Adult: 300 mg IV: Repeat 150mg for VF/VT refractory to the first dose and at least one defibrillation attempt.
Amiodarone IV PEDINarrow complex tachycardia NO EFFECT WITH ADENOSINE
Pedi: 5mg/kg (MAX 150 mg) IV over 20 min
Amiodarone IV INFUSION – CARDIACS MUST CALL MEDICAL CONTROL – STANDING ORDER FOR PARAMEDICSWide complex tachycardia WITH A PULSE
Adult: 150 mg IV over 10 min ( may repeat x1 in 10 min) If amiodarone is effective in terminating the arrhythmia consider maintenance infusion of 1 mg / min.Pedi: 5 mg/kg (max dose 150 mg) IV over 20 min (may repeat x1 in 10min)
(P) Amiodarone IV INFUSIONPost Cardiac Arrest
Adult: 1mg / min
Adult: 324-650mg POASPIRIN IS NEVER ADMINISTERED TO CHILDREN
Fentanyl IV/IM/IO/IN AdultPAIN (Severe greater than 6/10)
Adult: 0.5-1 mcg/kg IV/IM/IN (Max SINGLE dose 100 mcg), may repeat every 10 minutes to a maximum of 300 mcg cumulative dose. IV dose given over 2 minutes.
Fentanyl IV/IM/IO/IN PediPAIN (Severe greater than 6/10)
Pedi: 0.5-1 mcg/kg IV/IM/IN (Max SINGLE dose 75 mcg), may repeat every 10 minutes to a maximum of 150 mcg cumulative dose. IV dose given over 2 minutes.
(P) FentanylPatient with advanced airway in place
(P) FentanylPatient requiring electrical therapy
Furosemide IV AdultAcute Decompensated Heart Failure
Adult: If ALLof the following apply: Transport time greater than or equal to 30 min AND patient is prescribed Furosemide (Lasix) at home AND Systolic BP greater than or equal to 100/ administer daily dose of Lasix IV to max of 80mg ONLY
Glucagon INTRAMUSCULARLY – IMHypoglycemiaState the Adult AND Pedi doses
Adult: 1 mg IM
(P) Glucagon IVAllergic Reaction, Anaphylaxis
(P) Glucagon IV Overdose – beta blocker or CCB
Adult / Pedi: 1 Tube (15 Grams) PO If the patient is awake and able to swallow ONLY
Hydrocortisone (Solu-Cortef) IVAdrenal Insufficiency, Allergic Reaction, Anaphylaxis, Asthma, COPD, RAD
Adult: 100 mg IVPedi: 2 mg/kg (100 mg MAX)
(P) Hydroxycobalamin IV INFUSION
Ibuprofen OralPain, Fever 100.4 F or greater
Adult / Pedi: 10mg / kgAdult consider: APAP taken in last 4 hours and still greater than or equal to 100.4 F: 400-800 mg POPedi consider: 800 mg MAX Dose
(P) 20% Fat Emulsion
Ipratropium Bromide INHAsthma / COPD / RAD
Adult / Pedi: 0.5 mg unit dose alone or combine with albuterol dose inhaled (Duoneb)
Lactated Ringers IVIndications for use
Shock, Sepsis, PEA, Suspected Hypovolemia
Lactated Ringers OCCULAR IRRIGATIONEYE IRRIGATION
irrigation of minimum of 2 liters into affected eye for 15 minutes
(P) (IFT) Labetalol
Lidocaine IVVF / Pulseless VT
Adult: 100 mg IV repeat every 10 min x 2
Lidocaine IVWCT w/ pulse
Adult: 1 – 1.5 mg / kg IV (may repeat x1 in 5 min)
Lidocaine IV – CARDIACS MUST CALL MEDICAL CONTOL UNDER THIS PARTICULAR PROTOCOL – STANDING ORDER FOR PARAMEDICSWide Complex Tachycardia – WITH A PULSE
Adult: 1-1.5 mg / kg May repeat x1 in 5 minutes
(P) Lorazepam (Ativan) IVPatient with advanced airway in place
Lorazepam (Ativan) IVSeizures
Adult: 4 mg IV May repeat 2mg every 3-5 min to a max of 10 mg.
(P) Lorazepam (Ativan) IVAnxiolysis during CPAP therapy
Magnesium Sulfate INFUSION – CARDIACS MUST CALL MEDICAL CONTROL / PARAMEDIC STANDING ORDERPolymorphic VT Torsades WITH pulse
1-2 Grams IV over 5 minutes
(P) Magnesium Sulfate INFUSIONPolymorphic VT Torsades WITHOUT pulse
Mark 1 NAAK
Methylprednisolone (Solu-Medrol) IVAdrenal Insufficiency, Allergic Reaction, anaphylaxis, asthma, COPD RAD
Adult: 125 mg IV
Midazolam IV IM IN DO NOT NEED MEDICAL CONTROLExcited Delerium Syndrome, Electrical Therapy
Adult: 2.5 – 5 mg IV over 1 minutes then repeat x1 every 10 minutes x3 if SBP greater than 100. May be given IM IN 5mg.
