Term
| Drug Assisted Intubation (DAI) |
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Definition
Indications- trauma,stroke, rr<10, >40, spo2 <92, gcs 8 or less
Predoxygenate 12-15 L/nrm or BVM 3 minutes
Premedicate Lidocaine 1.5 mg.kg ivp, HTN, stroke, trauma
Gag reflex- benzocaine 1-2 sec spray
Pain- morphine 2mg ivp up to 10mg
Sedate- Versed 5mg ivp, Etomidate .5 mg/kg |
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Term
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Definition
Bp 90 or above warmth, tingling, fullness in mouth and throat, rash, itching.
Benadryl 1mg/kg - max 50 mg im or slow ivp |
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Term
| Allergic Reaction (Moderate) |
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Definition
Bp above 90 S&S Same as mild plus wheezing, edema of airway, dyspnea, cough, soft tissue emdema, flushing, nausea, vomiting.
Epinephrine (1:1000) .3 mg sub q/IM
May repeat in five to ten minutes Do not delay transport waiting for response.
Benadryl 50 mg ivp if no iv im
If wheezing albuterol 2.5 mg hhn or mask 6l |
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Term
| Allergic Reaction (Severe, Anaphylactic) |
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Definition
Bp less than 90
Life threatening symptoms include all of mild and moderate.
Time sensitive Pt
If airway/ventilations severely compromised: rx per dai sop
Iv NS consecutive 200 ml fluid challenge to attain bp of 90
Epi 1:10000 .1 mg increments up to 1 mg. Reassess after each .1 mg
If no iv epi 1:10000 1 mg ett
If no ett epi 1:1000 1 mg IM
If bp remains below 90 dopamine ivpb 10mcg/kg/min Titrated to 20 mcg/kg/min to attain bp of 90
If on beta or calcium blockers, pregnant or not responding to epi or dopamine Glucagon 1 mh slow ivp if no iv give im may repeat x1
If bp improves > 90 benadryl 50 mg ivp, if no iv give im
If wheezing albuterol 2.5mg/neb |
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Term
| Asthma/COPD (mild to moderate) |
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Definition
Wheezing and or cough variant asthma spo2 95%
Albuterol 2.5 mg via hhn or mask
Begin transport as soon as albuterol is started DO NOT wait for response
Continue/Repeat ALBUTEROL while enroute to hospital |
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Term
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Definition
Severe SOB,use of accessory muscles, speaks in syllables, tachypnea, breath sounds diminished or absent, spo2 94 % or less
TIME SENSITIVE
EPI 1:1000 .3 mg sub-q
BEGIN TRANSPORT AS SOON AS EPI IS GIVEN
may repeat x in 10 minutes if minimal resonse
Sever distress persists: Magnesium 50% 2 gm (4ml) mixed wuth 16 ml ns slow iv push over 2 minutes
If wheezing present after epi : Albuterol 2.5 mg |
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Term
Acute Coronary Syndrome (ACS)
None to Mild |
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Definition
Pain, discomfort present. alert, oriented, well perfused bp above 90
ASA 324 mg PO
Nitro .4 mg sl or spray
pain persists & bp above 100 repeat ntg q. 5 mintues max 3 doses
iv ns tko
Pain persists after 2nd nitro morphine 2 mg max 10 mg as lon bp above 90 |
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Term
Acute Coronary Syndrome (ACS)
Moderate |
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Definition
Cardiorespiratory compromise + pain, discomfort bp 90 - 100
IMC
IV NS 200 ml challenge if lungs clear
Nitro .4 mg bp > 100 q. 5 minutes max 3 doses
Pain after NTG x 2
Morphine 2 mg max of 10 mg bp maintained of >90 |
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Term
Acute Coronary Syndrome (ACS)
Severe |
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Definition
Altered Sensorium, signs of hypoperfusion, or bp <90
If hr less than 60 treat per bradycardia sop
If hr above 60 treat per cardiogenic shock with dopamine ivpb 5 mcg/kg/min; titrate to 20 mcg/kg.min to maintain systolic bp > 90 |
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Term
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Definition
IMC Aspirin 324 mg
None to mild cardiorespiratory compromise Well perfused and systolic bp 90 or above. Ongoing assessment
Moderate to severe cardio respiratory compromise
Altered sensorium bp <90
TCP 70-80 bpm
increase ma until capture
if capture continue pacing enroute do not turn off
if agitated versed 2 mg increments to 10 mg
if pain and bp >90 after pacing morphine 2mg to 10 mg slow IVP
Pacing ineffective - Atropine .5 mg (1mg ETT) may repeat q. 3 minutes to max of 3 mg or 6mg ETT
If pt on beta calcium channel blocker or beta - Glucagon 1 mg ivp
If pt remains unstable or cannot recieve Atropine treat per cardiogenic shock |
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Term
| Supraventricular Tachycardia (Mild to Moderate) |
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Definition
Mild to Moderate cardiorespiratory compromise hr greater then 140 and bp above 90.
