No longer prepare Atropine ahead of time Etomidate replaces Midazolam as the induction medication – no waiting period for effect Succinylcholine has been increased to 2 mg/kg (up from 1.5 mg/kg currently) Morphine 3 mg IV AND Midazolam 3 mg IV used for post-intubation sedation. Vecuronium and Rocuronium may be used for post-intubation sedation if the Morphine and Midazolam are not effective AND transport is going to be greater than 10 minutes.

Now combined into one protocol.

Peak flow measurement is gone.

3 branches of severity:Mild – Treatment as we are

used toModerate – CPAP,

MethylprednisoloneSevere – Epi IM, CPAP,

Magnesium Sulfate, Methylprednisolone

Generally is a guide to send you to the correct protocol for treatment,

however it does include a treatment pathway for stridor

– EPI IM.

NTG is now given if SBP is greater than 100, and can be given as needed, every 2-3 minutes. CPAP is second course of treatment MSO4 is third course of treatment Finally, Lasix is listed as fourth. Emphasis on movement of Lasix to bottom of treatment tree. Venous tourniquets are no longer listed in protocol

Note determining factor for decision tree is the presence/absence of adequate bystander CPR. Good bystander CPR = charge defibrillator Poor bystander CPR = compressions at 100/min x 2 minutes

General CCR information.

Epi and Vasopressin given together at start of protocol Followed by EPI 1 mg every 3-5 minutes No longer have all of the other pressor options (i.e. high dose, infusion, Norepi)

Epi and Vasopressin given together at start of protocol Followed by EPI 1 mg every 3-5 minutes No longer have all of the other pressor options (i.e. high dose, infusion, Norepi)

Fentanyl AND Midazolam used together for pre-medication with TCP Guidelines for TCP are a heart rate <60 AND SBP <90 AND symptomatic If using an EPI drip, titrate to a heart rate of 60.

2 branches of treatment: Stable and Unstable Stable: May give a repeat dose of Amiodarone Unstable: Now using Etomidate for pre-medication with Synchronized Cardioversion.

2 branches of treatment: Stable and Unstable Stable: May give a repeat dose of Amiodarone Unstable: Now using Etomidate for pre-medication with Synchronized Cardioversion.

2 branches of treatment: Stable and Unstable Stable: Diltiazem now given over 5 minutes Unstable: Etomidate now used for pre-medication with synchronized cardioversion.

NTG now given if SBP >100 Morphine is now 2- 5 mg IV Ondansetron is available for nausea Lorazepam is now available for anxiety.

If Blood Glucose is less than 60 and the pt is

malnourished, the Thiamine is given along

with Dextrose.

ASA now given 2 branches of treatment: Stable and Unstable Stable: Fentanyl AND Midazolam provided together for pain control. Unstable: Magnet now applied without Medical Control.

ASA now given 2 branches of treatment: Stable and Unstable Stable: Defined as SBP >100 Unstable: Defined as SBP <100. May now place magnet without Medical Control.

Treatment based on SBP <100 If SBP<100 then provide bolus to maintain SBP of 100, consider reduction of long bone fractures, consider needle chest decompressions. If SBP >100, and GCS is 15, then may use pain control protocol

Provide 2-liter bolus Epi given every 3 to 5 minutes Consider chest decompression and reduction of long bone fractures

2 branches for treatment: GCS <8 or GCS >8. If GCS>8, monitor, maintain SPO2 of 92% If GCS<8, then evaluate for Gag If gag, then RSI If no gag, then Lidocaine, intubate, sedate with Morphine and Midazolam, maintain ETCO2 of 40.

Guides care to the pain control protocol,

and also provides directions on care for

amputations.

10 % burn surface is determinate for treatment If <10%, then cool with Saline If >10%, then treat with dry dressings Fentanyl used for pain control Ondansetron available for nausea

Now able to provide pain control to abdominal pain Ondansetron available for nausea 500 cc Fluid bolus if orthostatic – may repeat to 2000 cc.

3 branches for treatment: Hives/rash only, respiratory distress, and Impending respiratory arrest/shock. Methylprednisolone available

3 branches for treatment: Glucose <60, Glucose 60-350, Glucose >350 Narcan now given as 0.5 mg IV, and repeated every 1 minute to effect. Max of 4 mg.

If non-traumatic and orthostatic, then will

provide 1000 cc bolus.

Reference to restraint procedure SP-35. Haloperidol AND Lorazepam given together as IM injection, with Medical Control. Followed with 2 liters NSS.

Hypotension is SBP <100. Provide fluid bolus in 500 cc doses, to a max of 20 cc/kg. If no improvement after 20 cc/kg, or if pulmonary edema develops, then Dopamine 5-20 mcg/kg/min.

500 to 2000 ml bolus If Cocaine overdose suspected, provide Lorazepam with Medical Control.

2 important temperature determinates: 95 F, and

88 F.

Criteria for Induced Hypothermia:Witness arrest & ROSC, Significant ALOC, Not following commands, No purposeful movement,Incomprehensible speech, No known surgery < 2 weeks, No history of bleeding disorder,Not pregnant, Age > 18 years, No evidence of trauma Review Steps of procedure

Defined as DBP >130 or SBP >200. Labetolol or NTG given with Medical Control

Acetaminophen available if pain severity does not warrant IV/IM access 2 branches for treatment: Abdominal pain, and other Abdominal pain = Fentanyl Other = Morphine or Fentanyl

2 branches for treatment: Status, and post-ictal If status, then Lorazepam 1-2 mg IV OR IM. May repeat every 2 minutes to 6 mg max. If post-ictal, then measure blood glucose If glucose >60, and seizure recurs, then Lorazepam as above. If glucose <60, then go to AMS protocol.

If orthostatic, 500 cc bolus Ondansetron available

Magnesium Sulfate given to pregnant seizing

patient.

2 branches for treatment: Mild or Moderate/Severe If Moderate/Severe, then Hydroxocobalamin, unless in arrest – contact Medical Control first