<:: HELIX Division Manual ::>

<:: Helix Division; Medical Compendium ::>



Contents:
(All content credit to Statua)



<:: Helix Training Scheme ::>
Being a part of HELIX division you have accepted the responsibility of not only being a unit but also being a doctor, so you will be trained in both fields. You are responsible for keeping track of what you have been trained in and what you have not. Failure to do so or lying will result in severe punishment.
You must complete each item on the training lists and receive the appropriate badge before being promoted.


Badges & Training

Badge List:

MT (Medical Training)
EMT (Extended Medical Training)
AMT (Advanced Medical Training)
GBR (Genetics/Biological Research)
AGBE (Advanced Genetics/Biological Experimentation)

05 Training {MT}

-Triage
- DRABC
- Evacuation Procedures
- Basic CPR
- Wound Sterilization
- Clean Up Procedures
- Basic 05 CORE Training

04 Training {EMT}

- Treating Gunshots and Shrapnel Wounds - Before Surgery
- Use of AED
- Treating Bone Fractures, Breaks, and Dislocations
- Connecting a patient to life monitoring apparatus
- Inspecting for head wounds
- Basic 04 CORE training

03 Training {AMT}

- Treating Shock, Burns - Before Surgery
- Surgery Preparation Procedures
- Surgery Assistance
- Performing a basic unit check-up--
- Post-Surgery Patient Treatment
- Basic 03 CORE training

02 Training {GBR}

- Standard Surgery
- Treating Chest Wounds
- Advanced Medical Training
- Pharmaceutical Training
- Fully Treating Gunshots and Shrapnel Wounds
- Basic CORE 02 Training

- Post-Surgery Patient Treatment
- Use of Anesthesia
- Examination of the teeth/Gums
- Basic CORE 02 Training

01 Training {AGBE}

- Respiratory Therapy
- Internal Examinations
- Basic CORE 01 Training

OfC Training

- Brain Surgery
- Brain Examination
- Brainwashing
- Basic CORE OfC Training

EpU Training*

*EpU will be given to the units in the division who has shown exceptional medical knowledge, the ability to teach others, and extreme loyalty to the union.

In-depth RP Medical Training


<Standard Equipment>

Monitoring Apparatus
Injection Equipment
Dressing Materials
Solutions & Gels
Immobilization Systems

<Safety Procedures>

DRABC
DANGER
RESPOND
AIRWAY
BREATHING
CIRCULATION
Immunization (Vaccines)
Biohazards

<General Principles>

Assess
Safety
Remain
Examine
First-aid

<The Goal of First Aid>

Identify the 5 P’s
Pain (Are they in pain, if so, where)
Pulse (Is it normal, or abnormal)
Pallor (Their appearance, do they Look pale, weak, or sick)
Paralysis (Are they conscious, if so, are they able to feel/move all body parts)
Paresthesia (The ‘pins & needles’ feeling after your leg/arm ‘falls asleep’, do they feel it)

<Forms of Medical Treatment>

Self
Buddy
Emergency
Surgery

<Operational Stress Reactions (OSR)>

Definition
Occurrences
Levels
Signs
3 R's
Recognise
Respond
Resolve

Reactions to combat and operational stress and trauma may include:

Problems concentrating or making decisions
Having disturbing dreams and memories or flashbacks
Feeling hopeless about the future
Feeling numb or lacking interest in anything
Having a negative view of the world or other people
Guilt and shame
Avoiding people, places, and things related to stressful operational experiences
Feeling on guard, constantly alert, or jumpy
Being irritable or having outbursts of anger
Having trouble sleeping
Feeling detached or withdrawn from others

<Haemorrhaging>

Definition
Causes
Treatment

<Shock>

Shock has an number of meanings. For example, it is often said that a person who has been frightened or received bad news is in shock. An electric current passing through the body delivers a shock.

However, shock (hypoperfusion) in the way described below as the state of collapse and failure of the cardiovascular system. When the circulation of blood in the body becomes inadequate, the oxygen and nutrient needs of the cells cannot be met.

In early stages of shock the body will attempt to maintain homeostasis (a balance of all systems in the body), however as shock progresses, blood circulation slows and eventually ceases. This abnormal state and inadequate oxygen and nutrient delivery to the cells of the body causes organs and then organs systems to fail. If not treated promptly, shock can be fatal.

Perfusion is the circulation of blood within an organ or tissue in adequate amounts to meel the cells’ current needs for oxygen, nutrients, and waste removal. When the body cannot meet these requirements it is considered in a state of hypoperfusion.

The cardiovascular system consists of three parts:
A pump (the heart)
A set of pipes (the blood vessels or arteries that act as the container)
Contents of the container (The blood).

These three parts can be referred as the “perfusion triangle”.

The pump allows the movement for the blood to reach the tissues and organs of the body.
The contents is the vehicle of which the blood takes to reach the tissues and organs of the body.
The container is the route which the contents travel to reach the tissues and organs of the body.

All types of shock can be identified as a problem with one of the three “perfusion triangle”.

Progression of shock, although you cannot see shock, you can see its signs and symptoms. The early stage of shock, while the body can still compensate for blood loss,l is called compensated shock. The last stage, when blood pressure is falling, is called decompensated shock. The last stage, when shock has progressed to a terminal stage, is called irreversible shock. A transfusion during irreversible shock will not save the patient's life.

