Microsoft word - para protocols _2012_ _signed_.doc

If Croup is suspected (P-12) in the pediatric patient
administer Racemic Epi (optional)11.25mg/0.5cc
diluted in 3cc NS via nebulizer 1st line. May repeat
dose X 1 if needed. If wheezing persists administerXopenex per protocol.
1. Oxygen
Arrhythmias, Return to this Algorithm.
• Xopenex (optional), 1.25mg via nebulizer,
may be substituted for Albuterol anywhere
4. IV, NS, TKO
• Epinephrine (1:1,000) 0.3mg, IM, may be
administered with severe respiratory
distress and wheezing, if no improvement
from a bronchodilater either patient or EMS 1. Nitroglycerin, 0.4mg, SL, if Systolic
2. Furosemide (Lasix), 40mg, IV
3. Morphine Sulfate, 2-6mg; may
repeat once in 10 minutes,if Systolic BP >90mmHg 4. ***Albuterol (Ventolin), 2.5mg/3cc, Nebulizer
1. Albuterol (Ventolin), 2.5mg/3cc
5. Continue Albuterol (Ventolin) until
2. Decadron 20mg, SIVP, if Wheezing is Present
PEDIATRIC DOSE
•Furosemide (Lasix), 1mg/kg to a max of 40mg
•Morphine Sulfate, 0.1mg/kg to a max of
Epinephrine (1:1,000) 0.3mg, IM,
***Repeat Albuterol as needed.
•Epinephrine, 1:1,000, 0.01mg/kg, IM, to a max
•Decadron, 0.6mg/kg to a max 20mg. Do not
administer to patients < 2 years of age.
•Albuterol (Ventolin) 2.5mg/3cc NS by Nebulizer,
•Xopenex (optional)1.25mg by Nebulizer, dose and
•Racemic Epi 2.25%(optional) (croup) 11.25mg/0.5cc
1. CPR (2010 Guidelines)*
2. Ventilate with Oxygen (Insert OPA/NPA)
3. ResQPOD
4. Attach Defibrillator**
5. IV, NS***
6. Epinephrine (1:10,000), 1mg, IV, Every 3-5 Minutes
Consider Whether One of the Followingmay be Involved and Treat Appropriately: •Tension Pneumothorax (Decompress Chest)•Thrombosis (Pulmonary, Coronary)•Trauma *** IV Fluid Should be Infused at a
in patients with core temp < 86°F.
**Asystole should be confirmed in 2 leads. If
rhythm is unclear and possibly Ventricular Fibrillation, go to Ventricular Fibrillation Algorithm.
* Ideally chest compressions should be interrupted only for rhythm check. The 2010 guidelines statethat when CPR is indicated the provider should perform 5 cycles (2 minutes) of chest compressions.
Continue CPR while drugs are prepared/administered. Providers must organize care to minimizeinterruption in chest compressions for rhythm checks, advance airway insertion, or vascular access.
1. CPR (2010 Guidelines)*
2. Ventilate with Oxygen (Insert OPA/NPA)
3. Use ResQPOD if the patient has reached puberty 5. IV, NS***
Epinephrine: Repeat Every 3 to 5 Minutes
•Hypoxia (Ventilate)•Hypo/Hyperkalemia •Tension Pneumothorax (Decompress Chest)•Thrombosis (Pulmonary, Coronary)•Trauma in patients with core temp < 86°F.
**Asystole should be confirmed in 2 leads. If
rhythm is unclear and possibly Ventricular Fibrillation, go to Ventricular Fibrillation Algorithm.
* Ideally chest compressions should be interrupted only for rhythm check. The 2010 guidelines statethat when CPR is indicated the provider should perform 5 cycles (2 minutes) of chest compressions.
Continue CPR while drugs are prepared/administered. Providers must organize care to minimizeinterruption in chest compressions for rhythm checks, advance airway insertion, or vascular access.
1. Oxygen
2. IV, NS, TKO
3. EKG
•Ischemic Chest Pain•Acute Heart Failure•Acute Decreased LOC 1. Atropine 0.5mg, IVP,
2. Fluid Challenge of NS, 500-1000cc
1. If BP > 90 consider Versed, 5mg, IV,
(2.5mg if >60 years old) May repeat once.
