Nausea/Vomiting

Proclorperazine 2.5 mg IV or 5 mg IM OR Promethazine (Phenergan) 6.25 mg IV diluted in 10 ml of 0.9% NaCl, which is administered over 2 mins via the furthest port from the vein May repeat either medication x1 in 10 mins if symptoms persist Ondanestron ((Zofran) 4 mg IV administered over 30 seconds. May […]

Hyperthermia

Remove patient to cool area If patient temperature >104F or >40C or if altered mental status, begin active cooling IV fluids 0.9% NaCl to maintain SBP ≥90 mm Hg or >minimum for age and signs of adequate perfusion If uncontrolled shivering occurs during cooling—ADULTS ONLY, lorazepam 0.5-1.0 mg IV/IM or diazepam 2 mg IV or […]

Tachycardia (Unstable)

Hypotension, altered mental status, signs of poor perfusion Synchronized cardioversion V-tach, A-fib, PSVT: 100j, 200j, 300j, 360j A-flutter: 50j, 100j, 200j, 300j, 360j Polymorphic V-tach: 200j, 300j, 360j or biphasic equivalents, based on manufacturers recommendations Consider procedural sedation if practical (Midazolam 2.5 mg IV or Diazepam 5 mg IV)

Tachycardia (Stable)

PSVT or narrow complex tach consistently >140-150, consider vagal maneuvers. If unsuccessful, adenosine 6 mg rapid IVP; repeat dose of 12 mg x2 as needed For all others, monitor and transport

Congestive Heart Failure

Consider Nitroglyerin 0.4 mg SL if SBP ≥ 90 if patient has not taken any erectile dysfunction drugs: sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) in the previous 24- 72 hrs Consider Lasix (furosemide) 0.5-1.0 mg/kg IV or Bumex (bumetanide) 1 mg IV Consider Morphine Sulfate 1-5 mg slow x1 Consider CPAP if not improving […]

Bradycardia

Atropine 0.5 IV/IO q 3-5 min (3 mg max) Consider pacing – preferable to atropine for patients with Mobitz II or 3rd degree HB with wide QRS – Consider sedation – Versed 2-4 mg/min IV/IM until patient’s speech slurs or a total of 8 mg. Lorazepam (Ativan™) 1 mg IV or 2 mg IM, repeatable […]

Acute Coronary Syndrome

12-lead ECG 324 mg baby aspirin (chewable). If patient states they cannot take ASA due to “stomach problems” or “doctor’s orders”, call medical control for guidance Nitroglycerin 0.4 mg SL every 5 minutes while symptoms persist if SBP >90. Avoid this for patients who take Sildenafil, tadalafil, or vardenafil in past 48 hours If ECG […]

V-Fib/Pulseless V-Tach

If unwitnessed and no bystander CPR, perform CPR for 2 minutes If EMS witnessed or bystander CPR in progress, defibrillate immediately Defibrillate at 360 joules (or biphasic equivalent) Epinephrine 1 mg (10 ml 1:10,000) IV/IO every 3 to 5 min during arrest OR Vasopressin 40 units IV/IO for 1st or 2nd of Epinephrine Defibrillate at […]

Asystole/PEA

Confirm asystole in two leads Search for and treat possible causes: tension pneumothorax, hypovolemia, hypoxia, drug overdose, hypo/hyperthermia, pulmonary embolism, acidosis, cardiac tamponade Epinephrine 1 mg (10 ml of 1:10,000) IV/IO. Repeat every 3-5 minutes for duration of cardiac arrest OR Vasopressin 40 units IV/IO for 1st or 2nd dose of Epinephrine Consider Sodium bicarbonate […]

Asthma/COPD/RAD

Albuterol (Proventil) 0.5 ml in 2.5 ml NS via HHN. May repeat every 5 min to a total of 4 treatments For first treatment may add ipratropium bromide or use Duoneb Consider CPAP if available Consider levalbuterol (Xopenex) 1.25 mg via nebulizer Consider 60 mg Prednisone PO or Solumedrol 125mg IV For patients who do […]