Remember that falling blood pressure may be the last factor to change in shock.


Progression of Shock


Compensated Shock
Agitation
Anxiety
Restlessness
Feeling of impending doom
Altered Mental Status
Weak, rapid (thready), or absent pulse
Clammy (pale, cool, diaphoretic) skin.
Pallor, with cyanosis around lips
SHallow, rapid breathing
Air hunger (SoB especially if chest trauma)
Nausea or vomiting
Capillary refill longer than 2 seconds.
Marked thirst

Decompensated Shock
Falling blood pressure (systolic BP of 90mm hg or lower in an adult)
Labored or irregular breathing
Ashen, mottled, or cyanotic skin.
Thready or absent peripheral pulses
Dull eyes, dilated pupils
Poor urinary output.


Type of Shock
Potential causes
S/S
Treatment
Cardiogenic
Inadequate heart function
Disease of muscle tissue
Impaired electrical system
Disease or injury.

Chest pain
Irregular pulse
Weak pulse
Low blood pressure
cyanosis
Cool, clammy skin
Anxiety
Rales
Pulmonary edema

Position comfortably
Administer oxygen
Assist ventilations
Transport promptly

Obstructive
Mechanical obstruction of the cardiac muscle:
Tension pnuemothorax
Cardiac tamponade

Dyspnea
Rapid, weak pulse
Rapid, shallow breaths
Decreased lung compliance
Unilateral, decreased or absent breath sounds
Decreased blood pressure
JVD
Sub. Emphysema
Cyanosis
Tracheal deviation
Beck Triad: - JVD, - Narrowing pulse, - muffled heart tones.

Dependent on cause:
ALS assist/rapid transport.

Septic
Severe bacterial infection
Warm skin
Tachycardia
Low Blood pressure

Transport promptly.
Administer oxygen
Full ventilation support
Keep patient leg

Neurogenic
Damaged cervical spine.
Bradycardia
Low blood pressure
Signs of neck injury

Secure airway
Spinal stabilization
Assist ventilations
Preserve body heat

Anaphylaxis
Extreme life-threatening allergic reaction
can develop within seconds
Mild itching
Urticaria
Burning skin
Vascular dilation
Generalized edema
Coma
Rapid Death

Manage airway
Assist ventilations
Hi-flow O2.
Determine cause
Assist with administration of epinephrine

ALS:
Vaporized albuterol 200mcg/5 mcg per mech. actuation.
Benadryl (50mg)
IV epinephrine (.5mg)
Endotracheal intubation

Psychogenic
Temporarily, generalized vascular dilation
Anxiety, bad news, site of injury, severe pain, tiredness

Rapid pulse
Normal or low blood pressure

Determine duration of unconsciousness
Record vital signs and LoC

Hypovolemic
Loss of blood or fluid

Rapid, weak pulse
Low blood pressure
AMS
Cyanosis
Cool, clammy, diaphoretic skin
Increased respiratory rate.

Secure airway
Assist ventilations
Administer High-flow O2
Control external bleeding.
Keep warm

Respiratory Insufficiency
severe chest injury
Airway obstruction

Rapid weak pulse
Low blood pressure
AMS
CYanosis
Cool, clammy, diaphoretic skin
Increased respiratory rate.

Secure airway
Clear air passages
Assist ventilations
Administer high-flow O2



<Injuries>

Gunshot Wounds
Shrapnel Wounds
Penetration with Foreign Bodies
Blast (primary, secondary, tertiary)
Crush (crush syndrome)
Head
Neck
Eye
Ear
Oral

<Burns>

Classification
Degree/Signs
Causes
Treatment

<Conclusion>

review (optional)
training badges (MT/EMT/AMT/GBR/AGBE)
promotion (requires OfC/DvL/CmD/SeC)




<:: Helix Rank Equipment ::>


Rank Recruit Equipment

Standard MPF Medical Equipment
Medical Light
Latex Gloves
Band-Aids

Rank 05 Equipment

Standard MPF Medical Equipment
Lined Bio-hazard Bag
Monitoring Apparatus
Medical Light
Latex Gloves
Band-Aids
Distilled Water

Rank 04 Equipment

Distilled Water
Sterile Gauze Patches
Non-Sterile Gauze Roll
Cloth Adhesive Tape Roll
Isopropyl Alcohol (antiseptic)
Tourniquet
AED (Defib Kit)
Oxygen
Non-rebreather mask
Bag-valve Mask
Nasal cannula
Forceps
EMT Shears
Universal Splint
Artificial Airways
CPR Mask
Cotton Balls
Universal SplintBio Gel Capsules
Syringes
Acetaminophen
Emergency Blanket
Occusive Dressing




Rank 03 Equipment

Acetaminophen
Morphine
Hydrogen Peroxide
IV Rehydration Kit
Nylon Sutures
Emergency Blanket
Burn Kit
12-Lead EKG

Rank 02 Equipment

Hydrogen Peroxide
IV Rehydration Kit
Nylon Sutures
Burn Kit
Pre Cut and Shaped Moleskin
Disposable, Sterile Scalpel


