Region VII SMO Revision

Report
Region VII BLS SMO
Revision
2011
2011 BLS SMO
This presentation will highlight
changes in the SMO’s and also
cover information that is on the
2011 SMO study booklet.
Code 2: Respiratory
Distress
Added reference to Failed Adult
Airway Code 75 for inadequate
breathing.
Code 75 – BLS providers now
allowed to use King Airway for
patients who are not getting
good ventilations with BVM
alone.
Code 3
The Airway Obstruction code,
in the past, referred to infant
situations.
The pediatric portion (less than
one year) was eliminated in this
revision and now Code 3 only
refers to patients that are over
1 year old.
Code 4 – Cardiac
Arrest
Codes 6, 9 and 11
now all refer back
to this code (Vfib,
Vtach, PEA,
asystole)
BLS treatment for
all is the same
anyway.
Includes
suggestion that
King Airway be
considered.
•Encourages
minimal
interruptions of
chest
compressions
per new AHA
guidelines.
Code 12 – Suspected
Cardiac Patient
•Have added “perform 12 lead EKG and transmit
if available” to BLS cardiac SMO.
•Have added box that includes times 12-lead use
should be considered:
•Chest pain/discomfort/pressure
•Arm pain
•Jaw pain
•Upper back pain
•Unexplained diaphoresis
•Vomiting without fever or diarrhea
•Shortness of breath
•Dizzy/syncope
•Epigastric pain
•Unexplained fall in elderly
•Weakness/fatigue
•Bradycardia or tachycardia
BLS and 12-leads
BLS providers will not be asked
to interpret 12-lead EKG’s.
But it will be within their scope
of practice to apply electrodes if
trained, and transmit the results
to the ER.
Will make the EMT-B of even
greater assistance to their
EMT-P partner, and to the ER.
Code 13 – Pulmonary
Edema Due to Heart
Failure
Adds “consider CPAP en route,
if available” for patients with a
BP > 90.
CPAP an exciting new addition
to the BLS toolbox for patients
with trouble breathing due to
pulmonary edema/CHF.
Also referred to in Code 30
(Asthma, COPD, Wheezing)
with approval of medical
control.
Trauma Codes
Codes 16 and 21 (trauma and
extremity injuries) now allow for
use of hemostatic agents by
BLS providers.
These are powders or
chemicals that are applied to
wounds to stop bleeding.
Your EMS coordinator will have
more information on whether
your department has purchased
hemostatic agents.
Code 21
ISOLATED EXTREMITY INJURY AND/OR
AMPUTATED AND AVULSED PARTS
INITIAL TRAUMA CARE
(ABCs always take priority over the severed part)
Control bleeding with direct pressure and elevation
For uncontrolled hemorrhage:
•
Consider use of a hemostatic agent
•
Use a tourniquet if needed
• Note time of placement
• Apply as close to the injury as possible
• DO NOT release once applied
NITROUS OXIDE (optional)
•Wrap part in sterile gauze, sheet or towel.
•Place part in waterproof bag or container and seal.
•DO NOT immerse part in any solutions.
•Place this container in a second one filled
with ice, cold water or cold pack.
Transport part to hospital with patient
TRANSPORT
NOTE TO PREHOSPITAL PROVIDER:
MORPHINE SULFATE 5-10mg slow IV in 5mg
increments every 5 minutes as necessary for pain.
Reviewed
Effective
ALS
10/01/11
05/01/98
Code 24 – Trauma in
Pregnancy
•Added F –
“Manually displace
uterus to the left
side during CPR.”
•Left uterine
displacement
increases cardiac
output by 30% and
restores circulation.
Intranasal
Medications
Codes 32, 33, 34 and 35 now
allow for BLS use of Intranasal
Narcan and Glucagon.
Fast-acting through the nasal
mucosa.
Allows for effective BLS
treatment of diabetics, drug
OD’s, comas of unknown origin
and seizures
Code 18
SUSPECTED SPINAL CORD INJURY
SPINAL IMMOBILIZATION
Mechanism:
Suspected Deceleration Injuries,
Motor Vehicle Crashes, Falls, etc.
Spine pain/tenderness or
complaint of neck/spine pain
No
Yes
Yes
Physical findings suggesting neck and/or back injury
No
Other painful injury identified
(Distracting Injury)
Yes
No
Decreased or altered level of consciousness
No
Yes
Abnormal?
Motor/Sensory Exam
Patient is
•Calm
•Cooperative
•Alert
•Ambulatory without pain
•No apparent distress
•No suspected intoxication
•Having an acute stress reaction
•Suspected of being intoxicated
•Have symptoms of brain injury
•Acting inappropriately
•Having difficulty communicating,
such as, speaks a foreign language, deaf, etc.
Reliable patient exam
Reviewed
Effective
ALS
10/01/11
05/01/98
NO IMMOBILIZATION NEEDED
IMMOBILIZE
Code 38 – Suspected
Stroke
“Hypertensive Crisis” code is
gone.
Replaced with “Suspected
Stroke” code.
Includes possible use of 12lead EKG
Also includes performance of
Cincinnati Stroke Scale and
checking of glucose.
Code 45 – Emergency
Childbirth
Removes “involuntary pushing
with contractions” and
“contractions less than 2
minutes apart” from criteria to
prepare for immediate delivery.
Bulging perineum or crowning
are most important things to
look for… the rest may still
allow you transport time.
Some other minor
changes
Code 55 and 56, pediatric
respiratory distress and arrest, now
refer to “back slaps” instead of
“back blows”.
Code 61, pediatric toxic exposure,
now says simply “do not induce
vomiting” instead of going into detail
about caustic substances.
Code 68, Behavioral Emergencies,
now reminds you to first “maintain
situational awareness and scene
safety”.
The End!

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