bridgeport drugs.txt

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  1. Activated Charcoal
    Absorbant
    OVERDOSE/POISONING [3.08]
    Adult
    • CONTACT MEDICAL DIRECTION
    • 60-100 gms
  2. Activated Charcoal
    Absorbant
    PEDIATRIC OVERDOSE/POISONING [5.15]
    • CONTACT MEDICAL DIRECTION for the following
    • 1 GRAM/KG
  3. Adenosine (Adenocard)
    TACHYCARDIA
    Unstable
    If cardioversion delay & regular SVT

    Adult Dose
    • 6 mg IV bolus over 1-3 seconds followed by 5-10 cc normal saline flush
    • a) May repeat at a dose of 12 mg
  4. Adenosine (Adenocard)
    TACHYCARDIA
    Stable
    Post Amiodarone or Lidocaine pt remains regular Wide Complex tachycardia & remains stable.
    Adult Dose
    • CONSIDER
    • a) 6 mg IV bolus over 1-3 seconds followed by 5-10 cc normal saline flush.
    • b) If no change in 1-2 minutes, repeat 12 mg IV bolus over 1-3 seconds followed by 5-10 cc normal saline flush.
  5. Adenosine (Adenocard)
    PEDIATRIC TACHYCARDIA
    Narrow complex tachycardia (QRS < 0.08 sec) (possible SVT) w/ signs of poor systemic perfusion (lack of peripheral pulses, delayed capillary refill, cold/mottled extremities, altered mental status)
    • CONTACT MEDICAL DIRECTION FOR CONSIDERATION
    • 0.1 mg/kg (max 6mg)
    • 0.2 mg/kg (max 12mg)
  6. Albuterol (Ventolin, Proventil)
    ACUTE RESPIRATORY DISTRESS/BRONCHOSPASM w/ KNOWN (HX ASTHMA, COPD, ANAPHYLAXIS) OR UNKNOWN ITIOLOGY
    Adult & Pedi
    2.5 mg of 0.5% solution in 3cc NS via neb.  May repeat in 10-20 minutes.

    (PEDI - consider blow by if pt woes not tolerate mask)

    (if intubated admin via a neb to ET tube adapter - not directly via ET tube)
  7. Albuterol (Ventolin, Proventil)
    HYPERKALEMIA [2.10]
    Adult & Pedi
    • In no improvement, CONTACT MEDICAL DIRECTION
    • 10-20mg via neb over 15 min
  8. Albuterol (Ventolin, Proventil)
    PEDIATRIC RESPIRATORY DISTRESS / FAILURE [5.10]

    Respiratory Distress of Unknown Etiology w/out Bronchospasm
    • CONTACT MEDICAL DIRECTION FOR CONSIDERATION
    • 2.5 mg OF 0.5% SOLUTION VIA NEB
  9. Albuterol (Ventolin, Proventil)
    PEDIATRIC ANAPHYLAXIS
    respiratory distress and present with bronchospasm
    2.5 mg of 0.5% solution via nebulizer
  10. Amiodarone (Cordorone)
    Antiarrythmic
    CARDIAC ARREST, ROSC, VFIB, VTACH
    Adult
    • 300 mg IV; may repeat at 150 mg
    • if conversion to normal & transport > 15 min consider 1mg/min
    • [150mg in 50cc w/ 60 dropset = 20 gtt/min]
  11. Amiodarone (Cordorone)
    Antiarrythmic
    PEDIATRIC CARDIAC ARREST, ROSC, VFIB, Pulseless VTACH
    • Give an antiarrhythmics during CPR, without a rhythm check.
    • 5 mg/kg. Maximum single dose is 300 mg
    • If no response may repeat 5 mg/kg up to max of 15 mg/kg. Maximum single dose is 300 mg.
  12. Amiodarone (Cordorone)
    Antiarrythmic

    UNSTABLE TACHYCARDIA after unsuccessful CARDIOVERSION [2.06,III,B,5,a]
    Adult
    • 150mg over 10 minutes
    • If conversion occurs and ectopy resumes consider rebolus with 75mg
  13. Amiodarone (Cordorone)
    Antiarrythmic
    UNSTABLE TACHYCARDIA after unsuccessful CARDIOVERSION
    Adult
    150 mg over 10 minutes if conversion occurs and ectopy resumes consider rebolus with 75 mg
  14. Amiodarone (Cordorone)
    Antiarrythmic
    TACHYCARDIA
    Stable
    Mono-morphic VTach
    Adult
    150 mg over 10 min
  15. Amiodarone (Cordorone)
    Antiarrythmic
    UNSTABLE TACHYCARDIA after conversion to normal rhythm w/ Amiodarone & transport time > 15 min
    Adult
    • CONSIDER continuous drip
    • 1 mg/min
    • (150 mg in 50 cc w/ 60 dripset = 20 gtt/min)
  16. Amiodarone (Cordorone)
    Antiarrythmic
    TACHYCARDIA
    Stable
    Mono-morphic VTach
    Adult Dose
    150 mg IV over 10 min
  17. Amiodarone (Cordorone)
    Antiarrythmic
    Pedi Dose - Wide Complex Tachycardia, QRS wide for age > 0.08sec (adequate & poor perfusion)
    5 mg/kg IV over 20-60 min
  18. Amiodarone (Cordorone)
    Antiarrythmic
    Pedi Dose - Cardiac Arrest (pulseless)
    5mg/kg IV/IO
  19. Aspirin (Acetylsalicylic Acid)
    Antiplatelet
    ACUTE CORONARY SYNDROMES
    Dose
    325mg tab or 4 chewable baby PO (81mg per tab)

    Do not admin if taken in last 24 hrs or known allergy.
  20. Atropine (Atropine Sulfate)
    Antimuscarinic, Parasympathetic Blocker, Antichilinergic
    RSI - age < 13 y/o
    • 0.02  mg/kg IV
    • max dose 0.5 mg
    • (if no contraindications - tachydysrhythmias)
  21. Atropine (Atropine Sulfate)
    Antimuscarinic, Parasympathetic Blocker, Antichilinergic
    RSI - PREEXISTING BRADYCARDIA NOT RELATED TO INCREASED ICP
    [NOT IN SHC PROTOCOL]
    • CONSIDER
    • 0.5 - 1.0 mg IV

    • CONTRAINDICATION(S)
    • Tachydysrhythmias
  22. Atropine (Atropine Sulfate)Antimuscarinic, Parasympathetic Blocker, Antichilinergic
    BRADYCARDIA
    Adult
    • 0.5 mg IV bolus
    • May repeat every 3-5 min up to 3 mg if pt remains unstable.

    • CONTRAINDICATION(S)
    • Tachydysrhythmias

    PACE if 2nd degree Type II AV block or complete HB (3rd degree)
  23. Atropine (Atropine Sulfate)
    Antimuscarinic, Parasympathetic Blocker, Antichilinergic
    PEDIATRIC BRADYCARDIA
    (w/ severe cardio-respiratory compromise - poor perfusion, hypotension, respiratory distress)
    • 0.02 mg/kg (minimum dose 0.1 mg) IV/IO/ET. Max single dose of 0.5 mg for child and 1.0 mg for adolescent. Minimum single dose is 0.1 mg.
    • Should be given before epinephrine if suspected increased vagal tone or AV block.

    • CONTRAINDICATION(S)
    • Tachydysrhythmias
  24. Atropine (Atropine Sulfate)
    Antimuscarinic, Parasympathetic Blocker, Antichilinergic
    ORGANOPHOSPATE POISONING
    Adult
    • Consider 2-4 mg IV or IM
    • Repeat every 5-10 min as needed.
    • CONTACT MEDICAL DIRECTION & transport ASAP
  25. Atropine (Atropine Sulfate)
    Antimuscarinic, Parasympathetic Blocker, Antichilinergic
    PEDIATRIC OVERDOSE / POISONING
    organophosphate poisoning (inhaled or exposed)
    • 0.02 mg/kg mg IV, IO or IM.
    • 1. Repeat every 5-10 minutes as needed.
  26. Calcium Chloride
    Electrolyte
    OVERDOSE/POISONING
    CALCIUM CHANNEL BLOCKER OD
    Adult
    • CONTACT MEDICAL DIRECTION
    • 0.5-1 gm IV slow (50 mg/min)

    • If cardiac arrest (med direction not required):
    • 8 mg/kg
  27. Calcium Chloride
    Electrolyte
    PEDIATRIC OVERDOSE/POISONING
    CALCIUM CHANNEL BLOCKER OD
    8 MG/KG SLOW IV (50 mg/min), MAX SINGLE DOSE 1 GM
  28. Calcium Chloride
    Electrolyte
    HYPERKALEMIA
    CARDIAC ARREST(Hs & Ts)

    Adult [2.02/2.03/2.04 (search for Hs&Ts) H1]
    Also BRADYCARDIA [2.07]
    • CONTACT MEDICAL DIRECTION
    • 8 mg/kg
  29. Calcium Chloride
    Electrolyte
    HYPERKALEMIA
    Adult
    If no improvement, CONTACT MEDICAL DIRECTION FOR THE FOLLOWING:

    CALCIUM CHLORIDE (10%): 500 TO 1000 MG (5 TO 10 ML) IV OVER 2 TO 5 MINUTES TO REDUCE THE EFFECTS OF POTASSIUM AT THE MYOCARDIAL CELL MEMBRANE (LOWERS RISK OF VENTRICULAR FIBRILLATION [VF])

