Tachycardias – Narrow Complex (Stable)

C305 Valsalva maneuver and note changes (or absence of) Obtain a 12-lead EKG after Valsalva maneuver Adenosine 6 mg with immediate 10 ml NaCl 0.9% flush Adenosine 12 mg with immediate 10 ml NaCl 0.9% flush Adenosine 12 mg with immediate 10 ml NaCl 0.9% flush Obtain a 12-lead EKG after any rhythm change Notify […]

Congestive Heart Failure

M404 CPAP if available Evaluate for contraindications to nitroglycerin: Systolic BP <100 mmHg Viagra/sildenafil in the last 24 hours Levitra/vardenafil in the last 48 hours Cialis/tadalafil in the last 72 hours Medications for pulmonary hypertension (ex: Flolan, Revatio, Adcirca) Assess vitals, acquire 12-lead ECG and establish IV Consider Nitroglycerin administration as described below (If inferior […]

Cardiogenic Shock

M401 500 ml bolus of 0.9 NS fluid challenge if lungs are clear, otherwise TKO Consider push dose Epinephrine 0.5-2 ml of a 10 mcg/ml solution every 2-5 min (5-20 mcg)

Bradycardia

C302 12-lead ECG Atropine 0.5 IV/IO Consider external pacing If pacing, consider sedation – Versed 2-5 mg/min IV/IM until patient’s speech slurs or a total of 8 mg. If no response to initial measures, repeat Atropine 0.5 mg IV/IO push every 3-5 min to max 3.0 mg If bradycardia and hypotension continue, consider push dose […]

Acute Coronary Syndrome

M400 12 lead ECG ASAP (<10 min) and transmit or relay findings 324 mg baby aspirin (chewable) if not contraindicated Determine erectile dysfunction or pulmonary hypertension drug use Nitroglycerin 0.4 mg SL q 5 min X 3 or 1″ topical Nitroglycerin Morphine Sulfate 1-5 mg (10 mg total) or Fentanyl 25-50 mcg IV/IO (200 mcg […]

Toxicological

M411 Evaluate the scene for provider safety and take appropriate precautions Poison control: 513.636.5111; medical orders MUST come from Medical Command Consider that patients may have multiple toxins on board Consider that patients may or may not be compliant Only treat patients who are symptomatic Transport all patients and notify receiving hospital

Altered Mental Status – Unknown

SB201/M406 Alcohol/drug overdose is suspected, go to Toxocological Emergencies protocol Dysrhythmia, assess for abnormal pulse or perfusion and go to appropriate cardiac treatment protocol Head Injury Maintain airway and administer oxygen as necessary to maintain SpO2 >95% Respiratory goal is to maintain normal rate of 10-12/min to maintain ETCO2 of 35-40 mmHg ONLY with assymetric […]