SFVEMSS Revised Protocols

BURN CENTER REFERRAL CRITERIA (Adult + Peds)

Partial-thickness burns >10% TBSA 9% 18% front of torso
Full thickness burns in any age group whole 18% back & buttocks
head
Burns involving face, hands, feet, genitalia, perineum, or major joints 18%
9% )~_whole
Electrical burns (lightning injury); Chemical burns; Inhalation injury whole
Burn injury in pts with preexisting medical disorders that could complicate management, prolong arm head

recovery, or affect mortality 14% each
whole leg
Any pts with burns and concomitant trauma (fractures) in which the burn injury poses the greatest

risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the pt’s

condition may be stabilized initially in a trauma center before transfer to a burn center. Physician

judgment will be necessary in such situations and should be in concert with the regional OLMC plan 9% front
and triage protocols. 9% back

Burned children in hospitals without qualified personnel or equipment to care for children.

Burn injury in pts who will require special social, emotional, or rehabilitative intervention.

Guidelines for the Operation of Burn Centers (pp. 79-86), Resources for Optimal Care of the Injured Pt 2006, Comm on Trauma, ACS.
Local Burn Centers: Loyola U Med Center; StrogeflCook County Hospital; U of Chicago Hospital; OSF St. Anthony Med Center

Concentration: 100 mcg/2 mL (50 mcg/mL) Additional °C oF °C oF
4 mcg/kg (max 100 mcg 1st dose) IV/IN/IO; may repeat 0.5 mcg/kg in 5 min (max 50 mcg) pounds to kg 84.2
conversions 42 107.6 29 80.6
Elderly (>65), debilitated: 0.5 mcg/kg (max 50 mcg) 41 10518 28 77
Contact OLMC for children < 2 and higher doses Ibs = kg 73.4
40 104 27 69.8
1 mcg/kg 0.5 mcg/kg 242 = 110 39 66.2
253 = 115 38 100.4 25
Dose = Amount Dose = Amount 264 = 120 24
275 = 125 36 96.8 23
22,401bs = 10-18kg 10 mcg = 0.2 mL 5 mcg =0.1 mL
286 = 130 34 93.2 21
44 - 62 Ibs = 20-28 kg 20 mcg = 0.4 mL 10 mcg = 0.2 mL 297 = 135
308 = 140 32 90.6 19
66;79 Ibs =30-38 kg 30 mcg = 0.6 mL 15 mcg = 0.30 mL 319 = 145 87~8
330 = 150
88 - 106 Ibs = 40-48 kg 40 mcg = 0.8 mL 20 mcg = 0.4 mL 341 = 155
352 = 160
110~128 Ibs~ 50~58 kg 50 mcg = 1 mL 25 mcg = 0.5 mL 363 = 165

132 - 150 Ibs = 60-68 kg 60 mcg = 1.2 mL 30 mcg = 0.6 mL

154 172 I bs= 70.78 kg 70 mcg = 1.4 mL 35 mcg = 0.7 mL

176 - 194 Ibs = 80-88 kg 80 mcg = 1.6 mL 40 mcg = 0.8 mL

198: 216 Ibs = 90’98 kg 90 mcg =1~8 mL 45 mcg = 0.9 mL

220-238 + Ibs = 100-108 kg 100 mcg = 2 mL 50 mcg - 1 mL

SFVEMSS Full Text 3/11/15 Page 99

HR (min) RR Interval (sec) Upper limits normal QT (sec) HR (min) RR Interval (sec) Upper limits normal QT (sec)

Decreasing ’ Increasing Men Women Decreasing Increasing . Men Women
Increasing Increasing Increasing Increasing
75 0.6
150 0.4 0.25 0.28 71 0.64 0.36 0.39
..... 136 0.44 68 0.88
, 0.48 0.26 0.29 65 0.92 0.37 0.4
125 ’ 0.52 62 0.96
115 0.56 0.28 0.3 60 0.38 0.41
57 1
107 0.29 0.32 52 1.04 0.38 0.42
50 1.08
0.3 0.33 1.2 0.39 0.43

