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King County
Paramedic Pocket Guide
2012
King County
Paramedic Pocket Guide
2012
TABLE OF CONTENTS
MEDICATIONS 5
CLINICAL PEARLS 43
STUDIES 50
TELEPHONE NUMBERS 58 T
AB
LE O
F C
ON
TE
NT
S
2
Medications Acetaminophen ............................................ 5 Adenosine (Adenocard) ............................... 6 Albuterol ...................................................... 7 Aminophylline .............................................. 8 Aspirin ......................................................... 9 Atropine ..................................................... 10 Atropine, High-Dose .................................. 11 Cyanide Antidote Kit ................................. 12 Calcium Chloride ....................................... 13 D50 ............................................................ 14 Diastat (Rectal Valium) .............................. 15 Diazepam (Valium) .................................... 16 Diltiazem (Cardizem) ................................. 17 Diphenhydramine (Benadryl) ..................... 18 Epinephrine 1:1000 .................................... 19 Epinephrine 1:10,000 ................................. 20 Etomidate .................................................. 21 Furosemide (Lasix) .................................... 22 Glucagon ................................................... 23 Ipratropium (Atrovent) ................................ 24 Isoproterenol (Isuprel) ................................ 25 Lidocaine ................................................... 26 Magnesium Sulfate .................................... 27 Metoprolol .................................................. 28 Midazolam (Versed) ................................... 29 Morphine .................................................... 30 Naloxone (Narcan) ..................................... 31 Nitroglycerin ............................................... 32 Norepinephrine (Levophed) ....................... 33 Ondansetron (Zofran) ................................ 34 Oxytocin (Pitocin) ....................................... 35 Phenobarbital ............................................ 36
TABLE OF CONTENTS
TA
BL
E O
F C
ON
TE
NT
S
3
Procainamide (Pronestyl) ........................... 37 Promethazine (Phenergan) ........................ 38 Rocuronium (Zemuron) .............................. 39 Sodium Bicarbonate ................................... 40 Succinylcholine (Anectine) ......................... 41 Tetracaine .................................................. 42
Clinical Pearls 12-Lead ECGs ........................................... 43 Diagnosing MI in presence of LBBB ........... 44 WPW (Wolff Parkinson White) ................... 45 A-fib with history of WPW ........................... 45 Brugada’s Syndrome .................................. 45 EKG in PE .................................................. 45 Hyperkalemia ............................................. 46 Hypokalemia .............................................. 46 Hypothermia ............................................... 46 Intraosseous .............................................. 47 APGAR ...................................................... 47 Burns ......................................................... 48 Parkland Formula ....................................... 48 Diabetic meds ............................................ 49 Normal Serum Lab Values ......................... 49 Study Guides ............................................. 50 ROC ALPS ............................................. 50 Lactate Study ......................................... 50 Hypothermia .......................................... 51 Bloodborne Exposure ................................. 52 Airborne Exposure ..................................... 52 MCI Run Card ............................................ 53 Mass Casualty Incident .............................. 54 Glasgow Coma Scale ................................. 55 Medical Plans—Plan A ............................... 56
TABLE OF CONTENTS
TA
BL
E O
F C
ON
TE
NT
S
4
Telephone Numbers ALS Providers ............................................ 58 Ambulance and Other Agencies................. 59 Community Resources ............................... 60 Dispatch Centers ....................................... 62 Emergency Departments ........................... 63 Fire Departments ....................................... 65 WA State EMS. .......................................... 69
ACKNOWLEDGEMENTS Thanks to Betty Hurtado for design and production. Thanks also to KCM1 for their contribution.
AC
KN
OW
LE
DG
EM
EN
TS
TABLE OF CONTENTS
5
MEDICATIONS
ME
DIC
AT
ION
S
—
AC
ET
AM
INO
PH
EN
ACETAMINOPHEN
Peds Dosage 10-15 mg/kg
Follow directions on container
Indications Reduction of fever in children particularly when associated with febrile seizures
Contraindica-tions
Allergy
Side effects Rarely, hypoglycemia
Other
6
MEDICATIONS
ME
DIC
AT
ION
S
—
AD
EN
OS
INE (
AD
EN
OC
AR
D)
ADENOSINE (Adenocard)
Adult Dosage 6 mg rapid IV push. May repeat dose of 12 mg, 12 mg
Peds Dosage 0.1 mg/kg IV push. Repeat dose of 0.2 mg/kg
Indications PSVT
Contraindica-tions
Atrial fibrillation, atrial flutter, VT, WPW
Side effects Hypotension, nausea, vomiting, bradycardia, asystole, broncho-constriction in asthma patients.
Other Adenosine should not be given to treat complex tachycardia of uncertain type. Reduce dosage by half if taking Persantine or Tegretol. Caution with calcium channel blockers, beta blockers. Caution in patients with bronchospasm
7
MEDICATIONS
ME
DIC
AT
ION
S
—
AL
BU
TE
RO
L
ALBUTEROL
Adult Dosage One vial by nebulizer, may be repeated (2.5 mg in 3 ml)
Peds Dosage Half-vial diluted with saline, repeat as needed
Indications Bronchospasm, hyperkalemia
Contraindica-tions
Allergy
Side effects Tachycardia, elevated blood pressure, CNS stimulation
Other Use cautiously in patients with coronary artery disease
8
MEDICATIONS
ME
DIC
AT
ION
S
—
AM
INO
PH
YL
LIN
E
AMINOPHYLLINE
Adult Dosage 6 mg/kg over 20-30 min, not to exceed 25 mg/min. Infusion: 250 mg in 250 ml D5W, at 0.5 to 1 mg/kg/hr
Peds Dosage 6 mg/kg loading. Infusion: 125 mg/ 250 ml D5W
Indications Bronchospasm (asthma, COPD), CHF
Contraindica-
tions
Allergy, hypotension, MI, cardiac dysrhythmia
Side effects Arrhythmias, hypotension, seizures, nausea, vomiting
Other
9
MEDICATIONS
ME
DIC
AT
ION
S
—
AS
PIR
IN
ASPIRIN
Adult Dosage 325 mg - 1 adult or 4 baby aspirin (80 mg) tablets
Peds Dosage Not indicated
Indications Cardiac chest pain. Indicated even when patient takes daily aspirin.
Contraindica-
tions
Allergy, active bleeding
Side effects GI distress, bleeding, dizziness
Other Patient use of coumadin, etc. is not a contraindication
10
MEDICATIONS
ME
DIC
AT
ION
S
—
AT
RO
PIN
E
ATROPINE
Adult Dosage Bradycardia: 0.5 to 1 mg IV (up to 3 mg IV). Asystole: 1 mg up to 3 mg IV. Bronchospasm: 0.4 to 1 mg via ETT or neb. OP Poisoning: 2 mg up to 50 mg as needed
Peds Dosage 0.01 to 0.03 mg/kg IV up to 0.04 mg/kg IV. Bronchospasm: 0.2 mg in neb, one treatment only.
