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1
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2
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- Name change to Southern Nevada Health District
- Changed pediatric age for CPR from < 8 yrs to <12 yrs (per new AHA
guidelines)
- Removed requirement that Activated Charcoal contain Sorbital (per MAB)
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3
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- Cardiac Dysrhythmia: Ventricular Ectopy (Adult)
- Nasogastric / Orogastric Tube Insertion
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4
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- Termination of Resuscitation (page 73)
- Spinal Immobilization (page 91)
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5
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6
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7
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- D.4.c. Cervical Spine Immobilization – Struck language due to
development of Spinal Immobilization Protocol. Removed alert box under D.4.2. stating “If a trauma patient is unable
to communicate or appropriately respond to the above questions, perform
a complete spinal immobilization”.
Now addressed in the Spinal Immobilization Protocol.
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8
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- Moved Cervical Spine Immobilization language from D.4.c. to D.1.d.
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9
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- G.2.(new): Added language
outlining telemetry reporting requirement for trauma patients.
- “For patients who meet Trauma
Field Triage Criteria, telemetry reports shall include:
- Patient age
- Gender
- Mechanism of Injury
- Ambulatory at scene
- Suspected injuries
- Vital signs
- Airway status
- Neuro status
- ETA
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10
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- H. Disposition: #’s 1-6 reordered
- 1. Trauma
- 2. Burns
- 3. Pediatrics
- 4. Sexual Assault Victims
- 5. All medical patients in cardiac arrest or in whom the ability to
adequately ventilate cannot be established (changed from “all unstable patients”)
- 6. Stable Patients
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11
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- H.7.: Changed language from
“Twenty (20) minutes after arrival…” to “Upon arrival…”
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12
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- Terminology “chest pain” changed to “ischemic discomfort”
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13
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- Removed Lidocaine for patients with suspected head injury
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14
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- 6: Struck “For severe distress…”
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15
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- Added alert box stating , “Under no circumstances are patients to be
transported restrained in the prone position.”
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16
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- Added:
- 5. WITNESSED ARREST, place patient on Automatic External Defibrillator
(AED) and follow prompts.
- 6. UNWITNESSED ARREST, provide two (2) minutes of uninterrupted CPR
prior to AED analysis and follow prompts. (per new AHA guidelines)
- Changed:
- 7. Changed language from “If AED
resuscitation is successful…” with “If patient has return of spontaneous
circulation…”
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17
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- Removed language referring to transcutaneous pacing. Per AHA guideline changes, it is no
longer recommended in asystolic arrests.
- 4. (new) referencing Termination of Resuscitation Protocol.
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18
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- Removed telemetry requirement for cardioversion in the pediatric
patient.
- Replaced Versed with Etomidate for sedation in the pediatric patient.
- Added language requiring reassessment for additional sedation prior to
repeating cardioversion.
- Added a repeat dose of Amiodarone as opposed to Lidocaine.
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19
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- Added pediatric dose for Adenosine.
- Replaced Versed with Etomidate for sedation.
- Deleted use for Amiodarone.
- Adenosine dose for unstable patients was changed from 6mg to 12mg (per
the health district's EMS Operational Medical Director).
- Added language requiring reassessment for additional sedation prior to
repeating cardioversion.
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20
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- Adenosine (Adenocard) should be used with caution in patients taking
Digoxin or Tegretol.
- Patients who develop high-level A-V block with the first dose of
Adenosine should not receive additional doses.
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21
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- Removed telemetry requirement for an unstable pediatric patient.
- Replaced Versed with Etomidate for sedation in the pediatric patient.
- Deleted use of Lidocaine.
- Added language requiring reassessment for additional sedation prior to
repeating cardioversion.
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22
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- Added procedural language for witnessed vs. unwitnessed arrest per AHA
protocol.
- Replaced Lidocaine with Amiodarone.
- Deleted reference to hypomagnesemic state.
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23
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- Added clarifying language for obvious/conclusive signs of death.
- Deleted reference to termination of resuscitation due to development of
the Termination of Resuscitation Protocol.
- Deleted reference to leaving medical
- interventions in place.
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24
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- Added procedural language for witnessed vs. unwitnessed arrest per AHA
guideline changes.
- Added clarifying language defining “witnessed arrest” as is witnessed by
EMS personnel and not by a bystander.
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25
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- Removed language regarding pediatric cardioversion because it was
causing some confusion.
- Separated Ventricular and Supraventricular rhythms.
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26
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- Deleted BP requirement for administering sedation to an alert patient.
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27
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- Removed all dosing information to require the users to refer to the
appropriate protocol.
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28
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- Changed Atropine Sulfate from a weight based dose (0.04mg/kg) to a
standard dose.
- Adults: 3mg Pediatrics: 1mg
- This change effects the following
protocols:
- Cardiac Dysrhythmia: Asystole
- Cardiac Dysrhythmia: Bradycardia
- Cardiac Dysrhythmia: Pulseless
Electrical Activity
- Overdoses/Poisoning (max dosing does not apply)
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29
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- Added language to pediatric route for Epinephrine clarifying “not to
exceed the adult dose”.
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30
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- Removed completely from the formulary per endorsement by the MAB in June
2006. This will effect the
following protocols:
- Advanced Airway Management
- Cardiac Dysrhythmia: Polymorphic
V-Tach / Torsades de Pointes
- Cardiac Dysrhythmia: V-Fib /
Pulseless V-Tach
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31
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32
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- Abdominal Pain, Back Pain, Flank Pain Protocol (page 15): Moved IVF language from ALS to ILS.
- Allergy / Anaphylaxis Protocol (page 21): Revised language for pediatric
Epinephrine to include dose/route.
- Epinephrine Auto-Injector (formulary page 112): Removed typo (extra zero was preceding
0.3ml).
- Pediatric Patient Destination Protocol (page 67) : #4 Replaced “transferred” with
“transported”.
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33
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- Trauma Field Triage Criteria Protocol (page 77) – Added an additional
exception
- “…nothing contained in these
guidelines precludes transport to the closest facility if, in the
provider’s judgment, an inability to adequately ventilate the patient
might result in increased patient mortality”.
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34
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Notes
