EMR - AHASTI Final
ASA (Aspirin) - Medication - ANS-Dose: 1 x 325 mg OR 2 x 81 mg
Indication: Ischemic chest pain (Angina or MI)
Contraindications: Allergy, Bleeding disorder, unconscious, asthma with past history of
sensitivity
Side Effects: GI Upset, Heartburn, N/V
How to administer: Chewed and swallowed
MAX 1 DOSE
Salbutamol (Ventolin) - Medication - ANS-Dose: 100 msg/ spray (puff)
Indications: severe bronchospasm due to chronic bronchitis or shortness of breath due
to asthma
Contraindications: Allergic to salbutamol
Side Effects: Muscle tremors, Transient muscle cramps, Tachycardia, Nervousness,
N/V, Headache, Heart palpitations
How to administer: Assist pt. Shake canister, inhale and hold for 5-10 sec. Repeat PRN
every 30-60 sec as needed
Ipratropium Bromide (Atrovent) - Medication - ANS-Dose: 20 msg/ spray (puff)
Indications: Severe bronchospasm due to chronic bronchitis or shortness of breath due
to asthma
Contraindications: Allergy to Ipratropium Bromide or atropine. Allergy to soy lethicin or
related food products (soybean/ peanuts)
Side Effects: Muscle tremors, Transient muscle cramps, Tachycardia, Nervousness,
N/V, Heart palpitations, Headache
How to Administer: Pt. assist. Shake container. Inhale, hold for 5-10 sec. Repeat every
30-60 sec as needed.
Epinephrine (Adrenalin) - Medication - ANS-Dose: 0.3 mg IM (later aspect of thigh)
Indications: Anaphylaxis
Contraindications: None in emergent setting
Side Effects: Headache, Anxiety, Heart Palpitations, Angina, N/V, Cardiac Arrhythmias,
Acute hypertension, Pallor, Shortness of breath
How to administer: Pt. Assist, Should be administered in lateral aspect of thigh @ 90
degree angle. Hold for 10 sec and rub.
Oral Glucose - Medication - ANS-Dose: 25 g
,Indications: S/S of hypoglycemia w/ BGL less than 3.8 mmol/L
Contraindications: Unconscious, Patient unable to follow commands, Hyperglycemia
Side Effects: N/V
How to administer: Must be swallowed. Tongue depressor can be used. Repeat once
every 5 min if needed. MAX DOSE 50 g
Naloxone (Narcan) - Medication - ANS-Dose: 0.8 mg IM OR 2 mg IN (1 mg each nare)
Indication: Suspected opiate overdose
Contraindications: Hypersensitivity
Side Effects: Anger/ Agitation, Sweating, N/V, Anxiety, Confusion
How to administer: IM every 5 min in lateral aspect of thigh to MAX of 3.2 mg;
IN every 3-5 min to MAX of 4 mg
Nitrous Oxide (Entonox) - NOT IN SCOPE - Medication - ANS-Dose: self administer
Indications: Pain due to burns, musculoskeletal injuries, fractures, child birth
Contraindications: Unable to follow directions, intoxication, her and/or altered LOC,
thoracic injury, bowel injury/ abdominal pain
Side Effects: Dizziness, N/V, tingling in fingers, dry mouth
How to administer: pt. assist. Invert tank 3x prior to admin.
Nitroglycerin (Nitrostat) - NOT IN SCOPE - Medication - ANS-Dose: 0.4 mg SL spray
Indications: suspected MI OR Angina
Contraindications: Systolic BP under 100
Viagra w/in last 24 hrs
Cialis w/in last 36 hrs
Levitra w/in last 48 hrs
Side Effects: Lightheadedness, headache, dizziness, N/V, syncope
How to Administer: One prime spray away from pt. Spray one spray under tongue of pt.
Repeat every 5 min until pain level 0.