93 0.64 0.32 0.35 0.4 0.44
0.41 0.45

88 I 0.68 0.33 0.36 0.42 0.47
0.44 0.48
78 0.72 0.35 0.38

ACLS Scenarios: Core Concepts for Care-Based Learning (Cummins, 1996)

12-L ECG Indications (Angina or Anginal Equivalents):

¯ Discomfort (nose to navel, shoulder, arm, back)

¯ SOB/HF ¯ GI c/o (nausea, indigestion)
¯ Palpitations ¯ Dysrhythmia (VT/SVT)
¯ Diaphoresis ¯ Dizziness/Syncope ¯ Weak/tired/fatigued

Risk factors:
HTN Smoking Diabetes Cholesterol high Age MI / HF

ISCHEMIA: 12 L CHANGES

Ctavicula \ M id-c~avicular Hyperacute T wave:
\~ lino Lead Placement
(sensitive, not specific, may occur early)

14t~ V1 T wave inversion
ICS - R (flipped - may precede ST elevation)

of sternum ST depression (consider reciprocal changes)

Ant-axillarv line INJURY:
ST elevation (STEMI):
4t~ ICS - L of sternum (>lmm (sm box) in 2 or > corf~juousleads)

V3 INFARCTION:
Midway between V2 & V4
(2 waves (New or old?)
V4 (> 0.04 sec/sm box; >25% height QRS)
5~ ICS Mid-clavicular line

Ant-axillary line, level w/V4 I Lateral Vl Septal V4 Anterior
II Inferior aVL Lateral V2 Septal V5 Lateral
V6 III Inferior aVF Inferior V3 Anterior V6 Lateral
Mid-axillary line, level w/V4

DIANA:12L card

SFVEMSS Full Text 3/11/15 Page 100

APPROVED MEDICAL ABBREVIATIONS D
A
D/C ............................................................................... discontinue
AAA..................................................... abdominal aortic aneurysm
ABC ...................................... Airway, Breathing, Circulation D5W ............................................................. 5% dextrose in water
ACS ..................................................... acute coronary syndromes
ADH ............................................................... antidiuretic hormone DBP .......................................................... diastolic blood pressure
ADL ............................................................. activities of daily living
AED .............................................. automated external defibrillator DCFS ...................... Department of Children and Family Services
A-Fib......................................................... Atrial Fibrillation
AIDS ................................. acquired immune deficiency syndrome Dig ..................................................................................... Digoxin
AIVR......................................... accelerated idioventricular rhythm
ALS ............................................................ Advanced Life Support DIB ................................................................. difaculty in breathing
AMA ............................................................ against medical advice
AMI ...................................................... acute myocardial infarction DKA ............................................................... diabetic ketoacidosis
amp .................................................................................... ampule
AMS ............................................................... altered mental status DM ....................................................................... diabetes mellitus
ANS .................................................... autonomic nervous system
A&O ........................................................................ alert & oriented DNR .................................................................... do not resuscitate
APGAR ............ appearance, pulse, grimace, activity, respirations
Approx ......................................................... approximately DOA ....................................................................... dead on arrival
ARDS ................................... acute respiratory distress syndrome
ASA ...................................................................................... aspirin DOB ............................................................ Date of Birth
ASAP .............................................................. as soon as possible
ATP .................... adenosine triphosphate (body’s energy source) DOE ................................................................ dyspnea on exertion
AV ............................................................................ atrioventricular
AVPU .................. mental status: alert, verbal, pain, unresponsive DT ........................................................................ delirium tremens
AVRT..................................... Atrio ventricular reentry tachycardia
d/t ........................................................................................ due to
B Dx .................................................................................... diagnosis