Indications Bradycardia, OP, carbamate poisoning, bronchospasm, prior to intubation in peds patient
Contraindica-
tions
Allergy, denervated heart
Side effects Tachycardia, headache, dry mouth
Other Atropine may be used as an alternative to ipratropium (Atrovent) for bronchospasm
11
MEDICATIONS
ME
DIC
AT
ION
S
—
HIG
H-D
OS
E A
TR
OP
INE
ATROPINE, HIGH-DOSE
Adult Dosage 2 mg IV every 5 to 15 min, Large doses may be required in a severely poisoned patient
Peds Dosage 2 mg IV every 5 to 15 min, Large doses may be required in a severely poisoned patient
Indications OP/carbamate/nerve agent poisoning
Contraindica-
tions
None in the context of the above
Side effects Palpitations, headache, dry mouth, dilated pupils
Other May require continued administration of atropine
12
MEDICATIONS
ME
DIC
AT
ION
S —
CY
AN
IDE K
IT
CYANIDE KIT (Amyl Nitrite And Sodium Thiosulfate)
Adult Dosage Adult: Amyl nitrite: 1 amp broken in 4X4, hold over patient’s nose, 15 seconds on, 15 seconds off, continue while starting IV. Sodium thiosulfate: 12.5 g IV (50 ml -- 1 vial).
Peds Dosage Pediatric: Amyl nitrite: 1 amp broken in 4X4, hold over patient’s nose, 15 seconds on, 15 seconds off, continue while starting IV. Sodium thiosulfate: 1.65 ml/kg up to 50 ml, IV
Indications Cyanide poisoning
Smoke inhalation with presumed cyanide poisoning (sodium thiosulfate only)
Contraindica-
tions
DO NOT use amyl nitrite for suspected CN poisoning from smoke inhalation
Side effects Hypotension, nausea, vomiting
13
MEDICATIONS
ME
DIC
AT
ION
S
—
CA
LC
IUM
CH
LO
RID
E
CALCIUM CHLORIDE
Adult Dosage 500 mg to 1 g (2 to 4 mg/kg) IV for suspected hyperkalemia, 500 mg for magnesium overdose
Peds Dosage 20 mg/kg IV
Indications Suspected hyperkalemia, Ca channel blocker OD, hydrofluoric acid exposure, magnesium overdose
Contraindica-
tions
VF, dig toxicity
Side effects Arrhythmias, hypotension, necrosis at injection site
Other Use separate line for NaHCO3. May need repeated doses for Ca channel blocker OD
14
MEDICATIONS
ME
DIC
AT
ION
S
—
D5
0
D50
Adult Dosage 25 g IV, may repeat once
Peds Dosage D25 should be used in children at 2-4 ml/kg. D10 should be used in neonates at 5-10 ml/kg.
Indications Hypoglycemia
Contraindica-
tions
Intracranial/intraspinal hemorrhage
Side effects Phlebitis/thrombosis at site
Other D25 (children > 1 yr) Dilute D50 1:1 w/LR or D5W D10 (children < 1 yr) Add 12.5 gm (1/2 amp) D50 to bag of D5W
15
MEDICATIONS
ME
DIC
AT
ION
S
—
DIA
ST
AT (
RE
CT
AL V
AL
IUM
)
DIASTAT (Rectal Valium)
Adult Dosage 5 - 10 mg
Peds Dosage < 2 years: 5 mg > 2 years: 5 - 10 mg
Indications Seizures when diazepam would normally be used but IV access is not available
Contraindica-
tions
Allergy
Side effects Hypoventilation, drowsiness, confusion, diarrhea
Other Place patient on side. Insert lubricated applicator tip into rectum, 3 seconds while pushing drug, then 3 seconds before removing applicator, then 3 seconds to hold buttocks together.
16
MEDICATIONS
ME
DIC
AT
ION
S
—
DIA
ZE
PA
M (
VA
LIU
M)
DIAZEPAM (Valium)
Adult Dosage 2.5 to 10 mg IV, repeated as needed
Peds Dosage 0.25 mg/kg IV
Indications Seizures, sedation, alcohol withdrawal
Contraindica-
tions
Allergy
Side effects Hypotension, respiratory depression
Other May be given rectally but Diastat is preferred. Rectal Pediatric dose per
rectum: 0.25 - 0.5 mg/kg maximum of 15 mg.
Adult dose per rectum: 5 -10 mg maximum of 30 mg.
IM administration as a last resort
17
MEDICATIONS
ME
DIC
AT
ION
S
—
DIL
TIA
ZE
M (
CA
RD
IZE
M)
DILTIAZEM (Cardizem)
Adult Dosage 20 mg (0.25 mg/kg) over 2 minutes IV Repeat at 25 mg (0.35 mg/kg) in 15 minutes as needed
Peds Dosage Not indicated
Indications Atrial flutter, atrial fibrillation, SVT
Contraindica-
tions
AV block, CHF, hypotension, VT, history of WPW
Side effects Hypotension, bradycardia, AV block
Other
18
MEDICATIONS
ME
DIC
AT
ION
S
—
DIP
HE
NH
YD
RA
MIN
E (
BE
NA
DR
YL)
DIPHENHYDRAMINE (Benadryl)
Adult Dosage 25-50 mg IV (IM also approved)
Peds Dosage 1 mg/kg IV
Indications Anaphylaxis, allergic reaction, dystonic reaction
Contraindica-
tions
Allergy. Excreted in breast milk; therefore use cautiously if woman is breastfeeding.
Side effects Sedation, headache, palpitations
Other Medications causing dystonic reactions include: Compazine, Haldol, Mellaril, Thorazine, etc. Pregnancy: Class B drug; may be used for serious allergic reactions
19
MEDICATIONS
ME
DIC
AT
ION
S
—
EP
INE
PH
RIN
E 1
:100
0
EPINEPHRINE 1:1000
Adult Dosage 0.3 to 0.5 mg SQ or IM
Peds Dosage 0.01 mg/kg SQ or IM. Neb: 0.01 mg/kg diluted Croup 3 - 5 mg, nebulized over 15 minutes
Indications Anaphylaxis, bronchospasm
Contraindica-
tions
None if anaphylaxis, caution if CAD
Side effects Tachycardia, hypertension, anxiety, headache
Other Nebulized epinephrine may be substituted for racemic epinephrine
20
MEDICATIONS
ME
DIC
AT
ION
S
—
EP
INE
PH
RIN
E 1
:10,0
00
EPINEPHRINE 1:10,000
Adult Dosage Cardiac arrest: 0.5 to 1mg IV every 3 to 5 min (can be given ETT at double the dose if no IV access) Anaphylaxis: 0.3 - 0.5 mg IV
Peds Dosage 0.01 mg/kg. IV Drip: 1 mg in D5W, titrate to effect
Indications VF, VT, asystole, PEA, anaphylaxis
Contraindica-
tions
None
Side effects Tachyarrhythmias, hypertension
Other
21
MEDICATIONS
ME
DIC
AT
ION
S
—
ET
OM
IDA
TE
ETOMIDATE
Adult Dosage 0.1 to 0.3 mg/kg IV (half if elderly or hypotensive). 0.1 mg/kg IV for conscious/deep sedation, administer slowly. One dose only.
Peds Dosage Not indicated in children under ten (10) years except after approval by medical control.
Indications Induction, conscious sedation
Contraindica-
tions
Hypersensitivity, use cautiously in pregnancy
Side effects Myoclonic jerks, pain at site, nausea, vomiting, laryngospasm, transient apnea
Other
22
MEDICATIONS
ME
DIC
AT
ION
S
—
FU
RO
SE
MID
E (
LA
SIX
)
FUROSEMIDE (Lasix)
Adult Dosage 40 - 80 mg IV if not currently taking or double daily dose up to 160 mg IV
Peds Dosage 1 mg/kg
Indications CHF/pulmonary edema, hypertensive crisis, hypertensive head injury
Contraindica-
tions
Dehydration, allergy, eclampsia
Side effects Hypotension
Other
23
MEDICATIONS
ME
DIC
AT
ION
S
—
GL
UC
AG
ON
GLUCAGON
Adult Dosage 1 mg SQ or IM. Second dose: 1 mg if no response. Beta-blocker OD: may require 2 to 10 mg.