Rank 01 Equipment

Synthetic Molecular Assembler
Mobile DNA Sequencer

<:: Helix Rank Authorizations ::>

-Recruit-

Learning Basic First Aid
& helping the 05/04’s
be a nurse

-05-

Running triage
Vital signs (pulse, respirations, blood pressure, blood glucose, SpO2 levels, pupils, skin ctc)
Oxygen administration
Cardiac monitoring
Dressing application
Basic cardiac life support (cpr, ventilation)
Airway Management (head tilt chin lift, jaw thrust, Heimlich maneuver, magills removal, suction, opa, npa)

-04-

All 05 Auths
Drug administration (IM, SubQ, IN, Neb)
Soft tissue wound management
Fracture management (exclusion: cannot set and cast)
Dislocation management
Spinal immobilization (c-spine and collar, backboarding)
Assisting 02/01 in non-surgical procedures

-03-

All 04 Auths
IV therapy
IO Therapy
Cardioversion, cardiac pacing, cardiac drugs
ET tube intubation
Chest drainage
Nasogastric suctioning
Assisting 02+ in surgeries
Advanced cardiac life support
12-Lead ECG

-02-

All 03 Auths
Blood Work and lab
X-Ray

Ultrasound
Amputation management (exclusion: cannot skin graft or apply prosthetic part)
Initiating amputation protocol

-01-

All 02 Auths
IO therapy
Fracture setting and casting
Skin grafting
Applying prosthetic parts
Most surgical procedures (Everything but brain surgery)

-OfC-

All 01 Auths
Can train Recruit/05-03
All surgical procedures

-EpU-

All EpU Auths

-DvL-

Everything Helix



Biogel (The Official what-is & how-to)



Biogel is a fairly grey subject in HL2RP. Some people use it as the magical fix-all potion. Others don't even know what they're doing with it so after some discussion, here's the official effects and usage.

Drug Uses
Encourages Mitosis (cells regenerate and repair faster)
Provides an antiseptic barrier to kill any bacteria in and around the wound
Introduces a dose of antibiotics to fight infection
Provides a local anesthetic to numb the pain
Heals wounds ~10x faster (a broken arm would only take 4-5 days to heal completely rather than 6 weeks)

Adverse Effects
Localized itching in the affected area
Fatigue
Anxiety
Nausea & Vomiting
Diarrhea
Severe swelling in affected area
Causes noticeable scarring
Risk of malignant cancer causing tumors if used too frequently

Dosage & Administration
Apply biogel ointment to cover entire affected area.
Surgically inject biogel to fill in space between broken bones
Do not exceed using 1 canister of biogel (250g) per week (may be fatal if multiple used within 48 hours, high risk of cancer if multiple used within 7 days)

Medical Conditions and Illnesses (For RP)

Cardiac

Problems with your heart

Acute Myocardial Infarction (Heart Attack)
What is it?
A heart attack occurs when the blood vessels that supply the heart muscle with oxygen are blocked. Sometimes more than one vessel can be blocked. Its often caused by buildup of crap in the vessels or a blood clot that gets stuck.
Signs and Symptoms
-Crushing pain in the chest (feels like a fat guy sitting on your chest)
-Difficulty breathing-
-Tiredness
-Feeling of a 'Racing' Heart
-Pale, sweaty skin
-Nausea and Vomiting
-Dizziness
-Abnormal signs on the cardiac monitor
-If severe, unconscious

Aortic Aneurysm
What is it?
A part of the wall of your aorta (biggest artery going away from the heart) becomes weak and pressure begins to push a bulge outward. Eventually it will burst, resulting is massive bleeding inside which ultimately results in death.
Signs and Symptoms
-Sudden, tearing chest pain that radiates into the back. Pain may also occur in the abdomen.
-Pale, sweaty skin

Cardiac Tamponade
What is it?
Fluid or blood pools into the sack that surrounds the heart and puts pressure on it. Usually caused by damage to a blood vessel in the heart that causes it to bleed into the sack.
Signs and Symptoms
-Low and narrow blood pressure
-High heart rate (above 100 beats per minute)
-Muffled heart sounds
-Neck veins sticking out

Toxics

Drug overdoses and poisoning

Opiate Overdose
What is it?
Drugs such as heroin, morphine, and codeine

Signs and Symptoms
-Unconscious
-Slow and shallow breathing
-Pinpoint pupils
-Low blood pressure
-Slow heart rate (below 60 beats per minute)
-Hypothermia

Sympathomimetic Overdose
What is it?
Drugs such as Epinephrine (EpiPen) and 'Speed'.

Signs and Symptoms
-High blood pressure
-High heart rate (over 100 beats per minute)
-Big, dilated pupils
-Sweating
-Agitated

Cholinergic Overdose
What is it?
Chemicals such as pesticides, nerve gas, and herbicides.

Signs and Symptoms
-Excessive salivating, tears (like cutting onions), urinating, and diarrhea
-Nausea and Vomiting
-Upset Stomach
-Slow heart rate (below 60 beats per minute)
-Throat closing up
-Excessive production of mucous in the throat

Anticholinergics
What is it?
Drugs such as gravol, benadryl, muscle relaxants

Signs and Symptoms
-High temperature
-Dehydration
-Anger
-Flushed skin
-Blindness

Sedatives/Hypnotics
What is it?
Drugs such as benzos, downers, nerve pills, and tranks.

