Anaphylactic Reaction

M409 Epinephrine 0.3ml 1:1000 IM if either hypotension or severe respiratory distress is present Albuterol (Proventil) 2.5mg in 2.5ml NS via HHN if wheezing or bronchospasm is present If hypotension infuse 1 liter NS IV WO rate. Benadryl 25-50mg IV/IM/PO; may be given without preceding Epinephrine in mild cases If hypotension persists, consider push dose […]

Stroke

M414 Age >16; may or may not have altered level of consciousness Assess ABCs and suspicion for trauma Assess patient with Cincinnati Stroke Scale Facial droop (big smile) Pronator drift (extend arms, palms up, eyes closed: one arm drift = positive; both = unclear) Speech (“The sky is blue in Cincinnati”) Assess and record the […]

Hypertension

X100 Treat patient per appropriate protocol Assess patient for stroke symptoms; assess BP in opposite arm of initial reading If positive for stroke symptoms, GO TO STROKE – M414

Head/Spinal Trauma

S501 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 pupils (> 1mm dif) and comatose, hyperventilate to goal ETCO2 of 30 mmHg Stop hyperventilation if pupils normalize ONLY with assymetric pupils (>1 mm dif) […]

Tachycardias – Wide Complex w/ pulse (Unstable)

C303 If rhythm is Torsades de Pointes- Mag Sulfate 1 gram If patient is to be cardioverted and does not have an altered LOC, consider sedation- Versed 2-4 mg IV/IM until patient’s speech slurs or a total of 8 mg Synchronized cardioversion at 100 joules (or biphasic equiv.) If no change, repeat synchronized cardioversion at […]

Tachycardias – Wide Complex (Stable)

C304 Obtain 12-lead EKG of initial rhythm If rhythm is Torsades de Pointes, Mag Sulfate 1 gram Consider Adenosine 6/12 if rhythm is regular Amiodarone 150 mg IV/IO over 10 minutes If wide complex tach persists, may repeat Amiodarone 150 mg IV/IO over 10 minutes Obtain a 12-lead EKG after any rhythm change

Tachycardias – Narrow Complex w/ pulse (Unstable)

C306 Obtain 12-Lead EKG of initial rhythm If patient is to be cardioverted and does not have an altered LOC, consider sedation- Versed 2-4 mg IV/IO/IM until patient’s speech slurs or a total of 8 mg Atrial fibrillation: synchronized cardioversion at initial energy of 120-200 joules biphasic Atrial flutter and all other SVTs: synchronized cardioversion […]

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)