Valsalva manuevers
Rhythm persists right carotid massage unless contraindicated
Regular R-R svt persists Adenocard 6 mg rapid ivp + 20 ml NS flush
SVT persists or recurs adenocard 12 mg rapid ivp + 20 cc lush
Irregular R-R A-Fib, A-Flutter
Cardizem .25 mg/kg ivp over 2 minutes |
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Term
| Supraventricular Tachycardia (Severe) |
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Definition
Bp less then 90 altered sensorium hr greather then 140
Lungls clear iv fluids 200 hundred cc challenge
Assess need for procedural sedation versed 2 Mg to 1 Mg slow ivp
Synchronized Cardioversion 10-200-300-360 |
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Term
| Ventricular Tachycardia with a Pulse (None to Moderate) |
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Definition
None to Moderate Hr >140, bp >90
Monomorphic VT Amiodarone 150 mg mixed with 7 ml ns slow ivp over 10 mins
Polymorphic VT Magnesium 2 GM mixed with 16 ml NS slow Ivp |
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Term
Ventricular Tachycardia with a Pulse
(Severe) |
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Definition
Severe - bp < 90 Procedural Versed 2 mg to 10 mg slow ivp.
Synchronized Cardioversion 100-200-300-360
Vt persists amiodarone 150 mg mixed with 7 ml slow iv bolus over 10 minutes
No iv and ett in place seek medical control for order of Lidocaine 1mg/kg ETT q. 3-5 minutes up to 3 mg/kg ETT
Synchronized cardiovert after each 1/2 of amiodarone. |
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Term
| Ventricular Fibrillation or Pulseless V-Tach |
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Definition
IMC ,ABC,CPR
Defib 200-300-360
Return of spontaneous circulation Assess VS support breathing follow appropriate SOP
Persistent VF/VT
resume cpr defib 360 after each minute of cpr
intubate
Establish Iv
Vasopressin 40 units ivp
No iv epi 1:1000 2 mg with 8 ml ns ETT q. 3-5 min
Administer vasopresson as soon as iv estabished
Defib 360
Amiodarone 30 mg ivp
No IV Seek med order for Lidocaine 2mg/kg ETT q. 3-5 minutes to 6mg/kg
Defib 360
sodium Bicarbonate 1meg/kg ivp
Continue cpr an transport Defib 360 each minute
Pt remains VF for 15 minutes after vasopressin EPI 1:10000 1 mg ivp or 2mg EPI 1:1000 in 8 ml ns ETT
EPI supply exhausted Dopamine 10mcg/kg/min to 20 mcg/kg/min ivpb |
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Term
| Implanted Cardiac Defibrillator (ICD) |
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Definition
Begin BLS IMC
Establish Unresponsivenss, position airway determine breathlessness,start cpr. ecg monitor soon as possible.
If pulseless vt/vf
Defib at 200,300,360 |
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Term
| Pulseless Electrical Activity (PEA) |
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Definition
CPR
Intubate
IV NS 200 challenge to maintain a bp of 90.
Reassess breath sounds after each 200 cc
Check for pulse and rhythm use proper sop
Epinephrine 1:10000 1mg ivp or EPI 1:1000 2 mg mixed with 8 cc NS ETT
Rate 60 or less is asystole sop |
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Term
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Definition
CPR
Vasopressin 40 units
Atropine 1mg IVP q. 3-5 minutes
If in asystole for 10 minutes or longer request order for termination of resucitation |
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Term
| Heart Failure/ Pulmonary Edema ( Mild to Moderate) |
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Definition
Alert normotensive or hypertensive (SBP >90 and DBP >60.
IMC 02 15L/C-Pap fio2 at 60% wih 5 cm of peep. May increase fio2 to 95% and 10 cm of peep to achieve spo2 of 95% or better
IF BP falls below 90 systolic remove c pap.