Signs and Symptoms
-Drowsiness
-Slow and shallow breathing
-Slurred speech
-Confusion
-Low blood pressure
-'Seeing shit'

Stimulants
What is it?
Drugs such as cocaine, meth, and diet aids

Signs and Symptoms
-Insomnia
-No desire to eat
-Big, dilated pupils
-High heart rate (greater than 100 beats per minute)
-Seizures
-In rare cases, heart attack
6.2 Neurological
Your brain and nervous system are broken

Ischemic Stroke
What is it?
Lack of blood flow to a part of the brain causes it to die from lack of oxygen. Usually caused by a blood clot getting stuck in the blood vessels of your brain.

Signs and Symptoms
-Weakness on one side of the body (the face and eyes will be on the opposite side)
-Slurred or incomprehensible speech
-High blood pressure
-Unconsciousness

Hemorrhagic Stroke
What is it?
A blood vessel in your brain ruptures, preventing blood from reaching the remaining part of the brain as well as puts pressure on the brain.

Signs and Symptoms
-Stroke Symptoms
-Massive headache
-High, wide blood pressure
-Slow heart rate (below 60 beats per minute)
-Confusion
-Nausea and Vomiting
-Neck pain and stiffness
-Blurred vision

Seizures
What is it?
Disruption of impulses of your nervous system caused by many things such as epilepsy, brain tumor, brain infection, low blood sugar, poisoning, drug overdose, and lack of oxygen. There are 2 common types of seizures. Tonic-Clonic (or Grand Mal) and absent seizures.

Signs and Symptoms
In a tonic-clonic (symptoms related to underlying cause such as low blood sugar), rapid uncontrolled shaking or vibrating with no coordination whatsoever

In an absent seizure (symptoms related to underlying cause such as lack of oxygen), person seems to 'space out' for a period of time (anywhere from a couple seconds to a few minutes) and doesn't respond to anything.

Gastrointestinal
Gastrointestinal System
Solid Organs
Liver
Spleen
Pancreas
Kidneys
Trauma to organs can cause shock and bleeding
Large amounts of blood vessels.

Hollow organs
Gallbladders
Stomach
Small intestines
Large intestine
Bladder

URQ: liver, kidney, colon, pancreas, gallbladder
LRQ: Colon, small intestines, major artery and veins, appendix
ULQ: stomach, spleen, kidney, colon, pancreas
LLQ: Colon, small intestines, major artery and veins.
Midline: Aorta, pancreas, small intestines, bladder, spine

Digestion Process:
Mouth - Saliva
Esophagus
Stomach: Gastric juices
Liver: Bile (breaks fats), toxic filters, Glucose strange, blood clotting & immune function agents  
Gallbladder: Stores bile
Small intestine: Duodenum, Jejunum, ileum
- Duodenum: Pancreas & liver digestive juices mix
- Pancreas: Enzymes to break down starch, fate, & protein. Releases amylase
- - Amylase: Breaks starches into sugar
- - Bicarbonate: Alkali to neutralize stomach acid
- - Insulin: Regulates glucose in blood stream
- Jejunum: Absorbs digestive products.
- Ileum: Solvable molecules absorb into blood
- - Fats & starches turned into amino acids, fatty acids, & simple sugars.
Colon: Food not broken down or used for nutrients.
Spleen: Filters blood, develops blood cells, reserves blood
- Produces antibodies

Urinary System
Kidneys: Regulate blood pressure
- Removing sodium chloride
Rid body of toxic wastes
- Forms urine from blood
Balances body fluid & electrolytes

GI/U Pathophysiology
Abdominal membrane - Peritoneum
Parietal peritoneum: Covers organs
Visceral Peritoneum: Covers abdominal cavity
- Irritation of the peritoneum = Peritonitis
Acute abdomen: Sudden onset of abdominal pain.

Peritonitis: Irritated peritoneum
May be fatal
Causes ileus: paralysis of muscular contractions
Emesis: vomiting
Distention follows shorty
Pulse and blood pressure may change.
May cause shock & hypotension
Tachycardia


Endocrine

Your natural blood chemistry is messed up

Hypoglycemia
What is it?
Your blood sugar is low. Usually occurs when you do lots of work without having anything to eat. Happens a lot faster in people with diabetes.

Signs and Symptoms
-Confusion
-Feeling 'off'
-Unconsciousness

Diabetic Ketoacidosis
What is it?
Occurs when people with type 1 (or insulin dependent) diabetics have extremely high blood sugars. Type 1 diabetics must take insulin to keep their blood sugars down. This can get really bad within 6-24 hours from its onset.

Signs and Symptoms
-Fruity/Alcohol smelling breath
-Low blood pressure
-Excessive urination
-Dehydration
-Restlessness
-Confusion
-Unconsciousness
-Irregular heartbeat
-High blood sugar

Hyperosmolar Hyperglycemic Nonketotic Coma
What is it?
Occurs in people with Type 2 (or non-insulin dependent) diabetics who have extremely high blood sugars. These diabetics can usually keep their blood sugars down by being careful with what they eat, however often are prescribed drugs to keep blood sugar down. Unlike DKA, this usually takes a few days to get worse from its onset.

Signs and Symptoms
-Excessive urination
-Extreme thirst
-Extreme hunger
-Nausea and Vomiting
-Abdominal pain
-High heart rate (faster than 100 beats per minute)
-Confusion
-Unconsciousness
-Low blood pressure
-Dehydration
-High blood sugar

Infections

Something uninvited is in your body

Sepsis
What is it?
Your body is going overkill to fight an infection. Usually occurs if you ignore an infection. It can cause your internal organs to get damaged and can easily result in death if untreated.


