Decompression Sickness
Information
Signs and symptoms of decompression sickness include stroke-like signs and symptoms such
as: visual disturbances, AMS, paralysis or weakness, numbness/tingling, bowel/bladder dysfunction. Any patient with these signs and symptoms who has used SCUBA gear or compressed air within a 48-hour period shall be considered a dive emergency, unless it is
certain that the patient has had an unrelated trauma. Divers in cardiac arrest should be transported to the closet ED.
Decompression Sickness
Adult & Pediatric
• Apply high flow oxygen.
• Maintain the EtCO2 between 35-45 mmHg.
• If patient is apneic or obtunded, assist respirations and intubate prn.
• Place the patient in a supine position.
• Treat arrhythmias as per appropriate protocol.
• Consider a tension pneumothorax.
• NORMAL SALINE: 1L bolus
• If patient has SOB, decreased breath sounds or hemoptysis, fluids should be decreased to a KVO rate.
• Transport all patients with suspected decompression sickness to the nearest
emergency department with helipad
• Contact DAN (Diver Alert Network) at (800)662-3637 or (919) 684-4326, for medical consultation as needed.
• MERCY HOSPITAL MIAMI OR ST. MARY’S PALM BEACH
• Consider Air Rescue transport (Max 500 ft. )
Dive History
Try to obtain an accurate history of the dive; i.e., number of dives, depth of dives, interval between dives and type of air mixture in tanks.
Fatal Drowning/ Non-fatal Drowning
- Information
Spinal Motion Restriction: routine stabilization of the cervical spine is not
necessary in the absence of circumstances that suggest a spinal injury occurred, such as: diving, rough surf, vehicle accident with subsequent
submersion, etc.
Fatal Drowning
Adult
• Follow appropriate cardiac arrest protocol.
• Immediate VENTILATION is a priority.
• No drowning victim is to be pronounced dead at the scene if the possibility
of hypothermia exists. Remove patient’s wet clothes, dry, and cover with
blankets.
Non-Fatal Drowning
Adult
• All non-fatal drowning patients must be transported to the hospital.
• Follow appropriate cardiac arrhythmia protocol prn.
• CPAP: (10 cm H2O) for pulmonary edema secondary to near drowning (For
patients greater than 30 kg).
Non-Fatal Drowning
Adult - If patient is hypotensive with clear Lung Sounds.
NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.
Non-Fatal Drowning
Adult - If patient is hypotensive with pulmonary edema
• Cardiogenic Shock protocol
Fatal Drowning
Pediatric
- Follow appropriate cardiac arrest protocol.
- No drowning victim is to be pronounced dead at the scene if the possibility of hypothermia exists. Remove patient’s wet clothes, dry, and cover with blankets.
Non-Fatal Drowning
Pediatric
- All non-fatal drowning patients must be transported to the hospital.
- Follow appropriate cardiac arrhythmia protocol prn.
Non-Fatal Drowning
Pediatric - If patient is hypotensive with clear Lung Sounds
NORMAL SALINE: 20ml/kg bolus IV/IO. May repeat 2x prn. Assess lung
sounds and blood pressure frequently.
Heat Emergencies
Information
Signs & Symptoms of heat stroke include: AMS, seizures, hypotension,
tachycardia, red, hot, flushed skin. Sweating may be absent.
Heat Emergencies
Adult - Heat Cramps & Heat Exhaustion
• Move patient into a shaded or air conditioned area. Remove excessive
clothing.
• Provide ORAL HYDRATION (preferably water) if available.
• Monitor patient for an altered mental status, which may indicate a heat
stroke.
• NORMAL SALINE: 1L IV/IO. Assess lung sounds and blood pressure every
500mL.
Heat Emergencies
Adult - Heat Stroke
- Patients with a heat-related illness associated with an altered mental status should be considered to have heat stroke once all the other possibilities for the AMS have been ruled out (hypoglycemia, drugs/alcohol, trauma, etc.)