Peds Dosage More than 20 kg: 1 mg SQ or IM Less than or equal to 20 kg: 0.5 mg SQ or IM
Indications Hypoglycemia with no IV access. Beta-blocker overdose (consider in calcium channel blocker overdose). Esophageal obstruction
Contraindica-
tions
Allergy, pheochromocytoma
Side effects Nausea, vomiting, diarrhea, hypertension, tachycardia
Other
24
MEDICATIONS
ME
DIC
AT
ION
S
—
IPR
AT
RO
PIU
M (
AT
RO
VE
NT)
IPRATROPIUM (Atrovent)
Adult Dosage 0.5 mg (one unit vial) mixed with one dose albuterol, repeated once
Peds Dosage Same
Indications Bronchospasm
Contraindica-
tions
Allergy
Side effects Tachycardia, CNS stimulation
Other
25
MEDICATIONS
ME
DIC
AT
ION
S
—
ISO
PR
OT
ER
EN
OL (
ISU
PR
EL)
ISOPROTERENOL (Isuprel)
Adult Dosage 1 mg in 250 ml D5W, titrate to effect
Peds Dosage Not indicated
Indications Bradycardia refractory to atropine/pacing; torsade
Contraindica-
tions
Allergy, caution in patients with myocardial infarction
Side effects Tachyarrhythmias, ventricular irritability
Other
26
MEDICATIONS
ME
DIC
AT
ION
S
—
LID
OC
AIN
E
LIDOCAINE
Adult Dosage 1 to 1.5 mg/kg IV with repeat doses of 0.5 to 1 mg/kg up to 3 mg/kg. Drip: 2 - 4 mg/min, reduced if elderly or liver disease
Peds Dosage 1 mg/kg
Indications VF, VT, ventricular ectopy, local anesthetic prior to central line access, etc
Contraindica-
tions
AV blocks, brady/escape rhythms
Side effects Anxiety, nausea, altered LOC, widening of QRS, seizures
Other Premixed bag for lidocaine drip—1 gram/250 ml = 4 mg/ml 60 drops = 1 ml (mini
drip) 2 mg/min = 30 drops/
min = 1 drop every 2 seconds
4 mg/min = 60 drops/min = 1 drop every second
27
MEDICATIONS
ME
DIC
AT
ION
S
—
MA
GN
ES
IUM
SU
LF
AT
E
MAGNESIUM SULFATE
Adult Dosage VF/VT/torsades: 2 g in 10 ml D5W up to 6 g IV Pre-eclampsia: 4 g in 100 ml D5W over 20 min. IV Eclampsia: 4 g over 5 to10 min. IV COPD/asthma: 2 g in 100 ml D5W, over 20 min IV
Peds Dosage Torsades, VF/VT: 25 to 50 mg/kg IV up to 2 gm
Indications VF/VT refractory to lidocaine, procainamide; torsade; eclampsia/ pre-eclampsia; COPD/asthma, V-Tach with tricyclic antidepressant OD, VF or VT from digitalis OD
Contraindica-
tions
AV block, hypocalcemia, renal failure
Side effects Altered LOC, hypotension, arrhythmias, bradycardia/asystole, resp depression, potentiates paralytics
28
MEDICATIONS
METOPROLOL
Adult Dosage 5 mg IV every 5 min up to 15 mg IV (give over 1 - 2 min)
Peds Dosage Not indicated
Indications Acute myocardial infarction, acute coronary syndrome, hypertensive crisis, refractory VT or VF, hyperthyroidism
Contraindica-
tions
Persons with chronic lung disease or asthma. Hypotension and bradycardia (BP<100 systolic, HR<60). Known allergy. Cocaine OD - can elevate BP.
Side effects Bradycardia, hypotension, heart block, CHF, bronchospasm
ME
DIC
AT
ION
S
—
ME
TO
PR
OL
OL
29
MEDICATIONS
ME
DIC
AT
ION
S
—
MID
AZ
OL
AM
(V
ers
ed
)
MIDAZOLAM (Versed)
Adult Dosage 1 - 5mg IV, IO, or IM, titrate to effect (repeat PRN)
Peds Dosage 0.05 - 0.2mg/kg IV,IO,IM, titrate to effect 0.1 – 0.4 mg/kg intranasal, titrate to effect
Indications Conscious sedation, RSI, seizures
Contraindica-
tions
Hypersensitivity, narrow-angle glaucoma
Side effects Hypotension, resp depression, bradycardia, nausea
Other May dilute for more accurate dosing
30
MEDICATIONS
ME
DIC
AT
ION
S
—
MO
RP
HIN
E
MORPHINE
Adult Dosage 2 mg IV increments to desired effect
Peds Dosage 0.05 mg/kg IV increments to desired effect
Indications Pain, pulmonary edema, adjunct to sedation
Contraindica-
tions
Allergy, closed head injury
Side effects Respiratory depression, hypotension, nausea, vomiting, dizziness, altered LOC
Other May pretreat with phenergan to reduce nausea and vomiting. Phenergan potentiates morphine’s effect.
31
MEDICATIONS
ME
DIC
AT
ION
S
—
NA
LO
XO
NE (
NA
RC
AN
)
NALOXONE (Narcan)
Adult Dosage 0.4 mg increments up to 10 mg IV, IM, or ETT. Nasal narcan: 0.8 mg/nostril
Peds Dosage 0.01 mg/kg
Indications Opiate OD
Contraindica-
tions
Allergy
Side effects Withdrawal symptoms, nausea, vomiting, diarrhea Rarely Narcan may precipitate severe hypertension or pulmonary edema.
Other
32
MEDICATIONS
NITROGLYCERIN
Adult Dosage 0.4 mg SL or spray every 3 - 5 min for acute coronary syndrome. May be given more frequently in CHF.
Peds Dosage Not applicable
Indications Acute coronary sydrome CHF/pulmonary edema Esophageal spasm
Contraindica-
tions
Hypotension, Hypertensive crisis related to CNS event. Recent use of Viagra or related meds:
Viagra - 24 hrs Levitra - 24 hrs Cialias - 48 hrs
Side effects Headache, dizziness, hypotension
Other Caution in pts with right ventricular infarct (consider fluid challenge)
ME
DIC
AT
ION
S
—
NIT
RO
GL
YC
ER
IN
33
MEDICATIONS
ME
DIC
AT
ION
S
—
NO
RE
PIN
EP
HR
INE (
LE
VO
PH
ED
)
NOREPINEPHRINE (Levophed)
Adult Dosage 4 to 8 mg in 250 ml D5W IV. Titrate to effect
Peds Dosage Not indicated
Indications Cardiogenic shock, profound hypotension secondary to drug OD, anaphylaxis, spinal shock
Contraindica-
tions
Hypotension due to hypovolemia (use fluid). Caution in pts taking MAOIs, tricyclics
Side effects Arrhythmias, hypertension
Other
34
MEDICATIONS
ME
DIC
AT
ION
S
—
ON
DA
NS
ET
RO
N (
ZO
FR
AN
)
ONDANSETRON (Zofran)
Adult Dosage 4 mg IV or IM (IV given over 2 minutes)
Peds Dosage 6 months to 12 years: 0.1 mg/kg IV or IM to max of 4 mg
Indications Nausea/vomiting
Contraindica-
tions
Hypersensitivity/allergy
Side effects Transient EKG changes (rare)
Other
35
MEDICATIONS
OXYTOCIN (Pitocin)
Adult Dosage 10 units IV or IM, followed by 40 units in 1000 ml Ringers, titrated to effect
Peds Dosage Not applicable
Indications Post-partum hemorrhage
Contraindica-
tions
Placenta not delivered, twin not delivered
Side effects Arrhythmias, increased blood loss, hypotension. Overdosage can cause uterine rupture
Other
ME
DIC
AT
ION
S
—
OX
YT
OC
IN (
PIT
OC
IN)
36
MEDICATIONS
PHENOBARBITAL
Adult Dosage 130 to 260 mg IV
Peds Dosage 10 to 20 mg/kg IV
Indications Seizures
Contraindica-
tions
Allergy, pregnancy
Side effects Decreased LOC, respiratory depression, hypotension
Other
ME
DIC
AT
ION
S
—
PH
EN
OB
AR
BIT
AL
37
MEDICATIONS
ME
DIC
AT
ION
S
—
PR
OC
AIN
AM
IDE (
PR
ON
ES
TY
L)
PROCAINAMIDE (Pronestyl)
Adult Dosage Cardiac arrest: 100 mg increments every 2 minutes up to 500 mg. Perfusing rhythm: 20 mg/min IV up to 17 mg/kg followed by drip of 1 - 4 mg/min.
