe Examination Skin Palpate Distal Extremities Color/Moisture/Temp Bilateral radial & pedal pulses Thoroughly and methodically feel for injuries Core Temperature if relevant Motor/Sensory deficits? Ongoing Assessment Treatment & Reassessment Documentation Provide medications and interventions as appropriate Ensure patient care report is complete and accurate Continuously monitor and re-evaluate patient, decisions and Notify receiving medical center of significant updates circumstances Concise and accurate verbal report upon hand-over 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 2 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet CPR Compression to Ventilation Ratios Adult Child Infant Neonate (over 9) (1-8) (1mo -1 yr) (under 28 days) One Rescuer 30:2 30:2 3:1 30:2 No AED Two Rescuer 15:2 15:2 CPR if below 60 bpm If patient is Hypothermic: Check pulse 45-60 seconds before starting CPR, and 3 AED cycles max Once compressions have been started, continue CPR until Return of Spontaneous Circulation (ROSC) High Performance “Pit Crew” CPR CPR (Airway Clear) CPR (Airway Obstructed)  Readjust & try 2nd Ventilation  Compressions Ventilation doesn’t go in  Remove OPA  AED  Compressions & AED  2 successful Ventilations  Look in Mouth  OPA  Finger Sweep if object visible  Compressions & Ventilations  Attempt Ventilation  Repeat until…  Repeat until either…  ROSC (obvious signs of life) 2 Ventilations go in…OPA 2 successful Ventilations ROSC (obvious signs of life) CPR in transport - Treatable CPR Condition Causes Action Hypoxia Asthma, COPD, CHF, Anaphylaxis or Tension Pneumothorax Hypovolemia Caused by Trauma, GI bleed, ruptured abdominal aortic arch Known Acidosis Sepsis, Diabetic Ketoacidosis, Post Workout Hyperkalemia Kidney failure, Pressure Sores, Crush Injury, Burns Consult Hypothermia Submersion, Cold Weather, Found on floor Medical Toxins Ingestion, Injection, Inhalation Oversight Tamponade (Cardiac) Post Cardiac Surgery, Infectious, IV Drug User, Trauma (CliniCall) Tension Pneumothorax Trauma, COPD, Asthma, Marfan’s Thrombosis (Pulmonary) Sudden Death, IVDU, Pregnancy, Fractures, Flights, Bed Rest, Cancer Thrombosis (Coronary) Sudden Death, Coronary Artery Disease Oxygen Cylinder Calculations Duration of Flow = (gauge pressure -200 psi) x C Flow Rate (lpm) C = Cylinder Constant D-Cylinder: C = 0.16 L/psi E-Cylinder: C = 0.28 L/psi M-Cylinder: C = 1.56 L/psi (most commonly used on scene) 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 3 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet Oxygen Flow Rates Canadian Red Cross Device BC EMALB O2 % Emergency Care Manual Standard (Simple) Mask 6 – 15 lpm 6-10 lpm 40-60 % Non-Rebreather Mask 8 – 15 lpm 10+ lpm 90+ % Bag Valve Mask 15 lpm 10+ lpm 90+ % Nasal Canula 2 – 4 lpm 1 – 4 lpm 24-36 % Resuscitation Mask (Pocket Mask) N/A 6+ lpm 35-55 % Normal Room Air 20.7 – 21 % Exhaled Air 16% Glasgow Coma Scale Best Motor Response Best Verbal Response Eye Opening 6 Obeys commands 5 Oriented 5 Localizes to pain 4 Spontaneously 4 Confused 4 Withdraws to pain 3 To voice 3 Inappropriate words 3 Flex to pain (Decorticate) Extend to pain 2 To pain 2 Incomprehensible sounds 2 (Decerebrate) 1 No response 1 No response 1 No response Eye + Verbal + Motor = GCS (3-15) GCS 13 or less is Rapid Transport Abnormal Flexion (Decorticate) Abnormal Extension (Decerebrate) APGAR 0 1 2 Activity Limp Some extremity flexion Active Movement Pulse Absent Below 100 bpm 100 bpm or higher Grimace No response Grimace Cough, sneeze, cry Appearance Body/Extremities Blue/Pale Body Pink – Extremities Blue Completely pink Respiration Absent Slow and Irregular Strong, crying 7-10 is “Normal … 4-6 is “Fairly Low” … 0-3 is “Critically Low” 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 4 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet Administration of Medications vs Assisting with Medications BC EMALB Licensed Responders Administer the following medications adhering to specific Administration Protocols 1. Entonox (EMR only) 7. Naloxone/Narcan 2. Oxygen 8. Salbutamol/Ventolin (EMR only) 3. Nitroglycerin (EMR only) 9. Epinephrine by Auto-Injector 4. Acetylsalicylic Acid/ASA 10. Epinephrine by IM Injection (EMR only) 5. Glucagon 11. Acetaminophen 6. Glucogel 12. Ibuprofen If patient requires any other medications, responder may Assist the patient while adhering to the 6 Rights 6-Rights of Medication Follow the 6-Rights when “Assisting” with medications 1 Person Does this person have a prescription 2 Medication Have they had it before…no Contraindications…is this their