Impaled Object - CRITICAL INTERVENTION - ANS-1) Delegate immobilization of object
using log cabin dressing (If obstructing airway OR CPR object may be removed - MUST
contact online medical control), 2) Consider transport position that makes sense
Deadly Bleed - CRITICAL INTERVENTION - ANS-1) Expose and examine, 2) Delegate
direct pressure w/ gloved hand (If C-Spine necessary should be manually controlled first
THEN bleeding), 3) Pressure dressing w/ bandage 4) If bleeding not controlled use
tourniquet, 5) Change gloves and continue
, Fracture/ Dislocation - CRITICAL INTERVENTION - ANS-1) Delegate manual
stabilization, 2) Apply split in secondary inspection; A) Check CMS, B) Apply splint
(must extend beyond joint), C) Pad splint, D) Secure above and below fracture, E)
Re-check CMS
Spinal Motion Restriction (SMR) - CRITICAL INTERVENTION - ANS-1) Delegate
manual stabilization PRIOR to introduction, 2) Apply C-Collar, 3) Roll to board, 4) strap
shoulder- hip/ shoulder-hip, 5) Strap hip-knee/ hip-knee, 6) Head blocks and tape, 7)
Release manual C-Spine
Sucking Chest Wound (Alberta) - CRITICAL INTERVENTION - ANS-1) Seal chest
wound w/ gloved hand
2) Delegate partner to cover wound w/ occlusive dressing taped on 3 sides (open side
facing the ground)
3) Re-check for signs of full occlusion - burp as necessary
Eviscerated Organs - CRITICAL INTERVENTION - ANS-1) Expose and examine where
blood is found, 2) Cover organs w/ moist sterile dressing, 3) cover dressing w/ occlusive
dressing taped on all 4 sides, 4) cover pt. w/ blanket
Pelvic Bind - CRITICAL INTERVENTION - ANS-S/S= Crepitus in pelvis
1) Delegate manual stabilization of pelvis, 2) prepare appropriate equipment
3) Place pelvic bind blanket under hips
4) ensure blanket is even on both sides. Twist blanket and pass to partner
5) Pass two more times
6) Flair out blanket and secure w Kelly clamps
**Use scoop if SMR necessary
Intracranial Pressure (ICP/ Cushings Triad) - CRITICAL INTERVENTION - ANS-S/S=
1) Hypertension - BP over 180 systolic (increasing)
2) Bradycardia - Pulse under 60 BPM (decreasing)
3) Cheyne-stokes breathing - Deep/irrgenular breathing w/ periods of apnea
*All 3 must be confirmed to proceed with treatment
Other: Unequal pupils, posturing, dropping GCS in EMR presence, seizures, N/V,
unresponsive
CARE: BVM @ 15 LPM
Elevate head 15-20 degrees
Hyperventilate: Breath every 3 seconds
Flail Chest - CRITICAL INTERVENTION - ANS-S/S = paradoxical chest movement
ASA (Aspirin) - Medication - ANS-Dose: 1 x 325 mg OR 2 x 81 mg
Indication: Ischemic chest pain (Angina or MI)
Contraindications: Allergy, Bleeding disorder, unconscious, asthma with past history of
sensitivity
Side Effects: GI Upset, Heartburn, N/V
How to administer: Chewed and swallowed
MAX 1 DOSE
Salbutamol (Ventolin) - Medication - ANS-Dose: 100 msg/ spray (puff)
Indications: severe bronchospasm due to chronic bronchitis or shortness of breath due
to asthma
Contraindications: Allergic to salbutamol
Side Effects: Muscle tremors, Transient muscle cramps, Tachycardia, Nervousness,
N/V, Headache, Heart palpitations
How to administer: Assist pt. Shake canister, inhale and hold for 5-10 sec. Repeat PRN
every 30-60 sec as needed
Ipratropium Bromide (Atrovent) - Medication - ANS-Dose: 20 msg/ spray (puff)
Indications: Severe bronchospasm due to chronic bronchitis or shortness of breath due
to asthma
Contraindications: Allergy to Ipratropium Bromide or atropine. Allergy to soy lethicin or
related food products (soybean/ peanuts)
Side Effects: Muscle tremors, Transient muscle cramps, Tachycardia, Nervousness,
N/V, Heart palpitations, Headache
How to Administer: Pt. assist. Shake container. Inhale, hold for 5-10 sec. Repeat every
30-60 sec as needed.
Epinephrine (Adrenalin) - Medication - ANS-Dose: 0.3 mg IM (later aspect of thigh)
Indications: Anaphylaxis
Contraindications: None in emergent setting
Side Effects: Headache, Anxiety, Heart Palpitations, Angina, N/V, Cardiac Arrhythmias,
Acute hypertension, Pallor, Shortness of breath
How to administer: Pt. Assist, Should be administered in lateral aspect of thigh @ 90
degree angle. Hold for 10 sec and rub.
