Treatment Guidelines

[Statua]

Citizen Hospital

Guidelines for treatment of health ailments.

Out of Character for OOC:

You are not expected to memorize this OOC. You are however expected to follow these guidelines for their specific situations.

In this document, you will find all guidelines outlining how to appropriately treat the specified pathological deficit. They have been organized in relation to the nature of the ailment.

Terms used in this document
LOC: Level of Consciousness
ABC: Airway Breathing Circulation
SAMPLE: Signs and Symptoms, Allergies, Medications, Past Medical History, Last Oral Intake, Events Leading Up to the Problem
OPQRST: Onset, Provocation, Quality, Region/Referral/Radiation, Severity, Time (OPQRST is for Pain)
MOI: Mechanism of Injury (Fall, stabbing, etc)
CMC: Condition, Mobility, Circulation
pt: Patient

General

Spoiler for Hiden:

Vital Signs and Normal Ranges

Spoiler for Hiden:

Pulse (60-100 per minute)
Respirations (12-20 per minute)
Blood Pressure (systolic 100-140) (diastolic 70-90)
SpO2 (>94%)
Temperature (36C-37C)
Pupils (equal, 2mm-4mm)
Skin (Pink and dry)
Blood Glucose (4-9)

Triage


Shock


Unconscious Patient


Airway Obstruction


Dyspnea and Respiratory Distress


Advanced Cardiac Life Support

Patient must have asystole in 2 or more leads and have had no return of spontaneous circulation or neurological function for 20 minutes of ACLS before death may be determined.

Criteria for Amputation

Medical

Out of Character for OOC:

Please refer to THIS guide for pathophysiology and signs and symptoms of medical conditions.

Spoiler for Hiden:

Chest Pain

Spoiler for Hiden:

-Place patient in position of comfort (preferably low or high fowlers)
-Administer high flow oxygen
-Apply cardiac monitor
-Administer nitroglycerine as per protocol
-Administer ASA as per protocol
-Repeat vitals every 5-15 minutes
-Prepare for ACLS
-Do NOT allow the patient to exert him/herself (eg. walking, standing)
-Obtain bloodwork: creatine, troponin, sodium, potassium, complete blood count, prothrombin time
-Obtain 12-Lead ECG
-Obtain Frontal and Lateral chest x-ray
-Based on findings, consider emergency bypass surgery for MI or Heparin administration

Cerebrovascular Accident (Stroke)

Spoiler for Hiden:

-Administer high flow oxygen
-Perform Cincinnati Stroke Test
-Rule out Hypoglycemia
-Rule out seizure or trauma that may have caused stroke symptoms
-Do NOT allow the patient to exert him/herself (eg. walking, standing)
-Obtain head CT to rule out intracranial hemorrhage
-Based on findings, administer Heparin

Intracranial Hemorrhage

Spoiler for Hiden:

-Follow CVA guideline up to ruling out Intracranial Hemorrhage
-Keep Blood pressure below 150 systolic
-Rule out Narcotic Overdose
-Elevate head 30 degrees
-Avoid Valsalva Maneuver (rectal stimulation, holding breath, flexing the neck sideways, extreme hip flexion, moving self/turning to the side)
-Consider emergency neurosurgery

Seizures

Spoiler for Hiden:

-Manage airway
-Administer high flow oxygen
-Protect pt from injury
-Rule out hypoglycemia
-Rule out opiate overdose
-Maintain body temperature
-Position pt on their side after tonic-clonic phase (left lateral recumbant)
-Apply cardiac monitor
-Consider sedatives if status epilepticus (seizure lasting longer then 5 minutes or multiple seizures with no recovery phase)
-Reassure pt
-Resolve possible cause

Aortic Dissection

Spoiler for Hiden:

-Administer high flow oxygen
-Apply cardiac monitor
-Rule out MI with ECG, X-Ray, and Bloodwork
-Chest CT to determine aneurysm
-Consider emergency surgery

Cardiac Tamponade

Spoiler for Hiden:

-Apply cardiac monitor
-Determine fluid buildup with Chest X-Ray and CT
-Perform pericardial drainage procedure

Narcotic Overdose

Spoiler for Hiden:

-Rule out hypoglycemia
-Apply high flow oxygen
-Apply cardiac monitor
-Administer narcan protocol

Other Drug Overdoses

Spoiler for Hiden:

-Manage airway
-Apply cardiac monitor
-Establish IV TKO
-Order bloodwork to determine drugs taken and blood chemistry balances
-Watch for MI (for stimulant overdose)
-Consider counter drugs

Poisoning

Spoiler for Hiden:

-Manage airway
-Apply cardiac monitor
-Establish IV TKO
-Pump stomach contents
-Order bloodwork to determine blood chemistry balances
-Consider counter drugs

Hypoglycemia

Spoiler for Hiden:

-Rule out sepsis or narcotic overdose
-Administer oral glucose if alert
-Else, administer Dextrose and Glucagon as per protocol
-Consider dextrose IV treatment if no signs of improvement

Diabetic Ketoacidosis

Spoiler for Hiden:

-Apply cardiac monitor
-Treat hypokalemia (loss of electrolytes)
-After determining high blood glucose, administer Insulin as per protocol
-Treat dehydration

Hyperosmolar Hyperglycemic Nonketonic Coma

Spoiler for Hiden:

-Apply cardiac monitor
-Treat hypokalemia (loss of electrolytes)
-After determining high blood glucose, administer Insulin as per protocol
-Treat dehydration