    [2.10]
  30. CARDIZEM (diltiazem HCL)
    calcium channel blockers
    TACHYCARDIA
    Afib/Aflutter
    • CONTACT MEDICAL DIRECTION
    • 0.25 MG/KG, SLOWLY, OVER TWO (2) MINUTES, FLUSH WITH SALINE. IF NO CHANGE AFTER 15 MINUTES, REPEAT CARDIZEM 0.35 MG/KG OVER TWO (2) MINUTES FLUSH WITH SALINE. (Contraindicated with Wolfe-Parkinson-White, sick sinus syndrome, second or third degree AV block, and hemodynamically unstable patients).
    • * If Hypotension and/or symptomatic bradycardia occur following admin, give 8 mg/kg of calcium chloride.
  31. CARDIZEM (diltiazem HCL)
    calcium channel blockers
    CONTRAINDICATIONS
    • 1. Wolfe-Parkinson-White
    • 2. sick sinus syndrome
    • 3. 2nd or 3rd degree AV block
    • 4. hemodynamically unstable pt's
  32. Cardioversion, Synchronized
    TACHYCARDIA - UNSTABLE
    (mono-morphic v-tach)
    Adult - Narrow Regular
    • 1st dose 60J
    • 2nd dose if no change 200J
    • 3rd dose if no change 300J
    • 4th dose if no change 360J
  33. Cardioversion, Synchronized
    PEDIATRIC TACHYCARDIA
    Narrow complex tachycardia (QRS < 0.08 sec) (possible SVT) w/ signs of poor systemic perfusion (lack of peripheral pulses, delayed capillary refill, cold/mottled extremities, altered mental status)
    • CONTACT MEDICAL DIRECTION FOR CONSIDERATION
    • (w/ sedation if needed)
    • 0.5 j/kg
    • repeat 1 k/kg if no response
  34. Cardioversion, Synchronized
    PEDIATRIC TACHYCARDIA
    Wide complex tachycardia (QRS > 0.08 sec) (possible V-Tach) w/ signs of poor systemic perfusion (lack of peripheral pulses, delayed capillary refill, cold/mottled extremities, altered mental status)
    • 1. Cardioversion immediately at 0.5 j/kg.
    • 2. Repeat cardioversion at 1.0 j/kg.
    • 3. Establish one proximal peripheral IV of 0.9% saline to run at KVO.a)

    If no peripheral IV access is obtainable, intraosseous access should be established according to Pediatric Intraosseous Guideline 7-15.
  35. Post Cardioversion
    PEDIATRIC TACHYCARDIA
    Wide complex tachycardia
    • CONTACT MEDICAL DIRECTION FOR CONSIDERATION OF THE FOLLOWING:
    • a) FLUID BOLUS NS 20 cc/kg.
    • b) IF SUCCESSFUL CONVERSION, LOADING DOSE OF LIDOCAINE 1 MG/KG.
    • c) IF UNSUCCESSFUL CARDIOVERSION, LIDOCAINE 1 MG/KG IV.
    • d) REPEAT CARDIOVERSION AT 1 J/KG.
    • e) TRIAL OF ADENOSINE 0.1 MG/KG (MAX SINGLE DOSE OF 6 MG).
  36. Cardioversion
    Adult - Narrow Regular
    50-100J
  37. Cardioversion
    Adult - Narrow Irregular
    120-200J
  38. Cardioversion
    Adult - Wide Regular
    100J
  39. Cardioversion
    Adult - Wide Irregular
    defib dose -> 120-200J
  40. Cardioversioin
    Pedi
    • Synchronized
    • 0.5 - 1 j/kg (may increase to 2 j/kg if needed)
  41. Defibrillate
    V-Fib/Pulseless V-Tach
    Adult
    • 1. 200J (360J monophasic)
    • 2. 300J (360J monophasic) - after 5 cycles
    • 3. 360J (360J monphasic) - after 5 cycles
  42. Defibrillate
    PEDIATRIC CARDIAC ARREST [5.06]
    • 1st dose: 2 j/kg using paddles of the appropriate size
    • 2nd dose: 4 j/kg

    • 1. Pediatric Paddles (or anterior-posterior placement) if less than 10 kg.
    • 2. Pediatric Defib/pacer pads if less than 15 kg.
    • 3. Resume CPR immediately, without a rhythm check.
  43. Dextrose (D50W or D25W)
    Carbohydrate
    ALTERED MENTAL STATUS [3.05]
    Adult Dose
    • Bgl < 80 (<60 if suspicious for stroke), consider:
    • (concentration based on severity and mental status, at discretion of Paramedic)
    • D 50% 25 gm (50 cc) IV bolus slowly.
    • D 10% IV (add 50 cc D50 to 250 cc NS). 
    • CONFIRM IV PLACEMENT PRIOR TO & DURING ADMIN
  44. Dextrose (D50W or D25W)
    Carbohydrate
    Pedi Dose
    1ml/kg of D50W slow IV push. Dilute 1-4 in those less than 1 week old and dilute 1 to 2 (D25W) in those 1 week to 16 y/o - CONFIRM IV PLACEMENT PRIOR TO & DURING ADMIN
  45. Diphenhydramine (Benadryl)
    Antihistamine, H1 blocker
    ANAPHYLAXIS/ALERGIC REACTION
    Adult Dose
    • 1 mg/kg IM/IV slow @ 50mg min
    • (max 50mg)
  46. Diphenhydramine (Benadryl)
    Antihistamine, H1 blocker
    PEDIATRIC ANAPHYLAXIS [5.12]
    severe cardiopulmonary compromise
    (impending upper airway obstruction with stridor, poor perfusion, hypotension, respiratory distress)[V;E]
    1 mg/kg IV, IO or IM up to a max 50 mg
  47. Diphenhydramine (Benadryl)
    Antihistamine, H1 blocker
    PEDIATRIC OVERDOSE/POISONING
    1 mg/kg IV or IM (max 50 mg)
  48. Diphenhydramine (Benadryl)
    Antihistamine, H1 blocker
    DYSTONIC REACTION
    Adult Dose
    • 50-100 mg IV
    • (If unable to obtain venous access, admin same dose deep IM)
  49. Dopamine (Intropin)
    Catecholamine (naturally occurring), Agrenergic Agent
    BRADYCARDIA
    Dose - Adult & Pedi
    CONTACT MEDICAL DIRECTION IF THERE IS NO IMPROVEMENT IN CARDIAC STATUS AFTER EXHAUSTING Hs &Ts THERAPY FOR CONSIDERATION:

    5.0 - 20.0 mcg/kg/min titrated to effect
  50. Epinephrine 1:10,000
    Natural Catecholamine, Adrenergic
    CARDIAC ARREST (VFib, Pulseless VTach, PEA, Asystole)
    Adult Dose
    • 0.5-1.0 mg (10cc 1:10,000 solution) IV/IO, ET (ET 2X dose)
    • Repeat every 3-5 minutes.
  51. Epinephrine 1:10,000
    Natural Catecholamine, Adrenergic
    NEWBORN RESUSCITATION
    • If no improvement in status, administer epinephrine
    • A. 1:10,000 0.1 mg/kg via ET tube.
    • CONTACT MEDICAL DIRECTION FOR CONSIDERATION
    • 1. IV OR UMBILICAL LINE: 0.01 MG/KG, 1:10,000
    • 2. CONTINUED ETT: 0.1 MG/KG, 1:10,000 VIA ENDOTRACHEAL TUBE
    • 3. REPEAT EVERY 3-5 MINUTES IF NO IMPROVEMENT
  52. Etomidate
    induction agent
    RSI GUIDELINE [7.06]
    Sedate
    dose for all > 1 y/o
    • 0.3 mg/kg IV
    • Sedate to maintain:
    • repeat at 0.1-0.3 mg/kg IV (5-7min sedation)
  53. Epinephrine 1:10,000
    Natural Catecholamine, Adrenergic
    BRADYCARDIA
    Adult Dose
    CONTACT MEDICAL DIRECTION IF THERE IS NO IMPROVEMENT IN CARDIAC STATUS AFTER EXHAUSTING Hs &Ts THERAPY FOR CONSIDERATION:

    2-10 mcg/min (1 g added to 500cc NS or D5W beginning @ 1 mcg per min)
  54. Dopamine (Intropin)
    Catecholamine (naturally occurring), Agrenergic Agent
    SHOCK PROTOCOL; CARDIOGENIC OR UNKNOWN ETIOLOGY [2.08]
    (NOT DUE TO HYPOVOLEMIA)
    Dose - Adult & Pedi [IV]
    Begin @ 5 mcg/kg, gradually increase rate to achieve systolic BP of 90 or max drip rate of 20 mcg/kg/min.
  55. Epinephrine 1:10,000
    Natural Catecholamine, Adrenergic
    Pedi Dose - Anaphyaxis w/ Shock
    0.01 mg/kg slow IV, IO push (max 0.3mg)
  56. Epinephrine 1:1,000
    PEDIATRIC RESPIRATORY DISTRESS / FAILURE
    Croup/Epiglottitis
    Pedi
    CONTACT MEDICAL DIRECTION FOR CONSIDERATION NEBULIZED (1:1000,2.5cc), 2.5 mg
  57. Epinephrine 1:1,000
    Natural Catecholamine, Adrenergic
    PEDIATRIC ANAPHYLAXIS
    severe cardiopulmonary compromise (impending upper airway obstruction with stridor, poor perfusion, hypotension, respiratory distress)
    • 0.01 mg/kg not to exceed 0.3 mg IM to the mid-anterolateral thigh. (can be administered without IV access if IV access unsuccessful or delayed).
    • If patient remains unstable after 5 minutes, may be repeated 1x.