(P) Midazolam iVCPR induced Consciousness
Adult: 1 mg IV may repeat every 5-10 minutes PRN.
(P) Midazolam iVPatient with advanced airway in place
Adult: 2.5 – 5 mg IV every 5 – 10 min as needed.
Midazolam IV IM INAggressive or Aggitated NO ALCOHOL ON BOARD
Adult: 2.5 – 5 mg IV or 5 mg IM IN. May repeat PRN if SBP is greater than 100 for a cumulative dose of 10mg. (Cummulative dose of 5mg if the patient is over 65 mg)
Midazolam IM or IN OnlySeizures No IV access
Adult: 10mg IM —–OR—– 2 mg IN
Midazolam IVSeizures WITH IV access
Adult: 2.5 mg IV (5mg IM or 2mg IN), may repeat 2mg every 3-5 min to a max of 20 mg)
Midazolam IV IN IMSympathomimetic / Stimulant Toxicity
Adult: 2.5 mg IV / IN. May repeat in 5 min. 2.5 mg IM. May repeat IM dose in 20 min.
Midazolam IV IN IMSevere Muscle Spasm related to stings, bites, or envenomations
Adult: 0.5 -2 mg IV over 2-3 min or 1-2 mg IN or 5 mg IN (max 5 mg)
Naloxone IV IN IM AdultSuspected Opioid Overdose
Adult: 0.4 mg IN IV IM. Every 3-5 min until adequate ventilation is restored or 10 mg is administered.
Naloxone IV IN IM PediRepeat dose at 3-5 Suspected Opioid Overdose
Pedi: 0.1 mg / kg IN IV IM —- MAX DOSE 2 MG—-repeat dose at 3-5 min intervals until ventilation is restored. For patient's greater than or equal to 20 kg consider Narcan 2mg IN IV IM, repeat at 3-5 min intervals until adeq vent restored
You have a patient in Cardiac Arrest. There is an organized rhythm but no pulse (PEA) and, based on the story family from family members, you suspect the patient may have been been hypovolemic prior to the arrest. You may consider what intervention?
Fluid bolus of Lactated Ringers or Normal Saline 500 -1000ml repeated x1.
You have been working a cardiac arrest and have defibrillated the patient several times along with several administration of Epinephrine and Amiodarone. As it pertains solely to electrical therapy what are two options for refractory VF / VT?
1> Change defibrillator pads and apply a new set of pads at the same site.2> Double Sequential External Defibrillation Protocol if resources allow (two monitors – 4 pads – defib simultaneously)
True or False: While treating a patient in Cardiac Arrest you must never use both Amiodarone AND Lidocaine?
False. If you have administered Amiodarone 300mg, repeated at 150mg and VF / VT is still refractory to at least one Defibrillation you may switch to Lidocaine 100 mg repeat every 10 min x 2.
In a Cardiac Arrest, if you decide to use the IO is placement above or below the level of the diaphragm preferred? (for example: In the leg or in the arm?)
ABOVE the level of the diaphragm as it is closer to the heart.
"Reversible Causes of Cardiac Arrest" are known as the "5 H's and 5 T's" – It is believed that if you can isolate and manage these conditions you may increase the likelihood of survival Can you name all of them?
Explain the 30 minute CPR rule illustrated by the RI Protocols.
Regardless of proximity to a receiving facility. Absent concern for provider safety or traumatic etiology for cardiac arrest. Continue resuscitative efforts for a MINIMUM of 30 minutes PRIOR TO MOVING THE PATIENT to the ambulance OR transporting
You are working a Cardiac Arrest and a BLS provider is performing CPR. You have intubated the patient successfully and have good lung sounds with no sounds over the epigastrum. The initial EtCO2 12 mmHg but is now 8. What should you do first?
Attempt to improve the quality of CPR. Good CPR will reflect an EtCO2 greater than or equal to 10 mmHG.
True / False: Pulse checks should be performed after each defibrillation?
FALSE!!!!! IMMMEDIATE CPR after each defibrillation attempt NO PULSE CHECKS
Midazolam IV CARDIACS MUST OBTAIN MEDICAL CONTROL ORDERS FOR THIS PARTICULAR PROTOCOLAssisting people with compliance with CPAP