Anaphylaxis

Spoiler for Hiden:

-Administer high flow oxygen
-Remove allergy causing substance (ie. stinger still in skin)
-Administer Epinephrine as per anaphylactic protocol
-Administer Salbutamol as per protocol
-Adimister Diphenhydramine as per protocol
-Repeat Epinephrine and Salbutamol as per protocol until pt recovers

Infections

Spoiler for Hiden:

-Rule out any other possible causes
-Administer IV antibiotics
-Schedule daily antibiotic administration for 2 weeks

Tension Pneumothorax

Spoiler for Hiden:

-Administer oxygen
-Apply cardiac monitor
-Landmark 2nd intercostal space at midclavicular line
-Insert 14g IV catheter at landmark
-Attach Heimlich valve assembly to catheter and secure the catheter
-Monitor patient for 24 hours after decompression

Left Sided Congestive Heart Failure

Spoiler for Hiden:

-Administer oxygen
-Apply cardiac monitor
-Sit pt upright
-Establish IV
-Consider nitro, lasix, morphine, and salbutamol
-Consider Heparin or Cardiac Surgery

Right Sided CHF

Spoiler for Hiden:

x

Asthma

Spoiler for Hiden:

-Administer oxygen
-Administer salbutamol
-If pt is critical, administer epinephrine as well

Bronchitis

Spoiler for Hiden:

-Administer oxygen
-Start C-PAP or Bi-PAP if necessary
-IV Access
-Apply monitor
-Consider salbutamol
-Obtain sputum sample or throat swab and check for microorganisms
-If positive, schedule daily salbutamol treatments for 2 weeks
-If immunosuppressed patient, schedule daily antibiotics for 2 weeks as well

Pneumonia

Spoiler for Hiden:

-Administer oxygen
-Obtain chest x-ray
-Obtain sputum sample and check for microorganisms
-If positive, schedule daily antibiotics for 2 weeks

Trauma

Spoiler for Hiden:

Soft Tissue Injuries

Spoiler for Hiden:

-Treat for shock
-Assess distal circulation from wound
-Irrigate wound of all debries
-Disinfect superficial wounds
-Control bleeding
-Stabilize impaled objects
-Reassess circulation
-Consider surgery for gunshot wounds, impaled objects, and damage to internal organs
-Suture wound and administer IV antibiotics
-Schedule IV antibiotics daily for 2 weeks

Amputations

Spoiler for Hiden:

-Treat for shock
-Irrigate wound and salvaged parts of debris
-Control bleeding
-Consider emergency reattachment surgery for salvageable parts
-Else, apply skin grafting procedure and prosthetic part

Fractures

Spoiler for Hiden:

-Treat for shock
-If open, irrigate wound and control bleeding
-Assess distal circulation (treat if absent or consider emergency setting of fracture)
-Immobilize affected part or apply traction if distal circulation absent
-Apply ice
-Reassess distal circulation
-Obtain x-ray of fractured part
-Set fracture (consider surgery if major)
-Cast and immobilize fracture
-Reassess with secondary x-ray

Dislocations

Spoiler for Hiden:

-Assess distal circulation (treat if absent or consider emergency setting of dislocation)
-Immobilize affected joint
-Obtain x-ray of joint
-Set joint and immobilize
-Reassess with secondary x-ray

Spinal Cord Injuries

Spoiler for Hiden:

-C-Spine precautions (c-spine collar)
-Rapid assessment
-Assess pulse, motor, sensation
-Prepare to longboard patient
-Check entire spinal column before/when rolling onto longboard
-Immobilize thorax, abdomen, hips, and head to longboard respectively
-Reassess pms
-Obtain x-ray to determine any fractures
-Treat accordingly

1st Degree Burns

Spoiler for Hiden:

-Stop burning (flush with cool water for several minutes)
-Cover with a dry, sterile dressing

2nd Degree Burns

Spoiler for Hiden:

-Stop burning (flush with cool water for several minutes)
-Elevate to reduce blister forming
-Do not rupture blisters
-Cover with antibiotic cream
-Cover with a wet dressing followed by a dry dressing
-Administer IV fluids
-Pain management

3rd Degree Burns

Spoiler for Hiden:

-Stop burning (flush with cool water for several minutes)
-Cover with antibiotic creme
-Cover with a wet dressing followed by a dry dressing
-Administer IV fluids
-Pain Management
-Consider skin grafting procedure

Chemical Burns

Spoiler for Hiden:

-Remove any affected clothing
-Flush with large amounts of water (brush off powder first if present)
-If in eyes, remove contacts and flush
-Treat burns accordingly

Electrical Burns

Spoiler for Hiden:

-Prepare for cardiac arrest
-Look for entrance and exit wound
-Expect major internal damage
-Treat burns accordingly

Eye Injuries

Spoiler for Hiden:

-Cover with a moist sterile dressing if eye is exposed
-Cover other eye to prevent movement
-Consider ocular surgery

Head Injuries

Spoiler for Hiden:

-Observe changes in LOC
-Watch for intercerebral pressure (cushing reflex: wide pulse pressure, bradycardia, and seizures)
-Prepare for vomiting
-Administer O2
-Reassess every 5 minutes
-Establish IV (25-50ml/hour if hypertensive, 20ml/kg/hour if hypotensive)
-Be aware of hypothermia
-Consider neurosurgery

X

Spoiler for Hiden:

x

Environmental

Spoiler for Hiden:

X

Spoiler for Hiden:

x