- Move patient into the back of the rescue as soon as possible. Decrease the air-conditioning temperature in the patient compartment.
- Obtain a temperature.
Heat Emergencies
Adult - If the patient is hypotensive with a temperature less than 103 Degrees F
NORMAL SALINE: 1L. Assess lung sounds and blood pressure every 500mL.
Heat Emergencies
Adult - If the patient has a temperature of greater than 103 Degrees F ____
Begin Rapid cooling
• Apply ICE PACKS to axilla and groin area. Do not cool to the point of shivering.
• CHILLED NORMAL SALINE: (if available) 1L IV/IO, assess lung sounds and blood pressure every 500mL
IF PATIENT IS SEIZING: follow Seizure protocol
Heat Emergencies
Pediatric - Heat Cramps & Heat Exhaustion
• Move patient into a shaded or air conditioned area. Remove excessive
clothing.
• Provide ORAL HYDRATION (preferably water) if available.
• Monitor patient for an altered mental status, which may indicate a heat
stroke.
• NORMAL SALINE: 20ml/kg bolus IV/IO. May repeat 2x prn. Assess lung sounds
frequently.
Heat Emergencies
Pediatric - Heat Stroke
• Patients with a heat-related illness associated with an altered mental status
should be considered to have heat stroke once all the other possibilities for
the AMShave been ruled out (hypoglycemia, drugs/alcohol, trauma, etc.)
• Move patient into the back of the rescue as soon as possible. Decrease the
air-conditioning temperature in the patient compartment.
• Obtain a temperature.
Heat Emergencies
Pediatric - If the patient is hypotensive with a temperature less than 103 degrees F.
NORMAL SALINE: 20ml/kg bolus IV/IO. May repeat 2x prn. Assess lung sounds
and blood pressure frequently.
Heat Emergencies
Pediatric - If the patient has a temperature of greater than 103 Degrees F ___
Begin Rapid Cooling
• Apply ICE PACKS to axilla and groin area. Do not cool to the point of shivering.
• CHILLED NORMAL SALINE: (If available) 20mL/kg IV/IO. May repeat 2x prn for hypotension. Assess lung sounds and blood pressure frequently.
IF PATIENT IS SEIZING
Follow Seizure Protocol
Bites and Stings
Information
This protocol includes the treatment for snake bites, dog and cat bites, insect stings, and marine animal envenomation and stings.
Florida Poison Information Center may be contacted at 1-800-222-1222
Bites and Stings
Adult
Snake Bites
• Mark area of edema with a pen.
• DO NOT apply ice packs, tourniquets or constrictive bands.
• Remove any constrictive jewelry or clothing.
• If the DEAD snake is on scene, take a picture of the body and head including the eyes with the ePCR device if possible.
• ADULT: If patient is hypotensive, NORMAL SALINE: 1L. Assess lung sounds and blood pressure
every 500mL.
- Benadryl 50mg IV, IO, IM,
- Solu-Medrol 125mg IV, IO, IM
Bites and Stings
Pediatric
Snake Bite
- Mark area of edema with a pen.
- DO NOT apply ice packs, tourniquets or constrictive bands.
- Remove any constrictive jewelry or clothing.
- If the DEAD snake is on scene, take a picture of the body and head including the eyes with the ePCR device if possible.
- If patient is hypotensive, NORMAL SALINE: 20ml/kg bolus IV/IO. May repeat 2x
prn. Assesslung sounds and blood pressure frequently. - Benadryl 1mg/kg IV, IO, IM,
- Solu-Medrol 2mg/kg IV, IO, IM
• Splint any extremity that has received a bite and ensure it remains below the heart.
Bites and Stings
Dog, Cat, and Wild Animal Bites
• Wound care as appropriate (DO NOT use hydrogen peroxide on deep puncture
wounds or wounds exposing fat).
• Clean the wound area with soap and water or sterile water.
• Advise dispatch to contact animal control and the police department for identification
and quarantine of the animal if necessary.
• Consider Pain Management Protocol.