Aspirin 324 mg po
Nitroglycerin .4 mg sl q. 5 minutes with no limit. SBP must remain >90
If Pedal Edema Lasix 1mg/kg not to exceed 80 mg
Pain or anxiety Morphine 2 mg increments to 10 mg slow IVP |
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Term
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Definition
Pump failure with Bp less than 90 W/S&S of hypoperfusion
Dopamine 5 mcg/kg/min titrated to 20 mcg/kg/min to maintain BP above 90
If hypovolemic and/or dehydrated and lungs are clear and respiration are not labored IV NS fluid challenge frequentyl reassess breath sounds
If alert with gag reflex aspirin 324 mg PO |
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Term
| Acute Abdominal/ Flank Pain |
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Definition
Morphine 2 mg as long bo above 90
if perotoniitis so pain meds |
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Term
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Definition
Blood Sugar 60 or below dextrose 50% 50 ml (25 gm) ivp
60-70 Dextrose 50% 25 ml 12.5 gm ivp
No iv glucagon im |
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Term
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Definition
Beta Blockers- p<60+bp < 90 glucagon ivp
Cocaine- Valium 2mg-10mg ivp or ir. Versed 5 mg im >200 10 mg im
Cyclic Atidepressant-Sodium Bicarb 1meg/kg ivp
Ecstacy-manage airway
GHB- manage airway
Narcotic- narcan .4 mg increments up to 2 mg ivp or 2 mg im
Organophosphates- atropine 1 mg ivp/2mg ett q. 3 minutes no limit. |
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Term
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Definition
| Valium 2 mg - 10 mg ivp or i.5 mg/kg ir . no iv versed 5 mg im. |
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Term
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Definition
Chest injury - Bilateral needle pleural decompression
cpr
Epi- 1:10000 1 mg ivp or Epi 1:1000 2 mg with 8 ml ns ett |
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Term
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Definition
Atropine- .5 mg reapid iv push q. 3 minutes
Dopamine -1omcg/kg/min titrated to 20 |
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Term
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Definition
| Needle Decompression on affected side |
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Term
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Definition
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Term
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Definition
| NS Iv Widle open up to 2 L |
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Term
| Eye Emergency- Chemical Burn |
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Definition
| Tetracaine .5% 1 gtt each affected eye |
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Term
| Eye Emergency Corneal Abrasion |
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Definition
| Tetracaine- .5% 1 gtt each affected eye |
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Term
| Eye Emergency Penetrating Injury/ Ruptured Globe |
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Definition
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Term
| Eye Emergency Centrail Retinal Artery Occlusion |
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Definition
| Massage globe, ntg .4 mg sl or spray |
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Term
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Definition
Sodium Bicarb 1 mg/kg ivp
Albuterol 5 mg |
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Term
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Definition
IN NS wide open
Amyl nitrate inhalants 1 per minute x 12 if available |
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Term
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Definition
Magnesium 2gm with 16 ml ns slow ivp over 2 mins.
Valium 2mg to 10 |
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Term
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Definition
Atropine .02 mg/kg
Lidocaine 1 mg/kg
Morphine for pain .1 mg/kg
Versed .1mg/kg |
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Term
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Definition
Benadryl 1 mg/kg im or slow ivp
epi 1:1000 .01 mg /kg sub q/IM |
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Term
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Definition
Epi 1:10000 .01 mg/kg up to 1 m ivp/io
No IV Epi 1:1000 .1mg/kg up to 1 mg ett
No ETT Epi 1:1000 .1mg/kg up to 1 mg im
Benadryl 1 mg/kg
Albuterol 2.5mg
Dopamine IVPB 10 mcg/kg/min |
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Term
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Definition
Albuterol 2.5 mg
Epi 1:1000 .01 mg/kg sub q
Magnesium 25mg/kg mixed with 16 ml NS over 10 o 20 mins |
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Term
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Definition
NS 6 ml in neb mask
Wheezing Albuterol 2.5 mg
Epi 1:1000 3 ml (3mg) via neb |
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Term
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Definition
| Epi 1:1000 3 ml (3mg) Neb mask |
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Term
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Definition
Epi 1:10000 .01 mg/kg ivp/io or 1:1000 .1mg/kg ett q. 3-5 min
Atropine .02 mg/kg rapid ivp/io
Dopamine 5mcg/kg.min |
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Term
| Peds narrow complex Tachycardia |
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Definition
Adenocard .1mg/kg rapid ivp with 5-10 ml flush may double an repeat once max second dose 12 mg
Synchronized Cardiovert at .5-1-2j/kg |
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Term
| Peds Ventricular Tachycardia with Pulse |
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Definition
Monomorphic- Amiodarone 5 mg/kg mixed with ns to total volume of 20 ml slow ivp over 20 mins
Polymorphic- Magnesium 25mg/kg up to 2 gm mix with 16 ml ns iv over 10-20 mins.
Synchronized Cardiovert .5-1-2 j/kg
Successful Cardiovert amiodarone 5mg/kg with ns to make to 20ml total over 20 minutes, or lidocaine 1mg/kg ett
cardiovert at 4 j/kg each minute during and or after drug therapy |
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Term
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Definition
Defib at 2-4-4 j/kg
Epi 1:10000 .01 mg /kg ivp/io or epi 1:1000 .1mg/kg ett
amiodarone 5mg/kg ivp/io or lidocaine 2mg/kg ett
long arrest sodium bicarb 1meq/kg in/io |
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Term
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Definition
CPR
Epinephrine 1:10000 .01 mg/kg ivp/io or 1:1000 .1mg/kg ett
If arrest due to hyperkalemia, hypermagnesemia, tricyclic od, or other sodium channel blocking agents
Sodium bicarb 1meq/kg |
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Term
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Definition
If blood sugar between 60-70 and symptomatic give 1/2 dose
If less than 60
1-8 yrs old dextrose 25% 2 ml/kg ivp/io
less than 1 dextrose 12.5% 2-4ml/kg ivp/io
No iv glucagon .03 mg/kg im |
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Term
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Definition
Beta Blockers- glucagon .03 mg/kg iv/io
if wide qrs sodium bicarb 1meq/kg ivp
Cocaine-Valium .3 mg/kg slow ivp i fno iv ir or versed .1mg/kg im
Cyclic Antidepressant- Sodium 1meq/kg ivp Valium .3mg/kg ivp/io
Narcotic- narcan .1mg/kg ivp/ett/io
Organophosphates- Atropine .02mg/kg rapid ivp |
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