BBB.................................................... Bundle Branch Block E
bG .............................................................. Blood Glucose
BLS.................................................................... Basic Life Support ECG or EKG ..................................................... electrocardiogram
BM .......................................................... Bowel Movement
BP ........................................................................... blood pressure ECRN ........................................ Emergency Communications RN
BPM or bpm ........................................................ beats per minute
BSA ................................................................... body surface area ED ............................................................. emergency department
BSl .......................................................... body substance isolation
BVM ....................................................................... bag valve mask EDD.................................................... esophageal detector device
EEG ............................................... Electroencephalogram
C EENT............................................. eyes, ears, nose, throat
EJ .......................................................... External Jugular
Ca ...................................................................................... calcium EMS ................................................. Emergency Medical Services
CABG..................................... Coronary Artery Bypass Graft EMS MD ...................................................... EMS Medical Director
CAD .......................................................... coronary artery disease
CC .......................................................................... chief complaint EMSS ................................. Emergency Medical Services System
C-Collar ................................................................... cervical collar EMT-B ............................. Emergency Medical Technician - Basic
CHF............................................ Congestive Head Faliure
cm .................................................................................. centimeter EMT-I.................... Emergency Medical Technician - Intermediate
CMS .................................................. circulation, motor, sensation
CNS ........................................................... central nervous system EMT-P ..................... Emergency Medical Technician - Paramedic
c/o ............................................................................... complains of
CO ...................................................................... carbon monoxide EOMs .................................................... i.. extraocular movements
CO2 ......................................................................... carbon dioxide EOR ............................................................................ end of report
COPD ............................... chronic obstructive pulmonary disease
CP................................................................. Chest Pain ET.............................................................................. endotracheal
CPAP ................................... continuous positive airway pressure
CPR................................................ cardiopulmonary resuscitation ETOH ...................................................... Ethanol Alcohol
CSF ................................................................. cerebral spinal fluid
CSHN ................................ children with special healthcare needs EtCO2 ....................................................... end tidal carbon dioxide
CT/CAT ............................ Computerized Axial Tomography
CV or CVD ................................................ cardiovascular disease ETA .......................................................... estimated time of arrival
CVA ......................................... Cerebral Vascular Accident
F
SFVEMSS Full Text 10/12014
F ....................................................................... Female
FB ............................................................................... foreign body
FiO2 .................................. fraction of inspired 02 (% 02 delivered)

Fr.............................................. french (suction catheter diameter)

Fx, fx ................................................................................... fracture

G

G/GRAV ............................................................. Gravida
GCS ............................................................. Glasgow Coma Score
GERD ....................................... gastro-esophageal reflux disease
GI............................................................................ gastrointestinal
Gm .......................................................................................... gram

GSW....................................................... Gun Shot Wound
gtt .......................................................................................... drops
GU ............................................................................. genitourinary
GYN ............................................................ Gynecology

H

h or hr ...................................................................................... hour

HA ................................................................................. headache
H20 ........................................................................................ water
HCO3 .......................................................................... bicarbonate
HEENT ............................... Head, Eyes, Ears, Nose, Throat
HEPA ............................ high efficiency particulate airborne mask
HF ............................................................................... heart failure
HHN................................................................. hand held nebulizer
HHNS ............ hyperosmolar hyperglycemic nonketotic syndrome
HR ................................................................................... heart rate
HTN ........................................................................... hypertension
Hx ......................................................................................... history

Page97

I O

IBOW ..............................................................i.ntact bag of waters 02 ........................................................................................ oxygen
ICP ................................................................ intracranial pressure
ICU ..................................................... Intensive Care Unit OB ..................................................................................... obstetric
IDPH....................................... Illinois Department of Public Health
IM .............................................................................. intramuscular OD .................................................................... Overdose
IMC .................................................................. Initial Medical Care
IN .................................................................................... intranasal OP/OPA ....................................................... oropharyngeal airway
IO................................................................................ intraosseous
IR ..................................................................................... intrarectal Oriented X 1 ...................................................... oriented to person
ITC................................................................... Initial Trauma Care
IV .................................................................................. intravenous Oriented X 2 ........................................... oriented to person, place
IVF ..................................................................... intravenous fluids
IVP ....................................................................... intravenous push Oriented X 3 .................................. oriented to person, place, time
IVPB .......................................................... intravenous piggy back
IVR ............................................................... idioventricular rhythm Oriented X 4 ....................... oriented to person, place, time, event

J P

J ............................................................................................. joules P ............................................................................................. pulse
JVD........................................................ jugular venous distension
PAC .......................................... Premature Atrial Contraction
K PALS .......................................... Pediatric Advanced Life Support