Medication 3 Time When was the last dose taken…is it needed now 4 Dose How much should they take 5 Route How should they take/use it 6 Documentation Record the time and effects of each dose RTC Critical Interventions Requiring History and/or Vital Signs Some patients may be RTC, but need critical interventions that require “Secondary” information before transport Intervention Information Required ASA for Cardiac Chest Pains Indications/Contraindications (SAMPLE-OPQRST) Naloxone by Intramuscular Injection for Opioid Indications/Contraindications (SAMPLE-OPQRST) Overdose full set of Vital Signs Glucagon by Intramuscular Injection to correct Indications/Contraindications (SAMPLE-OPQRST) Hypoglycemia full set of Vital Signs Indications/Contraindications (SAMPLE-OPQRST) Glucagon by Intranasal Injection to correct Patient Age Hypoglycemia full set of Vital Signs Indications/Contraindications (SAMPLE-OPQRST) Epinephrine by Auto-Injector for Anaphylaxis Patient Age/Estimated weight full set of Vital Signs including Chest Auscultation Epinephrine by weight-based intramuscular Indications/Contraindications (SAMPLE-OPQRST) injection for Anaphylaxis Estimated patient weight EMR only full set of Vital Signs including Chest Auscultation Indications/Contraindications (SAMPLE-OPQRST) Salbutamol for Bronchospasm Estimated patient weight EMR only full set of Vital Signs including Chest Auscultation Nitroglycerin for Cardiac Chest Pains Indications/Contraindications (SAMPLE-OPQRST) EMR only full set of Vital Signs including Chest Auscultation 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 5 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet Common Units of Measurement Unit Abbreviation Used for measuring… Millimeters of Mercury mmHg Blood Pressure Millimoles per Litre mmol/L Blood glucose levels Milligrams mg Medications such as ASA and Nitro Litres per minute lpm Oxygen flow rates Drips per millilitre gtts/ml How many droplets it takes to make 1 ml (Dripset Size) Drips per minute gtts/minute How many droplets go through the dripset in one minute Assisted Ventilations Ventilation Rate Problem Adult Child / Infant Respirations Absent but Pulse Present Timed between or with Breathing too Fast 1 breath 1 breath patient’s own breaths greater than 30 breaths per minute every every Breathing too Slow OPA/NPA after first 2 5-6 seconds 3-5 seconds successful Ventilations less than 10 breaths per minute Signs of Hypoxia or Respiratory Distress Weight Estimation for Pediatric Patients Estimated age-based weight for patients up to 10 years old 2x (age in years) + 8 = est. weight in kg Parent or caregiver estimations are generally more accurate that age-based calculations. A-T-M-I-S-T A-M-B-O ATMIST Details (what to say during verbal handover) A Age Age, Name, and Date of Birth T Time Time of Onset of Symptoms/Injury M Mechanism Mechanism of Injury/Medical Complaint I Injuries Injuries/Exam Findings S Signs Vitals, GCS T Treatment Treatment(s) given AMBO Details (what to say during verbal handover) A Allergies Provide any allergies the patient may have M Medication Verbalize or provide list of medications pertinent to patient care B Background May include social history, family, or notable information O Other Information Any other information relevant to ongoing patient care 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 6 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet BC EMALB Examination Guidelines compared to (EMR ONLY) PAC National Occupational Skill Competency Profiles BC EMALB Examination Guidelines PAC NOCP Guideline (What we follow in BC) (Red Cross Emergency Care Manual) Minimum Systolic B.P. to give Nitro 110 mmHg and HR between 50-150 100 mmHg Nitro Dose Frequency Every 3 minutes (q3) Every 5 minutes (q5) Nitro without Prescription Clini-Call permission Prescription Mandatory Realigning Gross Deformity If circulation compromised Only if more than 30 minutes to care Open Chest Wound Treatment Vented-Occlusive Dressing Non-Occlusive Dressings Only Glucogel for Unresponsive Patient Contraindicated if Unresponsive Administer if local protocols allow Burn Cooling 15-20 minutes (on-scene/enroute) At least 10 minutes Hypothermic Pulse Check Check Pulse for up to 45 seconds Check pulse for 60 seconds Hypothermic CPR-AED No Analyze or Shock after 3 Shocks Follow AED prompts Stroke Mnemonics F-A-S-T V-A-N F-A-S-T (T has different connotation) Critical Findings Finding Implication/Condition Intervention GCS 13 or less Decreased LOC OPA / NPA and RTC Breathing over 30 times/minute Tachypnea Assist Ventilations