LINK TO TEST
There were a number of changes to the grammar and formatting of the protocols.
Those are important, I suggest you read through those and discover them for yourself.
Congratulations AEMTS! You’ve ascended! You get three new (to here) medications!
Ibuprofen (PO) / Acetaminophen (PO/IV) / Ondansetron (SL/IV/IM)
Ibuprofen
Drug Class
- Nonsteroidal anti-inflammatory drug (NSAID)
- Non-opioid analgesic
- Antipyretic
Mechanism of Action
- Inhibits cyclooxygenase (COX-1 and COX-2) enzymes
- Decreases prostaglandin synthesis
- Reduces pain, inflammation, and fever
- Reversibly inhibits platelet aggregation (less than aspirin)
Contraindications / Precautions
- Known hypersensitivity/allergy to ibuprofen, aspirin, or other NSAIDs
- Active gastrointestinal bleeding or peptic ulcer disease
- Severe renal impairment
- Use during the third trimester of pregnancy
- Use with caution in older adults, dehydration, hypertension, cardiovascular disease, or patients taking anticoagulants (increased risk of bleeding)
Acetaminophen
Drug Class
- Non-opioid analgesic
- Antipyretic
Mechanism of Action
- Acts centrally in the CNS
- Inhibits prostaglandin synthesis (COX pathway in brain)
- Lowers pain perception and reduces fever
- Minimal anti-inflammatory or platelet effect
Contraindications / Precautions
- Severe hepatic impairment or active liver disease
- Known hypersensitivity
- Chronic alcohol use (increased hepatotoxicity risk)
- Setting of shock or overdose (especially suspected Acetaminophen)
Protocols and Dosing for both Ibuprofen and Acetaminophen
Pain Management – Adult / Fever – Adult
EMT
- If able to tolerate oral fluid, consider one of the following:
- Acetaminophen up to 1000 mg
- Ibuprofen up to 400 mg
AEMT
- Acetaminophen 1000 mg IV over 15 minutes
- For fever protocol:
- Normal Saline 500 mL bolus; may repeat once, if lung sounds remain clear (no concerns for pulmonary edema)
Pain Management – Pediatric / Fever – Pediatrics
Ondansetron (Zofran)
Drug Class
- Antiemetic (5-HT₃ serotonin receptor antagonist)
Mechanism of Action
- Selectively blocks serotonin (5-HT₃) receptors centrally in the chemoreceptor trigger zone (CTZ) and peripherally on vagal nerve terminals in the gastrointestinal tract
- Prevents nausea and vomiting by inhibiting serotonin-mediated activation of the vomiting reflex
Contraindications / Precautions
- Use with caution in patients with:
- prolonged QT interval
- electrolyte abnormalities
- congestive heart failure
- those taking other QT-prolonging medications (amiodarone, sotalol, macrolides, fluoroquinolones, haloperidol, quetiapine, citalopram, tricyclics)
Adults:
Pediatrics:
oral acetaminophen and ibuprofen
Pre-Eclampsia and Eclampsia have their own protocol now:
- Pre-eclampsia and eclampsia should be considered in patients presenting after 20 weeks gestation and up to 6 weeks postpartum.
Heat Emergencies
There is now a helpful description of active cooling, this is considered a time critical intervention;
- Begin active, whole-body cooling immediately until their mental status returns, at which time stop cooling efforts. Transport may be delayed if means of active cooling is available. Use any of the following in decreasing order of preference:
- Ice water immersion, cold water immersion, or
- Tarp-Assisted Cold water with Oscillation (TACO), or
- cold water dousing, or
- cold water-soaked towels with ice packs.
New Protocol:
NYS has finally warmed up to the idea of Oxytocin (brand name Pitocin), a synthetic hormone used to induce or strengthen uterine contractions to control bleeding after childbirth.
That doesn’t affect you, however normal fluid resuscitation does.
Tourniquet Conversion
Tourniquet conversion is the process of removing a tourniquet and replacing it with a hemostatic dressing or pressure bandage. The goal is to restore blood flow to the rest of the limb, preventing ischemic tissue damage.
- Tourniquet Conversion may be performed on a non-amputated extremity as follows:
- Apply a pressure dressing to the wound
- Slowly release the windlass and monitor for re-bleeding:
- If re-bleeding occurs, re-tighten the tourniquet
- If no bleeding occurs, release the tourniquet completely but leave in place
- and monitor the dressing for re-bleeding until facility arrival
TL;DR
https://www.health.ny.gov/professionals/ems/pdf/26-03.pdf
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