• Treat pain as per Pain Management Protocol (S-141)
• 500ml fluid bolus IV/IO for suspected volume depletion SO

Abdominal Discomfort / GI / GU

For nausea and/or vommiting

• Zofran 4mg IV/IM/ODT SO. MR x1 q10" SO

ALLERGIC REACTION / ANAPHYLAXIS

MILD

• Benadryl 50mg IV/IM SO

Abdominal Discomfort / GI / GU

Acute

• Epi 1:1,000 0.3mg IM SO. MR x2 q10" SO.
• Benadryl 50mg IM/IV SO
• Albuterol 6ml 0.083% via nebulizer SO.  MR SO.
• Atrovent 2.5ml 0.02% via nebulizer added to first dose of Albuterol SO.

Abdominal Discomfort / GI / GU

Anaphylaxis

• Epi 1:1,000 0.3mg IM SO. MR x2 q10" SO.
• 500 ml fluid bolus IV/IO for systolic BP < 90 SO.  MR to maintain systolic BP ≥90 SO
• Benadryl 50mg IM/IV SO
• Albuterol 6ml 0.083% via nebulizer SO.  MR SO.
• Atrovent 2.5ml 0.02% via nebulizer added to first dose of Albuterol SO

• Epi 1:10,000 0.1mg IV/IO BHO. MR x2 q3-5" BHO

• Dopamine 400mg/250ml @ 10-40 mcg/kg/min IV/IO drip; Titrate systolic BP ≥90 BHO

ALTERED NEUROLOGIC FUNCTION (Nontraumatic)

Symtomatic ?opiod OD with resiratory rate <12:

• Narcan 2mg IN/IM/IV SO titrate IV dose to effect.  MR 
• If patient refuses transport give additional Narcan 2mg IM SO

ALTERED NEUROLOGIC FUNCTION (Nontraumatic)

Hypoglycemia

• D50 25Gm IV/IO SO if BS <60
• If patient remains symptomatic and BS remains <60 MR SO

ALTERED NEUROLOGIC FUNCTION (Nontraumatic)

Seizures

• Versed 0.1mg/kg slow IV/IO to max dose 5mg SO (d/c if seizure stops). MR x 1 SO

BURNS

For patients with ≥20% or ≥5% 3rd degree burns and ≥15 y/o:

• 500ml fluid bolus IV/IO, then TKO SO

Burns

In the presence of respiratory distress with bronchospasm:

• Albuterol 6ml 0.083% via nebulizer SO.  MR SO

Burns

Chemical Burns

• Brush off dry chemicals
• flush with copious amounts of water

Burns

Thermal burns

Burns of <10% body surface area:

• Stop burning with non-chilled water or saline

Burns of ≥10% bodyy surface area:

• Cover with dry dressing and keep warm
• Do not allow the patient to become hypothermic

Burns

Burn center criteria

Patients with burns involving:

• >20% 2nd or >5% 3rd degree of BSA
• Suspected respiratory invlovment or significant smoke inhalation in a confined space
• Significant injury to the face, hands, feet, or perineum, or circumferential
• Significant electrical injury due to high voltage (greater than 110 volts)

DISCOMFORT / PAIN OF SUSPECTED CARDIAC ORIGIN

ALS

• Monitor EKG
• IV SO adjust prn
• Obtain 12 Lead EKG

If STEMI: notify base immediately and transport to appropirate STEMI center

• ASA 162mg chewable PO SO

If systolic BP ≥100

• NTG 0.4mg SL SO.  MR q3-5" SO
• NTG ointment 1" SO
• MS 2-4mg IV SO.  MR to max 10mg SO.  MR to max 20mg BHO

IF systolic BP <100:

• NTG 0.4mg SL BHO.  MR BHPO
• MS 2-4mg IV BHO.  MR to max 20mg BHO

Discomfort/Pain of ?cardiac Origin w/ associated shock:

• 250ml fluid bolus IV/IO with clear lungs SO.  MR to maintain systolic BP ≥90 SO

If BP refractory to fluid boluses:

• Dopamine 400mg/250ml @ 10-40mcg/kg/min IV/IO drip.  Titrate to systolic BP ≥90 BHO

DISCOMFORT / PAIN OF SUSPECTED CARDIAC ORIGIN

Notes

• If discomfort/pain is relieved prior to arrival, continue treatment with NTG ointment and ASA.  ASA should be given regardless of prior daily dose(s).
• If any patient has taken an erectile dysfunction medication such as Viagra, Cialis, and levitra within 48 hours, NTG is contraindicated.
• May encounter patients taking similar medication for pulmonary hytertension (revatio, flolan, veletri).  NTG is contraindicated for these patients as well.