Oral Glucose - Medication - ANS-Dose: 25 g
,Indications: S/S of hypoglycemia w/ BGL less than 3.8 mmol/L
Contraindications: Unconscious, Patient unable to follow commands, Hyperglycemia
Side Effects: N/V
How to administer: Must be swallowed. Tongue depressor can be used. Repeat once
every 5 min if needed. MAX DOSE 50 g
Naloxone (Narcan) - Medication - ANS-Dose: 0.8 mg IM OR 2 mg IN (1 mg each nare)
Indication: Suspected opiate overdose
Contraindications: Hypersensitivity
Side Effects: Anger/ Agitation, Sweating, N/V, Anxiety, Confusion
How to administer: IM every 5 min in lateral aspect of thigh to MAX of 3.2 mg;
IN every 3-5 min to MAX of 4 mg
Nitrous Oxide (Entonox) - NOT IN SCOPE - Medication - ANS-Dose: self administer
Indications: Pain due to burns, musculoskeletal injuries, fractures, child birth
Contraindications: Unable to follow directions, intoxication, her and/or altered LOC,
thoracic injury, bowel injury/ abdominal pain
Side Effects: Dizziness, N/V, tingling in fingers, dry mouth
How to administer: pt. assist. Invert tank 3x prior to admin.
Nitroglycerin (Nitrostat) - NOT IN SCOPE - Medication - ANS-Dose: 0.4 mg SL spray
Indications: suspected MI OR Angina
Contraindications: Systolic BP under 100
Viagra w/in last 24 hrs
Cialis w/in last 36 hrs
Levitra w/in last 48 hrs
Side Effects: Lightheadedness, headache, dizziness, N/V, syncope
How to Administer: One prime spray away from pt. Spray one spray under tongue of pt.
Repeat every 5 min until pain level 0.
Impaled Object - CRITICAL INTERVENTION - ANS-1) Delegate immobilization of object
using log cabin dressing (If obstructing airway OR CPR object may be removed - MUST
contact online medical control), 2) Consider transport position that makes sense
Deadly Bleed - CRITICAL INTERVENTION - ANS-1) Expose and examine, 2) Delegate
direct pressure w/ gloved hand (If C-Spine necessary should be manually controlled first
THEN bleeding), 3) Pressure dressing w/ bandage 4) If bleeding not controlled use
tourniquet, 5) Change gloves and continue
, Fracture/ Dislocation - CRITICAL INTERVENTION - ANS-1) Delegate manual
stabilization, 2) Apply split in secondary inspection; A) Check CMS, B) Apply splint
(must extend beyond joint), C) Pad splint, D) Secure above and below fracture, E)
Re-check CMS
Spinal Motion Restriction (SMR) - CRITICAL INTERVENTION - ANS-1) Delegate
manual stabilization PRIOR to introduction, 2) Apply C-Collar, 3) Roll to board, 4) strap
shoulder- hip/ shoulder-hip, 5) Strap hip-knee/ hip-knee, 6) Head blocks and tape, 7)
Release manual C-Spine
Sucking Chest Wound (Alberta) - CRITICAL INTERVENTION - ANS-1) Seal chest
wound w/ gloved hand
2) Delegate partner to cover wound w/ occlusive dressing taped on 3 sides (open side
facing the ground)
3) Re-check for signs of full occlusion - burp as necessary
Eviscerated Organs - CRITICAL INTERVENTION - ANS-1) Expose and examine where
blood is found, 2) Cover organs w/ moist sterile dressing, 3) cover dressing w/ occlusive
dressing taped on all 4 sides, 4) cover pt. w/ blanket
Pelvic Bind - CRITICAL INTERVENTION - ANS-S/S= Crepitus in pelvis
1) Delegate manual stabilization of pelvis, 2) prepare appropriate equipment
3) Place pelvic bind blanket under hips
4) ensure blanket is even on both sides. Twist blanket and pass to partner
5) Pass two more times
6) Flair out blanket and secure w Kelly clamps
**Use scoop if SMR necessary
Intracranial Pressure (ICP/ Cushings Triad) - CRITICAL INTERVENTION - ANS-S/S=
1) Hypertension - BP over 180 systolic (increasing)
2) Bradycardia - Pulse under 60 BPM (decreasing)
3) Cheyne-stokes breathing - Deep/irrgenular breathing w/ periods of apnea
*All 3 must be confirmed to proceed with treatment
Other: Unequal pupils, posturing, dropping GCS in EMR presence, seizures, N/V,
unresponsive
CARE: BVM @ 15 LPM
Elevate head 15-20 degrees
Hyperventilate: Breath every 3 seconds
Flail Chest - CRITICAL INTERVENTION - ANS-S/S = paradoxical chest movement