Peds Dosage Cardiac arrest: Not routinely indicated. Perfusing rhythm: 15 mg/kg infused over 30-60 min not to exceed 20 mg/min. 20 kg Child: 5-10 mg/min IV 40 kg Child: 10-20 mg/min IV 60 kg Child: 20 mg/min IV
Indications VT, VF, or wide-complex tachycardia of unknown origin, WPW
Contraindica-
tions
High degree AV block, bradycardias, torsade, prolonged QT
Side effects Anxiety, nausea, seizures, widening of QRS, hypotension, CNS toxicity
Other Stop if hypotension occurs or if QRS widens by 50%.
38
MEDICATIONS
PROMETHAZINE (Phenergan)
Adult Dosage 12.5 to 25 mg slow IV or IM (recommend thigh or buttocks due to chemical irritation)
Peds Dosage 0.25 mg/kg IV or IM Use caution due to respiratory depression.
Indications Nausea/vomiting
Contraindica-
tions
Decreased LOC, uncomplicated vomiting in children
Side effects Sedation, extra-pyramidal reaction (higher doses), tachycardia, bradycardia, hyperexcitability
Other When administering IV, dilute in LR to equal 10 ml
ME
DIC
AT
ION
S
—
PR
OM
ET
HA
ZIN
E (
PH
EN
ER
GA
N)
39
MEDICATIONS
ME
DIC
AT
ION
S
—
RO
CU
RO
NIU
M (
ZE
MU
RO
N)
ROCURONIUM
(Zemuron)
Adult Dosage Up to 0.5 mg/kg IV. Repeat dosing as required.
Peds Dosage Up to 0.5 mg/kg IV. Repeat dosing as required
Indications Maintain paralysis following intubation
Contraindica-
tions
Allergy
Side effects Prolonged paralysis
Other
40
MEDICATIONS
SODIUM BICARBONATE
Adullt Dosage Cardiac arrest: 1 mEq/kg IV, repeat 0.5 mEq/kg every 10 min. TCA overdose: treat unstable, wide-complex rhythms by titrating to normal rhythm
Peds Dosage 1 to 2 mEq/kg
Indications Acidosis, hyperkalemia, TCA OD
Contraindica-
tions
Alkalosis
Side effects
Other Incompatible with CaCl2, atropine, epinephrine
ME
DIC
AT
ION
S
—
SO
DIU
M B
ICA
RB
ON
AT
E
41
MEDICATIONS
ME
DIC
AT
ION
S
—
SU
CC
INY
LC
HO
LIN
E (
AN
EC
TIN
E)
SUCCINYLCHOLINE (Anectine)
Adult Dosage 1 to 1.5 mg/kg IV
Peds Dosage 1 to 2 mg/kg IV. <2 yrs: 2 mg/kg
Indications Facilitate endotracheal intubation
Contraindica-
tions
Malignant hyperthermia, caution with hyperkalemia, major burns, CVA, glaucoma, eye injury
Side effects Phlebitis/thrombosis at site
Other
42
MEDICATIONS
ME
DIC
AT
ION
S
—
TE
TR
AC
AIN
E
TETRACAINE
Adult Dosage 1 to 2 drops
Peds Dosage 1 to 2 drops
Indications Eye pain (non-penetrating injury)
Contraindica-
tions
Penetrating eye injury (leaking fluid)
Side effects
Other
43
CLINICAL PEARLS
CL
INC
AL P
EA
RL
S —
12-L
ED
EC
GS
12-Lead ECGs Location of Infarct Lateral: I, aVL, V5, V6
Inferior: II, III, aVF
Septal: V1, V2
Anterior: V3, V4
ST segment elevation (1 mm or more)
suggests INFARCT
ST segment depression (1 mm or more)
suggests ISCHEMIA
Flipped T waves suggest ISCHEMIA
Pathologic Q waves (1 mm wide or more)
suggest older infarct
RIGHT VENTRICULAR INFARCTION
Associated with inferior MI
ST elevation in V4R, V5R
Hypotension, JVD
Caution with use of nitroglycerin. Consider
fluid for hypotension
POSTERIOR INFARCTION
Reciprocal changes in V1, V2
Tall R waves
44
CLINICAL PEARLS
CL
INC
AL P
EA
RL
S —
EC
G D
IAG
NO
SIS
Diagnosing MI in presence of LBBB
Increased suspicion if: • ST elevation > 1 mm concordant with QRS • ST depression > 1 mm in V1, V2, V3 • ST elevation > 5 mm discordant with QRS When in doubt, treat as acute ischemia if clinically consistent picture
Distinguishing VT from SVT
Features favoring VT: • AV dissociation (more QRS than P waves) • Older age • History of heart disease/MI
When in doubt, treat for VT!
45
CLINCAL PEARLS
CL
INC
AL P
EA
RL
S —
EC
G D
IAG
NO
SIS
WPW (Wolff Parkinson White) • Short PR • Wide QRS • Delta wave • Prone to SVT
A-fib with history of WPW • Can be extremely fast • Prone to VF • Do not administer diltiazem
(or adenosine) • Procaine or cardioversion is
treatment of choice
Brugada’s Syndrome • May mimic STEMI
Inherited disorder most com-
mon among those from SE Asia
• Characterized by episodes of polymorphic VT, syncope, sudden death.
• EKG at rest may show ST segment elevation in V1 to V3 with RBBB pattern.
EKG in PE S1Q3T3 (high specificity but low sensitivity for pulmonary embolus – only 10% of PEs show)
46
Hyperkalemia • Tall, peaked T waves • Wide QRS (progressing to sine wave) • At risk of asystole, VF • Tx: calcium, bicarb, albuterol
Hypokalemia • Flat T wave • Large U wave • At risk for torsades, VF/VT
Hypothermia • Osborne (J) waves
CLINCAL PEARLS
CL
INC
AL P
EA
RL
S —
EC
G D
IAG
NO
SIS
47
CLINCAL PEARLS
CL
INC
AL P
EA
RL
S —
IN
TR
AO
SS
EO
US,
AP
GA
R
Intraosseous
Pink: pediatric (3 to 30 kg) Blue: adult (40 kg or greater) Yellow: obese, edema
Conscious patient: After starting an IO, administer 2% lidocaine 0.5 mg/kg peds (i.e. 20 kg child = 10mg (0.5cc) 20 to 40 mg (1 to 2 cc) adults Follow lidocaine with 10 cc ringer’s flush
APGAR
1 and 5 minutes
48
CLINICAL PEARLS
CL
INC
AL P
EA
RL
S —
BU
RN
S
Burns
Parkland Formula
% burned X pt wt (kg) X 4 = volume of fluid/24 hrs. Give half in first 8 hrs.