    Utilization of a single, 0.15 mg pediatric epinephrine autoinjector is preferred to minimize delay and reduce risk of improper dosage.
  58. Epinephrine 1:10,000
    Natural Catecholamine, Adrenergic
    PEDIATRIC ANAPHYLAXIS
    severe cardiopulmonary compromise INTUBATED pt w/ poor perfusion
    0.02 mg/ endotracheal
  59. Epinephrine 1:1,000
    Natural Catecholamine, Adrenergic
    Adult Dose - Status Asthmaticus
    0.3 mg SQ
  60. Epinephrine 1:1,000
    Natural Catecholamine, Adrenergic
    Adult Dose - Laryngeal or Linqual Edema
    0.3 mg SQ
  61. Epinephrine 1:1,000
    Natural Catecholamine, Adrenergic
    ACUTE RESPIRATORY DISTRESS [3.01]
    Acute Bronchospasm with known etiology (hx asthma, COPD, anaphylaxis) [II]
    If no response to Ipratropium x2 or Solumedrol or unable to tolerate bronchodilator. [D]
    • 0.3cc IM (adult)
    • CONTACT MEDICAL DIRECTION if patient has the following:
    • a) History of Hypertension
    • b) History of MI or cardiac pain
    • c) Patient 60 years of age or more
    • d) Pregnancy

    [previous -> 0.01 mg/kg (0.3 mg max) - essentially similar]
  62. Epinephrine 1:1,000
    Natural Catecholamine, Adrenergic
    ANAPHYLAXIS / ALLERGIC REACTION
    Adult
    • CONSIDER
    • 0.3 mg IM/SQ (0.3cc - 1 mg/cc)
    • (0.3 mg max)
    • Injected into the mid-anterolateral thigh. If patient remains unstable after 5 minutes, may be repeated once.
    • CONTACT MEDICAL DIRECTION
    • a) hx hypertension
    • b) hx MI or cardiac pain
    • c) >= 60 y/o
    • d) pregnancy
  63. Epinephrine 1:10,000
    Natural Catecholamine, Adrenergic
    ANAPHYLAXIS / ALLERGIC REACTION - INTUBATED
    Adult
    0.01 mg/kg (0.1cc/kg) via ET Tube
  64. Epinephrine 1:10,000
    Natural Catecholamine, Adrenergic
    PEDIATRIC CARDIAC ARREST
    Pulseless Electrical Activity (PEA)
    • 0.01 mg/kg IV/IO or 0.1 mg/kg epinephrine 1:1000 ET.
    • If no response, repeat epinephrine at same dose every 3-5 minutes.
  65. EPINEPHRINE DRIP
    ANAPHYLAXIS / ALLERGIC REACTION
    1 MG IN 500 CC NS BEGIN AT 1MCG/MINUTE (30 CC/HR). TITRATE TO EFFECT 2-10 MCG/ MINUTE.

    (Medical direction will determine specific regimen according to the patient’s needs.)
  66. Epinephrine 1:10,000
    Natural Catecholamine, Adrenergic
    ANAPHYLAXIS / ALLERGIC REACTION, PROFOUND HYPOTENSION / POOR PERFUSION
    Adult
    0.5 cc at a time - slow. over 1-2 min up to 0.01 cc/kg initial dose (max 0.5mg or 5 cc). Initial dose may be repeated every 10 min.
  67. Epinephrine 1:1,000
    Natural Catecholamine, Adrenergic
    ANAPHYLAXIS / ALLERGIC REACTION
    Pedi
    • 0.01 mg/kg IM (0.3 mg max)
    • To be injected to the mid-anterolateral thigh.
    • If patient remains unstable after 5 minutes, may be repeated once.
    • (1:1000 can be administered IM without IV access for 1:10,000 if IV access unsuccessful or delayed).
  68. Epinephrine 1:10,000
    Natural Catecholamine, Adrenergic
    PEDIATRIC CARDIAC ARREST, VFib/Pulseless VTach, PEA, Asystole
    • 0.01 mg/kg (0.1cc/kg) IV/IO, Q 3-5 min
    • (or 0.1 mg/kg epi 1:1,000 ET)
  69. Epinephrine 1:10,000
    Natural Catecholamine, Adrenergic
    PEDIATRIC BRADYCARDIA
    (w/ severe cardio-respiratory compromise - poor perfusion, hypotension, respiratory distress)
    • 0.01 mg/kg IV/IO or 0.1 mg/kg (1:1,000) ET
    • (may repeat same dose Q 3-5 min, if clinically indicated)
    • IF SUSPECTED INCREASED VAGAL TONE OR AV BLOCK  ATROPINE SHOULD BE GIVEN PRIOR.
  70. Epinephrine 1:1,000
    Natural Catecholamine, Adrenergic
    PEDIATRIC CARDIAC ARREST, VFib/Pulseless VTach, PEA
    (if IV/IO unobtainable)
    0.1 mg/kg (0.1 cc/kg) via endotracheal tube
  71. Epinephrine 1:10,000
    Natural Catecholamine, Adrenergic
    PEDIATRIC CARDIAC ARREST
    VFib/Pulseless VTach, Asystole
    IF NO REPONSE TO THERAPIES & ANAPHYLAXIS, SEPSIS OR OVERDOSE OF BETA BLOCKERS OR CALCIUM CHANNEL BLOCKERS
    CONTACT MEDICAL DIRECTION FOR CONSIDERATION OF 0.03 MG/KG, IV/IO Q 3-5 MINUTES.

    (also MAG SULFATE noted)
  72. Epinephrine 1:10,000
    Natural Catecholamine, Adrenergic
    PEDIATRIC CARDIAC ARREST
    CASES OF ANAPHYLAXIS, SEPSIS OR OVERDOSE OF BETA BLOCKERS OR CALCIUM CHANNEL BLOCKERS
    CONTACT MEDICAL DIRECTION FOR CONSIDERATION OF 0.03 MG/KG, IV/IO Q 3-5 MINUTES.
  73. Epinephrine 1:1,000
    Natural Catecholamine, Adrenergic
    Pedi Dose - Laryngeal or Lingual Edema
    0.01 mg/kg (0.3 mg max)
  74. Epinephrine 1:1,000
    Natural Catecholamine, Adrenergic
    Pedi
    Dose - Status Asthmaticus
    0.01 mg/kg (0.3 mg max)
  75. Fentanyl (Sublimaze)
    Synthetic Narcotic Analgesic
    PAIN MANAGEMENT [3.11]
    Adult
    • A. 1mcg/kg IV, IO SLOW titrated at rate of 50mcg/min MAX single dose 100mcg
    • B. Repeat dose 1x in 5-10min after reassess 0.5mcg/kg SLOW titrated at rate of 50mcg/min MAX single dose 50mcg
    • C. May also admin IM/INTRANASAL 1mcg/kg MAX single dose 100mcg. Divide dose = between nostrils MAX 1mL per nostril.
    • 1. hypotension develops fluid bolus NS
    • 2. respiratory depression develops admin Narcan
    • D. CONTACT MED DIR FOR CONSIDERATION OF:
    • 1. Additional Fentanyl
    • 2. Midazolam 2-10mg IV for sedation
    • ++++++++++++++++++++++++++++++
    • CONTRAINDICATIONS:
    • 1. MAO Inhibitors w/in 14days
    • 2. Myasthenia Gravis
    • PRECAUTIONS:
    • 1. Increased ICP
    • 2. Elderly
    • 3. Debilitated
    • 4. COPD
    • 5. Respiratory Problems
    • 6. Hepatic & Renal Insufficiency
  76. Fentanyl (Sublimaze)
    Synthetic Narcotic Analgesic
    PEDIATRIC PAIN MANAGEMENT [5.19]
    All patients evaluated for pain. [I]
    All patients will have their pain levels documented, using the 0-10 scale, on the patient care report. [II] Patients in severe pain (7-10/10), in whom a narcotic analgesic will have a beneficial effect on outcome should be considered as candidates for pain management. This includes, but is not limited to:
    1. Extremity trauma.
    2. Burns.
    • V. If indicated, administer pain management:
    • CAREFULLY CONSIDER LEVEL OF CONCIOUSNESS, BLOOD PRESSURE AND RESPIRATORY STATUS. FENTANYL SHALL BE ADMINSTERED SLOWLY IV AND TITRATED TO EFFECT.
    • A. Admin fentanyl 1 mcg/kg IV, IO titrated to effect at a rate of 50 mcg/minute increments slow IVP with maximum single dose of 100 mcg.
    • B. Repeat dose in 5-10 minutes after reassessment with 0.5 mcg/kg titrated to effect at a rate of 50 mcg/minute to a maximum single dose of 50 mcg.
    • C. Fentanyl may also be administered IM/INTRNASAL DOSE: 1 mcg/kg maximum single dose of 100 mcg. Divide INTRNASAL dosage of drug equally between the nostrils to a maximum of 1 mL per nostril.

    If hypotension develops post Fentanyl administer fluid bolus of normal saline.

    If respiratory depression develops post fentanyl administer Narcan.
  77. Fentanyl (Sublimaze)
    Synthetic Narcotic Analgesic
    Tachycardia [2.06]
    Unstable [III]
    Mono-morphic Ventricular Tachycardia [B]
    Synchronized Cardioversion @ 100J [1]
    CARDIOVERSION/DEFIRILATION SEDATION
    • 1) Versed 2mg IV & possible analgesia w/ 1 mcg Fentanyl
    • 2) If not properly sedated, CONTACT MEDICAL DIRECTION FOR ADDITIONAL SEDATION OPTIONS
  78. ADD PULMONARY EDEMA
  79. Glucagon
    Pancreatic Hormone
    OVERDOSE/POISONING - BETA-BLOCKER OD
    Dose - Adult
    • MED DIRECTION
    • 1 MG (1 UNIT) IV Q5 MIN PRN
    • [CONTRAINDICATED IF PT ON DIGOXIN]
  80. Glucagon
    Pancreatic Hormone
    PEDIATRIC OVERDOSE/POISONING
    BETA BLOCKER OD
    • a) >25KG,1MGIV
    • (1) REPEAT DOSE Q 5 MINUTES PRN TO A MAX DOSE OF 3 MG.
    • b) <25 KG, 0.5 MG IV, IO (1) REPEAT DOSE Q 5 MINUTES PRN TO A MAX DOSE OF 1.5 MG.
    • c) CONTRAINDICATED IF PATIENT ON DIGOXIN.
  81. Glucagon
    Pancreatic Hormone
    OVERDOSE / POISONING [3.08]
    BETA-BLOCKER OD
    • CONTACT MEDICAL DIRECTION FOR THE FOLLOWING:
    • ADMINISTER 1 MG IV Q 5 MINUTES PRN.
    • (1) CONTRAINDICATED IF PATIENT ON DIGOXIN.
  82. Glucagon
    Pancreatic Hormone
    PEDIATRIC ALTERED MENTALSTATUS [5.09]
    (HYPOGLYCEMIA/ COMA)
    • (1) IF OVER 2 YEARS OLD
    • (2) HISTORY OF IDDM WITH BLOOD GLUCOSE <60
    • (3) >20KG, 1MG IM, <20KG, 0.5MG
    • GLUCAGON MAY BE CONTRAINDICATED FOR STARVATION INDUCED HYPOGLYCEMIA (DEHYDRATED, NOT EATING, NO HISTORY OF IDDM, ETC.)
  83. Glucagon
    Pancreatic Hormone
    BETA-BLOCKER OD (CARDIAC ARREST)
    Dose - Adult
    1 MG IV
  84. Glucagon
    Pancreatic Hormone
    ALTERED MENTAL STATUS [3.05]
    Adult
    • Bgl < 80 (<60 if suspicious for stroke), consider:
    • 1mg (1 unit)
  85. Glucagon
    Pancreatic Hormone
    PEDIATRIC ALTERED MENTAL STATUS
    (HYPOGLYCEMIA/COMA) [5.09]
    • AFTER DEXTROSE
    • CONTACT MEDICAL DIRECTION FOR CONSIDERATION OF THE FOLLOWING:
    • a) REPEAT DEXTROSE.
    • B) GLUCAGON
    • (1) IF OVER 2 YEARS OLD
    • (2) HISTORY OF IDDM WITH BLOOD GLUCOSE <60
    • (3) IF>20KG,1MGIM,IF<20KG,0.5MG
    • (A) GLUCAGON MAY BE CONTRAINDICATED FOR STARVATION INDUCED HYPOGLYCEMIA (DEHYDRATED, NOT EATING, NO HISTORY OF IDDM, ETC.) 