KED ..................................................... Kendrick extrication device PCN ................................................................... Penicillin
kg ....................................................................................... kilogram pCO2 or PaCO2 ........................ partial pressure of carbon dioxide

L PE ................................................ Pulmonary Embolism
PEA ...................................................... pulseless electrical activity
L ................................................................................................ liter
Ped/Peds ......................................................... Pediatric(s)
LBBB .......................................... Left Bundle Branch Block
lbs ....................................................................................... pounds PEEP .......................................... positive end expiratory pressure
LLQ................................................................... left lower quadrant pH ....................................................... hydrogen ion concentration
L/minute ................................................................ liters per minute
LMP ............................................................... last menstrual period PHRN .............................................. Prehospital Registered Nurse
LOC ............................................................ level of consciousness PID ..................................................... pelvic inflammatory disease
LSB..................................................... Long Spine Board
Lt ............................................................................................... left PMS ............................................................ pulses, motor, sensory
LUQ .................................................................. left upper quadrant
LV ............................................................................... left ventricle PND ............................................... paroxysmal nocturnal dyspnea

M................................................................... Male PO ...................................................................... per os (by mouth)
mA ........................................................... milliamps (pacing) pO2 ....................................................... partial pressure of oxygen
mcg ...................................................................... microgram
mcgtts .................................................................. microdrops PPE ............................................... personal protective equipment
MCI ............................................................ mass casualty incident
MED/MEDS ................................................... Medication(s) PRI ............................................................................. P-R interval
MERCI ................... Medical Emergency Radio Comm. of Illinois prn .......................................................... pro re nata or as needed
mEq .............................................................. milliequivalents
mg ...................................................................... milligram(s) Pt ......................................................................................... patient

min ....................................................................................... minute PTA............................................................. Prior to arrival

mL ................................................. " ........................ milliliter(s) PVC ........................................... premature ventricular contraction
mmHg ............................................... millimeters of mercury
MODS ...................... multiple organ dysfunction syndrome q............................................................................................. every
MOI ................................................................ mechanism of injury
MPI .......................................................... multiple patient incident R
MRI ......................................... Magnetic Resonance Imaging
MVC ............................................................... motor vehicle crash R................................................................................... respirations
RA ..................................................................................... room air
N RBOW ........................................................ ruptured bag of waters
RN ..................................................................... Registered Nurse
NC ............................................................................ nasal cannula R/O ..................................................................................... rule out
NKA/NKDA ........ No Known Allergies/No Known Drug Allergies Rh ........................................................ rhesus factor (blood + or -)
NP/NPA..................................................... nasopharyngeal airway RLQ..................................................... right lower quadrant
NPO .................................................................... nothing by mouth ROM ...................................................................... range of motion
NRM .............................................................. non-rebreather mask ROSC........................................ return of spontaneous circulation
NS ............................................................................. normal saline RR .......................................................................... respiratory rate
NSR ................................................................ normal sinus rhythm RSV ........................................................ respiratory syncytial virus
NTG ........................................................................... nitroglycerine Rt ............................................................................................. right
N/V ....................................................................... nausea/vomiting RTS .............................................................. revised trauma score
NNID ........................................... nausea/vomiting/diarrhea RUQ ............................................................... right upper quadrant

$

SA ............................................................................ sinoatrial node
SBP ........................................................... systolic blood pressure
SCI ...................................................................... spinal cord injury
SIDS .............................................. sudden infant death syndrome
SL ................................................................................... sublingual
SNS ................................................. sympathetic nervous system
SOP/SMO ........... Standard Operating Procedures/Standing Medical Orders
SpO2 ....................................................................... pulse oximetry
S&S ................................................................... signs & symptoms
STD................................................... sexually transmitted disease
Sub-Q ....................................................................... subcutaneous
SVR ................................................. systemic vascular resistance
SVT ................................................... supraventricular tachycardia