49
Diabetic Meds
Pre-dispose to long-lasting hypoglycemia
Sulfonoureas: Diabinese, Tolinase, Orinase,
Amaryl, Glucotrol/Glipizide, Micronase, Diabeta, Glyburide
Meglitinides: Prandin
Thiazolidinediones: Rezulin, Avandia, Actos
Others (long-lasting hypoglycemia uncommon)
Alpha-glucosidase inhibitors: Precose, Glyset
Biaguanides: Metformin/Glucophage
*when in doubt about disposition, call!
Normal Serum Lab Values
CLINCAL PEARLS
CL
INC
AL P
EA
RL
S —
DIA
BE
TE
S,
LA
B V
AL
UE
S
Potassium (K+) 3.6 - 5.2
Sodium (Na+) 135 - 145
HCO3- (bicarb) 21 - 28
Creatinine (Cr) 0.6 – 1.4
Hemoglobin 12 - 16
Hematocrit 36 - 48
Platelets (Plt) 150k-400k
White count (WBC) 4 - 11
Lactate < 2
ABG (pH/paO2/pCO2) 7.4 / 90 / 40
INR < 1.2 (2 – 3 with coumadin)
50
STUDY GUIDELINES ROC ALPS
Actions
Verbalize for recorder
Is VF present after shock? (may peek)
Epi, flush
1st dose ALPS drug: -- 2 syringes (1 if <100 lbs)
Shock/intubate/more epi as needed
2nd dose ALPS drug if VF
Rescue drug: anything but lido
Stickers on MIRF and ER sheet
Give ER sheet to ER and advise
Call ALPS: 1-800-607-2926
Lactate
Actions
Insert strip into lactate meter
Wick drop of blood from IV (no fingersticks)
DON’T report lactate to ED staff
DO report that pt. is enrolled in study
Call lactate study pager 1-800-607-1879 -- report lactate number
Include Adult trauma to HMC
IV access
Exclude <15 or <50 kg if age
unknown known prisoner
CLINCAL PEARLS
CL
INC
AL P
EA
RL
S —
RO
C A
LP
S &
LA
CT
AT
E S
TU
DY
Include Adult, non-trauma
cardiac arrest VF recurs after 1
or more shocks
Exclude Peds, pregnant, prisoners
DNAR, Opt-out bracelet
Already received lido
Broken syringe
51
STUDY GUIDELINES
Hypothermia
Actions
Insert esophageal probe, record temp
Call HMC for randomization 1-800-462-9826
-- Shockable or non-shockable? -- Transport hospital
Both study groups: Call study nurse: 1-888-210-6779
Include
Non-traumatic adult
cardiac arrest → pulses
Unconscious, temp 34C
or warmer
Exclude
Peds, pregnant,
prisoners
Head bleed
Hypothermia Give 1 L cold NS
Sedate valium 1-5 mg
Give roc .5mg/kg
Record temp
If 33C or warmer, give
2nd L cold saline
Record temp
Record temp at hosp
Control
Use minimal
covers, no active cooling
Record temp at
hosp arrival
CLINCAL PEARLS
CL
INC
AL P
EA
RL
S —
HY
PO
TH
ER
MIA
ST
UD
Y
52
Bloodborne Exposure These steps are time-critical 1. Wash exposed site thoroughly with soap
and water. Flush mucous membranes with water only.
2. Collect 1 red top and 1 lavender top blood tube from the source patient AND retain this blood for exposure testing.
3. Contact MSO-1 Immediately 4. Collect source patient name, address,
phone number, destination hospital and next of kin
5. PEP if appropriate after MD contact
Airborne Exposure For meningitis and TB, collect as much pt information as possible and contact MSO 1 or MSO 10 ASAP.
Meningitis PEP (after MD contact): Cipro. Meningitis has a treatment window of 72
hours after exposure.
CLINCAL PEARLS
CL
INC
AL P
EA
RL
S —
BL
OO
DB
OR
NE &
AIR
BO
RN
E E
XP
OS
UR
E
53
MCI Run Card
CLINCAL PEARLS
CL
INC
AL P
EA
RL
S —
MC
I R
UN
CA
RD
Pati
en
ts
Fir
e U
nit
s
Med
ics
M
SO
T
ran
sp
ort
1-1
0
5 T
ota
l U
nits
2
1
5 A
MB
11
-19
8 T
ota
l U
nits &
MC
I U
nit
3
2
10 A
MB
20
-29
12 T
ota
l U
nits &
MC
I U
nit
4
3
15 A
MB
30
-39
16 T
ota
l U
nits
Zo
ne 5
Task F
orc
e
MC
I U
nit
4
3
20 A
MB
1 M
etr
o B
us
40
-49
16 T
ota
l U
nits
Zo
ne 5
Task F
orc
e
Engin
e S
trik
e T
eam
M
CI U
nit
4 K
ing
1 A
LS
S
trik
e T
eam
3
25 A
MB
1 M
etr
o b
us
50 +
16 T
ota
l U
nits
Zo
ne 5
Task F
orc
e
Zo
ne 1
En
gin
e S
trik
e T
eam
M
CI U
nit
4 K
ing
1 A
LS
S
trik
e T
eam
4
25 A
MB
1 M
etr
o b
us
100
+
16 T
ota
l U
nits
Zo
ne 5
Task F
orc
e
Zo
ne 1
& 6
Engin
e S
trik
e T
eam
M
CI U
nit
Port
MC
I 77
7
4 K
ing
2 A
LS
S
trik
e T
eam
s
4
25 A
MB
2 M
etr
o B
usses
54
CL
INC
AL P
EA
RL
S —
MA
SS C
AS
UA
LT
Y I
NC
IDE
NT
MASS CASUALTY INCIDENT
First arriving medic unit, initial tasks
Activate the DMCC:
HMC: 206-744-3253. Overlake as backup: 425-688-5100 Cause, number of pts, location, special
considerations ( hazmat, multiple burns, etc)
Secure a "Medical" radio channel Medical:
Identify and set up a treatment area close to the transportation corridor
Delineate red, yellow, and green areas as indicated
Control the flow of pts to the transport area
Transport:
Establish transportation corridor Establish ambulance staging Obtain tracking sheets and bands Establish communication with DMCC