Epinephrine Drip,
*Epinephrine Drip
2-10mcg/min
• Mix 1mg Epi (1:1,000)• Run at 12 - 60gtts/min • Mix 1mg Epi (1:1,000)• Run at 30 - 150gtts/min 1. ABCs
2. Oxygen
3. Assist Ventilations if Respirations Inadequate
4. Intubate Patient if Unable to Maintain Airway
5. IV, NS, TKO (Use IO Access if Necessary)
6. Assess Vital Signs & Perfusion
Patient has any of the Following:•Signs/Symptoms of Hypoperfusion? •Hypotension?•Respiratory Difficulty? Oxygenation & Ventilation, Heart Rate:•<80/min in an Infant (<1 year old)•<60/min in a Child (1-12 years old) Epinephrine:
•IV/IO: 0.01mg/kg (1:10,000, 0.1mL/kg) to a max of 5cc per •ET: 0.1mg/kg (1:1,000, 0.1mL/kg) to a max of 0.5cc per Atropine, 0.02mg/kg, IV
•Minimum Dose 0.1mg•Maximum Single Dose 0.5mg•May Repeat every 3-5 Minutes (In children 0-8 years of age to a max of 1mg) (In Adolescence 9-15 years of age to a max of 2mg) 1. Oxygen
2. IV, NS, TKO
4. Aspirin, 325mg, PO (chew and swallow)
5. Monitor EKG (obtain 12 lead if available, Consider 6. Transmit suspect EKGs to the receiving ER (if possible) ST elevation in V4R may furtherconfirm an RVI.
rate to maintain a systolicBP of >90mmHG.
1. Reference the Cardiac Triage/Transport Scheme (P-39) Nitroglycerin, 0.4mg, Sublingual or
Nitrospray, 1 Spray, Sublingual
* Atypical MI Signs
and Symptoms
1. Resp. Distress/Dyspnea2. Weakness/Fatigue without 1. Reference the Cardiac Triage/Transport Scheme (P-39) Consider patient a candidate
3. Hyperlipidema4. Obesity5. Stress6. Sedentary life style 1. Morphine Sulfate,2-6mg, IV (Repeat as needed
every 10 Minutes until signs and symptoms relieved or For interfacility transfers, if the patient 2. Continue Nitroglycerin every 5 minutes until signs and
symptoms relieved or Systolic BP <90mmHg worse, you may administer sublingualNitro in addition to the drip orincrease the Nitro drip in incrementsof 5mcg/min until:1. Symptoms relieved2. Systolic BP <90mmHg Consider Zofran, 4mg, IVP, in a patient with profound nausea and/or vomiting.
1. Oxygen
2. Assist Ventilations if Respirations Inadequate
3. Intubate Patient, if Necessary
4. IV, NS, TKO
5. Monitor EKG
Fluid Challenge, 500-1000cc, NS
1. Dopamine, 5mcg/kg/min, IV, Increased
1. Infuse NS as Needed to Maintain
PEDIATRIC
Fluid challenge 20cc/kg over 10 minutes.
PEDIATRIC DOSE
•Dopamine, 5mcg/kg/min, IV; If perfusion is not adequate
after 2 minutes, Increase to max of 10mcg/kg/min 1. Ventilate with Oxygen (Insert OPA/NPA)
2. Oxygen
4. IV, NS, TKO
4. IV, NS, TKO
Amiodarone Delivered
1. Lidocaine, 1mg/kg, IV,
2. Lidocaine Drip 2mg/min, IV
1. Fluid Challenge, 500-1000cc, NS
2. If No Response to Fluid Challenge,
Dopamine, 5mcg/kg/min, IV, Increased
by 5mcg/kg/min every 2 minutes until:
•Max of 20mcg/kg/min•Systolic BP 90-110mmHg PEDIATRIC
Fluid challenge 20cc/kg over 10 minutes.