SFVEMSS Full Text 10/12014 Page98

T W

T .................................................................................. temperature w/ .............................................................................................. with
TB ................................................................................ tuberculosis WNL ................................................................. within normal limits
TBI ................................................................ traumatic brain injury w/o ....................................................................................... without
TCP................................................ Transcutaneous Pacing WOB ................................................................... work of breathing
TIA ........................................................... transient ischemic attack
TKO........................................................................... to keep open Y
TPN .......................................................... total parenteral nutrition
Tx or Rx ........................................................................... treatment y/o ....................................................................................... year old

U Symbols

URI ....................................................... upper respiratory infection a ............................................................................................. alpha
UTI ................................................................. urinary tract infection @ ................................................................................................. at
I~ .............................................................................................. beta
V o ........................................................................................... degree
# ......................................................................................... number
V-fib or VF ..................................................... ventricular fibrillation 1" or 4, ........................................................ increased or decreased
VS .................................................................................... vital signs
VSD .......................................................... ventricular septal defect >_................................................................. equal to or greater than
V-tach or VT ............................................... ventricular tachycardia < ............. . ......................................................... equal to or less than
VT ................................................................................ tidal volume + ............................................................................. positive or plus

SFVEMSS Full Text 10/12014 Page99

Normal Body Mass Index Obese
Body Weight (pounds)
BMI
Height (inches) Body Weight (pounds)

58
59
60
61
62
63
64
65
66
67
68
69
7O
71
72
73
74
75
76

[ Obese

BMI 39

Height I
(inches)

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

SFVEMSS Ful Text 10/12014 PagelO0

SOB HF/PE AMI COPD Pneumonia
Cough
Sputum ÷ ÷ ÷ ÷
Fever
Sweats -/+ + Cold/clammy + / early am +
Chest pain Frothy (pink) +/- Clear
Chest pain nature Yellow/green
+ Cold/clammy Heavy, tight Almost always
Chest pain duration Varies; ÷
+ Risk
Smoking Hx + Risk usually > 20 min + /Hot
Hype~ension + Risk +/-
+/- + Risk
Cyanosis Good upper/worse +/- Sharp, pleuritic
Gradually worsening,
Air entry to lungs at bases Good
+/- +/- then constant
Wheezing +/-
+ + with HF/
Crackles otherwise clear ÷ +/-
1‘ is a risk factor; 1" is a risk factor;
BP ,1, if severe S&S ,l, if severe S&S Poor Patchy
Must have air entry to wheeze
Tachycardia +/- +/- +/- patchy
Usually unaffected; + patchy; isolated to
,~ if severe S&S
infected lobes
-I-
Usually unaffected

÷

¯ PMH/meds for: CVD, CAD, MI, ¯ Wt gain (tight shoes, belt, watch, rings) ¯ PMH/meds for: asthma, COPD,
¯ Fatigue
HF, HTN, cardiomyopathy, high chronic bronchitis, emphysema,

cholesterol, ICD, bivent, pacing, ¯ Crackles orwheezes smoking (steroids, broncho-dilators,

DM, renal failure, smoking, ¯ Capnograph: square waveform anticholinergics)
¯ Cough: productive - yellow/green
¯ alcoholism ¯ 12-L abnormal (acute MI, AF, ¯ SIS respiratory infection: fever,
Meds: See list on HF SOP p. 21 LVH, ischemia, BBB, "age-

¯ Paroxysmal nocturnal dyspnea undetermined infarct) ¯ chills, rhinorrhea, sore throat
¯ Orthopnea (multiple pillows to sleep) ¯ S3 (3rd heart sound, after lub-dub, ¯ Exposure to known allergen
best heard at apex)
¯ Dyspnea on exertion Capnograph: "sharkfin" waveform

¯ Cough: (non-productive or ¯ JVD, pedal edema (RHF) ¯ Wheezes (initially expiratory)

productive; frothy, clear, white, pink)

Diana: hf-03-08

CPAP

Indications: Alert, intact airway/vent drive: acute pulmonary edema; flail chest; COPD/asthma w/severe distress;
submersion, palliative care