Signs and Symptoms
-Fever or extreme hypothermia
-Decreased urination
-High heart rate (greater than 100 beats per minute)
-Rapid breathing
-Nausea and Vomiting
-Diarrhea

Pneumonia
What is it?
Infection growing in your lungs. Can be caused by many things including a flu or cold. Probably the most common infection you'd see in the HL2 universe.

Signs and Symptoms
-Cough producing green or blood tinged mucous
-Fever
-Chills
-Fast, shallow breathing and feeling short of breath
-Pain in your chest wall
-High heart rate (greater than 100 beats per minute)
-Tiredness or weakness
-Nausea and Vomiting
-Diarrhea
-Absent lung sounds in one of your lungs

Cellulitis
What is it?
Infection of the skin. Most often caused by an uncleaned break in the skin such as a cut, blister, scrape, or puncture. It can spread quickly resulting in sepsis.

Signs and Symptoms
-Painful, red, hot, swollen skin which might weep fluid
-Red streaks extending from the site toward the rest of the body
-Fever
-Chills
-Pus drainage
-Generally feeling unwell

Appendicitis
What is it?
Infection of your appendix (which is located in the lower right part of the abdomen, attached to the beginning of the large intestine) which eventually could burst, spilling infectious material into the abdomen causing a rapid, serious, and fatal infection of the abdomen, usually resulting in death if not treated within a few hours.

Signs and Symptoms
-Dull pain in the upper left part of the abdomen that gets sharp as it moves down (first sign)
-Loss of appetite
-Nausea and Vomiting
-Swelling of the abdomen
-Fever
-Inability to fart


Guidelines:

You are not expected to memorize this OOC. You are however expected to follow these guidelines for their specific situations.


In this document, you will find all guidelines outlining how to appropriately treat the specified pathological deficit. They have been organized in relation to the nature of the ailment.

Terms used in this document

LOC: Level of Consciousness
ABC: Airway Breathing Circulation
SAMPLE: Signs and Symptoms, Allergies, Medications, Past Medical History, Last Oral Intake, Events Leading Up to the Problem
OPQRST: Onset, Provocation, Quality, Region/Referral/Radiation, Severity, Time (OPQRST is for Pain)
MOI: Mechanism of Injury (Fall, stabbing, etc)
CMC: Condition, Mobility, Circulation
pt: Patient


<:: Treatment Guidelines ::>

General

Vital Signs and Normal Ranges
Pulse (60-100 per minute)
Respirations (12-20 per minute)
Blood Pressure (systolic 100-140) (diastolic 70-90)
SpO2 (>94%)
Temperature (36C-37C)
Pupils (equal, 2mm-4mm)
Skin (Pink and dry)
Blood Glucose (4-9)

Routes of Administration
Per Rectum (PR) - Via the anus - Rapid.

Per Os (PO) - Orally - Slow.
Oral Glucose, Charcoal, Aspirin

Intravenous injection (IV) - Through the veins - Immediate.

Intraosseous (IO) - Through bone marrow - Immediate.

Subcutaneous injection (SC) - Under the skin - Slow.

Intramuscular injection (IM) - Through the muscle - Moderate.
Epipen

Inhalation - Breathing in - Rapid.
Inhaler

Sublingual (SL) - Under tongue - Rapid.
Nitroglycerin

Transcutaneous - On the skin - Slow.
Nitroglycerin patches.

Intranasal (IN) - Inhaled in nasopharynx - Rapid.



Patient Assessment
Scene Size Up:
Scene Safe
MoI/NoI
BSI
# of patients
Additional resources

Patient Assessment:
General Impression
LoC
Airway
Breathing
Circulation
Rapid Scan
Transport Decision

History Taking
Chief Complaint
SAMPLE (w/ OPQRST)

Secondary Assessment
Vitals
Full Body Scan

Reassessment:
Repeat Patient Assessment
Reassess Vitals
Reassess Chief Complaint
Recheck Interventions
Identify and treat changes in patient conditions

Triage



Shock






Unconscious Patient



Airway Obstruction



Dyspnea and Respiratory Distress





Advanced Cardiac Life Support


Patient must have asystole in 2 or more leads and have had no return of spontaneous circulation or neurological function for 20 minutes of ACLS before death may be determined.





Criteria for Amputation




Medical

Chest Pain
-Place patient in position of comfort (preferably low or high fowlers)
-Administer high flow oxygen
-Apply cardiac monitor
-Administer nitroglycerin as per protocol
-Administer ASA as per protocol
-Repeat vitals every 5-15 minutes
-Prepare for ACLS
-Do NOT allow the patient to exert him/herself (eg. walking, standing)
-Obtain blood work: creatine, troponin, sodium, potassium, complete blood count, prothrombin time
-Obtain 12-Lead ECG
-Obtain Frontal and Lateral chest x-ray
-Based on findings, consider emergency bypass surgery for MI or Heparin administration