Breathing less than 10 times/minute Dyspnea/Bradypnea Assist Ventilations Adult Blood Pressure less than 80 mmHg Systolic Hypotension Position Supine Blood Glucose less than 4 mmol/L Hypoglycemia Glucagon / Glucose Oxygen Saturation (SpO2) less than 95% Hypoxia / Hypoxemia Increase O2 intake Neonatal pulse less than 60 bpm Equivalent to Absent Begin CPR Body core temperature below 35 - 36 C Mild Hypothermia Rewarm slowly Body core temperature below 30 - 34 C Moderate Hypothermia Rewarm slowly (EMR ONLY) Severe Hypothermia Rewarm slowly Body core temperature below 60 bpm Brachycardia Consider underlying causes 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 7 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet Head to Toe Assessment Mnemonics Why might a patient have an altered level of consciousness? A Alcohol T Trauma E Epilepsy I Infection I Insulin (Diabetic) P Psychiatric O Overdose P Poison U Uremia S Stroke During a Head to Toe assessment…watch for: B Burns C Contusions S Swelling O Open Wounds A Abrasions C Crepitus L Lacerations P Penetrations R Rigidity D Deformity I Instability P Punctures T Tenderness S Subcutaneous Emphysema Relevant S-A-M-P-L-E and Mechanism of Injury Information MVA Location of patient Which vehicle patient was in How many vehicles involved Impact speed Exterior damage Interior damage Type of restraints Initial position of patient Condition of patient Loss of consciousness Condition of other patients Wearing a seat belt? Fall Where from Height Free fall or hit other objects Landing surface Position of patient at impact What hit first Position Found Loss of consciousness Cause of fall Pedestrian Struck What hit them Size and weight of object Velocity of vehicle Vehicle part that hit patient Damage to vehicle Distance patient thrown Loss of consciousness Condition of patient Condition of Vehicle Occupants Shooting Type of firearm Range and Angle Loss of consciousness Type of bullet Entrance and exit wounds Initial position and condition of patient Stabbing Type and size of weapon Loss of consciousness Type of wound Number of wounds Other injuries Initial position and condition 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 8 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet Average Vital Signs Resting Respiratory Systolic Blood Weight Resting Heart Rate Rate Pressure Age Kilograms (kg) Beats/minute (bpm) Respirations/minute mmHg Neonate (30 kg Adult Epi-Pen (0.3 mg) Q5 up to 3 doses total as needed Dose 14- 30 kg Epi-Pen Jr. (0.15 mg) Q5 up to 3 doses total as needed Confirmation  Ensure indications are met and contraindications are ruled out  Document full set of Vital Signs  Auscultate Chest (6 points minimum) Preparation  Ensure Auto-Injector is not expired.  Examine window in Auto-Injector to ensure fluid is clear.  Explain procedure to patient. Administration Instructions  Remove safety cap.  Firmly push the tip of the epinephrine auto-injector against the middle third of the patient’s outer thigh.  A click will be heard when the dose is administered.  Hold the auto-injector in place for up to 10 seconds to allow time for the medication to enter the patient.  Remove the auto-injector.  Rub the injection site for up to 30 seconds, to promote absorption. Documentation  Document medication name, dose, time, route and effects Transport Patients in respiratory distress require urgent transport. Notes Transport may be deferred long enough to administer first dose of Epinephrine on scene as a critical intervention but significant delays in transport should be avoided. 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 15 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet Acetaminophen Administration Indications Mild to Moderate Pain Hypersensitivity to acetaminophen or any component of the formulation Severe alcoholic hepatitis or liver dysfunction with active alcohol consumption Contraindications Acute liver injury Acetaminophen-induced liver disease Adult (11 years or older) 15 mg/kg PO (Parenteral) to a maximum of 1000 mg Typically available in either 500 mg or 1000 mg tablets. May repeat once after 4 hours. 