Contraindications
¯ AMS; aspiration risk; inability to clear secretions; questionable ability to protect airway
¯ Need for immediate intubation and/or BVM ventilations, facial burns
¯ Consider intubation if imminent arrest, .1. level of consciousness, severe hypotension, near-apnea, and/or copious

frothy sputum
¯ Unstable respiratory drive; ventilatory failure
¯ Severe hemodynamic or ECG instability (BP < 90 & DBP < 60 mmHg or MAP < 65)
¯ Gastric distention; impaired swallowing, persistent vomiting, active upper GI bleed; possible esophageal rupture
¯ Compromise of thoracic organs (penetrating chest trauma); pneumothorax
¯ Facial anomalies that would complicate CPAP mask seal, epistaxis
¯ Uncooperative pt or those unable to tolerate mask due to extreme anxiety, claustrophobia, or pain
¯ Pregnant

On-going care/monitoring
*Reassess RR/depth & lung sounds, SpO2, capnography q. 3-5 min after CPAP applied

*Reassess VS q. 3-5 min; If BP starts to drop, gradually titrate PEEP from 10 down to 5. If SBP < 90 (MAP <65) remove CPAP.
*Continuously monitor for signs indicating need to D/C CPAP &/or intubate

SFVEMSS Full Text 10/12014 Page101

Weight Dose g = mL Weight Dose g = mL Weight Dose g = mL
6.6 Ibs = 3 kg 1.5 g = 15 mL 9.5 g = 95 mL 77 Ibs = 35 kg 17.5 g / 175 mL
8.8 Ibs = 4 kg 2 g = 20 mL 41.8 Ibs = 19 kg 10 g = 100 mL 79.2 Ibs = 36 kg 18 g = 180 mL
11 Ibs = 5 kg 2.5 g = 25 mL 44 Ibs = 20 kg 10.5 g = 105 mL 81.4 Ibs = 37 kg 18,5 g = 185 mL
13.2 Ibs = 6 kg 3 g = 30 mL 46.2 Ibs = 21 kg 11g=110mL 83,6 Ibs = 38 kg 19 g = 190 mL
15.4 lbs= 7 kg 3.5 g = 35 mL 48.4 Ibs = 22 kg 11.5g= 115mL 85.8 Ibs = 39 kg 19.5 g = 195 mL
17.6 Ibs = 8 kg 4g=40mL 50.6 lbs = 23 kg 12 g = 120 mL 88 Ibs = 40 kg 20 g = 200 mL
19.8 Ibs = 9 kg 4.5 g = 45 mL 52.8 Ibs = 24 kg 12.5 g = 125 mL 90.2 Ibs = 41 kg 20.5 g = 205 mL
22 Ibs = 10 kg 5g=50mL 55 Ibs = 25 kg 13 g = 130 mL 92.4 Ibs = 42 kg 21 g = 210 mL
24.2 Ibs = 11 kg 5.5 g = 55 mL 57,2 Ibs = 26 kg 13.5 g = 135 mL 94,6 Ibs = 43 kg 21,5 g = 215 mL
26.4 Ibs = 12 kg 6 g = 60 mL 59.4 Ibs = 27 kg 14 g = 140 mL 96.8 Ibs = 44 kg 22 g = 220 mL
28.6 Ibs - 13 kg 6.5 g = 65 mL 61.6 Ibs = 28 kg 14.5 g = 145 mL 991bs=45kg 22.5 g = 225 mL
30.8 Ibs = 14 kg 7g=70mL 63,8 lbs = 29 kg 15 g = 150 mL 101.2 Ibs = 46 kg 23 g = 230 mL
33 Ibs = 15 kg 7.5 g = 75 mL 66 Ibs = 30 kg 15.5 g = 155 mL 103.4 Ibs = 47 kg 23.5 g = 235 mL
35.2 Ibs = 16 kg 8 g = 80 mL 68.2 Ibs = 31 kg 16 g = 160 mL 105.6 Ibs = 48 kg 24 g = 240 mL
37.4 Ibs = 17 kg 8.5 g = 85 mL 70.4 Ibs = 32 kg 16.5 g = 165 mL 107.8 Ibs = 49 kg 24.5 g = 245 mL
39.6 Ibs = 18 kg 9g=90mL 72.6 Ibs = 33 kg 17 g = 170 mL 110 Ibs = 50 kg 25 g = 250 mL
74.8 Ibs = 34 kg