Cerebrovascular Accident (Stroke):
-Administer high flow oxygen
-Perform Cincinnati Stroke Test
-Rule out Hypoglycemia
-Rule out seizure or trauma that may have caused stroke symptoms
-Do NOT allow the patient to exert him/herself (eg. walking, standing)
-Obtain head CT to rule out intracranial hemorrhage
-Based on findings, administer Heparin


Intracranial Hemorrhage
-Follow CVA guideline up to ruling out Intracranial Hemorrhage
-Keep Blood pressure below 150 systolic
-Rule out Narcotic Overdose
-Elevate head 30 degrees
-Avoid Valsalva Maneuver (rectal stimulation, holding breath, flexing the neck sideways, extreme hip flexion, moving self/turning to the side)
-Consider emergency neurosurgery


Seizures
-Manage airway
-Administer high flow oxygen
-Protect it from injury
-Rule out hypoglycemia
-Rule out opiate overdose
-Maintain body temperature
-Position pt on their side after tonic-clonic phase (left lateral recumbent)
-Apply cardiac monitor
-Consider sedatives if status epilepticus (seizure lasting longer than 5 minutes or multiple seizures with no recovery phase)
-Reassure pt
-Resolve possible cause


Dissection
-Administer high flow oxygen
-Apply cardiac monitor
-Rule out MI with ECG, X-Ray, and Blood Work
-Chest CT to determine aneurysm
-Consider emergency surgery


Cardiac Tamponade
-Apply cardiac monitor
-Determine fluid buildup with Chest X-Ray and CT
-Perform pericardial drainage procedure


Narcotic Overdose
-Rule out hypoglycemia
-Apply high flow oxygen
-Apply cardiac monitor
-Administer narcan protocol


Other Drug Overdoses
-Manage airway
-Apply cardiac monitor
-Establish IV TKO
-Order bloodwork to determine drugs taken and blood chemistry balances
-Watch for MI (for stimulant overdose)
-Consider counter drugs


Poisoning
-Manage airway
-Apply cardiac monitor
-Establish IV TKO
-Pump stomach contents
-Order bloodwork to determine blood chemistry balances
-Consider counter drugs


Hypoglycemia
-Rule out sepsis or narcotic overdose
-Administer oral glucose if alert
-Else, administer Dextrose and Glucagon as per protocol
-Consider dextrose IV treatment if no signs of improvement


Diabetic Ketoacidosis
-Apply cardiac monitor
-Treat hypokalemia (loss of electrolytes)
-After determining high blood glucose, administer Insulin as per protocol
-Treat dehydration


Hyperosmolar Hyperglycemic Nonketotic Coma
-Apply cardiac monitor
-Treat hypokalemia (loss of electrolytes)
-After determining high blood glucose, administer Insulin as per protocol
-Treat dehydration


Anaphylaxis
-Administer high flow oxygen
-Remove allergy causing substance (ie. stinger still in skin)
-Administer Epinephrine as per anaphylactic protocol
-Administer Salbutamol as per protocol
-Administer Diphenhydramine as per protocol
-Repeat Epinephrine and Salbutamol as per protocol until it recovers


Infections
-Rule out any other possible causes
-Administer IV antibiotics
-Schedule daily antibiotic administration for 2 weeks


Tension Pneumothorax
-Administer oxygen
-Apply cardiac monitor
-Landmark 2nd intercostal space at midclavicular line
-Insert 14g IV catheter at landmark
-Attach Heimlich valve assembly to catheter and secure the catheter
-Monitor patient for 24 hours after decompression


Left Sided Congestive Heart Failure
-Administer oxygen
-Apply cardiac monitor
-Sit pt upright
-Establish IV
-Consider nitro, lasix, morphine, and salbutamol
-Consider Heparin or Cardiac Surgery


Asthma
-Administer oxygen
-Administer albuterol
-If pt is critical, administer epinephrine as well


7.2.18 Bronchitis
-Administer oxygen
-Start C-PAP or Bi-PAP if necessary
-IV Access
-Apply monitor
-Consider salbutamol
-Obtain sputum sample or throat swab and check for microorganisms
-If positive, schedule daily albuterol treatments for 2 weeks
-If immunosuppressed patient, schedule daily antibiotics for 2 weeks as well


Pneumonia
-Administer oxygen
-Obtain chest x-ray
-Obtain sputum sample and check for microorganisms
-If positive, schedule daily antibiotics for 2 weeks


Trauma

Abrasion - Superficial layer skin wound caused by friction
Laceration - Jagged cut caused by sharp cuts or blunt force that tears tissue
Incision - Smooth shape cut
Avulsion - Injury that separates various layers of soft tissue
Amputation - Injury where part of the body is completely severed
Puncture wound - Injury from a sharp, pointed object



Soft Tissue Injuries:
-Treat for shock
-Assess distal circulation from wound
-Irrigate wound of all debris
-Disinfect superficial wounds
-Control bleeding
-Stabilize impaled objects
-Reassess circulation
-Consider surgery for gunshot wounds, impaled objects, and damage to internal organs
-Suture wound and administer IV antibiotics
-Schedule IV antibiotics daily for 2 weeks


Amputations
-Treat for shock
-Irrigate wound and salvaged parts of debris
-Control bleeding
-Consider emergency reattachment surgery for salvageable parts
-Else, apply skin grafting procedure and prosthetic part


