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FAMILY HEALTH CENTER
Administrative Policy
NO. AC-26
TITLE:
DEPARTMENT:
Patient Emergency Protocol
Clinical
APPROVED BY:
ORIGINATED BY:
Kay Strom
EFFECTIVE DATE:
1/18/07
SUPERSEDES DATE:
10/28/02
PURPOSE:
To provide a standardized process to deal with emergency situations.
POLICY:
FHC will provide consistent, quality care in emergency situations by following a
standardized procedure to CALL 911 (EMERGENCY MEDICAL SERVICES), KEEP
CALM AND START TREATMENT PROMPTLY.
PROCEDURES:
FOR CARDIAC EMERGENCIES
Basic cardiovascular life support techniques will be used for cardiac emergencies.
1. Assess the client’s unresponsiveness by shaking the client and shouting, “Are you
OK?”
2. Call for help and have a nurse or provider call 911 to activate the Emergency
Medical System (EMS).
3. Have a nurse find any available provider in clinic to assess situation and to give
orders until Emergency Medical System arrive.
4. Observe for chest movement. Listen and feel for breaths.
5. If breathing is not detected, open the airway and give two slow breaths.
6. Feel for carotid pulse. If no pulse is detected, begin CPR at a ratio of 2 breaths/30
compressions. Use AED according to directions if indicated.
7. As help arrives, add oxygen, and establish an IV with normal saline.
8. If a patient of Family Health Center’s, assign someone to request the chart from
Health Information Services. The assigned person will make copies of the data base
and the medication sheet for the EMS.
9. Assign someone to complete Medical Screening Examination form with all actions
taken until EMS arrives. Upon arrival of the EMS copy Medical Screening
Examination form give EMS the original and place the copy in Health information
Services to be filed in the patient’s chart.
AC-26-1.3
Policies & Procedures
Patient Emergency Protocol
FAMILY HEALTH CENTER
Administrative Policy:
AC-26
10. Transfer care to EMS staff upon their arrival.
11. Transport to hospital Emergency Department.
FOR TREATMENT OF ACUTE ANAPHYLAXIS
The following steps should be performed as necessary in the order given:
1. KEEP CALM AND START TREATMENT PROMPTLY, AND CALL EMERGENCY
MEDICAL SERVICES (911). If you think the allergic reaction is progressing from the
injection site to involve the whole extremity and perhaps the entire body, DO NOT
WAIT FOR SYMPTOMS TO SUBSIDE. CALL FOR HELP.
2. For severe generalized reactions (shock, laryngeal edema, wheezing, urticaria,
generalized pruritis):
 Administer 0.01 ml/kg aqueous epinephrine hydrochloride 1:1000
SUBCUTANEOUSLY into the limb opposite the injection site (1 kg = 2.2 pounds).
See chart below for dosage by weight.
 Massage area to promote absorption.
 Dosage may be repeated every 20-30 minutes as needed, based on frequent
monitoring of blood pressure and pulse. Frequently, marked tachycardia and
excitability make further administration of the drug unwise.
BODY WEIGHT
Up to 15 lbs.
15 to 25 lbs.
26 to 40 lbs.
41 to 50 lbs.
51 to 60 lbs.
61 to 70 lbs.
71 to 80 lbs.
81 to 100 lbs.
Above 100 lbs.
IF WEIGHT UNKNOWN:
Children 2-6 yrs.
Children 7-12 yrs.
DOSAGE 1:1000 EPINEPHRINE
0.05 ml.
0.10 ml.
0.15 ml.
0.20 ml.
0.25 ml.
0.30 ml.
0.35 ml.
0.40 ml.
0.50 ml.
0.15 ml.
0.20 ml.
3. Tourniquet above the injection site to retard absorption. Do not cut off circulation to
the limb. Check for pulse after applying tourniquet to make sure arterial flow has not
been interrupted.
 IF THE ANTIGEN INJECTION WAS GIVEN SUBCUTANEOUSLY (NOT
INTRAMUSCULARLY), inject an additional dose of epinephrine hydrochloride
1:1000 subcutaneously, locally into the antigen injection site, using a dose of
0.01 ml/kg (up to 0.3 ml). This will slow absorption of the antigen.
4. MAINTAINING AN ADEQUATE AIRWAY ESENTIAL. If at all possible, and if the
patient’s condition warrants, he or she should be transferred immediately by
ambulance to the nearest hospital emergency room.
AC-26-2.3
Policies & Procedures
Patient Emergency Protocol


FAMILY HEALTH CENTER
Administrative Policy:
AC-26
All nurses should be prepared to perform cardiopulmonary resuscitation if
necessary, including external cardiac massage and mouth-to-mask breathing.
The primary concern should be to prepare the patient for transfer to a medical
facility.
Tracheotomy may be required in cases of severe laryngeal edema.
Endotrachael intubation and assisted ventilation may be necessary in severe,
unrelenting bronchospasm. This can only be performed by a licensed physician.
5. Lay the patient flat, with feet elevated, and keep warm with a blanket. If respiratory
difficulty occurs, head and chest may be elevated slightly. Oxygen may be
administered by mask or nasal catheter, and assisted with proper use of AMBU Bag,
attached to 100% 02.
6. If the reaction is life threatening (shock, laryngeal edema, wheezing), after above
treatment has been completed, it may be necessary to administer medications
intravenously. DO NOT BEGIN AN INTRAVENOUS INFUSION OR IV
MEDICATIONS UNLESS INSTRUCTED BY A PHYSICIAN.
7. Inject Benadryl intramuscularly to inhibit the effects of further histamine release.
Benadryl is NOT the primary drug to use in a severe or life-threatening reaction, but
it may shorten the duration of the reaction and prevent relapses.
BODY WEIGHT
15 lbs. or less
16 to 30 lbs.
31 to 110 lbs.
above 110 lbs.
DOSAGE BENADRYL
0.125 ml. (6.25 mg.)
0.25 ml. (12.5 mg.)
0.5 ml. (25 mg.)
1.0 ml. (50mg.)
8. Carefully monitor and record the patient’s condition, including blood pressure, pulse,
respirations, all treatments, and verbal orders on Medical Screening Examination
form. Make a copy for the patient’s chart and give the original to EMS.
This policy and procedure shall be periodically reviewed and updated
consistent with the requirements and standards established by the Board
of Directors and by Health Center management, federal and state law and
regulations, and applicable accrediting and review organization.
AC-26-3.3