Standing Orders
Standing orders for all hypothermic patients:
· Remove wet garments
· Protect against further heat loss and wind chill (use blankets and insulating equipment)
· Maintain horizontal position
· Avoid rough movement and excess activity
· Monitor cardiac rhythm
· Assess responsiveness, breathing and pulse
· Do pulse check for 30-45 seconds (clinical signs of death may be misleading).
1. Pulse and breathing present:
a. Begin oxygen therapy.
b. Begin transport immediately.
c. Obtain IV access en route.
d. Monitor ECG.
e. Rewarming:
- Mild Hypothermia(temperature ³ 92º F or if patient is shivering) – Passive rewarming, active external rewarming.
- Moderate hypothermia(temperature ³ 86º F to < 92º F or if patient is shivering) – Passive rewarming, active external rewarming to truncal areas only (neck, armpits, groin).
- Severe hypothermia(temperature < 86º F) – transport for active internal rewarming.
2. For pulseless patients, with or without organized ECG rhythm:
a. Begin CPR.
b. For VF/VT, defibrillate up to 3 times (energy rates as prescribed by current AHA ACLS guidelines; e.g. 200 J, 200 to 300 J, 360 J, or equivalent biphasic). Withhold drugs and further shocks and transport immediately.
c. Obtain IV access and contact medical control physician en route.
d. Warm packs should not be used.
After Obtaining Verbal Orders
e. May consider cardiac arrest drugs and defibrillation but they are usually not effective until hypothermia is corrected.
Standing Orders
1. Begin oxygen therapy.
2. Begin cooling measures. Apply cool packs, if available, to head and truncal areas. Suspend cooling measures if shivering occurs.
3. If patient confused or unconscious, start IV Normal saline. May infuse up to 300 ml without further orders.
4. Transport lights and siren, monitoring ECG en route.
Standing Orders
1. Attempt to remove contact lenses, if present.
2. Immediately and continuously flush the affected eye(s) with normal saline solution for a minimum of 20 minutes, continuing en route to hospital.
3. Begin transport.
Standing Orders
1. For any significant burn:
a. Begin oxygen therapy. Use positive pressure ventilatory assist as needed.
b. Obtain IV access.
2. If less than 20% of body surface, apply sterile dressings and saturate with cool water (leave Gel-pack in place if applied by first responders). Do not allow any burn patient to become chilled and shiver.
3. More than 20% of body surface:
a. Remove any non-adherent burned clothing and cover patient with sterile sheet.
b. Do not cool down with water (exception: presence of smoldering clothes, articles or material adhering to skin that would continue burning process, i.e., hot tar, etc.).
c. Begin rapid transport and contact a medical control physician for further orders and destination decision.
d. Consider direct transport to burn center for major burns.
e. Consider pain management per protocol. See "Pain Management" page 1-11.
4. Electrical burns: monitor ECG for any high voltage burn, including lightning strike, or if extensive low voltage injury present.
Standing Orders
1. If patient is severely agitated and poses an immediate threat to self or others, consider:
a.
Versed5 mg IM/IV
OR
b.
Ativan2mg IM/IV
2. For continued agitation, contact a medical control physician for further orders.
Standing Orders
1. If patient has severe nausea or vomiting, start IV and consider Compazine 10mg IV/IM or Benadryl 25mg IV/IM if allergy to Compazine.
2. Contact a medical control physician for further medication orders if needed.