End-Tidal-Carbon-Dioxide detection (EtCO2) should be used to confirm the initial placement of all advanced airways (in addition to physical exam) per EtCO2 standard operating procedure, on any ambulance that has the capability of performing capnography. Continuous EtCO2 monitoring should be used throughout patient encounter on ALL patients with advanced airways.
Advanced airways are to be confirmed and secured prior to moving the patient. Any time the patient has been moved (i.e. from the scene to the vehicle, in the vehicle, from the vehicle to the ED) the airway placement is to be re-confirmed.
Documentation on the run sheet is to include:
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If capnography available, see “Verification of Endotracheal Tube (ETT) and Supraglottic Airway Device Placement Procedure”
The Esophageal Detector Device (EDD) may be used to verify initial tube placement:
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Documentation should include all of the following:
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Criteria: Any patient 18 years or older with a non-traumatic presentation of atropine-refractory symptomatic bradycardia
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PVADs (pre-existing vascular access devices) include any indwelling catheter/device placed into one of the central veins to provide vascular access for those patients requiring long term intravenous therapy and hemodialysis shunts or grafts.
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Criteria: Any patient with refractory ventricular fibrillation or pulseless ventricular tachycardia that has not responded to ≥3 standard defibrillation attempts (i.e. - NO break in Vfib/tach)
≥3 conventional shocks delivered, refractory VF using first set of pads (Pads-A)
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Apply 2nd set of pads (Pads-B)>
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Attempt defibrillation using alternate vector: Shock using Pads-B |
Continued refractory VF: Shock using dual sequential (Pads-A + Pads-B) |
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(Estimated by Broselow tape) |
Adults |
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Infusion Rate |
mcg/min |
mcg/min |
mcg/min |
mcg/min |
mcg/min |
mcg/min |
mcg/min |
gtt set |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
gtt set |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
gtt set |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
BLS providers should immediately direct trained caregivers to replace trach tube. ALS providers should locate emergency replacement trach tubes that are usually kept near the patient and attempt tube replacement. |
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Suctioning
Ventilation
Displaced Tracheostomy Tube
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Ventilator Patients