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ENVIRONMENTAL EMERGENCIES
A. Call for specialized assistance if indicated. Remove patient from hazardous environment if not jeopardizing EMS personnel. Notify hospital if contamination suspected. B. Airway, O2, ventilate, intubate PRN. C. IV NS, titrate to BP > 90/S. D. Monitor ECG/treat dysrhythmias according to AHA Handbook when appropriate. 1. Adult: albuterol 2.5mg with Atrovent 0.5mg in 3ml NS SVN continuously. 2. Pediatric: Use blow-by if <5 years old.
a. >6 months: albuterol 2.5mg with Atrovent 0.25mg in 3ml
b. <6 months: albuterol 1.25mg with Atrovent 0.25mg in 3ml
B. Monitor Carbon Monoxide (CO) if able and when appropriate. If readings 2. Assure O2 delivery is high flow at 100% for CO readings >5% in a non- 3. Consider CPAP for CO readings in adults >12%. 4. Contact Base Station for possible transport for hyperbaric therapy with CO readings >25% in adults and >15% in children and pregnant women. C. Treat for cyanide poisoning, any person removed from or having high potential unprotected exposure to fire gasses and smoke: 1. Remove the patient from the smoke filled environment. 2. Assure O2 delivery is high flow at 100%. 3. Establish an IV, monitor the cardiac rhythm and administer an MPD approved cyanide poisoning antidote agent (Cyanokit-hydroxocobalamin) if available. B. Remove wet clothing, dry as soon as possible, warm patient by using warm C. Monitor ECG/treat dysrhythmias according to AHA Handbook when appropriate. A. Move to a cool environment, remove clothing. B. Institute cooling measures (fan, mist with water, ice packs) while rapidly A. Remove wet clothing, dry as soon as possible, warm patient by using warm B. Watch for vomiting, prevent aspiration. C. Monitor ECG/treat dysrhythmias according to AHA Handbook when appropriate. A. Transport in horizontal supine position. B. Consider horizontal lateral recumbent if vomiting. C. Consider decompression via hyperbaric chamber. VII. Envenomations (animal/insect bites, stings). A. Identify and retain the source specimen if possible. B. For snake bite: Keep site at heart level or below. Apply a pressure immobilization bandage (i.e. ace bandage) around the entire length of the involved extremity. C. Administer epinephrine for anaphylaxis, (see Shock Emergencies section). D. Diazepam 2 – 10mg IV for muscle spasms. VIII. Organophosphate/Nerve Agent poisoning (symptomatic). A. Decontaminate. Remove clothing. Protect against secondary contamination. 1. If not using the DuoDote/Mark I/NAAK and patient is unresponsive, give atropine 1mg IV every 1 minute, not to exceed 10mg until symptoms clear. a. For mild to moderate symptoms, administer one dose of atropine and b. If signs or symptoms are still present after 5 – 10 minutes (depending on severity), repeat a second dose of atropine and 2-PAM IM. c. If signs or symptoms are still present after 5 – 10 minutes (depending on severity), repeat a third dose of atropine and 2-PAM IM. d. For severe symptoms, administer three doses (sets) of atropine and 2-

Source: http://www.spfrtraining.org/trainingsiteresources/documents_library%5CEnvironmental%20Emergencies%20Protocols.pdf

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THE DRUGS The only consistently tinnitus reducing or alleviating drug has been Lidocaine. Thiswas first observed by Barany (1935). This is a drug with local anaesthetic, anti-arrhythmic and anticonvulsive properties. The effect of this on tinnitus has beenstudied by many especially Shea et al. (1981), Emmett and Shea (1984). Unfortunately this can only be administered intravenously for tinnitus

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