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Chemical restraint is to be used only where the patient can be adequately and repeatedly monitored by EMT-P providers. It is to be reserved for patients who cannot otherwise be restrained or restrained only at the risk of significant harm to the patient, law enforcement, or EMS providers or if provider has concern for excited delirium. Once applied, patients should be isolated and placed in an ALS ambulance as soon as possible. All patients who are administered midazolam or ketamine are required to be monitored with waveform EtCO2 for adequate ventilation. All patients will be transported to closest appropriate facility for further evaluation.
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Pediatric Dose – 0.2 ml/kg of 10% calcium chloride slow IVP (1 gram max)
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Pediatric Dose – 0.02 mg/kg IV/IO/IM every 5 minutes
If bleeding persists after 10 minutes:
Criteria for ALS level care:
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Criteria: Continuous seizure activity for longer than 3 minutes or two or more consecutive seizures without regaining consciousness.
Focal seizure activity meeting the above criteria should also be considered status epilepticus
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Criteria: Continuous seizure activity for longer than 3 minutes or two or more consecutive seizures without regaining consciousness.
Focal seizure activity meeting the above criteria should also be considered status epilepticus
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Patients with:
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Patients may present as having fallen, unable to walk, have new balance problems or with acute altered level of consciousness. |
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Abnormal – one side of face does not move as well as the other side Arm Drift (have patient close eyes and hold both arms out, palms up):
Abnormal – one arm does not move or one arm drifts down compared with the other Speech (have the patient say “you can’t teach old dog new tricks”):
Abnormal – patient slurs words, uses inappropriate words, or is unable to speak |
Facial Palsy | Absent | |
---|---|---|
Mild | ||
Moderate/Severe | ||
Arm Motor Impairment | Normal/Minimal | |
Moderate | ||
Severe | ||
Leg Motor Impairment | Normal/Minimal | |
Moderate | ||
Severe | ||
Head and Gaze Deviation | Absent | |
Present | ||
Ask the patient: (1) While showing patient the paretic arm, “Whose arm is this?” (2) “Can you lift both arms and clap?” |
Patient recognizes his/her arm and the impairment | |
Does not recognize his/her arm or the impairment | ||
Does not recognize his/her arm AND the impairment | ||
Instruct the patient: (1) Close your eyes” (2) “Make a fist.” |
Performs both tasks correctly | |
Performs one task correctly | ||
Performs neither task correctly |
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Abnormal – one side of face does not move as well as the other side Arm Drift (have patient close eyes and hold both arms out, palms up):
Abnormal – one arm does not move or one arm drifts down compared with the other Speech (have the patient say “you can’t teach old dog new tricks”):
Abnormal – patient slurs words, uses inappropriate words, or is unable to speak |
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