Post on 29-Jun-2020
Sample Medical Emergency Response Protocol
Emergency Preparedness Policies and Procedures
Practice Name: SAMPLE
Practice Address: _________________________________
_________________________________
Doctor’s Name: _________________________________
Preface for ALL STAFF:
Dear Staff Members:
Please take some time to review this manual. Periodic training will be provided on the protocols outlined in this manual. The most important aspect in any training is repetition. Our goal is to practice to perfection so that, in the event of an emergency, all we have to do is execute. By repetition, execution will be smooth and efficient.
If you have any questions at all, please feel free to approach
_____________________________ (Doctor’s Name), and I will gladly review any areas to
assure you feel competent and confident.
Emergency Preparedness Officer:
_____________________________________(Doctor’s Name)
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Sample Medical Emergency Response Protocol
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Sample Medical Emergency Response Protocol
SUMMARY LIST OF EMERGENCY DRUGS(KIT LOCATED IN CRASH CART/MEDICAL EMERGENCY KIT)
Health First SM30 Emergency Kit For Adult and Children
Nitroglycerin spray 0.4mg/spray 60 doses (x1) Epinephrine auto-injector - pediatric 0.15mg (x1) Epinephrine auto-injector - adult 0.3mg (x1) Auto-injector training unit (x1) Back-up epinephrine 1:1000 1mg/1mL, 1mL (x2) Diphenhydramine 50mg/1mL, 1mL (x2) Albuterol inhaler (x1) Ammonia inhalants (x3) Oral glucose gel (x1) Aspirin 2 - pack (x2) Naloxone HCl nasal spray (x2) Syringes 1cc with 20G x 1.5 in needle (x2) - to draw up medications and provide IM injections CPR shield (x1) Medication instructions (x1)
Additional if administering Level 1 Minimal Oral Sedation in Office
Flumazenil 0.1mg/ml, 10 ml (x1)
***Auto-Replenishment Service is arranged upon expiration date***
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Sample Medical Emergency Response Protocol
Nausea and Vomiting
Nausea may be caused by: Empty stomach Nitrous oxide Sedation medications
---------------------------------------------------------------------------RESPONSE if due to empty stomach:
1. Give pt popsicle or juice to get sugar levels up2. Re-evaluate
-----------------------------------------------------------------------------------------------RESPONSE if due to nitrous oxide:
1. Turn nitrous oxide off2. Administer 100% oxygen for 5-10 minutes3. If no improvement, give juice or popsicle to get sugar levels up
-----------------------------------------------------------------------------------------------RESPONSE if due to sedation medications:
1. Turn patient sideways2. Chin down, suction airway3. Administer 100% oxygen4. If no improvement, may be possible aspiration (see aspiration guide)
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Sample Medical Emergency Response Protocol
Acute Asthma Attack (Bronchospasm)
Signs: Shortness of Breath Wheezing Coughing Chest tightness Cyanosis Tachycardia
RESPONSE1. Sit upright or in comfortable position2. Administer oxygen3. Administer bronchodilator 4. If bronchodilator ineffective or the patient loses consciousness, activate
EMS response and administer epinephrine
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Sample Medical Emergency Response ProtocolAirway Obstruction
Signs a patient is experiencing airway obstruction: Agitation Turning blue Confusion Difficulty Breathing Wheezing Retractions Unconscious
RESPONSE
1. Place patient in supine position 2. Clear airway manually 3. Administer oxygen via Bag Valve Mask to take over breathing4. If condition doesn’t improve, activate EMS response5. Continue attempting airway rescue using appropriate airways if needed
until EMS arrives
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Sample Medical Emergency Response ProtocolChange in Intended Sedation Level
Signs a patient is beyond moderate sedation:- No response to verbal commands- Responds purposefully to tactile/painful stimulation only after
multiple repeated painful stimulation- Eyes appear to roll back- Oxygen desaturation
RESPONSE – GOOD AIRWAY IS MOST IMPORTANT
1. Turn OFF Nitrous, flush bag and fill with 100% Oxygen2. Jaw thrust and chin tilt while delivering oxygen3. Attempt painful stimulation (posterior mandible pressure)4. If pt appears to become more easily arousable, continue with Oxygen5. If pt continues to appear deeply sedated, maintain airway, administer
reversal agents, monitor recovery 2 hours after6. Ensure no objects obstructing airway7. Continue Oxygen, and add positive pressure if necessary8. If no improvement or patient stops breathing on their own, USE AMBUBAG
to administer oxygen and activate EMS Response
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Sample Medical Emergency Response Protocol
LaryngospasmLaryngospasm is when a person’s throat (larynx) goes into spasm and doesn’t allow oxygen to go to lungs. Most laryngospasms can be broken with airway positioning and positive pressure oxygen.