PEDIATRIC DOSE
•Dopamine, 5mcg/kg/min, IV; If perfusion not adequate
after 2 minutes, Increase to max of 10mcg/kg/min •Lidocaine, 1mg/kg, IV
•Lidocaine Drip 30mcg/Kg/min, IV
1. Oxygen
2. IV, NS, TKO
3. Lidocaine, 1mg/kg, IV
4. Lidocaine Infusion, 2mg/min, IV
1. Lidocaine, 0.5mg/kg, IV, Every 5 Minutes
2. After Each Bolus, Increase Lidocaine Infusion,
*SIGNIFICANT PVCs
1. Runs of Ventricular Tachycardia2. R on T Phenomenon3. Multiformed PVCs or PVCs > 10/min w/ Chest Pain, Hypotension,or Shortness of Breath Stable Bigeminy, Trigeminy &
Quadrigeminy should NOT be treated.
1. Oxygen
2. IV, NS, TKO
3. Synchronized Cardiovert @ 300 Joules*4. Synchronized Cardiovert @ 360 Joules* Adenosine, 12mg, IV
Adenosine, 12mg, IV
is conscious give Versed,
**Amiodarone, 150mg IV Over 10 minutes.
(may mix into 100cc of D5W)
PEDIATRIC DOSES
• Sync. Cardiovert @ 1Joule/kg to a max of 100 J Sync. Cardiovert @ 2Joules/kg to a max of 360 J* •Adenosine, 0.1mg/kg to a max of 12mg
•Versed, 0.1mg/kg, IV, to a max of 2.5mg
•Amiodarone 5mg/kg, IV, over 20 minutes, to a max
single dose of 150mg. May be repeated X 2
(Do not mix into 100cc of D5W)
** The Administration of Lidocaine during IO placement
for pain control ONLY does not contraindicate
the administration of Amiodarone if indicated
2. Ventilate with Oxygen (Insert OPA/NPA)
5. Defibrillate @ 360 Joules, or Biphasic Equivalent
6. Resume CPR
7. IV/IO, NS***
* In all witnessed or known short duration
1. Resume CPR
2. Epinephrine (1:10,000), 1mg, IV, Repeat
3. Intubate Patient, if not previously done4. Defibrillate @ 360 Joules, or Biphasic Equivalent5. Resume CPR 1. Resume CPR
2. Amiodarone, 300mg IV, repeat once 150mg IVP in 3 to 5 minutes.***
3. Defibrillate @ 360 Joules, or Biphasic Equivalent
4. Resume CPR
***
• IV fluid should be infused at a Wide Open Rate to a max of 3000cc
• If IV or IO access unavailable administer Lidocaine 2mg/kg, ET
• If V-Fib/ V-Tach not suppressed repeat Lidocaine 2mg/kg, ET, every 3-5 minutes to
• Once an antiarrhythmic is administered DO NOT administer a different antiarrhythmic.
• If IV or IO access is obtained after ET Lidocaine was administered, administer
Lidocaine 1mg/kg, IV, may repeat every 3-5 minutes to a max of 3mg/kg, IV
(Should not administer more than 3 total doses whether IV/IO or ET)
• The Administration of Lidocaine during IO placement for pain control ONLY does not
contraindicate the administration of Amiodarone if indicated
** Ideally chest compressions should be interrupted only for rhythm checks and actual defibrillations. The 2010 guidelines state that when CPR is indicated the provider should perform 5 cycles (2 Minutes) of chest compressions. Continue CPR while drugsare prepared/administered and the defibrillator is charging. Providers must organize care to ensure that chest compressions,initial and subsequent defibrillations are not delayed in order to administer drugs, place advanced airways or obtain vascular access.
VENTRICULAR FIBRILLATION,or PULSELESS VENTRICULAR 1. CPR (2010 Guidelines)**
2. Ventilate with Oxygen (Insert OPA/NPA)
3. Use ResQPOD if the patient has reached puberty
4. Attach Defibrillator
5. Defibrillate @ 2 Joules/kg or Biphasic Equivalent
7. IV / IO, NS***
patient and withhold IV medicationsin patients with a core temp < 86°F *Patients > 1 YOA
1. Resume CPR
2. Epinephrine: Repeat Every 3 to 5 Minutes
3. Intubate Patient, if not previously done5. Defibrillate @ 4 Joules/kg, to a max of 360 Joules 1. Resume CPR
2. Amiodarone, 5mg/kg to a max of 300mg. May repeat once in 3-5
minutes at 2.5mg/kg to a max of 150mg.*** 3. Defibrillate @ 4 Joules/kg, to a max of 360 Joules or Biphasic Equivalent4. Resume CPR ***• A fluid challange of 20cc/kg should be administered over 10 minutes in all cardiac arrest situations.