Fractures
-Treat for shock
-If open, irrigate wound and control bleeding
-Assess distal circulation (treat if absent or consider emergency setting of fracture)
-Immobilize affected part or apply traction if distal circulation absent
-Apply ice
-Reassess distal circulation
-Obtain x-ray of fractured part
-Set fracture (consider surgery if major)
-Cast and immobilize fracture
-Reassess with secondary x-ray


Dislocations
-Assess distal circulation (treat if absent or consider emergency setting of dislocation)
-Immobilize affected joint
-Obtain x-ray of joint
-Set joint and immobilize
-Reassess with secondary x-ray


Spinal Cord Injuries
-C-Spine precautions (c-spine collar)
-Rapid assessment
-Assess pulse, motor, sensation
-Prepare to longboard patient
-Check entire spinal column before/when rolling onto longboard
-Immobilize thorax, abdomen, hips, and head to longboard respectively
-Reassess pms
-Obtain x-ray to determine any fractures
-Treat accordingly


1st Degree Burns
-Stop burning (flush with cool water for several minutes)
-Cover with a dry, sterile dressing


2nd Degree Burns
-Stop burning (flush with cool water for several minutes)
-Elevate to reduce blister forming
-Do not rupture blisters
-Cover with antibiotic cream
-Cover with a wet dressing followed by a dry dressing
-Administer IV fluids
-Pain management


3rd Degree Burns
-Stop burning (flush with cool water for several minutes)
-Cover with antibiotic cream
-Cover with a wet dressing followed by a dry dressing
-Administer IV fluids
-Pain Management
-Consider skin grafting procedure


Chemical Burns
-Remove any affected clothing
-Flush with large amounts of water (brush off powder first if present)
-If in eyes, remove contacts and flush
-Treat burns accordingly


Electrical Burns
-Prepare for cardiac arrest
-Look for entrance and exit wound
-Expect major internal damage
-Treat burns accordingly


Eye Injuries
-Cover with a moist sterile dressing if eye is exposed
-Cover other eye to prevent movement
-Consider ocular surgery


Head Injuries
-Observe changes in LOC
-Watch for intracerebral pressure (cushing reflex: wide pulse pressure, bradycardia, and seizures)
-Prepare for vomiting
-Administer O2
-Reassess every 5 minutes
-Establish IV (25-50 ml/hour if hypertensive, 20 ml/kg/hour if hypotensive)
-Be aware of hypothermia
-Consider neurosurgery








<:: Protocols for Drug Administration ::>

Terms

Indications: Any reason required to administer the drug
Contraindications: Any reason to prevent you from administering the drug.
Onset: Time it takes for the drug to start working
Peak Effectiveness: Time it takes for drug to work at full effect
Duration: How long the drug will last


Acetaminophen (aka Tylenol or Paracetamol)
Mild painkiller. Fever control.
Indications: Mild to moderate pain, fever
Contraindications: None
Side Effects: None
Dose and Administration: 650 mg Orally every 4 hours.

Duration of Action:
-onset: 30 minutes
-peak effectiveness: variable
-duration: 4 hours

Acetylsalicylic Acid (aka ASA or Aspirin)
Anti-inflammatory, Prevents clotting
Indications: chest pain suggestive of MI
Contraindications: Internal bleeding
Side Effects: heartburn, nausea & vomiting, wheezing in allergic patients, prolonged bleeding
Dose and Administration: 160 mg chewed orally once

Duration of Action:
-onset: 30-45 minutes
-peak effectiveness: variable
-duration: 7-10 days


Amiodarone (aka Cordarone)
Reverses abnormal heart rhythms such as v-fib
Indications: patient with no vital signs and either v-fib or v-tach
Contraindications: Hypothermic cardiac arrest, renal failure, 2nd or 3rd degree heart block, hypotension, bradycardia
Side Effects: hypotension, bradycardia, nausea, fever
Dose and Administration: 300 mg initial slow IV push, 150mg second slow IV dose after 10 minutes if indicated

Duration of Action:
-onset: 5-15 minutes
-peak effectiveness: variable
-duration: variable


Atropine
Increases slow heart rate
Indications: asystole, pulseless electrical activity, shocky bradycardia, nerve gas exposure
Contraindications: trauma or hypothermic cardiac arrest, tachycardia
Side Effects: headache, dizziness, nausea & vomiting, tachycardia, flushed hot dry skin
Dose and Administration: 1 mg IV push every 3-5 minutes up to a max of 3mg

Duration of Action:
-onset: immediate
-peak effectiveness: 1-2 minutes
-duration: 2-6 hours


D50W (Dextrose)
Brings up blood sugars
Indications: Blood sugar below 4 mmol/L
Contraindications: Hyperglycemia
Side Effects: warmth, pain, burning, tissue death if leaked out of the vein
Dose and Administration: 25g slow IV push, may be repeated once after 5 minutes if BGL >4 mmol/L
Duration of Action:
-onset: <1 minute
-peak effectiveness: variable
-duration: variable


Dimenhydrinate (aka Gravol)
Decreases nausea and vomiting
Indications: symptomatic relief of nausea and vomiting
Contraindications: Hypertension
Side Effects: sedation, hypotension, seizures, hallucinations, vomiting, dry mouth and throat
Dose and Administration: 25-50 mg IM, IV, or Orally
Duration of Action:
-onset: 15-30 minutes
-peak effectiveness: 1 hour
-duration: 3-12 hours