Signs of laryngospasm: Increased effort to breathe Oxygen desaturation Possible bradycardia (decreased heart rate) Tracheal tug Inspiratory wheezing
RESPONSE1. Clear airway of debris2. Open the airway, perform mandible pull 3. Use positive pressure (BVM) oxygen (100%) to break spasm4. If no improvement, activate EMS response 5. Continue attempting airway rescue until EMS arrives
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Sample Medical Emergency Response ProtocolUrticaria (Mild Allergy)
Signs of Urticaria:- Itchy, raised skin- Hives- Swelling
RESPONSE Urticaria1. Discontinue all sources of allergens2. Diphenhydramine (Benadryl) age appropriate dose3. If no improvement, administer epinephrine OR if sedation meds on board,
MUST administer EPI as Benadryl will increase depth of sedation4. If no improvement, activate EMS response
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Sample Medical Emergency Response ProtocolAnaphylaxis
Signs of Anaphylaxis:- Flushing- Wheezing- Difficulty breathing- Bronchospasm- Laryngeal edema- Weak pulse- Low blood pressure- Unconscious
Anaphylaxis is a severe allergy and requires IMMEDIATE action, otherwise the airway may swell up, close, and impede breathing
RESPONSE Anaphylaxis1. Supine position, clear airway2. Oxygen, may be necessary to ventilate manually3. Administer epinephrine4. Administer diphenhydramine (Benadryl) IM5. Activate EMS response6. CPR if necessary until EMS arrives
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Sample Medical Emergency Response ProtocolSyncope – Fainting
AIRWAY #1 CONCERN
Signs:- Feeling warmth- Skin moist/pale- At first rapid pulse, then slow and weak- Dizziness- Hypotension- Cold extremities- Nausea- Vomiting- Unconscious
RESPONSE 1. Lay patient supine to manage airway2. Open airway for patency3. Ammonia inhalant4. Administer supplemental oxygen5. Cold towel on back of neck6. Positive pressure ventilation, if necessary 7. Assess vitals8. Elevate feet9. If no improvement, activate EMS response
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Sample Medical Emergency Response Protocol
Convulsions – Seizure
The most important thing to remember is to keep patient safe and prevent self-injury. Most seizures will not last very long.
Signs:- Warning aura- Disorientation- Blinking- Blank stare- Uncontrolled muscle movement- Dizziness/Confusion
RESPONSE 1. Maintain airway, suction after the convulsion2. Prevent patient from biting tongue, protect your hands3. If status epilepticus or lasting > 5 min, administer diazepam, call 9114. Activate EMS Response
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Sample Medical Emergency Response Protocol
Angina Pectoris (Chest Pain)Chest pain in an adult can indicate several things, but the most important/ominous is that it can be an early sign of impending myocardial infarction (heart attack).
Signs: Chest pain that is significant but not severe (can last up to 20 min) Chest fullness Burning Tightness Dyspnea diaphoresis Typically not the patient’s first time experiencing this type of pain
RESPONSE1. Stop the procedure2. Semi-reclined position, ACTIVATE EMS response3. Note time of onset4. Nitroglycerin sublingually, repeat if necessary5. Provide supplemental oxygen if necessary6. Continue to attempt to stabilize patient until EMS arrives
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Sample Medical Emergency Response ProtocolAspiration (contents in lung)
Signs of aspiration: - Coughing- Difficulty breathing- Choking
RESPONSE:1. Turn sideways, evaluate airway, suction throat2. Heimlich if actively choking3. If unable to obtain contents from airway, administer 100% oxygen4. Activate EMS Response5. If patient becomes unconscious, gently lay on floor, initiate CPR and
continue until EMS arrives
*If a dental instrument, crown, or other item is lost in oropharynx and item cannot be located, send patient to nearest medical facility with radiology capabilities for chest radiograph.
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Sample Medical Emergency Response Protocol
Hyperventilation (Panic attack)
Signs of hyperventilation: Rapid breathing, deep at first, then shallow Increased heart rate (tachycardia) Palpitations Weakness Feeling of “tight” chest Dizziness
RESPONSE1. Terminate procedure2. Position for comfort3. Calm patient, attempt to slow breathing by having them focus on a pen
light or counting breaths4. Have patient breathe in and out while cupping their hands around their
mouth.5. DO NOT administer oxygen!!!6. If no improvement, activate EMS response
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Sample Medical Emergency Response ProtocolHypertension (High Blood Pressure)
Signs of Hypertension High blood pressure
RESPONSE1. Position patient for comfort2. Monitor vital signs3. Administer oxygen4. Consider administering nitrous oxide5. If no improvement, activate EMS response
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Sample Medical Emergency Response Protocol
Hypotension (Low Blood Pressure)Signs of hypotension
Fatigue Dizziness Lightheaded Nausea Clamor Blurry vision Unconscious
RESPONSE1. Lay supine to manage airway2. Open airway – keep patent3. Administer supplemental O24. Positive pressure ventilation, if necessary5. Assess blood pressure and pulse6. Elevate feet7. If no improvement, activate EMS response8. BLS protocols until EMS arrival
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Sample Medical Emergency Response Protocol
Hypoglycemia (Low Blood Sugar)Signs of hypoglycemia:
Excess sweating Hunger Lightheaded Feels faint Shaky Slurs speech Unconscious (passing out)
RESPONSE – Conscious patient1. Administer glucose tablets, one tube of glucose gel or juice/soda 2. Evaluate response3. If unimproved, activate EMS response
RESPONSE – Unconscious patient1. Activate EMS response immediately2. DO NOT GIVE INSTAGLUCOSE – it can clog airway3. BLS protocols until EMS arrival
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Sample Medical Emergency Response ProtocolSudden Cardiac Arrest (Stopped
Breathing)Signs:
Unconscious and without a pulse
RESPONSE1. Activate EMS response immediately2. Initiate rapid defibrillation of the heart using an AED3. Early BLS protocols
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Sample Medical Emergency Response Protocol
Myocardial Infarction (Heart Attack)Signs of Hypertension
- Radiating pain down left side of body- Pain in upper chest- Pain between shoulder blades- Pain in back- Pain in jaw (mandible)- Pain in arm- Impending sense of doom
RESPONSE – INITIATE BLS/ACLS protocol1. Medical assistance, call 9112. Note time of onset3. Record vitals4. Chewable aspirin 4x81 mg 5. Be prepared for CPR
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Sample Medical Emergency Response Protocol
EMS RESPONSE
1. In event of ANY emergency, get Doctor’s attention immediately.2. STAY CALM3. Doctor will ASSIGN ROLES – very important to follow role
assigned.