• If IV or IO access unavailable administer Lidocaine 2mg/kg, ET
• If V-Tach not suppressed repeat Lidocaine 2mg/kg, ET, every 3-5 minutes to a max of 6mg/kg, ET
• Once an antiarrhythmic is administered DO NOT administer a different antiarrhythmic
• If IV or IO access is obtained after ET Lidocaine was administered, administer Lidocaine 1mg/kg,
IV, may repeat every 3-5 minutes to a max of 3mg/kg, IV (Should not administer more than 3 totaldoses whether IV/IO or ET) • The Administration of Lidocaine during IO placement for pain control ONLY does not contraindicate
the administration of Amiodarone if indicated
** Ideally chest compressions should be interrupted only for rhythm checks and actual defibrillations. The 2010guidelines state that when CPR is indicated the provider should perform 5 cycles (2 Minutes) of chest compressions.
Continue CPR while drugs are prepared/administered and the defibrillator is charging. Providers must organize careto ensure that chest compressions, initial and subsequent defibrillations are not delayed in order to administer drugs, place advanced airways or obtain vascular access.
1. Oxygen
2. IV, NS, TKO
Patient Experiencing Any of the Following: •Signs/Symptoms of CHF?•Other Signs/Symptoms of Hypoperfusion? Amiodarone 150mg, IV, over 10 minutes.
If patient remains without above signs and
symptoms. Amiodarone may be repeated
every 10 minutes as needed to a max
of 450mg. (May mix into 100cc of D5W)
starts to experience anyof the signs and symptomsnoted above, go directlyto Cardioversion.( Page 19) PEDIATRIC DOSE
•Amiodarone 5mg/kg, IV, over 20 minutes,
to a max single dose of 150mg. May be
repeated X 2 (Do not mix into 100cc of D5W)
If systolic BP >90mmHg consider Versed,
2. Synchronized Cardiovert @ 200 Joules** 3. Synchronized Cardiovert @ 300 Joules** 4. Synchronized Cardiovert @ 360 Joules** 1. Amiodarone 150mg, IV, over 10 minutes.
Amiodarone may be repeated every
10 minutes as needed to max of 450mg.
(May mix into 100cc of D5W)
2. Synchronized Cardiovert @ 360 Joules,** or Energy Setting Previously Successful,
Following Each Dose of Amiodarone.
PEDIATRIC CARDIOVERSION
Infant- 1J/kg up to a max of 100JChild- 2J/kg up to a max of 360J PEDIATRIC DOSE
• If IV or IO access unavailable administer Lidocaine 2mg/kg, ET.
• Amiodarone 5mg/kg, IV, over 20 minutes,
Lidocaine 2mg/kg, ET, every
• Versed, 0.1mg/kg, IV, to a max of 2.5mg
• Once an antiarrhythmic is administered DO NOT administer a • Lidocaine 2mg/kg, ET, every 3-5 minutes,
• If IV or IO access is obtained after ET Lidocaine was administered,
• If IV or IO access is obtained after ET Lidocaine
administer Lidocaine 1mg/kg, IV, may repeat every 3-5 minutes
was administered, administer Lidocaine 1mg/kg, IV,
to a max of 3mg/kg, IV (Should not administer more than 3 total may repeat every 3-5 minutes to a max of 3mg/kg, IV (Should not administer more than 3 total doses • The Administration of Lidocaine during IO placement for pain
control ONLY does not contraindicate the administration of
• Once an antiarrhythmic is administered Amiodarone if indicated
DO NOT administer a different antiarrhythmic.

Source: http://ovaa.files.wordpress.com/2011/12/spems-cardiovascular-emergency-protocols1.pdf