New Jersey EMS protocols,
in your pocket.

Proximal Humerus IO (infant/child): How to identify the target landmark

Place your palm on the patient's shoulder anteriorly — the area that feels like a 'ball' under your palm is the general target area. This ball can be felt even on obese patients by pushing deeply.

Needle Thoracostomy: Adult Insertion Sites

Two acceptable sites are: (1) the 4th or 5th intercostal space at the mid-axillary line (abduct the arm on the affected side; in males, the 5th ICS is approximately at nipple level; in females, just superior to the mammary fold if nipple is displaced), and (2) the 2nd intercostal space at the midclavicular line (MCL), defined as the midpoint of the clavicle from jugular notch to distal clavicle.

Cricothyroid Membrane: Landmark Location

The cricothyroid membrane is located at the inferior portion of the thyroid cartilage. With the head in neutral position, it is approximately 3 finger widths above the sternal notch. It may be difficult to locate in obese patients.

An EMT responds to a 58-year-old male with chest pain. His O2 saturation is 97% and he is not in respiratory distress. What is the correct approach to oxygen administration per the ACS protocol?

• Apply oxygen at 15 L/min via non-rebreather mask immediately
• Apply oxygen at 2 L/min via nasal cannula as a precaution
• ✓ Do not administer oxygen, as the patient does not meet the criteria of dyspnea, hypoxia, or signs of heart failure
• Administer oxygen only after nitroglycerin is given

The protocol states oxygen should be administered ONLY to patients with dyspnea, hypoxia (O2 saturation <94%), or signs of heart failure, at a rate to keep O2 saturation ≥94%. This patient has an O2 sat of 97% and no respiratory distress, so supplemental oxygen is not indicated.

You are treating a 72-year-old female with weakness, diaphoresis, and nausea. She denies chest pain. According to the protocol, which of the following best explains why ACS should still be suspected?

• ✓ Elderly women rarely present with chest pain and may instead show atypical symptoms such as diaphoresis, weakness, and nausea
• Nausea and diaphoresis are pathognomonic for ACS in all age groups regardless of other symptoms
• The absence of chest pain rules out ACS, so another diagnosis should be sought
• Only male patients present atypically; women always present with classic chest pain

The protocol explicitly states that patients with ACS — especially women, patients with a history of diabetes, and the elderly — may present with atypical signs and symptoms other than chest pain, including diaphoresis, shortness of breath, weakness, syncope, and nausea.