Difference between revisions of "Sepsis Septic Shock"

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==Section 5 -MEDICAL==
 
==Section 5 -MEDICAL==
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===5.18 SUSPECTED KIDNEY STONE===
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===5.19 CYANIDE TOXICITY / POISONING===
  
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[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - Provide [[Oxygen|OXYGEN]] or assist ventilations as appropriate for patient condition. Use vomiting precautions.
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Cyanide Poisoning may result from the inhalation, ingestion or dermal exposure to cyanide containing compounds including smoke from closed space fires. Patients who may have had exposure to or inhalation of smoke from products of combustion must be carefully assessed for the possibility of cyanide poisoning in addition to carbon monoxide.  
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* If age >50, consider Abdominal Aortic Aneurysm etiology
 
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* If hypotension / shock are present, refer to [[Shock|SHOCK PRACTICE PARAMETER]] (5.13).
 
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* For patients with severe vomiting, obtain detailed history, and then administer [[Zofran|ZOFRAN (ONDANSETRON HYDROCHLORIDE)]]:
 
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** Adult: 4mg slow IVP. (Consider diluting in 10-20cc to aid in administering slowly) or 4mg/2ml deep IM in a large muscle.
 
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** Pediatric : Refer to Handtevy System
 
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*Obtain detailed history as to hydration status:
 
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** Dry mucous membranes, tongue
 
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** Sunken eyes
 
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** Urine output
 
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** Multiple episodes of vomiting or diarrhea
 
  
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Cyanide exposure must be considered when a victim with smoke inhalation has one or more of the following:
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* Common Symptoms:
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** Headache
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** Confusion
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** Shortness of Breath
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** Chest Pain or tightness
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** Nausea and/or vomiting
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* Common Signs:
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** Patient has visible soot around the nose, mouth or oropharynx
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** Altered mental status
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** Seizures or coma
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** Dyspnea/Tachypnea
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** Respiratory distress or apnea
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** Hypertension (early sign)
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** Hypotension (late sign)
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** Cardiovascular collapse or cardiac arrest
  
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'''''If PROPERLY hydrated and no suspected dehydration, consider administration of: [[Toradol|TORADOL (KETOLORAC)]] 30mg slow IVP'''''
 
  
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[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - Provide [[Oxygen|OXYGEN]] or assist ventilations as appropriate for patient condition.
 +
* Stabilize the cardiovascular system, ventilations and cardiac compressions as needed.
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* If hypotension / shock are present, refer to [[Shock|SHOCK PRACTICE PARAMETER]] (5.13).
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* For patients with a high index of suspicion of cyanide poisoning administer a [[Cyanokit|Cyanokit]] of 5 grams (two 2.5 gram vials) IV/IO over 15 minutes.
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** Refer to Handtevy WMD Page for Pediatrics.
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** Dilute / prepare the [[Cyanokit|Cyanokit]] product as per manufacturer instructions.
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** Use of Cyanocobalamin, hydroxocobalamin or related compound is contraindicated in patients with known anaphylactic reactions to these products.
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* If severe symptoms persist after the administration of the first dose of the [[Cyanokit|Cyanokit]] consider administering an additional 5 gram dose of [[Cyanokit|Cyanokit]] over 15 minutes.
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* Monitor for signs of hypertension, nausea and / or vomiting.
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* Transport the patient to the closest facility with hyperbaric capabilities.
  
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'''''For Pain Management: Refer to [[Analgesia and Sedation|ANALGESIA/SEDATION PRACTICE PARAMETERS]] (2.04) [[Morphine_Sulfate|MORPHINE]] 2-20 mg (IV,IO, IN, IM), titrated to effect'''''
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[[Category:Medical|0519]]
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If patient presents with:
 
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* Possible dehydration
 
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* History of renal impairment
 
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* Current renal impairment
 
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Fluid Bolus, 200-300cc NS followed by [[Toradol|TORADOL (KETOROLAC)]] 15mg slow IVP. Administer nothing by mouth.
 
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[[Category:Medical|0518]]
 

Revision as of 07:14, 13 November 2020

Section 5 -MEDICAL

5.19 CYANIDE TOXICITY / POISONING

Cyanide Poisoning may result from the inhalation, ingestion or dermal exposure to cyanide containing compounds including smoke from closed space fires. Patients who may have had exposure to or inhalation of smoke from products of combustion must be carefully assessed for the possibility of cyanide poisoning in addition to carbon monoxide.

Cyanide exposure must be considered when a victim with smoke inhalation has one or more of the following:

  • Common Symptoms:
    • Headache
    • Confusion
    • Shortness of Breath
    • Chest Pain or tightness
    • Nausea and/or vomiting
  • Common Signs:
    • Patient has visible soot around the nose, mouth or oropharynx
    • Altered mental status
    • Seizures or coma
    • Dyspnea/Tachypnea
    • Respiratory distress or apnea
    • Hypertension (early sign)
    • Hypotension (late sign)
    • Cardiovascular collapse or cardiac arrest


INITIAL MEDICAL CARE (2.01) - Provide OXYGEN or assist ventilations as appropriate for patient condition.

  • Stabilize the cardiovascular system, ventilations and cardiac compressions as needed.
  • If hypotension / shock are present, refer to SHOCK PRACTICE PARAMETER (5.13).
  • For patients with a high index of suspicion of cyanide poisoning administer a Cyanokit of 5 grams (two 2.5 gram vials) IV/IO over 15 minutes.
    • Refer to Handtevy WMD Page for Pediatrics.
    • Dilute / prepare the Cyanokit product as per manufacturer instructions.
    • Use of Cyanocobalamin, hydroxocobalamin or related compound is contraindicated in patients with known anaphylactic reactions to these products.
  • If severe symptoms persist after the administration of the first dose of the Cyanokit consider administering an additional 5 gram dose of Cyanokit over 15 minutes.
  • Monitor for signs of hypertension, nausea and / or vomiting.
  • Transport the patient to the closest facility with hyperbaric capabilities.
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