    (0.5-1.0 mg OLD)
  86. Dextrose
    Carbohydrate
    PEDIATRIC ALTERED MENTAL STATUS
    (HYPOGLYCEMIA/ COMA)
    BGL < 60 (newborns up to 1 wk < 40)
    • Administer dextrose 0.5 gm/kg IV.
    • a) < 1 y/o, D10.
    • Administer 5 cc/kg of D10 solution.
    • (1) Mix 10 cc of D50 with 40 cc of NS or Sterile H20.
    • b) > 1 y/o and < 10 y/o
    • (1) D10 as noted above
    • OR
    • (2) D25. Administer 2 cc/kg of D25 solution.(a) Mix 30 cc D50 with 30 cc of NS or Sterile H20.
    • c) If > 10 y/o
    • (1) D10 as noted above
    • OR
    • (2) D50. Administer 1 cc/kg of D50 solution.
  87. Glucose (Dextrose - D10W)
    Carbohydrate
    NEWBORN RESUSCITATION
    • CONTACT MEDICAL DIRECTION FOR CONSIDERATION
    • 5-10 CC/KG IV/UMBILICAL
    • (Mix 10 cc of D50 with 40 cc of NS or Sterile H20)
  88. IO
    PEDIATRIC TACHYCARDIA
    Narrow complex tachycardia (QRS < 0.08 sec) (possible SVT) w/ signs of poor systemic perfusion (lack of peripheral pulses, delayed capillary refill, cold/mottled extremities, altered mental status)
    • CONTACT MEDICAL DIRECTION FOR CONSIDERATION
    • IF IV ACCESS HAS BEEN UNSUCCESSFUL, PERMISSION TO ESTABLISH INTRAOSSEOUS ACCESS.
  89. Ipratropium (Atrovent)
    Anticholinergic Bronchodilator
    ACUTE RESPIRATORY DISTRESS w/ unknown itiology
    Adult
    500 mcg (2.5ml) in 3 cc NS  via neb - consider repeat if indicated. If intubated admin via neb to ET tube adaptor.  Should not admin directly via ET tube.
  90. Ipratropium (Atrovent)
    Anticholinergic Bronchodilator
    PEDIATRIC RESPIRATORY DISTRESS / FAILURE
    No improvement w/ Albuterol neb or high Albuterol use prior to EMS arrival.

    • CONSIDER DuoNeb/Atrovent (ipratopium) 500 mcg neb
    • a. may repeat 1x
    • b. if indicated more than 2x use Albuterol only
    • [CONSIDER EPI 1:1,000, 0.01 mg/kg SQ (max 0.3 mg)]
  91. Ketoraloc Tromethamine (Toradol)
    Non-Steroidal Anti-Inflamatory (NSAID)
    Adult Dose
    • Pt's < 65 y/o: 1 dose 30mg slow IV or deep IM
    • Pt's > 65 y/o, renally impaired & or < 50kg (110lb) 1 dose 15mg slow IV or deep IM
  92. Ketoraloc Tromethamine (Toradol)
    Non-Steroidal Anti-Inflamatory (NSAID)
    Pedi Dose
    1 dose 0.5mg/kg max of 30mg slow IV or deep IM
  93. Lactated Ringers
    Isotonic Crystalloid
    Adult Dose
    Pt condition dependent; TKO, rapid bolus, "wide open" - IV
  94. Lactated Ringers
    Isotonic Crystalloid
    POST PARTUM HEMORRHAGE (For those pts experiencing significant vaginal bleeding after delivery of the fetus.)
    Adult Dose
    • IV bolus titrate to BP > 90 systolic
    • (normal saline acceptable too)
  95. Lactated Ringers
    Isotonic Crystalloid
    Pedi Dose
    TKO, 20ml/kg (bolus)
  96. Lidocaine (Xylocaine)
    Antiarrhythmic
    RSI - SUSPECTED INCREASED ICP
    Adult
    • 1 mg/kg IV
    • max dose 100 mg
    • (if no contraindications)
    • 1) severe bradycardia (cardiac origin)
    • 2) 2nd degree & 3rd degree heartblocks
  97. Lidocaine (Xylocaine)
    Antiarrhythmic
    CARDIAC ARREST - VFIB/VTACH
    • 1.0-1.5 mg/kg
    • MAX 3 doses or 3 mg/kg
  98. Lidocaine (Xylocaine)
    Antiarrhythmic
    CARDIAC ARREST - ROSC
    • if conversion & transport > 15 min CONSIDER
    • 2-4 mg/min
  99. Lidocaine (Xylocaine)
    Antiarrhythmic
    UNSTABLE TACHYCARDIA after unsuccessful CARDIOVERSION
    Adult
    • 1-1.5 mg/kg IV push Q 5-10 minutes to max dose 3 mg/kg.
    • (1) If conversion occurs, and ectopy resumes and max dose not given consider rebolus with half the last dosage.
  100. Lidocaine (Xylocaine)Antiarrhythmic
    PEDIATRIC CARDIAC ARREST
    VFib/Pulseless VTach
    • If amiodarone is unavailable admin:
    • 1 mg/kg IV/IO first dose (max 100 mg), then 0.5 mg/kb, max of 3 mg/kg total.
  101. Lidocaine (Xylocaine)
    Antiarrhythmic
    UNSTABLE TACHYCARDIA after conversion to normal rhythm w/ Lidocaine & transport time > 15 min
    Adult
    • CONSIDER continuous drip
    • 2-4 mg/min
  102. Lidocaine (Xylocaine)
    Antiarrhythmic
    TACHYCARDIA
    StableMono-morphic VTach
    Adult Dose
    • If amiodarone is not available admin
    • 1.5 mg/kg slowly (less than 50 mg/minute)
    • a) If patient remains in ventricular tachycardia and is hemodynamically stable repeat *Lidocaine bolus every 5-10 minutes at 0.75 mg/kg up to 3 mg/kg.
    • If conversion occurs, begin Lidocaine drip at 2-4 mg/min.
  103. Lorazepam (Ativan)
    Benzodiazepine
    SEIZURE [3.06,III,C]
    Status Epilepticus
    ACTIVE GENERAL MOTOR SEIZURE
    Adult
    1-2 mg IV over 30 sec or until seizure subsides

    no IM???
  104. Magnesium Sulfate
    Electrolyte
    POLYMORPHIC VTACH (including Torsades) if defib unsuccessful
    Adult
    1-2 gm IV over 1-2 min
  105. Magnesium Sulfate
    Electrolyte
    PEDIATRIC CARDIAC ARREST
    POLYMORPHIC VTACH (including Torsades)
    25-50 mg/kg IV/IO (Max 2 gm)
  106. Magnesium Sulfate
    Electrolyte
    PEDIATRIC CARDIAC ARREST [5.06]
    VFib/Pulseless VTach [III]
    IF NO REPONSE TO THERAPIES [C]
    • CONTACT MEDICAL DIRECTION FOR CONSIDERATION OF THE FOLLOWING:
    • 25-50 MG/KG (2 GRAMS MAX DOSE) IV/IO OVER 10 MINUTES

    (IF CASES OF ANAPHYLAXIS, SEPSIS OR OVERDOSE OF BETA BLOCKERS OR CALCIUM CHANNEL BLOCKERS EPINEPHRINE 1/10,000, 0.03 MG/KG, IV/IO Q 3-5 MIN)
  107. Magnesium Sulfate
    Electrolyte
    TACHYCARDIA
    Stable
    POLYMORPHIC VTACH (including Torsades)
    2 gm IV over 1-5 min
  108. Magnesium Sulfate
    Electrolyte
    ECLAMPSIA
    Adult
    • CONTACT MEDICAL DIRECTION
    • 4 gm IV over 2-3 min IV slow followed by infusion 2 gm/hr (10 gm in 250 cc NS  @ 50 cc/hr)
    • *BE ALERT FOR RESPIRATORY DEPRESSION. IF DEPRESSION OCCURS STOP MEDICATIONS & CALL MEDICAL DIRECTION
  109. Magnesium Sulfate
    Electrolyte
    ACUTE RESPIRATORY DISTRESS [3.01]
    (if bronchodilator & epi unsuccessful)
    Adult
    • If no relief, MEDICAL DIRECTION
    • 1-2 gm over 7-10 min
    • a) 1 gm in 50cc NS; 60gtt/cc drip set WO
    • b) 2 gm in 100cc NS; 60gtt/cc drip set WO
  110. Midazolam (Versed)
    Benzodiazepine (short acting)
    RSI - Sedate & maintain ETT
    Adult
    CONTACT MEDICAL DIRECTION

    • 2 mg IV
    • (may be repeated at dose of 0.1 mg/kg slow IV to max of 10 mg)
  111. Midazolam (Versed)
    Benzodiazepine (short acting)
    RSI - Sedate & maintain ETT [7.06 P 3 B]
    Pediatric
    CONTACT MEDICAL DIRECTION