55
CL
INC
AL P
EA
RL
S —
GL
AS
GO
W C
OM
A S
CA
LE
Glasgow Coma Scale
for Head Injury
EYE OPENING Spontaneous 4 To loud voice 3 To pain 2 None 1 VERBAL RESPONSE Oriented 5 Confused, disoriented 4 Inappropriate words 3 Incomprehensible sounds 2 None 1 BEST MOTOR RESPONSE Obeys 6 Localizes 5 Withdraws (flexion) 4 Abnormal flexion posturing 3 Extension posturing 2 None 1
56
MEDICAL PLANS Plan A VF/Pulseless VT • Follow BLS guidelines for CPR • Defibrillate when indicated • Sodium bicarb 1 mEq/kg when indicated • Epi 1 mg q 3 to 5 min • Lidocaine 1 to 1.5 mg/kg, second dose
0.5 to 1 mg/kg, third dose same • Procaine 100 mg increments • Start drip 1 to 4 mg/min of appropriate
anti-arrhythmic • If still in VF, MgSO4 2 gm in 10cc LR, up
to 6 gm for torsades
Asystole • Epi 1 mg q 3 to 5 min • Bicarb 1 mEq/kg if indicated
CLINICAL PEARLS
CL
INIC
AL P
EA
RL
S —
PL
AN
A
57
PEA • Epi 1 mg q 3 to 5 min • Atropine 1 mg (repeated to 3 mg) if HR is
less than 60 • Pacing if HR is less than 60 • Bicarb 1 mEq/kg if indicated • Levophed drip titrated to BP • Consider: - Hypovolemia: fluid - Tamponade: centesis - HyperK: bicarb, calcium, albuterol - Overdoses TCA (bicarb) Ca channel blockers (Ca) Beta blockers (glucagon) Pediatric cardiac arrest • Airway management • See Broselow for drug dosages • Epi q 3 to 5 min • If VF, shock at 2 j/kg, up to 4 j/kg • Correct acidosis, hypoxia, hypovolemia,
hypothermia
CLINICAL PEARLS
CL
INIC
AL P
EA
RL
S —
PL
AN
A
58
ALS PROVIDERS
TE
LE
PH
ON
E N
UM
BE
RS —
AL
S P
RO
VID
ER
S
Org
an
izati
on
Ad
dre
ss
Tele
ph
on
e
Belle
vue F
ire D
epart
me
nt
450 1
10th
Avenue N
E
Belle
vue, W
A 9
8004
(425)
452-6
892 (
Phone)
(425)
452-5
287 (
Fa
x)
Harb
orv
iew
Medic
al C
ente
r P
ara
medic
Tra
inin
g
325 N
inth
Avenue
S
eattle
, W
A 9
8104
(206)
521-1
224 (
Phone)
(206)
521-1
215 (
Phone)
Kin
g C
ounty
Medic
One
7064 S
outh
220
th S
treet
#9
Kent, W
A 9
8032
(206)
296-8
550 (
Phone)
(206)
296-0
515 (
Fa
x)
Redm
ond F
ire D
epart
ment
8450 -
161st A
venue N
E
Redm
ond, W
A 9
8052
(425)
556-2
200 (
Phone)
(425)
556-2
227 (
Fa
x)
Seattle
Fire D
epart
ment
Medic
One
325 N
inth
Avenue
Seattle
, W
A 9
8104
(206)
386-1
483 (
Phone)
(206)
386-1
364 (
Fa
x)
Shore
line F
ire D
epart
me
nt
17525 A
uro
ra A
venue N
. S
hore
line, W
A 9
8133
(206)
533-6
500 (
Phone)
(206)
546-5
719 (
Fa
x)
Vashon Isla
nd F
ire &
Rescue
10020 S
W B
ank R
oad
Vashon, W
A 9
8070
-1150
(206)
463-2
405 (
Phone)
(206)
463-2
954 (
Fa
x)
59
TE
LE
PH
ON
E N
UM
BE
RS —
AM
BU
LA
NC
E A
ND
OT
HE
R A
GE
NC
IES
AMBULANCE AND OTHER AGENCIES
Org
an
izati
on
A
dd
ress
T
ele
ph
on
e
Tri-M
ed
Am
bu
lan
ce
18
82
1 E
. V
alle
y H
igh
wa
y
Ke
nt, W
A 9
80
32
(2
06
) 2
43-5
62
2 (
Ph
one
) (4
25
) 4
54-0
20
8 (
Fa
x)
Am
erica
n M
ed
ica
l R
e-
sp
onse
1
30
75 G
ate
wa
y D
rive S
E
Su
ite
10
0
Tu
kw
ila, W
A 9
816
8
(20
6)
44
4-4
44
0 (
Ma
in)
(20
6)
62
3-1
11
1 (
Dis
pa
tch
) (2
06
) 4
44-4
59
9 (
Fa
x)
Th
e B
oe
ing C
om
pan
y
P.O
. B
ox 3
70
7, M
S 1
0-5
1
Se
attle
, W
A 9
81
24
(2
06
) 6
55-7
70
0 (
Ph
one
) (2
06
) 6
55-1
45
4 (
Fa
x)
KC
She
riffs O
ffic
e
Se
arc
h &
Re
scue
Sp
ecia
l O
pera
tio
ns
73
00 P
erim
ete
r R
oa
d S
., R
oom
14
3
Se
attle
, W
A 9
81
08-3
849
(2
06
) 2
96-3
85
3 (
Ph
one
) (2
06
) 2
96-4
27
1 (
Fa
x)
Ru
ral/M
etr
o A
mb
ula
nce
6
40
5 –
218
th S
tree
t S
W
Mt. L
ake T
err
ace
, W
A 9
80
43
(4
25
) 6
72-1
11
1 (
Ph
one
) 1-8
00-9
89-9
993
(4
25
) 7
71-3
89
1 (
Fa
x)
60
COMMUNITY RESOURCES
TE
LE
PH
ON
E N
UM
BE
RS —
CO
MM
UN
ITY R
ES
OU
RC
ES
Ag
en
cy
P
ho
ne N
um
be
r R
easo
n t
o C
all
Crisis
Clin
ic o
f K
ing C
ounty
206-4
61
-3222
(206)
461
-8368 (
Fa
x)
Menta
l health r
esourc
e a
gency
for
concern
ed p
are
nts
, re
latives,
etc
. M
enta
l H
ealth
H
MC
Outp
atie
nt S
erv
ices
HM
C C
om
munity C
are
Lin
e,
C
onsultin
g N
urs
e P
rogra
m
UW
Medic
al C
ente
r C
linic
(206)
731
-3120 (
Fa
x)
(206)
731
-2500
(206)
598
-3300
Menta
lly ill
patie
nts
not serio
us
enough t
o h
ospitaliz
e, but in
need
of
pro
fessio
nal counselin
g
Kin
g C
ounty
EM
S D
ivis
ion
(2
06)
296
-4693
A
dm
inis
tratio
n o
f E
MS
serv
ices
Language B
ank
Am
erican R
ed C
ross
(206)
323
-2345
F
ore
ign la
nguage t
ransla
tio
n
Medic
al E
xam
iner
– K
ing
County
(2
06)
731
-3232
R
eport
expecte
d n
atu
ral death
; re
quest
death
in
vestig
atio
n
61
TE
LE
PH
ON
E N
UM
BE
RS —
CO
MM
UN
ITY R
ES
OU
RC
ES
A
gen
cy
P
ho
ne N
um
be
r R
easo
n t
o C
all