24 hour maximum of 3000 mg. o In patients with suspected or known liver dysfunction (e.g., advanced chronic liver disease or cirrhosis), the 24-hour maximum should be lowered to 1,000-2,000 mg. Dose Pediatric (up to 10 years old) < 30 kg 15 mg/kg PO (liquid preparation) 30 kg – 50 kg 500 mg PO (liquid preparation or tablets depending on patient ability) > 50 kg 500-1000 mg PO May repeat once after 4 hours 24 hours maximum 75 mg/kg or 1000 mg Do not exceed 5 doses in 24 hours for patients under 12 years old Confirmation  Ensure indications are met and contraindications are ruled out  Document full set of Vital Signs Preparation  Ensure Acetaminophen is not expired and confirm doseage. Instructions Administration  Patient swallows tablets or liquid preparation  A small sip of water may be appropriate  Responders may need to provide extra assistance to pediatric patients Documentation  Document medication name, dose, time, route and effects Mild to moderate pain is very subjective The context for this type of oral analgesic is relief of pain such as a toothache, ankle Notes sprain or simple headache. May be used concurrently with ibuprofen for analgesia. 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 16 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet Ibuprofen Administration Indications Mild to Moderate Pain Hypersensitivity to ibuprofen or other nonsteroidal anti-inflammatory drugs Contraindications Active GI hemorrhage or ulcers Pregnancy (first, second, or third trimesters) Adult (11 years or older) 300-400 mg PO (Parenteral) May repeat every 4-6 hours. Maximum daily dose of 1200 mg. Dose Pediatric (up to 10 years old) 10 mg/kg PO May repeat once after 6 hours Maximum daily dose of 40 mg/kg/day Confirmation  Ensure indications are met and contraindications are ruled out  Document full set of Vital Signs Preparation  Ensure Ibuprofen is not expired and confirm doseage. Instructions Administration  Patient swallows tablet(s)  A small sip of water may be appropriate  Responders may need to provide extra assistance to pediatric patients Documentation  Document medication name, dose, time, route and effects Mild to moderate pain is very subjective The context for this type of oral analgesic is relief of pain such as a toothache, ankle Notes sprain or simple headache. May be used concurrently with acetaminophen for analgesia. 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 17 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet Glucagon Administration – Intramuscular (IM) Engage Glucagon protocol when there is suspected Hypoglycemia or Unresponsive NYD (not yet diagnosed) and the patient appears incapable of maintaining their own airway. CapBgl < 4mmoL Indications Incapable of following instructions or maintaining own airway Known hypersensitivity to glucagon Contraindications Pheochromocytoma (tumor on adrenal gland) Intramuscular (IM) Injection If < 25 kg: 0.5 mg (one dose only) Dose If ≥ 25 kg 1.0 mg (one dose only) Confirmation  Ensure indications met and contraindications ruled out.  Document full set of Vital Signs including CapBgl. Preparation  Expose injection site (deltoid or thigh)  Clean area with alcohol swab and allow to air dry.  Ensure glucagon is not expired or non-viable.  Remove flip-off seal from glucagon bottle.  Remove needle protector and inject entire contents of syringe into glucagon bottle.  DO NOT remove plastic clip from syringe. Instructions  Swirl bottle gently until glucagon dissolves completely.  Ensure glucagon is clear and has a water-like consistency.  Using syringe, hold bottle upside down and, making sure the needle tip remains in the solution, gently withdraw all the solution (1mL mark on the syringe) from bottle.  Holding syringe upright, remove needle from bottle and remove bubbles from syringe.  Flick/tap syringe until all bubbles move to top and expel air until only medication is left. Administration  Stretch injection site skin using Z-track technique.  Insert needle at 90° angle to the skin and inject medication into muscle. Documentation Document medication name, dose, time, route and effects Transport Patients with a decreased level of responsiveness require urgent transport. Transport may be deferred long enough to administer Glucagon on scene as a critical intervention but significant delays in transport should be avoided. Effects Notes Glucagon does not introduce sugar into the body. Glucagon initiates the release of glycogen stored in the patient’s liver into the bloodstream It can take 8-10 minutes for effects of glucagon to become evident. Effects may be minimal if patient does not have sufficient glycogen stores in their liver. Do not delay transport to see if the patient responds positively. 