Unstable Bradycardia

Wide Complex bradycardia

• Monitor EKG
• 250 ML fluid bolus IV/IO with clear lungs SO to maintain BP ≥90.  MR SO
• External cardiac pacemaker SO

IF capture occurs and BP ≥100, consider medication for discomfort:

• Morphine 2-10mg IV/IO prn SO

For discomfort related to pacing not relieved with morphine and BP ≥100:

• Versed 1-5mg IV/IO SO

• Dopamine 400mg/250ml @10-40mcg/kg/min IV/IO drip, titrate to BP ≥90 (after initiation of pacing) BHO

If external pacing unavailable:

• May give Atropine 0.5mg IV/IO for pulse <60 SO.  MR q3-5" to max 3mg SO

Unstable Bradycardia

Narrow Complex Bradycardia

• Mointor EKG
• 250ml fluid bolus IV/IO with clear lungs SO to maintain BP >90, MR SO
• Atropine 0.5mg IV/IO for pulse <60 SO.  MR q3-5" to max 3mg SO.

If rhythm refractory to a minimum of Atropine 1mg:

• External cardiac pacemaker SO

If capture occurs and BP ≥100, consider medication for discomfort.

• Morphine 2-10mg IV/IO prn SO

For discomfort related to pacing not relieved with Morphine and BP ≥100:

• Versed 1-5mg IV/IO SO

Dopamine 400mg/250ml @ 10-40mcg/kg/min IV/IO drip, titrate to BP ≥90 (after amx Atropine or intiation of pacing) BHO

SVT

Stable SVT

• Monitor EKG
• 250ml fluid bolus IV/IO with clear lungs to maintain BP ≥90, MR SO
• VSM SO. MR SO
• Adenosine 6mg rapid IV/IO, followed with 20ml NS IV/IO SO.
• (Patients with history of bronchospasm of COPD BHO)
• Adenosine 12mg IV/IO Followed with 20ml NS IV/IO SO if no sustained rhythm chnage, MR x1 in 1-2" SO

SVT

Unstable Conscious SVT

• Monitor EKG
• 250ml fluid bolus IV/IO with clear lungs to maintain BP ≥90, MR SO
• VSM SO. MR SO
• Versed 1-5mg IV/IO prn pre-cardioversion BHO
• If age ≥60 consider lower dose with attention to age and hydration status.
• Syncchronized cardioversion at manufactor's recommended energy dose BHO.  MR BHO.

SVT

Unstable Unconscious SVT

• Monitor EKG
• 250ml fluid bolus IV/IO with clear lungs to maintain BP ≥90, MR SO
• VSM SO. MR SO
• Syncchronized cardioversion at manufactor's recommended energy dose SO.  MR BHO.

• Monitor EKG
• 250ml fluid bolus IV/IO with clear lungs SO to maintain BP ≥90, MR SO. 

Conscious:

• Versed 1-5mg IV/IO prn pre-cardioverson BHPO
• IF age ≥60 consider lower dose with attention to age and hydration status.
• Synchronized cardioversion at manufacturer's recomended energy dose BHPO.  MR BHPO.

Unconscious:

• Synchronized cardioversion at manufacturer's energy energy dose SO.  MR x 3 SO.  MR BHO.

Ventricular Tachycardia (VT)

Stable

• Monitor EKG
• 250ml fluid bolus IV/IO with clear lungs SO to maintain BP ≥90, MR SO
• Lidocaine 1.5mg/kg IV/IO SO.  MR at 0.5mg/kg IV/IO q 8-10" to max 3mg/kg (including inital bolus) SO

OR

• Amiodarone 150mg IV/IO SO.  MR x1 in 10" BHO

Ventricular Tachycardia (VT)

Unstable Conscious

• Monitor EKG
• 250ml fluid bolus IV/IO with clear lungs to maintain BP ≥90, MR SO
• Versed 1-5 IV/IO prn precardioversion SO
• If age ≥60 consider lower dose with attention to age and hydration status.
• Synchronized cardioversion an manufacturer's recommended energy dose SO.  MR x3 SO. MR BHO

Ventricular Tachycardia (VT)

Unstable Unconscious

• Monitor EKG
• 250ml fluid bolus IV/IO with clear lungs to maintain BP ≥90, MR SO
• Synchronized cardioversion at manufactor's recommended energy dose SO.  MR x3 SO.  MR BHO.

VF/ Pulseless VT

• Begin CPR

IF arrest witnessed by medical personnel:

• Perform CPR until ready to defibrillate

If unwitnessed arrest:

• Perform CPR x 2 min

• Monitor EKG
• Defibrillate x 1 at manufacturer's recommended energy dose SO
• Resume CPR for 2 minutes immediately after shock
• Perform no more than 10 second rhythm check, and pulse check if rhythm is orginized.
• Defibrilate for persistent VF/pulseless VT PRN SO
• Continue CPR for persistent VF/pulseless VT.  Repeat 2 minute cycle followed by rhythm/pulse check, followed by defibrillation/medication, if indicated
• IV/IO SO.  Do not interupt CPR to Establish IV/IO

Once IV/IO established, if no pulse after rhythm/pulse check:

• Epinephrine 1:10,000 1mg IV/IO SO.  MR q3-5" SO
• Intubate/PAA SO.  Avoid interruption of CPR.
• EtCO2 monitoring SO
• NG/OG PRN SO

If return of pulses:

• Obtain 12-Lead SO
• Transport to STEMI Recieving Center

Pronouncement on scene BHPO