ValleyProtocolBook

The Valley Hospital MICU Department Standards of Care

Respiratory Assessment : 1. Full set of ALS vitals (BP, pulse, respirations) 2. Obtain a 12 lead ECG as applicable and necessary. 3. Auscultate bilateral lung sounds 4. Document degree of distress (accessory muscle usage, level of distress) 5. Pulse oximetry reading; preferably pre and post-treatment 6. Assess skin color, temperature and moisture 7. Assess JVD 8. Ascertain past medical history, medications and allergies Intubation: (Subsection of above) 1. Utilize 3-3-2 rule to ascertain feasibility of intubation 2. Obtain and document end-tidal CO2 readings and waveforms for intubated patients 3. A minimum of two end-tidal CO2 readings and wave-form is required a. First: when endotracheal intubation is completed and confirmed b. Second and subsequent: any time the patient is moved during transport including movement to the Emergency Department stretcher (mandatory) 4. Document the confirmation steps taken to confirm the endotracheal tube placement which includes: a. Presence of bilateral breath sounds and chest rise b. Absence of epigastric sounds c. Direct visualization of vocal cords d. End-tidal CO2 readings and waveform

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