Washin
gto
n P
ois
on C
ente
r 1-8
00
-222-1
222
In
gestio
n o
f substa
nces
Sexual A
ssault
- K
ing C
ounty
Resourc
e C
ente
r -
24 h
r R
esourc
e L
ine
(425)
226
-5062
1-8
88
-998-6
423
Support
for
rape v
ictim
s
Seattle
Menta
l H
ealth
(2
06)
302
-2300
A
ll m
enta
l health s
erv
ices
inclu
din
g 2
4hr
Crisis
Response
Serv
ice
N
ISS
A N
ort
hw
est In
fant
Surv
ival and S
IDS
Alli
ance
(2
06)
548
-9290
S
upport
for
fam
ilies w
ho h
ave
exp
erie
nced a
SID
S d
eath
Dom
estic V
iole
nce H
otlin
es
- K
ing C
ounty
-
Washin
gto
n S
tate
-
Natio
nal
(206)
205
-5555
1-8
00
-562-6
025
1-8
00
-799-7
233
Dom
estic v
iole
nce in
form
atio
n
Kin
g C
ounty
24 h
our
Crisis
Lin
e
(206)
461
-3222
1-8
66
-427-4
747
E
motio
nal, P
hysic
al or
Dru
g
Abuse, S
uic
ide
Natio
nal S
uic
ide P
reventio
n
Lifelin
e
1-8
00
-784-2
433
1-8
00
-273-8
255
S
uic
ide,
em
otio
nal, fam
ily
COMMUNITY RESOURCES
62
TE
LE
PH
ON
E N
UM
BE
RS —
DIS
PA
TC
H C
EN
TE
RS
DISPATCH CENTERS
Airport Communication Center SeaTac International Airport 17801 Pacific Highway South Seattle, WA 98188
Phone: (206) 787-5229 FAX: (206) 787-5167
NORCOM 450 -110th Avenue NE Bellevue, WA 98004
Phone: (425) 577-5656 FAX: (425) 577-5629
Enumclaw Police Department 1705 Wells Enumclaw, WA 98022
Phone: (360) 825-3505 FAX: (360) 825-0184
Seattle Fire Department Dispatch 105 Fifth Avenue South Seattle, WA 98104
Phone: (206) 386-1490 FAX: (206) 684-7276
Valley Communications Center 27519 108th Avenue SE Kent, WA 98030
Phone: (253) 852-2121 FAX: (253) 372-1506
63
TE
LE
PH
ON
E N
UM
BE
RS —
EM
ER
GE
NC
Y D
EP
AR
TM
EN
TS
EMERGENCY DEPARTMENTS H
os
pit
al
Cit
y
Tele
ph
on
e
Do
or
Co
de
Auburn
Regio
nal M
edic
al C
ente
r A
uburn
253-3
33
-2561
Child
ren's
Hospital
Seattle
206-9
87
-2222
St. E
lizabeth
E
num
cla
w
360-8
02
-3208
Everg
reen H
ospital
Kirkla
nd
425-8
99
-1711
Good S
am
arita
n H
ospital
Puyallu
p
253-6
97
-4200
Gro
up H
ealth -
Centr
al
Seattle
206-3
26
-3223
Gro
up H
ealth -
Easts
ide
B
elle
vue
425-5
02
-4120
Harb
orv
iew
Medic
al C
ente
r S
eattle
206-7
44
-4074
Hig
hlin
e C
om
munity H
ospital
Burie
n
206-4
31
-5316
Hig
hlin
e C
om
m.
Hospital -
Riv
ert
on
T
ukw
ila
206-2
48
-4730
Mary
Brid
ge C
hild
ren’s
Hospital
Ta
com
a
253-4
03
-1418
Monro
e V
alle
y H
ospital
Monro
e
360-7
94
-1402
Nort
hw
est
Hospital
Seattle
206-3
68
-1765
Overla
ke H
ospital
Belle
vue
425-6
88
-5100
64
EMERGENCY DEPARTMENTS (CONT.)
TE
LE
PN
ON
E N
UM
BE
RS —
EM
ER
GE
NC
Y D
EP
AR
TM
EN
TS
Pro
vid
ence H
ospital –
Colb
y
Evere
tt
425-2
61
-3000
Pro
vid
ence H
ospital –
Pacific
E
vere
tt
425-2
58
-7555
Snoqualm
ie V
alle
y H
ospital
Snoqualm
ie
425-8
31
-2323
St. C
lare
Hospital
Lakew
ood
253-5
89
-8700
St. F
rancis
Hospital
Fe
dera
l W
ay
253-9
44
-7971
St. J
oseph M
edic
al C
ente
r T
acom
a
253-4
26
-6963
Sw
edis
h H
ospital
Edm
onds
425-6
40
-4682
Sw
edis
h H
ospital -
Balla
rd
Seattle
206-7
81
-6341
Sw
edis
h H
ospital -
Centr
al
Seattle
206-3
86
-2573
Sw
edis
h H
ospital -
Pro
vid
ence
Seattle
206-3
20
-2111
Ta
com
a G
enera
l H
ospital
Ta
com
a
253-4
03
-1050
UW
Medic
al C
ente
r S
eattle
206-5
98
-4000
VA
Puget S
ound H
ealth C
ente
r S
eattle
206-7
62
-1010
Valle
y M
edic
al C
ente
r R
ento
n
206-5
75
-2574
Virgin
ia M
ason H
ospital
Seattle
206-5
83
-6433
65
TE
LE
PH
ON
E N
UM
BE
RS —
FIR
E D
EP
AR
TM
EN
TS
FIRE DEPARTMENTS O
rgan
izati
on
Ad
dre
ss
Tele
ph
on
e
Belle
vue F
ire D
epart
me
nt
450 1
10th
Avenue N
E
Belle
vue, W
A 9
8004
(425)
452-6
892 (
Phone)
(425)
452-5
287 (
Fa
x)
Mounta
in V
iew
Fire &
R
escue, S
tatio
n #
98 (
KC
D
istr
ict #44)
22015 S
E 2
96th
Str
eet
Bla
ck D
iam
ond, W
A 9
8010
(253)
735-0
284 (
Phone)
(253)
735-0
287 (
Fa
x)
Both
ell
Fire &
EM
S
10726 B
eard
sle
e B
lvd.
Both
ell,
WA
9
8011-3
250
(425)
486-1
678 (
Phone)
(425)
486-4
556 (
Fa
x)
Burie
n/N
orm
andy P
ark
Fire
Depart
ment
(KC
FD
#2)
15100 E
ighth
Avenue S
W
Seattle
, W
A 9
8166-2
244
(206)
242-2
040 (
Phone)
(206)
433-6
042 (
Fa
x)
Duvall
Fire D
epart
ment
15600 F
irst A
venue N
E
Duvall,
WA
9
8019
(425)
788-1
625 (
Phone)
(425)
788-0
199 (
Fa
x)
Easts
ide F
ire &
Rescue
175 N
W N
ew
port
Way
Issaquah, W
A 9
8027
(425)
392-3
433 (
Phone)
(425)
313-3
200 (
Phone)
(425)
391-8
764 (
Fa
x)
Enum
cla
w F
ire D
epart
ment
(KC
FD
#28)
1330 W
ells
Str
eet
Enum
cla
w, W
A 9
8022
(360)
825-5
544 (
Phone)
(360)
825-9
442 (
Fa
x)
66
TE
LE
PH
ON
E N
UM
BE
RS —
FIR
E D
EP
AR
TM
EN
TS
FIRE DEPARTMENTS (CONT.)