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 18 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet Glucagon Administration – Intranasal (IN) Engage Glucagon protocol when there is suspected Hypoglycemia or Unresponsive NYD (not yet diagnosed) and the patient appears incapable of maintaining their own airway. CapBgl < 4mmoL Indications Over 4 years old Incapable of following instructions or maintaining own airway Known hypersensitivity to glucagon Contraindications Pheochromocytoma (tumor on adrenal gland) Intranasal (IN) Spray 3 mg (one dose only) Dose Must be over 4 years old for Intranasal Spray Confirmation  Ensure indications met and contraindications ruled out.  Document full set of Vital Signs including CapBgl. Preparation Check the glucagon package to ensure it is not compromised and is not expired. Remove packaging from tube, open lid and remove the device. Administration  Hold the device between fingers and thumb: place your 2nd and 3rd fingers on either side Instructions of the nozzle and place your thumb on the plunger.  DO NOT depress the plunger at this time.  Place the tip of the nozzle into the nostril, inserting the tip until your fingers on either side are resting against the outside of the nose (approx. ¾” into the nostril).  Firmly depress the plunger with your thumb until the green line disappears.  Remove the device from the patient’s nose. Documentation  Document medication name, dose, time, route and effects Transport Patients with a decreased level of responsiveness require urgent transport. Transport may be deferred long enough to administer Glucagon on scene as a critical intervention but significant delays in transport should be avoided. Responders must ensure indications are met, contraindications are ruled out, and a full set of Vital Signs including CapBgl are documented prior to first dose. Notes Effects Glucagon does not introduce sugar into the body. Glucagon initiates the release of glycogen stored in the patient’s liver into the bloodstream It can take 8-10 minutes for effects of glucagon to become evident. Effects may be minimal if patient does not have sufficient glycogen stores in their liver. Do not delay transport to see if the patient responds positively 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 19 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet Glucogel Administration - Parenteral Engage Glucogel protocol when there is suspected Hypoglycemia with a decreased level of responsiveness and the patient appears capable of maintaining their own airway. CapBgl < 4mmoL Indications  Decreased Level of Responsiveness  Capable of following instructions and maintaining own airway Contraindications  n/a 12-15 g glucogel (half of a 30 g tube) Dose Q5 (up to 4 doses) Consult medical supervision before exceeding 4 doses Confirmation  Ensure indications met and contraindications ruled out.  Document full set of Vital Signs including CapBgl. Administration Instructions  Patient self-administers 15 g Glucogel  Other sugars/juice/oral carbohydrates may be appropriate Documentation  Document medication name, dose, time, route and effects Transport Patients with a decreased level of responsiveness require urgent transport. Transport may be deferred long enough to administer first dose of Glucogel on scene as a critical intervention but significant delays in transport should be avoided. Notes Additional Doses Remeasure capBgl every 5 minutes Apply another 15 g of Glucogel if still below 4 mmol/L Repeat for up to 4 doses (2 tubes) then consult Medical Supervision 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 20 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet EMR ONLY Salbutamol (Ventolin) Administration – Nebulizing Mask Shortness of Breath associated with Bronchospasm Indications  eg. Asthma, Bronchitis, Emphysema, COPD Known hypersensitivity to salbutamol Contraindications Hemodynamically significant tachycardia Age > 1 year old 5 mg in 5 ml of solution Repeat as appropriate Q 10 minutes/when each dose is finished Dose Age < 1 year old 2.5 mg in 2.5 ml of solution Repeat as appropriate Q 10 minutes/when each dose is finished Confirmation  Ensure indications are met and contraindications are ruled out  Document full set of Vital Signs  Auscultate Chest Preparation  Ensure salbutamol ampules are not expired.  Twist off top of ampule and squirt appropriate amount into the well of the nebulizer  Attach oxygen tubing to bottom of nebulizer and turn up O2 flow meter until Instructions medication begins to mist out of mask (usually 6-10 lpm) Administration  Place nebulizer over patient’s mouth and nose and instruct them to breathe as slowly and deeply as possible.  