    • 0.1 mg/kg IV - Max single dose 2mg 
    • (may be repeated at dose of 0.1 mg/kg slow IV to max of 2.5 mg)
  112. Midazolam (Versed)
    Benzodiazepine (short acting)
    PATIENT RESTRAINT & TREATMENT POST-NON-LETHAL INCAPACITATING DEVICES
    Chemical Retraint Procedure
    extreme patient combativeness
    Adult Patients only (over 13 years old)
    • for extremely combative patients should be a last result. Contact Medical Direction if at all possible, prior to administering chemical restraint
    • i. 2 mg IV OR 5 mg deep IM
    • ii. Be alert for respiratory depression and airway compromise
    • iii. CONTACT MEDICAL DIRECTION FOR ALL REPEAT DOSES
  113. Midazolam (Versed)
    Benzodiazepine (short acting)
    PATIENT RESTRAINT & TREATMENT POST-NON-LETHAL INCAPACITATING DEVICES
    Chemical Retraint Procedure
    extreme patient combativeness
    Pediatric
    • CONTACT MEDICAL DIRECTION
    • 0.1 MG/KG IV, MAX SINGLE DOSE OF 2 MG
    • 0.2 MG/KG (MAX DOSE 5 MG) DEEP IM
  114. Midazolam (Versed)
    Benzodiazepine (short acting)
    PATIENT RESTRAINT & TREATMENT POST-NON-LETHAL INCAPACITATING DEVICES
    Chemical Retraint Procedure
    extreme patient combativeness
    REPEAT DOSAGES
    • i. IV REPEAT DOSES
    • ii. IM REPEAT DOSES
    • ADULT: MIDAZOLAM (VERSED) 5 MG DEEP IM
    • PEDIATRIC: 0.2 MG/KG (MAX DOSE 5 MG) DEEP IM
  115. Midazolam (Versed)
    Benzodiazepine (short acting)
    SEIZURE
    • CONTACT MEDICAL DIRECTION CONSIDER
    • 2-5 mg slow IV titrated to stop seizure
    • (may repeat same dose 1x after 5 min if indicated)
    • If unable to achieve IV admin 5mg deep IM.
  116. Midazolam (Versed)
    Benzodiazepine (short acting)
    PEDIATRIC SEIZURE / STATUS EPILEPTICUS [5.11,D,1,a]
    Status Epilepticus
    • CONTACT MEDICAL DIRECTION
    • 0.1 mg/kg (MAX dose 2.5 mg) slow IV, titrated to stop seizure.
    • May REPEAT at same dose 1x after 5 min if indicated.
    • If unable to achieve IV admin 0.2 mg/kg (MAX dose 5mg) deep IM.
  117. Midazolam (Versed)
    Benzodiazepine (short acting)
    Tachycardia [2.06]
    Unstable [III]
    Mono-morphic Ventricular Tachycardia [B]
    Synchronized Cardioversion @ 100J [1]
    CARDIOVERSION/DEFIRILATION SEDATION
    • 1) 2mg IV & possible analgesia w/ 1 mcg Fentanyl
    • 2) If not properly sedated, CONTACT MEDICAL DIRECTION FOR ADDITIONAL SEDATION OPTIONS
  118. Naloxone (Narcan)
    Narcotic Antagonist
    ALTERED MENTAL STATUS
    (narcotic overdose suspected & respiratory insufficiency present)
    Adult
    • 0.4-2.0 mg - IV bolus (IM if no IV available)
    • May admin 2 mg IN via MAD, as per Procedural Guideline
    • Consider repeat 0.4 - 2.0 mg IV (IM if no IV available) if respirations continue to be inadequate.
  119. Naloxone (Narcan)
    Narcotic Antagonist
    VFIB/PULSELESS VTACH, ASYSTOLE, BRADYCARDIA
    Hs & Ts
    Adult
    2 mg IV or ET, Repeat PRN
  120. Naloxone (Narcan)
    Narcotic Antagonist
    PEDIATRIC ALTERED MENTAL STATUS
    IF NARCOTIC OD IS SUSPECTED
    Pedi
    • slow IV or IM, if IV unsuccessful.
    • titrate dose, starting @ lowest possible
    • a) base admin on respiratory rate & mental status
    • b) repeat 1x if limited response or respiratory depression returns
    • < 6 y/o 1 mg max
    • > 6 y/o 2 mg max
    • [0.1mg/kg MidState]

    • CONTACT MED DIRECTION CONSIDERATION...
    • 1. additional dose
    • 2. permission to establish IO if IV unsuccessful
    • 3. other treatment options
    • (why do you need permission for IO w/ altered mental & respiratory depression?)
  121. Nitroglycerin
    Smooth Muscle Relaxant, Vascular
    ACUTE PULMONARY EDEMA
    • 2-4 measured doses admin by aerosol (0.8 to 1.6 mg) Q five min sublingual/oral, as long as the systolic BP > 110 mm Hg.
    • (monitor vitals every 5 min)

    Nitrates most important preload & afterload w/ PE. Insure pt has not taken any ED drugs w/in last 24 hours. If so CONTACT MEDICAL DIRECTION.
  122. Nitroglycerin
    Smooth Muscle Relaxant, Vascular
    ACUTE CORONARY SYNDROMES
    (chest pain or symptoms characteristic of, or suspicious of, cardiac etiology)
    • If 12-lead EKG is suspicious for inferior wall MI, use nitroglycerin with caution & consider right side precordial leads to identify Right Ventricular Infarct.
    • Systolic BP > 100
    • 1-2 dose(s) (0.4- 0.8 mg)
    • 1. Monitor BP Q 5 minutes
    • 2. If patient becomes hypotensive, place in Trendelenburg position and administer 250 cc NS.
    • Continue admin 0.4 mg sublingual Q 5 min until one of the following end points:
    • 1. chest pain or symptoms characteristic of, or suspicious of, cardiac etiology are resolved. (If no 12 lead obtained or non-diagnostic 12 lead EKG)
    • 2. 12 lead EKG ST segment changes normalized. (If AMI is suspected by 12-lead findings)
    • 3. BP < 100 mm Hg systolic.
  123. Normal Saline (0.9% NaCl)
    Isotonic Electrolyte
    Cardiac Arrest Hs&Ts Hypovolemia
    Adult Dose
    Fluid Challenge 500 cc, repeat PRN
  124. Normal Saline (0.9% NaCl)
    Isotonic Electrolyte
    POST PARTUM HEMORRHAGE (For those pts experiencing significant vaginal bleeding after delivery of the fetus.)
    Adult Dose
    • IV bolus titrate to BP > 90 systolic
    • (lactated ringers acceptable too)
  125. Normal Saline (0.9% NaCl)
    Isotonic Electrolyte
    SHOCK PROTOCOL: CARDIOGENIC OR UNKNOWN ETIOLOGY
    Adult Dose
    250 cc no as a fluid challenge. (Unless signs of congestive heart failure)
  126. Normal Saline (0.9% NaCl)
    Isotonic Electrolyte
    PEDIATRIC CARDIAC ARREST
    Asystole
    fluid bolus 20 cc/kg as quickly as possible
  127. Normal Saline (0.9% NaCl)
    Isotonic Electrolyte
    NEWBORN RESUSCITATION
    FLUID BOLUS NS 10 CC/KG
  128. Normal Saline (0.9% NaCl)
    Isotonic Electrolyte
    PEDIATRIC SEPSIS AND DEHYDRATION
    (20 cc/kg as quickly as possible) to maintain age appropriate pulse and perfusion
  129. Normal Saline (0.9% NaCl) (preservative free)
    Isotonic Electrolyte
    PEDIATRIC RESPIRATORY DISTRESS / FAILURE
    Croup/Epiglotitis
    nebulized, via blow by technique as not to agitate pt
  130. Ondansetron (Zofran)
    Antiemetic; Serotonin Receptor Antagonist, 5-HT3
    Adult Dose
    4mg IM or Slow IV 2-5 minutes
  131. Ondansetron (Zofran)
    Antiemetic; Serotonin Receptor Antagonist, 5-HT3
    Pedi Dose
    0.1 mk/kg (max. single dose 4mg) IM or slow IV 2-5 min
  132. Oxygen
    Gas
    ACS
    LPM titrated to least amount needed to maintain SPO2 > = 94%
  133. Oxygen
    Gas
    PEDIATRIC RESPIRATORY DISTRESS / FAILURE
    Respiratory Distress of Unknown Etiology w/out Bronchospasm
    Pedi
    Humidified or nebulized NS (preservative free)
  134. Oxygen
    Gas
    NEWBORN RESUSCITATION
    signs of adequate ventilation & perfusion do not improve w/ high flow O2 & heart rate < 100, provide assisted ventilation via BVM with 100% oxygen
  135. Phenylephrine (Neo-Synephrine)
    Topical Vasoconstrictor
    Dose (facilitate nasotracheal intubation)
    2-4 sprays each nostril
  136. Procainamide (Pronestyl)
    Antiarrhythmic
    VFIB /PULSELESS VTACH [2.02]
    Adult Dose
    • IF AMIODARONE HAS NOT BEEN ADMINISTERED
    • 100 mg slow IVP (over 2 min). Repeat 100 mg slow IV (over 2 minutes) followed by Defibrillation, at 2 minute intervals until 1 gm administered or conversion occurs.
    • ROSC if conversion & transport > 15 min CONSIDER continuous drip 1-4 mg/min
  137. Procainamide (Pronestyl)
    Antiarrhythmic
    TACHYCARDIA Unstable
    (If unsuccessful synchronized cardioversion.)