Org
an
izati
on
Ad
dre
ss
Tele
ph
on
e
Fa
ll C
ity F
ire
Depart
ment
4301 -
334th
Pla
ce S
E
Fa
ll C
ity, W
A 9
8024-0
609
(425)
222-5
841 (
Phone)
(425)
222-4
566 (
Fa
x)
Kin
g C
ounty
Fire D
istr
ict #40
18002 1
08th
Avenue S
E
Rento
n, W
A 9
8055
(425)
255-0
931 (
Phone)
V
oic
e M
ail
for
Deanna
(206)
296-7
742 (
Fa
x)
Kangle
y/P
alm
er
Fire
Depart
ment
(KC
FD
#47)
33536 S
E 3
09
th S
treet
Palm
er,
WA
9
8051
-0206
(360)
886-1
915 (
Phone)
V
oic
e M
ail
for
Anita
Kent F
ire L
ife a
nd S
afe
ty
24611 -
116th
Avenue S
E
Kent, W
A 9
8031
(253)
856-4
300 (
Phone)
(253)
856-6
300 (
Fa
x)
Kin
g C
ounty
Medic
One
7064 S
220
th S
treet
Build
ing #
9
Kent, W
A 9
8032
(206)
296-8
550 (
Phone)
(800)
459-7
544
(206)
296-0
515 (
Fa
x)
Kirkla
nd F
ire
Depart
ment
123 F
ifth
Avenue
Kirkla
nd, W
A 9
8033
(425)
587-3
650 (
Phone)
(425)
587-3
651 (
Fa
x)
67
TE
LE
PH
ON
E N
UM
BE
RS —
FIR
E D
EP
AR
TM
EN
TS
FIRE DEPARTMENTS (CONT.)
Org
an
izati
on
Ad
dre
ss
Tele
ph
on
e
Maple
Valle
y F
ire &
Life
Safe
ty
23775 S
E 2
64
th
Maple
Valle
y, W
A 9
8038
(425)
432-0
200 (
Phone)
(425)
413-2
040 (
Fa
x)
Merc
er
Isla
nd F
ire
Depart
ment
3030 –
78
th S
E
Merc
er
Isla
nd, W
A 9
8040-
2823
(206)
275-7
607 (
Phone)
(206)
275-7
970 (
Fa
x)
Mounta
in V
iew
Fire &
R
escue
32316 –
148
th A
venue S
E
Auburn
, W
A 9
8092
(253)
735-0
284 (
Phone)
(253)
735-0
287 (
Fa
x)
Nort
hshore
Fire
Depart
ment
7220 N
E 1
81st S
treet
Kenm
ore
, W
A 9
8028
(425)
354-1
780 (
Phone)
(425)
354-1
781 (
Fa
x)
Port
of S
eattle
Fire
Depart
ment
2400 S
outh
170
th S
treet
Seattle
, W
A 9
8158
(206)
787-5
327 (
Phone)
(206)
787-4
908 (
Fa
x)
Redm
ond F
ire
Depart
ment
8450 -
161st A
venue N
E
Redm
ond, W
A 9
8052
(425)
556-2
200 (
Phone)
(425)
556-2
227 (
Fa
x)
68
TE
LE
PH
ON
E N
UM
BE
RS —
FIR
E D
EP
AR
TM
EN
TS
FIRE DEPARTMENTS (CONT.) O
rgan
izati
on
Ad
dre
ss
Tele
ph
on
e
Rento
n F
ire a
nd
Em
erg
ency S
erv
ices
1055 S
outh
Gra
dy W
ay, 6th
Flr
Rento
n, W
A 9
8055
(425)
430-7
000 (
Phone)
(425)
430-7
044 (
Fa
x)
SeaT
ac F
ire
Depart
ment
2929 S
outh
200th
Str
eet
SeaT
ac, W
A 9
8198
(206)
973-4
500 (
Phone)
(206)
973-4
529 (
Fa
x)
Seattle
Fire D
epart
ment
301 S
econd A
venue S
outh
S
eattle
, W
A 9
8104
(206)
386-1
400 (
Phone)
(206)
386-1
412 (
Fa
x)
Shore
line F
ire
Depart
ment
17525 A
uro
ra A
venue N
ort
h
Shore
line, W
A 9
8133
(206)
533-6
500 (
Phone)
(206)
546-5
719 (
Fa
x)
Skykom
ish/S
tevens
Pass F
ire D
epart
ment
107 W
est C
ascade H
ighw
ay
Skykom
ish, W
A 9
8288
(360)
677-2
686 (
Phone)
(360)
677-2
574 (
Fa
x)
Skyw
ay/B
ryn M
aw
r/Lakerid
ge F
ire D
epart
. 12424 -
76th
Avenue S
outh
S
eattle
, W
A 9
8178
(206)
772-1
430 (
Phone)
(206)
772-6
095 (
Fa
x)
Snoqualm
ie F
ire D
epart
-m
ent
37600 S
E S
noqualm
ie P
ark
-w
ay
Snoqualm
ie, W
A 9
8065
(425)
888-1
551 (
Phone)
(425)
888-1
513 (
Fa
x)
Snoqualm
ie P
ass F
ire &
R
escue
69802 S
W S
noqualm
ie P
ass
Sum
mit D
rive
Snoqualm
ie P
ass, W
A 9
8068
(425)
434-6
333 (
Phone)
(425)
434-6
355 (
Fa
x)
69
TE
LE
PH
ON
E N
UM
BE
RS —
FIR
E D
EP
AR
TM
EN
TS
FIRE DEPARTMENTS (CONT.) O
rgan
izati
on
Ad
dre
ss
Tele
ph
on
e
South
Kin
g F
ire &
R
escue
31617 F
irst A
venue S
outh
F
edera
l W
ay, W
A 9
8003-5
201
(253)
839-6
234 (
Phone)
(253)
529-7
204 (
Fa
x)
Tu
kw
ila F
ire D
epart
ment
444 A
ndover
Park
E.
Tu
kw
ila, W
A 9
8188
(206)
575-4
404 (
Phone)
(206)
575-4
439 (
Fa
x)
Valle
y R
egio
nal F
ire
Auth
ority
1101 "
D"
Str
eet N
E
Auburn
, W
A 9
8002
(253)
288-5
800 (
Phone)
(253)
288-5
900 (
Fa
x)
Vashon Isla
nd F
ire &
R
escue
10020 S
W B
ank R
oad
Vashon, W
A 9
8070
-1150
(206)
463-2
405 (
Phone)
(206)
463-2
954 (
Fa
x)
Woodin
vill
e F
ire &
R
escue
17718 W
oodin
vill
e-S
nohom
ish
Road N
E
Woodin
vill
e, W
A 9
8072
(425)
483-2
131 (
Phone)
(425)
486-0
361 (
Fa
x)
WA
Sta
te O
ffic
e O
f E
merg
ency M
edic
al
Serv
ice a
nd T
raum
a
Syste
m
P.O
. B
ox 4
7853
Oly
mpia
, W
A 9
8504-7
853
(360)
236-2
800 (
Offic
e)
(360)
236-2
830 (
Fa
x)
Medical Control Hospitals HMC: 206-744-3252 Auburn: 253-872-5688 Evergreen: 425-899-1730 Highline: 206-246-7533 Overlake: 425-688-5100 Northwest: 206-368-1981 St. Francis: 253-874-0456 Other Children’s: 206-987-2222 ME: 206-731-3232 Poison Control: 1-800-709-0911 Studies Hypothermia Randomization: 206-462-9826 Study nurse: 1-888-210-6779 ALPS: 1-800-607-2926 Lactate: 1-800-607-1879
© 2012 King County EMS JANUARY 2012
Medical Control Hospitals HMC: 206-744-3252 Auburn: 253-872-5688 Evergreen: 425-899-1730 Highline: 206-246-7533 Overlake: 425-688-5100 Northwest: 206-368-1981 St. Francis: 253-874-0456 Other Children’s: 206-987-2222 ME: 206-731-3232 Poison Control: 1-800-709-0911 Studies Hypothermia Randomization: 206-462-9826 Study nurse: 1-888-210-6779 ALPS: 1-800-607-2926 Lactate: 1-800-607-1879
© 2012 King County EMS JANUARY 2012