When salbutamol is finished or after 10 minutes, reassess patient and repeat dose as appropriate. Documentation  Document medication name, dose, time, route and effects Transport Patients in respiratory distress require urgent transport. Notes Transport may be deferred long enough to administer first dose of Salbutamol on scene as a critical intervention but significant delays in transport should be avoided. 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 21 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet EMR ONLY Salbutamol (Ventolin) Administration – Metered Dose Inhaler (MDI) Shortness of Breath associated with Bronchospasm Indications  eg. Asthma, Bronchitis, Emphysema, COPD Known hypersensitivity to salbutamol. Contraindications Hemodynamically significant tachycardia. Under 10 kg One MDI spray = 100 micrograms (mcg) which can also be expressed as 0.1 millgrams (mg) Adult (11 years or older) 4 x 100 mcg per course Repeat as needed Pediatric (up to 10 years old) < 10 kg Dose n/a 10-20 kg 5 x 100 mcg per course Repeat up to 3 times as needed > 20 kg 10 x 100 mcg per course Repeat up to 3 times as needed Confirmation  Ensure indications are met and contraindications are ruled out  Document full set of Vital Signs & Auscultate Chest (6 points minimum) Preparation  Ensure Metered Dose Inhaler (MDI) is not expired.  Shake inhaler and remove cap from inhaler  Place mouthpiece of inhaler into spacer & remove cap from spacer Administration Instructions  MDI upright with mouthpiece at bottom, have the patient tilt their head back slightly and instruct them to breathe out slowly and completely.  Instruct the patient to place the mouthpiece of the spacer into their mouth.  Press down on the inhaler to spray one puff of medication into the spacer, and instruct the patient to start breathing in and out slowly.  Repeat process to the appropriate dose, removing the inhaler from the spacer after each spray to shake it, then re-inserting it to start the next spray/breath in the dose. Documentation  Document medication name, dose, time, route and effects Transport Patients in respiratory distress require urgent transport. Notes Transport may be deferred long enough to administer first dose of Salbutamol on scene as a critical intervention but significant delays in transport should be avoided. 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 22 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet EMR ONLY Epinephrine Administration – Intramuscular Injection (IM) Anaphylaxis Indications Signs of Anaphylaxis, Hx of Allergic Response, Exposure to Allergen, Unstable (DLOC, or Systolic BP < 90 mmHg or Respiratory Distress) There are no absolute contraindications to Epinephrine use in life-threatening situations Contraindications such as anaphylaxis 1 ml of 1:1000 epinephrine hydrochloride solution contains 1 mg of Epinephrine Adult (11 years or older) 0.5 mg in 0.5 ml 1:1000 solution Q5 up to 3 doses total as needed Dose Pediatric (up to 10 years old) 0.01 mg per kg of body weight in 1:1000 solution Maximum 0.5 mg per dose Q5 up to 3 doses total as needed Confirmation  Ensure indications are met and contraindications are ruled out  Document full set of Vital Signs  Auscultate Chest (6 points minimum) Preparation  Expose injection site (deltoid or thigh)  Clean area with alcohol swab and allow to air dry.  Ensure 1:1000 epinephrine hydrochloride is not expired.  Calculate desired dose. Instructions  Remove top/cover from ampule/bottle of epinephrine hydrochloride.  Hold ampule/bottle upright, insert needle and draw solution into syringe.  Holding syringe upright, remove needle from bottle & remove bubbles from syringe.  Tap syringe until all bubbles move to top & expel air until only medication is left. Administration  Stretch injection site skin using Z-track technique.  Insert needle at 90° angle to the skin and inject medication into muscle. Documentation  Document medication name, dose, time, route and effects Transport Patients with a decreased level of responsiveness require urgent transport. Notes Transport may be deferred long enough to administer first dose of Epinephrine on scene as a critical intervention but significant delays in transport should be avoided. 