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LA COUNTY PROTOCOLS FOR 2024 UPDATED STUDY GUIDE.
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LA COUNTY PROTOCOLS FOR 2024 UPDATED STUDY GUIDE.
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LA COUNTY PROTOCOLS FOR 2024 UPDATEDSTUDY GUIDE.
What is 1200.2 - Base Contact?
1200.2 Base Contact required for all children when - less than or equal to 36 months
old except those with no medical complaint or with isolated minor extremity injury,
and critically ill pediatric patients who meet transport guidelines to a PMC, regardless
of provider impression or field treatment rendered.
1200.2 Base contact criteria STILL apply if the patient is - refusing transport AMA,
which includes parents or legal guardians who refuse transport of pediatric patient
1200.2 Base Contact Guidelines with the following provider impressions - 8
CCAARDSS and 4 BCPN for pads
1. Childbirth
2. Cardiac Arrest
3. Anaphylaxis
4. Agitated Delirium
5. Respiratory Failure
6. Dystonic Reaction
7. Shock
8. Stroke
Pads
1. BRUE
2. Chest Pain
3. Pregnancy/Labor
4. Newborn
1200.2 Base Contact required for following provider impressions under the
SPECIFIC CONDITIONS (10) - Specified Conditions is a Catastrophe
1. Medical Device Malfunction
2. Cardiac Dysrhythmia
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,3. ALOC
4. Traumatic Injury
5. Airway Obstruction
6. Seizure
7. Submersion
8. Respiratory Distress
9. Overdose/ Poisoning/ Ingestion
10. Pregnancy Complication
1200.2 Base Contact Specified Condition of Airway Obstruction? (1) - 1) severe
respiratory distress or respiratory arrest
1200.2 Base Contact Specified Condition of ALOC - persistent ALOC of unclear
etiology
1200.2 Base Contact Specified Condition of Cardiac Dysrhythmia (3) - 1) fib w/ RVR
2) Symptomatic bradycardia
3) Wide complex tachycardia
1200.2 Base Contact Specified Condition of Medical Device Malfunction - ventricular
assist device VAD malfunction
1200.2 Base Contact Specified Condition of OD/ Poisoning/ Ingestion - only if
signing AMA
1200.2 Base Contact Specified Condition of Pregnancy Complication (1) - 1) only if
>20 weeks gestation w/ vaginal bleeding
1200.2 Base Contact Specified Condition of Respiratory Distress of any etiology (2) -
1) severe respiratory distress unresponsive to CPAP
2) Unmanageable airway
1200.2 Base Contact Specified Condition of Seizure (2) - 1) pregnant patient
2) Status epileptics
1200.2 Base Contact Specified Condition of Submersion (2) - 1) ALOC
2) Decompression sickness
1200.2 Base Contact Specified Condition of Traumatic Injury (4) - 1) crush syndrome
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, 2) Eye problem, suspected penetrating globe injury
3) Prolonged entrapment >30 minutes
4) Trauma criteria or guidelines met
What is crush syndrome pathophysiology? - 1. As the compression occurs, cells in
the immediate area are quickly damaged.
2. Within the next hour, the pressure continues to decrease circulation to the area.
When this happens, the decrease in oxygen requires the cells needing to switch how
they are able to function. This altered process is called anaerobic metabolism —
which is metabolism without oxygen — and generates large amounts of lactic acid.
With the decrease in oxygen, the cell walls have a harder time containing cell
contents, which begin to leak through the walls because of the increasing wall
permeability.
3. Cells continue to leak, and other cells begin to die. As this happens, their contents
— which can include potassium, myoglobin, purines and other toxic substances —
are dumped from the cells into the surrounding tissues. These contents because
major problems and can kill the patient.
4. These effects are normally isolated to the area involved; it may be a type of
survival factor that allows the patient to remain stable and survive long periods of
time. Rescuers often do not realize that the patient needs treatment before rescue.
5. Once freed and the weight is released, blood flow is returned and all the cell
contents are now spread throughout the body. Without proper treatment, the effects
of these contents are:
Potassium — Potassium is normally kept in balance within the body. However,
excess potassium leaking from the cells will disrupt the conductivity of the heart,
causing arrhythmias or even cardiac arrest.
Myoglobin — Myoglobin can be toxic to the renal tubular cells. Myoglobin can
precipitate in the renal system (kidneys) and obstruct renal flow leading to failure or
rhabdomyolysis [1].
Purines and other toxic substances — can lead to respiratory distress and liver
damage.
6. Depending on the amounts of toxins and chemical
1200.2 Base Contact is required CONCURRENTLY when the following treatments
are initiated - TX CONCURRENT PACT
1. Adenosine in pediatric patients
2. Cardio version
3. push-dose epic
4. TCP transcutaneous pacing
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