exceptions, such as a patient with a potential spinal injury who cannot be logrolled while being transported and may be at risk of a compromised airway. Concerning mechanisms that may result in spinal column injury: Fall from over 3 feet, including adult fall from standing, or 5+ stair steps MVC at 30+ mph, or rollover or ejection Motorcycle, bicycle, other mobile conveyance, or pedestrian-vehicle accident Diving or axial load Electric shock Symptoms of spinal column injury may include: Posterior neck or back pain or tenderness; Paresthesias or loss of sensation in extremities; Weakness or paralysis of extremities; Conditions placing individuals at risk to not perceive or complain of the symptoms of spinal column injuries: Altered mental status due to disease, injury, intoxication, or other causes; Inability to adequately communicate; History of cervical spine injury or abnormality, or conditions causing fragile bones; Distracting injury (such as long-bone fracture); Age extremes (including >65 of age); Individuals sustaining lesser injuries, patients who do not have symptoms of spinal column injury and do not experience a condition that would impair the patient’s ability to perceive or communicate symptoms of spinal column injuries do not require spinal immobilization. Penetrating injuries to the neck generally do not require spinal immobilization. ASSESSMENT / TREATMENT PRIORITIES 1. Ensure scene safety, appropriate universal precautions, request additional EMS resources (BLS or ALS), perform thorough primary survey, any life threatening injuries immediately, appropriate oxygen and IV therapy MEDICAL CONTROL OPTIONS a. ADVANCED EMT, EMT-INTERMEDIATE AND PARAMEDIC: Additional Normal Saline 250 mL - 500 mL bolus(es), wide open or titrated to patient's hemodynamic status. b. PARAMEDIC: For suspected neurogenic shock (without hypovolemia): Norepinephrine infusion: 0.1mcg/kg/min IV/IO, titrate to goal Systolic Blood Pressure of 90mmHg, OR Dopamine IV/IO.
exceptions, such as a patient with a potential spinal injury who cannot be logrolled while being transported and may be at risk of a compromised airway. Concerning mechanisms that may result in spinal column injury: Fall from over 3 feet, including adult fall from standing, or 5+ stair steps MVC at 30+ mph, or rollover or ejection Motorcycle, bicycle, other mobile conveyance, or pedestrian-vehicle accident Diving or axial load Electric shock Symptoms of spinal column injury may include: Posterior neck or back pain or tenderness; Paresthesias or loss of sensation in extremities; Weakness or paralysis of extremities; Conditions placing individuals at risk to not perceive or complain of the symptoms of spinal column injuries: Altered mental status due to disease, injury, intoxication, or other causes; Inability to adequately communicate; History of cervical spine injury or abnormality, or conditions causing fragile bones; Distracting injury (such as long-bone fracture); Age extremes (including >65 of age); Individuals sustaining lesser injuries, patients who do not have symptoms of spinal column injury and do not experience a condition that would impair the patient’s ability to perceive or communicate symptoms of spinal column injuries do not require spinal immobilization. Penetrating injuries to the neck generally do not require spinal immobilization. ASSESSMENT / TREATMENT PRIORITIES 1. Ensure scene safety, appropriate universal precautions, request additional EMS resources (BLS or ALS), perform thorough primary survey, any life threatening injuries immediately, appropriate oxygen and IV therapy MEDICAL CONTROL OPTIONS a. ADVANCED EMT, EMT-INTERMEDIATE AND PARAMEDIC: Additional Normal Saline 250 mL - 500 mL bolus(es), wide open or titrated to patient's hemodynamic status. b. PARAMEDIC: For suspected neurogenic shock (without hypovolemia): Norepinephrine infusion: 0.1mcg/kg/min IV/IO, titrate to goal Systolic Blood Pressure of 90mmHg, OR Dopamine IV/IO.
treatment-protocols-2016.docx