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 23 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet EMR ONLY FAST VAN Stroke Mnemonic F (Face) Right-sided droop? Or Left-sided droop? A (Arm) Right-sided weakness? Or Left-sided weakness? S (Speech) Slurred speech? T (Time) Awoke with Signs/Symptoms? Or Signs/Symptoms started less than 6 hours ago? If “Yes” to T and any of the other F-A-S criteria, urgent transport to hospital and continue with VAN questions If “No” to T, but yes to any of the other F-A-S criteria, urgent transport to hospital V (Vision) Right gaze affected? Or Left gaze affected? A (Aphasia) Naming difficulties? N (Neglect) Ignoring one side of the body? (typically the left side) If “Yes” to any of the V-A-N criteria, notify receiving hospital of possible large vessel occlusion EMR ONLY IV Drip Set Calculations Drip Set Sizes gtts = “drips” Standard (Regular) 15 gtts / ml ml = “milliliters” Macro (Adult) 10 gtts / ml gtts / ml = “how many drips add up to one milliliter” Micro (Mini) 60 gtts / ml gtts / minute (drips per minute) = volume (expressed in milliliters) to be infused X gtts / ml Infusion time (expressed in minutes) EMR ONLY Common IV Solutions Solution Commonl Used or… Ringer’s Lactate Blood loss D5W and D10W Hypoglycaemia Normal Saline Dehydration 2/3 – 1/3 Dehydration EMR ONLY Common IV Complications Interstitial Circulatory Overload Thrombosis and Thrombophlebitis Catheter Embolism Infection of Catheter Site Allergic Reaction Air Embolism 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 24 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet EMR ONLY Entonox Mnemonics Contraindications C inability to Comply D Decompression sickness  Ensure the area is adequately ventilated, C altered level of Consciousness including turning on the vent system in the back P Pneumothorax of the Ambulance A Air embolism  Auscultate the Chest to rule out Pneumothorax I Inhalation injury N Nitroglycerin in the last 5 minutes  Contraindications mean you cannot administer. Cautions  Precautions mean you need to fix something S Shock first, or monitor closely to ensure the Entonox is A Abdominal distension not creating/exasperating any problems D Depressant drugs  2 Precautions = Contraindicated C COPD F Facial Injuries EMR ONLY Entonox Administration Indications Significant Pain Rule out Contraindications C-D-C-P-A-I-N S-A-D-C-F Note Precautions Nasal canula may be utilized to mitigate mild shock symptoms SAMPLE, OPQRST and Vital Signs Completed before Contraindications ruled out (requires Chest Auscultation) administration Mix bottle if stored improperly Adequate ventilation secured (vehicle ventilation system activated if available)  Not left unused over long periods Proper Storage  Not stored below -6 Celsius  Stored horizontally (not vertically, which can cause component separation)  Self-administered using mask/bite valve  “Pull” Entonox out of the bottle by inhaling through bite valve  Pain should be relieved Instructions to Patient  May begin to feel light-headed, giddy, drowsy or nauseas  Stop or start at any time  Use until pain is relieved or adverse effects are felt After Discontinuing  Supplemental Oxygen with Non-Rebreather Mask at 15 lpm Entonox  Consider Entonox to relieve chest pain if Nitro is contraindicated and has not been Cardiac Chest Pain administered in the past 5 minutes 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 25 of 26 Medi-Pro Response Solutions Professional Responder Cheat Sheet EMR ONLY Sager Traction Splint Utilized for suspected Femur Fractures not involving the hip or knee and with no RTC criteria. In the vast majority of circumstances the Traction Splint will be applied on-scene. Traction splint applied after complete secondary survey, including head to toe. Saddle S  Distal Pulse – check for presence or absence Hinge side down Assess  Motor-Sensory check injured leg  Look and feel to determine exact location and extent of injury Analgesia  Administer Entonox as appropriate per Entonox protocols  Adjust saddle to ensure short side of saddle hinge is down T Thigh strap  Nestle saddle against injured leg (short hinge down)  Have helper stabilize splint  Apply small thigh strap check distal circulation Apply  Apply ankle harness above malleoli Traction  Apply traction of 10% body weight A Ankle Strap o 15 lbs maximum per limb o 5 lbs maximum for open fractures o 5 lbs maximum for Pediatric patients P Pull Traction  30 lbs maximum for Bi-Lateral fractures (15 lbs per leg) check distal circulation  Ensure adequate padding  3 straps around splint…above and below injury L Leg Straps Secure Splint  Secure thigh strap…then the other two straps  Secure Figure 8 Strap check distal circulation  Reassess all splint straps and Traction Gauge E Evaluate Traction Reassess  Ensure Leg in line with body…same length as other leg Injury  Recheck presence or absence of Distal Pulse S Stirrup Strap  Ensure no movement / aggravation of injured limb check distal circulation 2024-08-13 mediprofirstaid.com | 778-724-9054 | [email protected] Page 26 of 26