ROLES & Duties
EMS activator Calls 911, serves as communication liaison
Drugs Retriever Retrieves and draws medications as doctor instructs
Airway Manager Assures that patient’s airway is patent
AED Retriever Gets AED, clears field, and preps patient’s chest for AED
Recorder Records time based record of sequence of events, drugs administered, and vital signs
EMS Liaison Clear hallways and rooms for EMS access
4. Once Doctor has assigned roles, proceed to follow duties assigned to that role
5. After airway management and drug options have been exhausted, CPR may need to be initiated.
6. If patient progresses past CPR sequence, then chest compressions initiated, and Doctor + Airway manager will switch off compression roles
*ALWAYS USE CLINICAL JUDGMENT: IF DR NOT IN IMMEDIATE VICINITY AND YOU RECOGNIZE AN EMERGENCY, PROCEED WITH RESCUE PROTOCOL.
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Sample Medical Emergency Response Protocol
CPR Tips
IF you identify a patient in distresso Yell for HELP, check pulse while attempting to engage
patiento If no pulse, initiate CPR
IF EVER respiratory rate or heart rate = ½ resting rates, BEGIN CPR with airway/BVM and chest compressions
Head tilt-chin lift to open airway unless cervical spine injury suspected – CAUTION against hyperextending infant necks
Cardiac arrest with agonal gasps BEGIN CPR
Adult with chest pain – CALL 911
Proper technique: Good rate, depth, and full chest recoil
No pulse CHEST COMPRESSIONS immediately
Earlier defibrillation = Higher survival rate
If choking victim becomes unresponsive lay on floor, initiate CPR, check for object between breathso NO MORE HEIMLICH once unconsciouso NO BLIND FINGER SWEEPS
Minimize interruptions between compressions
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Sample Medical Emergency Response ProtocolCALLING 911
REMAIN CALM
Give location (office address)
Give phone number (identify land line or cell phone)
Inform operator of medical emergency
Inform whether patient is conscious or unconscious
Details of incident
Explain current intervention
Inform operator who the assigned EMS liaison is and best route into facility
Ask how long for EMS to arrive
Stay on phone until instructed otherwise
Inform Doctor of any pertinent updates
MEET EMS personnel at designated entrance with EMERGENCY TREATMENT
RECORD and convey all pertinent information
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Sample Medical Emergency Response Protocol
Compression to Ventilation Ratios
Age Single Rescuer
Two Rescuer
Hand Placement
Compression Depth
Adult 30:2 30:2 2 Hands Lower ½ of breastbone (sternum)
At least 2 in (5 cm)
Child (1-8) 30:2 15:2 2 hands or 1 on lower ½ of breastbone
At least 1/3 A-P diameter of chest~(2 in or 5 cm)
Infant (<1) 30:2 15:2 1 rescuer: 2 fingers center of chest below nipple line2 rescuers: 2 thumbs encircling hands in center of chest below nipple line
At least 1/3 A-P diameter of chest ~(1.5 in or 4 cm)
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Sample Medical Emergency Response Protocol
Emergency Treatment RecordPt Name: ______________________ Date: ___________ Time: __________
Pt Age: ______________________ Pt Weight: ______________________
Pt Gender: ______________________ Allergies: ______________________
Meds taken/administered prior to emergency: ________________________________________
Time BP Pulse RR O2 Sat O2 Flow L/min
Meds Administered
Med Dosage
Med Route
Time Called 911: _______________________ Time EMS Arrived: _____________________
Hospital transported to: __________________________________________________________
Condition of pt at time of transportation: ____________________________________________
EMS Personnel: _________________________________________________________________
Office staff present: _____________________________________________________________
Name of Recorder: __________________________ Date: __________________________
Signature: __________________________
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Sample Medical Emergency Response Protocol
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