    Adult Dose
    • If Patient has not taken or received Amiodarone: 
    • 20-30 mg/min
    • 1. admin until no ectopy is present
    • 2. 17 mg/kg is given (1 gm?)
    • 3. hypotension worsens
    • 4. QRS complex widens by greater than 50% of its original width.
    • (1) Using 50cc NS: mix 1 gram in 50 cc ns, set to 60-90 gtt/min with micro drip set
    • (2) Using 100 cc NS: mix 1 gram in 100 cc ns, set to 120-180 gtt/min with micro drip set
  138. Procainamide (Pronestyl)
    Antiarrhythmic
    UNSTABLE TACHYCARDIA after conversion to normal rhythm w/ Lidocaine & transport time > 15 min
    Adult Dose
    • CONSIDER continuous drip
    • 1-4 mg/min
  139. Procainamide (Pronestyl)
    Antiarrhythmic
    TACHYCARDIA Stable
    Mono-morphic Ventricular Tachycardia

    Adult Dose
    • If patient remains in Wide Complex tachycardia AND patient has not taking or received Amiodarone, CONSIDER
    • 20 mg/minute until
    • 1. V-tach resolves
    • 2. up to 17 mg/kg is given
    • 3. hypotension ensues
    • 4. QRS complex widens > 50 percent of its original width.
    • a) Using 50cc NS: mix 1 gram in 50 cc ns, set to 60 gtt/min with micro drip set
    • b) Using 100 cc NS: mix 1 gram in 100 cc ns, set to 120 gtt/min with micro drip set
    • c) If conversion occurs, begin Procainamide drip at 2-4 mg/min
  140. Procainamide (Pronestyl)
    Antiarrhythmic
    Afib/Aflutter - WPW (Wolff-Parkinson-White syndrome)
    Adult Dose
    • CONTACT MEDICAL DIRECTION:
    • 20 MG/MIN IV UNTIL
    • 1. DYSRHYTHMIA RESOLVED
    • 2. 17 MG/KG ADMINISTERED
    • (1) Using 50cc NS: MIX 1 GRAM IN 50 CC NS, SET TO 1 GTT/SEC WITH MICRO DRIP SET
    • (2) Using 100 cc NS: MIX 1 GRAM IN 100 CC NS, SET TO 2 GTT/SEC WITH MICRO DRIP SET
    • (3) IF DYSRHYTHMIA RESOLVED, BEGIN PROCAINAMIDE INFUSION AT 1-4 MG/MIN
  141. Procainamide (Pronestyl)
    Antiarrhythmic
    RETURN OF SPONTANEOUS CIRCULATION (ROSC) & POST-CARDIAC ARREST CARE (patient was in v-fib or v-tach & Procainamide resolved ectopy)
    Adult Dose
    • a) Repeat bolus at half the successful dose
    • b) Maintenance infusion 1-4 mg/min
  142. Procainamide (Pronestyl)
    Antiarrhythmic
    UNSTABLE TACHYCARDIA after unsuccessful CARDIOVERSION [2.06,III,B,c]
    Adult
    • If Patient has not taken or received Amiodarone:
    • 20-30 mg/min, admin until
    • (1) no ectopy is present
    • (2) up to 17 mg/kg is given
    • (3) hypotension worsens
    • (4) QRS complex widens > 50% of its original width.
    • (1) Using 50cc NS: mix 1 gram in 50 cc ns, set to 60-90 gtt/min with micro drip set
    • (2) Using 100 cc NS: mix 1 gram in 100 cc ns, set to 120-180 gtt/min with micro drip set
  143. Procainamide (Pronestyl)
    Antiarrhythmic
    TACHYCARDIA
    Stable
    WPW (Wolff-Parkinson-White syndrome)

    Adult
    • 20 MG/MIN IV UNTIL DYSRHYTHMIA RESOLVED OR UP TO 17 MG/KG ADMINISTERED.
    • (1) Using 50cc NS: MIX 1 GRAM IN 50 CC NS, SET TO 1 GTT/SEC WITH MICRO DRIP SET
    • (2) Using 100 cc NS: MIX 1 GRAM IN 100 CC NS, SET TO 2 GTT/SEC WITH MICRO DRIP SET
    • (3) IF DYSRHYTHMIA RESOLVED, BEGIN PROCAINAMIDE INFUSION AT 1-4 MG/MIN.
  144. Procainamide (Pronestyl)
    Antiarrhythmic
    Pedi Dose
    (for V-tach w/ a pulse w/ good & poor perfusion)
    15 mg/kg IV over 30-60 for min
  145. Promethazine (Phenergan)
    Antihistamine (H1antagonist)
    General Dose
    12.5 mg max single IV dose; 25 mg max total dose (depending on size & weight of pt)
  146. Sodium Bicarbonate (NaHCO3)
    Alkalotic Agent
    HYPERKALEMIA [2.10]
    General Dose
    If no improvement, CONTACT MEDICAL DIRECTION FOR THE FOLLOWING:

    50 MEQ IV OVER 5 MINUTES (MAY BE LESS EFFECTIVE FOR PATIENTS WITH END-STAGE RENAL DISEASE)
  147. Sodium Bicarbonate (NaHCO3)
    Alkalotic Agent
    DOCUMENTED TRICYCLIC ANTIDEPRESSANT OD - CARDIAC ARREST - Hs&Ts
    General Dose
    50 MEQ IV OVER 5 MINUTES (MAY BE LESS EFFECTIVE FOR PATIENTS WITH END-STAGE RENAL DISEASE)
  148. Sodium Bicarbonate (NaHCO3)
    Alkalotic Agent
    Trycyclic Antidepressant OD (documented)
    Hyperkalemia
    Acidosis
    VFib/Pulseless VTach [2.02]
    PEA [2.03]
    ASYSTOLE [2.04]
    BRADYCARDIA [2.07]
    Hs&Ts