ABSENT DECREASED INCREASED

Malfunction Hypothermia Hyperthermia
Shivering
sensor/monitor
Pain
¢" sensor; exhale into

Arrest w/o CPR Shock Cardiac output
Exsanguination Arrest w/CPR Reperfusion after

Pulmonary embolism ROSC
$ Cardiac output

Apnea HYPERventilation HYPOventilation
ETT extubation
ETT obstruction Bronchospasm Resp depression
Esophageal tube Mucus plugging COPD

DIANAcapnotable

SFVEMSS Full Text 10/12014 Page102

Age group Adults Children Infants

CPR sequence CAB - unless hypoxia-related arrest (drowning)
Compression depth
At least 2 inches Atleast V3 AP depth At least ½ AP depth
Chest wall recoil (about 2 inches) (about 1½ inches)
Compression interruptions
Allow complete recoil between compressions

Attempt to limit to < 10 seconds
Ideally, interrupt only for ventilations (until advanced airway placed),

rhythm check & shock delivery

Airway Head tilt, chin lift; if suspected SCI-jaw thrust

Ventilations 1 breath every 5 to 6 sec (10-12 breaths/min)
BEFORE advanced airway Give O2 when available

Defibrillation Attach and use AED or cardiac monitor as soon as available

Minimize interruptions in chest compression before & after shock
Apply pads with chest compressions in progress; continue CPR while defibrillator is charging

Resume CPR beginning w/compressions immediately after each shock

CPR notes:
¯ Pts should not be moved while CPR is progress unless in a dangerous environment or pt is in need of intervention not

immediately available. CPR is better and has fewer interruptions when resuscitation is conducted where the pt. is found.
¯ Continue resuscitation efforts for 20 minutes before moving or seeking order to cease resuscitation.

Weight 0.5 J/kg 1 J/kg 2 J/kg Weight 0.5 J/kg 1 J/kg 2 J/kg

13 Ibs = 6 kg 36 12 62 Ibs = 28 kg 14 28 56
26 Ibs = 12 kg 5 ...........10 20 ! 66 bs~ 30 kg ~5 30 60
35 Ibs = 16 kg 2 64
44 Ibs = 20 kg 12 24 70 Ibs = 32 kg 16
53 Ibs = 24 kg 72
16 32 79 Ibs = 36 kg 18 36 80

10 20 40 88 Ibs = 40 kg 20 40 100

12 24 48 110 Ibs = 50 kg 25 50 Page103

SFVEMSS Full Text 10/12014

01 2 Numeric Pain Rating Scale !I
No pain Mild pain
3 45 6 7 9 10
No pain Distressing pain Unbearable pain

Verbal Rating Scale

Moderate pain Severe pain I

Very severe pain Worst possible pain

Wong-Baker Faces Pain Rating Scale (0-6)

No Hurl Hurts Hurts Hurts Hurts Hurts
Worst
Little Bit Little More Even More Whole Lot

Category 0 1 2
Face No expression or smile Occasional grimace or frown, Frequent to constant quivering
Legs Normal position or relaxed
Activity Lying quietly, normal, moves easily withdrawn, disinterested chin, clenched jaw
Cry No cry (awake or asleep) Uneasy, restless, tense Kicking or legs drawn up

Consolability Content, relaxed Squirming, shifting back & forth, tense Ached, rigid, or jerking
Crying steadily, screams or sobs,
Moans or whispers, occasional complaint
frequent complaints
Reassured by occasional touching, hugging or
being talked or, distractible Difficult to console or comfort

Merkel, S.I. et al. (1997), The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatric Nrs, 23(3), 293-297.

Score

Facial expression: Looking tense, frowning, grimacing, looking frightened

Behavioral Change: 1" confusion, combativeness, refusing to eat, alteration in usual patterns, difficulty sleeping,
increased wandering, decreased social interactions

Physical changes: Skin tears, pressure areas, arthritis, contractures

Assess if pain is acute; chronic; or acute on chronic for this patient

SFVEMSS Full Text 10/12014 Page104