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2009 Adult Cardiac EMS Protoco
Adult Cardiac
11
Medical
Professional
12/25/2008
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Term
Asystole:
 Definition
Asystole:Common Causes: Hypoxia, Hypothermia, Trauma, Electrolyte Imbalance, Acidosis
  • CPR (8-10 breaths/minute)
  • Monitor
  • IV
  • Epi 1:10 = 1mg IV, IO
  • Atropine: 1mg IV, IO
  • Bicarb: 1mEq/kg IV, IO
Term
Bradycardia:
 Definition
Bradycardia:
  • 12 Lead (Trasmit)
  • IV
  • If Symptomatic with BP<90
    • Atropine: 0.5mg IVP, IO (Max 3mg)
    • Pacing: Rate-80bpm
      • Ativan: 1-2mg IVP, IO, MAD
      • Conscious – 5mA & increase by 5mA
      • Unconscious – 20mA & increase by 20mA
    • Dopamine: 2-20mcg/kg/min
    • Epi – Drip
Term
Chest Pain / MI:
 Definition
Chest Pain / MI:
  • Monitor - 12Lead - Transmit
  • O2
  • Aspirin: 324mg PO
  • IV (Bolus: 300-500mL if Hypotensive , JVD, CTA)
  • NTG Spray x 3 (if BP > 90)
  • NTG Paste x 1”
  • Fentanyl: 50-100mcg IV, IO q 20mins
If PVC’s, HR>60, without 2nd or 3rd degree Block
  • Lidocaine:
    • 1.5mg/kg IV, IO, ET
    • Lidocaine Drip (2gm>500mL then 2mg/min)
    • If PVC’s persist, see PVC Protocol
Term
Dialysis Patients in Cardiac Arrest:
 Definition
Dialysis Patients in Cardiac Arrest:
  • CPR
  • Sodium Bicarb: 100mEq IV, IO
  • Flush with 50-100mL NS
  • Calcium Chloride: 1gm IV, IO
  • Go to Appropriate ACLS Protocol
Term
Hypertension:
 Definition
Hypertension:
  • Diastolic > 140mgHg or > 120mgHg with Sx’s
  • IV
  • Monitor – 12 Lead - Transmit
  • Nitro Spray: x 3 until Diastolic < 100mgHg
  • NTG Paste: 1”
If Systolic < 90:
  • Fluid Bolus: 300-500ml
 
Term
Narrow Complex Tachycardia: (PSVT)
 Definition
Narrow Complex Tachycardia: (PSVT)
  • Monitor – 12 Lead – Transmit
  • IV
Stable:
  • Valsalva Maneuver: Initially & after each Rx     
  • Adenosine: 6mg IV
  • Adenosine: 12mg IV
  • Adenosine: 12mg IV
Unstable:
  • Ativan: 1-2mg IV, IO, MAD
  • Cardioversion: 50, 100, 200, 300, 360J
Term
PEA:
 Definition
PEA:Hypoxia / Hypothermia / Trauma / Electrolyte Imbalance  Pneumothorax / OD / HyperK+
  • CPR
  • IV
  • Monitor – 12 Lead – Transmit
  • Epi 1:10 = 1mg IV, IO
  • Atropine: 1mg IV, IO if < 60bpm (Brady)
  • Fluid Bolus: 300-500mL
Consider:
  • Hypoglycemia: Dextrose 50% 25gm 50mL IV, IO
  • Hypovolemia: Fluid Bolus
  • Hypoxia: O2, BVM
  • Hypothermia
  • Tension Pneumo: Decompression
  • HyperK+: Acidosis, Tricyclic OD: Sodium Bicarb 1mEq/kg IV, IO
Term
Post Arrest:
 Definition
Post Arrest:Semi-Trendelenburg
  • IV
  • Fluid Bolus
  • Monitor – 12 Lead – Transmit
  • Vitals q 3-5mins
  • Pulse Ox & Capnography
  • Induce Hypothermia
Hypotension:
  • Fluid Bolus: 300-500ml
  • Dopamine: 2-20mcg/kg/min
Ectopy:
  • Lidocaine: 1-1.5mg/kg IV, IO
  • See PVC Protocol
Bradycardia: Treat per Brady Protocol   
Term
Premature Ventricular Contractions (PVC’s):
 Definition
Premature Ventricular Contractions (PVC’s):
  • Monitor – 12Lead – Transmit
  • IV
If HR >60bpm: Suspected AMI, PVC’s >6min, R on T,More than 2 PVC’s in Succession
  • Lidocaine: 1-1.5mg/kg IV, IO
    • ET Double the Dose: 2-2.5mg/kg
If; AMI, CHF, Circulatory Shock, Liver Dysfx, >70yo:
  • Lidocaine: 0.5-0.75mg/kg IV, IO
If PVC’s Persist:
  • Rebolus after 10mins:
  • Lidocaine: 0.5-0.75mg/kg IV, IO Max 3mg/kg
PVC’s Resolved:
  • Lidocaine Drip: 2-4mg/min
 
Term
V-Fib / Pulseless V-Tach:
 Definition
V-Fib / Pulseless V-Tach:
  • Monitor – 12Lead – Transmit
Witnessed:
  • Defib 200J
  • CPR x 2mins
Not Witnessed:
  • CPR x 2mins
  • Defib: 200J
Both:
  • IV
  • Airway
  • Epi 1:10 = 1mg IV, IO q 3mins
  • Defib: 300J
  • CPR x 2mins
  • Amiodarone: 300mg IV, IO
  • Defib: 360J
  • CPR x 2mins
  • Amiodarone: 150mg IV, IO
Consider:
  • Bicarb 1mEq/kg IV, IO
  • Mag Sulfate 1-2gm IV, IO
  • Defib: 360
  • CPR x 2mins
  • Meds & Defib: 360J
Term
Wide Complex Tachycarda (V-Tach w/Pulse):
 Definition
Wide Complex Tachycarda (V-Tach w/Pulse):
  • Monitor – 12Lead – Transmit
  • IV
Stable:
  • Amiodarone: 150mg in 100ml over 10mins
Unstable:
  • Ativan 1-2mg IV, IO, MAD
  • Cardioversion: 100, 200, 300, 360J
  • Amiodarone: 150mg in 100ml over 10mins
  
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