    General Dose
    1.0 mEq/kg IV

    For asystole CONTACT MEDICAL DIRECTION for consideration of repeat dose.
  149. Solu-Medrol
    ANAPHYLAXIS / Allergic Reaction [3.04]
    • CONSIDER
    • 125 mg IV
  150. Solu-Medrol
    ACUTE RESPIRATORY DISTRESS MEDICAL
    GUIDELINES [3.01]
    ACUTE BRONCHOSPASM w/ KNOWN ITIOLOGY (history of Asthma, COPD, Anaphylaxis) [II] C
    • CONSIDER
    • 125 mg IV
  151. Solu-Medrol
    ACUTE RESPIRATORY DISTRESS
    • CONSIDER
    • 125 mg IV
  152. Sodium Bicarbonate (NaHCO3)
    Alkalotic Agent
    HYPERKALEMIA (If pt meets protocol criteria.)
    General Dose
    • If no improvement from other treatment  CONTACT MEDICAL DIRECTION for:
    • 50 MEQ IV OVER 5 MINUTES (MAY BE LESS EFFECTIVE FOR PATIENTS WITH END-STAGE RENAL DISEASE)
  153. Zofran
    Antiemetic, Serotonin Receptor Antagonist, 5-HT3
    INTRACTABLE VOMITING AND/OR
    VERTIGO [3.18]
    4 mg ( IV or ODT, Oral Dissolved Tablet)
  154. Transcutaneous Pacing
    ROSC
    yes. if pt was in AV block or Bradycardia
  155. Vasopressin (Pitressin)
    Vasopressor, Antidiuretic
    Dose
    1X dose of 40 units IV push
  156. PEDIATRIC IV CANNULATION/FLUID THERAPY INDICATIONS
    • 1. Cardiac Arrest
    • 2. Clinical impression indicating possible need for IV meds.
    • 3. Shock or compensated shock.
    • 4. Respiratory failure or arrest.
    • 5. Altered mental status.
  157. Defibrillation
    PEDIATRIC CARDIAC ARREST, VFib/Pulseless VTach
    • 2 j/kg using paddles appropriate size.
    • 1.  pediatric paddles (or anterior-posterior placement) if < 10kg.
    • 2. pediatric defib/pacer pads if < 15kg
    • 3. Resume CPR immediately, w/out rhythm check.
    • After 5 cycles (~2min), check pulse & rhythm. ......  If no pulse & shockable...
    • Repeat defibrillation @ 4 j/kg repeat every 5 cycles (~2min)???
  158. IV Solutions:
    • A. Normal Saline Solution.
    • B. Lactated Ringers Solution.
    • C. 5% Dextrose in Water.
    • D. 10% Dextrose in Water.
    • E. Saline flushed Loc adapter.
  159. PASG
    ANAPHYLAXIS / Allergic Reaction
    CONSIDER
  160. PASG
  161. IV Catheters/Cannulas
    • A. Catheter over the needle.
    • B. Catheter sizes may range from 14 ga to 24 ga.
    • C. Huber needle for Port-A-Cath access as indicated in procedural guideline
    • D. IO as indicated in procedural guidelines.
  162. IV Indications (adult)
    • Clinical impressions indicating the need for
    • A. possible medication administration
    • B. impending shock
    • C. cardiac arrest
  163. IV Indications (pediatric)
    • A. Cardiac Arrest
    • B. Clinical impression indicating possible need for IV medication administration.
    • C. Shock or compensated shock.
    • D. Respiratory failure or arrest.
    • E. Altered mental status.
  164. IV Sites
    • A. Peripheral IV
    • B. External Jugular as per specific procedural guideline
    • C. IO as per specific procedural guideline
    • D. Port-a-cath as per specific procedural guideline V.
  165. Intraosseous sites include: (pediatric) 
    • A. medial aspect of the proximal tibia
    • B. distal medial tibia above the medial mallelous
    • C. distal femur above the condyles
  166. ECLAMPSIA
    • I. Routine paramedic care
    • II. Assess nervous system & cardiorespiratory function
    • III. If hypoglycemia / drug OD induced status epilepticus, treat according to Altered Mental Status Guideline
    • IV. CONTACT MEDICAL DIRECTION FOR CONSIDERATION OF THE FOLLOWING
    • a. valium  5-10 mg slow IV
    • b. 4 gm magnesium sulfate IV slow over 2-3 min
    • c. 4 gm magnesium sulfate IV slow over 2-3 min followed by infusion of magnesium sulfate 2 gm/hr (10 gm in 250 cc NS @ 50 cc/hr)
    • BE ALERT FOR RESPIRATORY DEPRESSION, IF DEPRESSION OCCURS, STOP MEDICATIONS & CALL MEDICAL DIRECTION
    • V. If seizures recur or do not subside, CONTACT MEDICAL DIRECTION for repeat of the above.
    • VI. Transport AS SOON AS POSSIBLE.
  167. TACHYCARDIA
    Ustable
    If CARDIOVERSION unsuccessful, Consider (choose one and do not mix medications):
    [2.06,III,B,5...]
    • a) Amiodarone OR if amiodarone is not available
    • b) Lidocaine OR
    • c) If Patient has NOT taken or received Amiodarone: Procainamide
  168. UNSTABLE TACHYCARDIA
    If cardioversion & drug therapy unsuccessful.
    • CONTACT MEDICAL DIRECTION
    • (A) REPEAT CARDIOVERSION
    • (B) OTHER TREATMENT MODALITIES
  169. UNSTABLE TACHYCARDIA
  170. Severe HYPOTHERMIA
    Cardiac Arrest
    • 1) start CPR
    • 2) if VFIB or pulseless VTACH
    • (a) defibrillate 1x @ 200J
    • (b) if no changed continue CPR
    • (c) w/hold further defibfrillations & meds till core temp > 30C/86F
  171. TENSION PNEUMOTHORAX WITH SHOCK INDICATIONS
    • 1) Unstable vital signs consistent with shock
    • 2) Signs and symptoms consistent with the diagnosis of a tension pneumothorax
    • (a) Absent breath sounds unilaterally.
    • (b) Tracheal deviation.
    • (c) Distended neck veins.
    • (d) Chest hyper resonant to percussion.
    • (e) Massive subcutaneous emphysema.
  172. NEEDLE CHEST DECOMPRESSION
    Indications
    • Tension pneumothorax with patient in extremis:
    • 1. Diminished / absent lung sounds
    • 2. Hypotension
    • 3. Arrest
  173. NEEDLE CHEST DECOMPRESSION
    Contraindications
    • 1. Suspected simple pneumothorax.
    • 2. Patients with tension pneumothorax that can be relieved by removal of an occlusive dressing from an open chest wound.
  174. NEEDLE CHEST DECOMPRESSION
    Complications
    • 1. Intercostal vascular or nerve injury
    • 2. Pneumo /hemothorax
    • 3. Direct damage to lung
    • 4. Pericardial / cardiac injury
    • 5. Infection
  175. NEEDLE CHEST DECOMPRESSION
    Procedure
    • A. The skin should be cleansed with an antiseptic solution.
    • B. A 12 or 14 gauge intravenous catheter (attached to a syringe if possible) should be introduced through the chest wall at the mid-clavicular lines' second or third intercostal space. Entry must be at the superior rib margin.
    • C. Note air escape or aspirate air with syringe.
    • D. Note any change in the patient's status.
    • E. Secure catheter hub to chest wall with a dressing.
    • F. If patient is spontaneously breathing AND is not intubated and/or receiving positive pressure ventilations, a valve may be attached to the in-dwelling catheter en route to the hospital.
    • 1. Utilize a three way stop cock. Place stop cock on catheter and close at the end of patients expiration. Valve can be re-opened if signs of tension develop.
    • 2. Consider placing a finger cut from an exam glove over catheter hub. Cut a small hole in end of finger to make a flutter valve. Secure glove finger with tape or rubber band. This must be completed prior to placing the needle.
    • 3. Don't waste time to prepare flutter valve; if necessary, control airflow through catheter hub with your gloved finger.
  176. defibrillation
    TACHYCARDIA
    Poly-morphic Ventricular Tachycardia (including torsades de Pointes)
    • 1st dose 200 j
    • 2nd dose if no change 300 j
    • 3rd dose if no change 360 j
    • If unsuccessful CONSIDER Magnesium Sulfate
    • IF ABOVE UNSUCCESSFUL, CONTACT MEDICAL DIRECTION FOR ONE OR MORE OF THE FOLLOWING:
    • a) REPEAT CARDIOVERSION.
    • b) OTHER TREATMENT MODALITIES.
  177. cardioversion
    TACHYCARDIA 
    SVT, AFIB/AFLUTTER
    • 1. Prepare for immediate cardioversion.
    • 2. If delay in cardioversion, and a regular SVT, CONSIDER trial of Adenosine
    • 3. Perform synchronized cardioversion
    • 1st dose 100J
    • 2nd dose 200J
    • 3rd dose 300J
    • 4th dose 360J
    • IF ABOVE UNSUCCESSFUL, CONTACT MEDICAL DIRECTION FOR ONE OR MORE OF THE FOLLOWING:
    • a) REPEAT CARDIOVERSION.
    • b) OTHER TREATMENT MODALITIES.
  178. TACHYCARDIA
    Stable
    SVT; narrow complex, regular, rate > 150
    • 1. CONSIDER Vagal Maneuver
    • 2. Adenosine
    • 3. If Adenosine diagnostic AFib/AFlutter Cardizem
    • 4. If no changed 2nd dose Adenosine
  179. WPW (Wolff-Parkinson-White syndrome)
    W A R N I N G
    • DO NOT ADMINISTER CARDIZEM OR ADENOSINE
  180. PEDIATRIC INTRAVENOUS CANNULATION/FLUID THERAPY
    Infusions (the following crystalloid solutions may be used):
    • A. Lactated Ringers Solution.
    • B. 0.9% Saline Solution.
    • C. D10
  181. Fluid Bolus
    PEDIATRIC CARDIAC ARREST
    Pulseless Electrical Activity (PEA)
    20cc/kg as quickly as possible
  182. Fluid Bolus
    PEDIATRIC TACHYCARDIA
    Narrow complex tachycardia (QRS < 0.08 sec) (possible SVT) w/ signs of poor systemic perfusion (lack of peripheral pulses, delayed capillary refill, cold/mottled extremities, altered mental status)
    • CONTACT MEDICAL DIRECTION FOR CONSIDERATION
    • NS 20cc/kg
  183. Fluid Bolus
    PEDIATRIC ANAPHYLAXIS
    severe cardiopulmonary compromise
    (impending upper airway obstruction with stridor, poor perfusion, hypotension, respiratory distress)
    20 cc/kg as quickly as possible to maintain age appropriate pulse and perfusion
  184. Fluid Bolus
    PEDIATRIC MULTI-SYSTEM TRAUMA/HYPOVOLEMIA
    • 20 cc/kg as quickly as possible to maintain age appropriate pulse and perfusion
    • A. IV fluids should be administered as a bolus.
    • B. Patient should be reassessed after each fluid bolus.
    • C. Do not admin > 3 doses of 20 cc/kg.

    CONTACT MEDICAL DIRECTION FOR REPEAT BOLUS, 20 cc/kg
  185. PEDIATRIC ANAPHYLAXIS
    severe cardiopulmonary compromise
    (impending upper airway obstruction with stridor, poor perfusion, hypotension, respiratory distress)
    • CONTACT MEDICAL DIRECTION FOR CONSIDERATION OF THE FOLLOWING:
    • 1) PTs WITH PROFOUND HYPOTENSION, POOR PERFUSION AND/OR AIRWAY OBSTRUCTION, PER MISSION TO  EPINEPHRINE 1:10,000, 0.01 MG/KG IV OR INTRAOSSEOUS, MAX OF 0.3 MG, ADMINISTERED SLOWLY
    • 2) REPEAT EPINEPHRINE.
    • 3) REPEAT/ CONTINUE RAPID INFUSION OF 20 CC/KG.
  186. Chest Compressions
    PEDIATRIC BRADYCARDIA
    If, despite oxygen and ventilation, heart rate remains bradycardic (less than 60/min), perform them.
  187. External Cardia Pacing
    PEDIATRIC BRADYCARDIA
    CONSIDER (if < 15 kg use pediatric pads)
  188. PEDIATRIC ALTERED MENTAL STATUS
    (HYPOGLYCEMIA/ COMA)
    BGL < 60 (newborns up to 1 wk < 40)
    • CONTACT MEDICAL DIRECTION FOR CONSIDERATION OF THE FOLLOWING:
    • a) REPEAT DEXTROSE.
    • b) GLUCAGON
    • (1) IF OVER 2 YEARS OLD
    • (2) HISTORY OF IDDM WITH BLOOD GLUCOSE <60
    • (3) IF >20 KG, 1 MG IM, IF <20 KG, 0.5 MG
    • (A) GLUCAGON MAY BE CONTRAINDICATED FOR STARVATION INDUCED HYPOGLYCEMIA (DEHYDRATED, NOT EATING, NO HISTORY OF IDDM, ETC.)
    • c) OTHER TREATMENT OPTIONS.
  189. PEDIATRIC SEIZURE/STATUS EPILEPTICUS
    General Motor Seizure (Grand Mal)
    Status Epilepticus [5.11,IV]
    • A. Status Epilepticus: (3 or more general motor seizures without a lucid interval. Seizures
    • lasting five minutes or more may also be considered Status seizures).
    • B. obtain bGl
    • C. IV KVO
    • D. CONTACT MEDICAL DIRECTION FOR CONSID OF...
    • 1. MIDAZOLAM (VERSED) 0.1MG/KG (MAX 2.5MG) SLOW - TITRATED TO STOP SEIZURE
    • IF UNABLE TO ACHIEVE IV ACCESS, ADMINISTER MIDAZOLAM (VERSED) 0.2 MG/KG (MAX DOSE 5 MG)
    • DEEP IM 
    • a) MAY REPEAT AT 5 MIN IF INDICATED
  190. SEIZURE [6.06]
    STATUS EPILEPTICUS
    • A. Consider etiology (hypoglycemia, drug OD & trauma)
    • 1. Obtain BGL
    • B. Pregnant -> ECLAMPSIA [3.07]
    • C. Active General Motor Seizure CONSIDER Ativan:
    • 1. IV, Lorazepam(Ativan) 1-2 mg IV 30 sec or until seizure seizure.
    • D. Active seizure continues or recurs, CONTACT MEDICAL DIRECTION for 1 of the following:
    • 1. Diazepam(Valium) 5-10 mg 30 sec or until seizure subsides.
    • 2. No IV, rectal Valium
    • 3. Midazolam(Versed) 2-5 mg slow IV or until seizure subsides.
    • 4. No IV, Midazolam(Versed) 5 mg deep IM
    • 5. No IV, permission to admin Valium rectally AS
  191. PEDIATRIC TRAUMATIC CARDIAC ARREST [5.14]
    • Field time for multi-system trauma patient and hypovolemic patients must be kept to a minimum. Airway and C-spine control are the primary goals of pre-hospital care for the multi-system trauma patient. All other treatments should be performed while en route to the hospital.
    • I) Routine Pediatric Paramedic Care.
    • II) Basic primary and secondary surveys should be accomplished during on-going resuscitative measures.
    • III) Begin transport as quickly as possible. Continue treatment en route and CONTACT MEDICAL DIRECTION AS SOON AS POSSIBLE.
    • IV) Establish one or more peripheral IV lines as appropriate with large bore catheters and infuse fluid (20 cc/kg as quickly as possible) to maintain age appropriate pulse and perfusion.
    • A. If no peripheral IV access is obtainable, intraosseous access should be established according to Pediatric Intraosseous Procedural Guideline 7-15.
    • V) Administer 0.01 mg/kg epinephrine 1:10,000 IV/IO or 0.1 mg/kg epinephrine 1:1000 ET.
    • A. If no response, repeat epinephrine at same dose every 3-5 minutes.
    • VI) Notify receiving facility of Trauma Alert as appropriate, using Trauma Alert Guideline
    • VII) CONTACT MEDICAL DIRECTION FOR CONSIDERATION OF THE FOLLOWING:
    • A. REPEAT/ CONTINUE RAPID INFUSION, 20 CC/KG.
  192. TRAUMA ALERT GUIDELINES [6.01]
    • Every effort should be made to call a trauma alert as soon as possible, preferably while still on scene.
    • A. Physiologic Criteria
    • 1. Systolic BP < 90 (adult) or hypotension or tachycardia in a child
    • 2. GCS of 13 or less
    • 3. Respiratory distress or airway compromise (intubate if RR <10 or >29)
    • B. Anatomic Criteria
    • 1. Penetrating injuries excluding hands or feet
    • 2. Paralysis or lateralizing neuro signs
    • 3. Burns 2nd or 3rd degree with >5% TBSA or ANY airway involvement
    • 4. Limb amputation excluding digits.
    • 5. More than one fracture
    • 6. Injuries to more than one organ system
    • C. Mechanism Criteria
    • 1. Unrestrained occupant in rollover
    • 2. Death of same-vehicle occupant
    • 3. Ejection from vehicle
    • 4. Significant vehicle deformity with intrusion to passenger compartment or steering wheel deformity
    • 5. Fall from height > 20 feet for adult or > 10 feet for child
    • 6. Pedestrian/bicyclist struck or motorcycle crash > 20 MPH
    • D. Other Considerations
    • 1. Head injury while on warfarin
    • 2. Pt already receiving blood
    • 3. Pt who, in the prehospital provider’s opinion, is rapidly deteriorating
    • 4. Multiple or mass casualty incidents where it is difficult to immediately determine extent of all pts.
  193. Activity (Muscle Tone)
    APGAR
    • 0 - absent
    • 1 - arms & legs flexed
    • 2 - active movement
  194. Pulse
    APGAR
    • 0 - absent
    • 1 - < 100
    • 2 - > 100
  195. Grimace (Reflex/Irritability)
    APGAR
    • 0 - flaccid
    • 1 - some flexion of extremities
    • 2 - active motion (sneeze, cough, pull away)
  196. Appearance (skin color)
    APGAR
    • 0 - blue/pale
    • 1 - body pink w/ extremities blue
    • 2 - completely pink
  197. Respirations
    APGAR
    • 0 - absent
    • 1 - slow/irregular
    • 2 - vigorous cry
  198. APGAR Scoring System
    • 1. Activity (muscle tone)
    • 2. Pulse
    • 3. Grimace (reflex/irritability
    • 4. Appearance (skin color)
    • 5. Respirations