Diphenhydramine (aka Benadryl)
Blocks allergic reactions
Indications: relief of allergies, anaphylaxis, motion sickness
Contraindications: hypertension
Side Effects: sedation, hypotension, seizures, hallucinations, vomiting, dry mouth and throat
Dose and Administration: 25-50 mg IM, IV, or Orally
Duration of Action:
-onset: 15-30 minutes
-peak effectiveness: 1 hour
-duration: 3-12 hours


Epinephrine (aka Adrenaline or EpiPen)
Opens up airways, increases heart rate and blood pressure
Indications: absent vitals with v-fib or v-tach, asystole without death determination, PEA, severe bronchospasm, anaphylaxis
Contraindications: hypothermic cardiac arrest, hypertension, pulmonary edema, hypovolemic shock,
Side Effects: hypertension, pulmonary edema, anxiety, nausea, chest pain, headache
Dose and Administration: Cardiac Arrest: 1 mg IV push every 3-5 minutes. Anaphylaxis: 0.3mg IM
Duration of Action:
-onset: immediate
-peak effectiveness: within minutes
-duration: several minutes


Furosemide (aka Lasix)
Reverses fluid buildup in the lungs caused by heart failure
Indications: shortness of breath with crackles in both lungs, pulmonary edema
Contraindications: hypotension, hypovolemia
Side Effects: dry mouth, may make hypovolemia or hyperglycemia worse
Dose and Administration: 40 mg IV Bolus
Duration of Action:
-onset: 5 minutes
-peak effectiveness: 30 minutes
-duration: 4-6 hours


Glucagon
Helps raise blood sugars
Indications: hypoglycemia
Contraindications: hyperglycemia, known adrenal tumor
Side Effects: tachycardia, hypertension
Dose and Administration: 1 mg IM
Duration of Action:
-onset: 1 minute
-peak effectiveness: 30 minutes
-duration: 60-90 minutes


Oral Glucose
Tube of pure glucose to raise blood sugars
Indications: hypoglycemia
Contraindications: decreased LOC, no gag reflex, nausea, vomiting, hyperglycemia
Side Effects: nausea and vomiting
Dose and Administration: 50 grams buccally
Duration of Action:
-onset: immediate
-peak effectiveness: variable
-duration: variable


Heparin
Clot busting drug.
Indications: blood clot occluding a blood vessel
Contraindications: Hemorrhaging
Side Effects: bleeding, inability to clot
Dose and Administration: 60-80 units/kg IV loading dose, 14-18 units/kg IV infused per hour
Duration of Action:
-onset: immediate
-peak effectiveness: variable
-duration: 4 hours after last dose


Lorazepam (aka Ativan)
Sedative
Indications: seizure lasting longer than 5 minutes, severe anxiety, other sedation needs
Contraindications: hypersensitivity, coma, shock, suspected drug abuse
Side Effects: respiratory depression, drowsiness, sedation, confusion, restlessness, hypotension, bradycardia
Dose and Administration: 2 mg IM. Repeat after 15 minutes if symptoms persist
Duration of Action:
-onset: 1-5 minutes
-peak effectiveness: variable
-duration: 6-8 hours


Morphine
Analgesic
Indications: pain control
Contraindications: undiagnosed head injury, shock, respiratory depression, hypotension, hypovolemia, decreased LOC
Side Effects: respiratory depression, hypotension, decreased LOC, nausea, vomiting, bradycardia, tachycardia, euphoria, bronchospasm, dry mouth
Dose and Administration: 2 mg slow IV every 5 minutes as needed up to 10 mg
Duration of Action:
-onset: immediate
-peak effectiveness: 20 minutes
-duration: 2-7 hours


Naloxone (aka Narcan)
Reverses effects of opiates such as morphine, codeine, and heroin
Spoiler for Hiden:Indications: opiate overdose, unconsciousness of unknown origin
Contraindications: None
Side Effects: withdrawal symptoms in addicts, tachycardia, hypertension, nausea, vomiting, diaphoresis
Dose and Administration: 0.4mg IV, IM, or SC every 3-5 minutes as necessary up to 2 mg
Duration of Action:
-onset: 2 minutes or less
-peak effectiveness: variable
-duration: 30-81 minutes


Nitroglycerine (aka Nitro)
Dilates blood vessels
Indications: chest pain indicative of ischemia, hypertension, congestive heart failure
Contraindications: hypotension, use of viagra within 24 hours or cialis within 72 hours, intracranial bleed, head injury
Side Effects: headache, hypotension, fainting, tachycardia, nausea, vomiting, diaphoresis
Dose and Administration: 0.3mg Sublingually every 5 minutes as necessary up to 0.9mg
Duration of Action:
-onset: 1-3 minutes
-peak effectiveness: 5-10 minutes
-duration: 20-30 minutes


Salbutamol (aka Ventolin)
Relaxes airways
Indications: bronchospasm (wheezing, respiratory distress, and feeling of "can't breathe")
Contraindications: None
Side Effects: Dizziness, tachycardia, nervousness, nausea, vomiting, increased blood pressure, synergistic with epinephrine
Dose and Administration: 2.5mg via Nebulizer every 15 minutes as necessary
Duration of Action:
-onset: 5-15 minutes
-peak effectiveness: 60-90 minutes
-duration: 3-6 hours