NJ MICU Standing Orders

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Author:
medicstudent1125
ID:
295623
Filename:
NJ MICU Standing Orders
Updated:
2015-02-11 20:33:59
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NJ MICU StandingOrders
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Description:
MONOC Standing Orders
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  1. PEA / Asystole (6 steps)
    • 1) Start CPR
    • 2) Adv. Airway   
    •     Continuous Compressions 100/min   
    •     Vent. 8-10/min - 2min Cycles
    • 3) IV/IO w/ 500mL Normal Saline   
    •     Epi 1:10,000 1mg (2mg ETT) q 3-5    
    •     or 40units Vasopressin
    • 4) Reversible Causes   
    •     BGL less then 60 w/ IV 25g of D50%   
    •     No IV 1mg Glucogon IM   
    •     Opiate OD - 2mg Narcan appropriate route
    • 5) Rhythm Check q 2mins   
    •     If VT/VF follow SO for VT/VF
    • 6) Contact Medical Control   
    • **Terminate only after MC input, and after    
    •     Adv. Airway w/o reversible causes.   
    • **20cc flush after all meds   
    • **50cc max ETT
  2. Active Seizures (5 steps)
    • 1) Secure Airway
    • 2) IV access
    • 3) ALS witness 2mins or more, or repeat 
    •     seizure
    •     2mg Ativan IVP   
    •     5mg Valium IVP   
    •     No IV access -
    •     5mg Versed 2mg Ativan
    •     by appropriate route
    • 4) BGL -
    •     Less then 60 25g of D50 IV   
    •     No IV, 1mg Glucogon IM
    • 5) Contact Medical Control
  3. Allergic Reaction (5 steps)
    • 1) Secure Airway
    • 2) o2 if indicated
    • 3) IV access
    • 4) 50mg Benadryl IVP
    • 5) Contact Medical Control
  4. Anaphylaxis (8 steps)
    • **with any -
    •     Resp. Distress   
    •     Cool, Clammy, Mottled skin   
    •     Hypotension BP </= to 90 systolic   
    •     Altered Mental Status   
    •     Delayed Capillary Refill
    • 1) Secure Airway
    • 2) o2 if indicated
    • 3) 0.3mg Epi 1:1000 IM Deltoid or Lat. Thigh
    • 4) If wheezeing 2.5mg/3mL Albuterol Neb   
    •     Repeated x1
    • 5) IV access w/ 500mL NSS  
    • **Repeat up to 1L if systolic less then 100 
    •      and rales are not present**
    • 6) 50mg Benadryl IV
    • 7) 125mg Solu-Medrol IV
    • 8) Contact Medical Control
  5. Bradycardia (6 Steps)
    • 1) Secure Airway
    • 2) 12 lead
    • 3) IV access
    •     **No IV pace**
    • 4) No signs/symptoms of MI   
    •     No Heart Transplant   
    •     0.5mg Atropine q 3-5mins max 3mg
    • 5) No Response or Signs/Symptoms of MI
    •     Pace - 70BPM @ lowest mA's for capture
    • 6) Contact Medical Control   
    •     **Mobitz type 2 or 3rd degree, apply
    •         pacer pads **
  6. Burn Management (13 steps)
    • 1) Stop Burning Process
    • 2) If Hazmat   
    •     Take Precautions   
    •     Contact Medical Control
    • 3) C-Spine if indicated
    • 4) Secure Airway - If trauma go to SO
    • 5) Consider ETT for airway burns
    • 6) o2 if indicated
    • 7) Cover w/ dry sterile dressings
    • 8) Maintain body temp
    • 9) Transport decesion
    • 10) IV access
    • 11) 1L of NSS or LR's
    • 12) BP of 90 systolic     
    •      0.1mg/kg Morphine max 10mg        
    •      1mcg/kg Fentanyl max 100mcg
    • 13) Contact Medical Control
  7. Non Traumatic Hypotension (4 steps)
    Sys BP <90 w/o  trauma or bradycardia

    • possible sepsis
    • dehydration
    • no significant bleed
    • shock

    • 1) Secure Airway
    • 2) IV access w/ 500mL bolus of NSS
    • 3) Reassess vitals
    • 4) Contact medical control
  8. Nerve Agent Poisoning (4 steps)
    • 1) Scene Safety and ensure Decon
    • 2) Assess for SLUDGEM
    • 3) Determine level of exposure   
    •     **MILD** Conscious and Breathing   
    •     Secure Airway   
    •     Hi-flow o2   
    •     Observe for Resp. Distress   
    •     IV access   
    •     **Severe** Unconscious w/ Resp.
    •        distress 
    •    Secure Airway   
    •    Hi-Flow o2   
    •    IV access   
    •    2mg Atropine IV   
    •    1g Pralidoxime IV
    •    **NO IV use NAAK auto injector kits   
    •    2mg Atropine, 600mg Pralidoxime**
    • 4) Contact medical control
  9. Pulmonary Edema / CHF (8 Steps)
    • 1) Secure Airway
    • 2) o2 if indicated
    • 3) 0.4mg Nitro SL q5min     
    •     w/ BP >/=100 systolic
    • 4) 12 lead
    • 5) If MI 324mg ASA (include already taken)
    • 6) IV access
    • 7) 20mg Lasix or 0.5mg Bumex
    • 8) Contact medical control
  10. COPD Bronchospasm w/ Wheeze (5 steps)
    • 1) Secure Airway
    • 2) 0.5mg Atrovent + 2.5mg Albuterol in
    •     3mL Nebulizer
    • 3) IV access
    • 4) Reassess; repeat 2.5mg/3mL Albuterol 
    •     x2   
    •     **If CHF/Pulm Edema go to SO**
    • 5) Contact Medical Control
  11. Chest Pain / AMI (8 steps)
    • 1) Secure Airway
    • 2) o2 if indicated
    • 3) ASA 324mg PO (Include already taken)
    • 4) 12 lead
    • 5) 0.4mg Nitro SL q 5min if sys BP >/= 100
    • 6) IV access
    • 7) Consider Thrombolytic eligibility
    • 8) Contact Medical Control
  12. Unconscious / AMS (5 steps)
    • 1) Secure Airway
    • 2) BGL 
    •    If less than 60 - 25g D50% w/ IV   
    •    No IV - 1mg Glucogon IM   
    •    Possible Stroke - Neuro Exam
    • 3) IV access
    • 4) BGL greater than 60 or no response   
    •     Administer 0.4mg max 2mg Narcan to    
    •     reverse resp. depression
    • 5) Call medical control

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