    • 0 - 3 severely depressed
    • 4 - 6 moderately depressed
    • 7 - 10 excellent condition
  199. DETERMINATION OF DEATH / DISCONTINUATION OF PREHOSPITAL RESUSCITATION  [3.16]
    Resuscitation must be started on all patients who are found apneic and pulseless, unless:
    1. The patient has a valid Do Not Resuscitate Order (DNR).2. The patient shows signs of decomposition putrefaction, decapitation, hemicorporectomy, or incineration.3. Dependent Lividity and/or Rigor Mortis require additional assessment: (NOTE: THIS SECTION (3) DOES NOT APPLY IN CASES OF HYPOTHERMIA, LIGHTNING STRIKES, OR DROWNING)a. Reposition the airway and look, listen, and feel for at least 30 seconds for spontaneous respirations or auscultate for lung sounds; respiration is absent.b. Palpate the carotid pulse for at least 30 seconds or auscultate for heart sounds; pulse or heart sound is absent.c. Examine the pupils of both eyes with a light; both pupils are non-reactive.d. Cardiac monitor (in at least 2 leads) for at least 30 seconds to further document lack of cardiac activity.4. Injuries incompatible with life (such as massive crush injury, complete exsangination, severe displacement of brain matter) require additional assessment as in #3 above
  200. DETERMINATION OF DEATH / DISCONTINUATION OF PREHOSPITAL RESUSCITATION  [3.16]
    TERMINATION OF RESUSCITATIVE EFFORTS:
    A. NONTRAUMATIC CARDIAC ARREST1. Discontinuation of CPR and ALS intervention may be implemented after contact with medical control if all of the following criteria have been met.a. Patient must be least 18 years of age.b. Patient is in cardiac arrest at the time of arrival of advanced life support, no pulse, no respirations, and no heart tones.c. ACLS is administered for at least twenty (20) minutes, according to AHA/ACLS Guidelinesd. There is no return of spontaneous pulse and no evidence of neurological function.e. Patient is asystolic in two (2) leadsf. No evidence or suspicion of any of the following: drug/toxin overdose, hypothermic, active internal bleeding, preceding trauma.g. All Paramedic personnel involved in the patient’s care agree that discontinuation of the resuscitation is appropriate.2. All seven items must be clearly documented in the ambulance patient care report (PCR).3. Direct medical oversight (DMO) should be established prior to termination of resuscitation in the field. The final decision to terminate resuscitative efforts should be a consensus between the on-scene paramedic and the DMO physician. CONTACT MEDICAL DIRECTION for confirmation of terminating resuscitation efforts.4. If any of the above criteria are not met and there are special circumstances whereby discontinuation of pre-hospital resuscitation is desired, contact Medical Control.5. Logistical factors should be considered, such as collapse in a public place, family wishes, and safety of the crew and public.a. Examples: Patient too large to extricate, significant physical environmental barriers, unified family wishes with presence of a living will.6. All patients who are found in ventricular fibrillation or whose rhythm changes to ventricular fibrillation should in general have full resuscitation continued and be transported.7. Patients who arrest after arrival of EMS should be transported.
  201. RSI GUIDELINE [7.06]
    INDICATIONS FOR THE USE OF RSI
    • Patients who require immediate airway control and:
    • 1. combative and have impaired airway maintenance
    • 2. suspected of having increased ICP
    • 3. laryngospasm
    • 4. trismus
    • 5. prolonged Seizure activity refractory to benzodiazepines
  202. RSI GUIDELINE [7.06]
    CONTRAINDICATIONS TO ALL RSI
    • A. Patient with a "difficult airway":
    • 1. Opening of mouth < 2 finger widths
    • 2. Short chin (distance from chin to thyroid notch < 2 finger widths)
    • 3. Large overbite
    • 4. Short neck
    • 5. Decreased neck mobility
    • B. Tracheal foreign body, tumor or infections (epiglottitis, peritonsillar, or retropharyngeal).
    • C. Upper airway obstruction.
    • D. Severe facial and/or neck trauma.
    • E. Inability to ventilate patient with BVM.
  203. RSI GUIDELINE [7.06]
    MEDICATION CONTRAINDICATIONS
    • A. Lidocaine
    • 1. Severe Bradycardia (cardiac origin)
    • 2. Second degree and third degree heartblocks
    • B. Atropine
    • 1. Tachydysrhythmias
    • C. Etomidate
    • 1. Children less than 1 year old
  204. ACUTE RESPIRATORY DISTRESS MEDICAL
    GUIDELINES [3.01]
    Acute Bronchospasm with known etiology (history of asthma, COPD, Anaphylaxis) [II]  
    • A. Bronchodilater by neb: ipratropium (atrovent) 500mcg in 3cc
    • B. Consider repeat of bronchodilator if indicated
    • C. Consider Solu-Medrol 125mg IV
    • D. If no response to above or unable to tolerate bronchodilator, admin Epinephrine (1:1,000) dose 0.3cc IM (adult)
    • 1. CONTACT MEDICAL DIRECTION if pt has the following:
    • a) history of HTN
    • b) history of MI or cardiac pain
    • c) Pt >= 60 y/o
    • d) Pregnancy
    • E. If intubated, brochodilators should be admin via a neb to ET tube adapter. (not directly via ET tube)
    • F. Asthma
    • 1. Slower ventilation rate (6-12min) smaller tidal vol (6-8ml/kg) shorter inspiratory times and longer expiratory times (ration of 1:4 or 1:5)
    • 2. Evaluate and treat tension Pneumothorax
    • G. If no relief, CONTACT MEDICAL DIRECTION for consideration of:
    • 1. Magnesium Sulfate 1-2gms over 7-10min
    • a) in 50cc NS: 60GTT/CC drip set w/o
    • b) in 100cc NS: 60GTT/CC drip set w/o
    • 2. CPAP
  205. ACUTE RESPIRATORY DISTRESS MEDICAL GUIDELINES [3.01]
    Acute respiratory distress with unknown etiology [IV]

    • A. Consider ipratropium (atrovent) 500 mcg in 3cc
    • B. CPAP , if clinically indicated.
    • C. CONTACT MEDICAL DIRECTION for further orders.
  206. ACUTE RESPIRATORY DISTRESS MEDICAL GUIDELINES [3.01]
    If respirations begin to decrease in rate or depth with change in mental status or cyanosis [V]  
    begin to assist ventilations immediately
  207. BRADYCARDIA
    [2.07]
    • I RPC w/ early transport
    • II Consider 12L. If AMI suspected - ACLS
    • III Symptomatic bradycardia with unstable hemodynamics, signs and symptoms of shock, CHF, CP suggestive of cardiac etiology, ventricular escape beats.
    • A. Atropine Sulfate 0.5 mg IV bolus.
    • 1. If second degree type II AV block or complete heart block (Third Degree), proceed to
    • C below.
    • B. May be repeated every 3-5 minutes up to a total of 3 mg, if patient remains unstable.
    • C. If no response to Atropine or if second degree type II or complete heart block (third degree).
    • 1. Prepare for transcutaneous pacemaker (TCP) and begin pacing if patient unconscious.
    • 2. Consider sedation. If patient profoundly hyportensive, do not delay TCP.
    • a) CONTACTING MEDICAL DIRECTION FOR SEDATION WITH MIDAZOLAM (VERSED) 2 MG IV AND POSSIBLE ANALGESIA WITH FENTANYL 1 MCG/KG IV SLOW PUSH.

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