• NOTE:
  PARAMEDICS SHOULD CONSIDER THE POSSIBILITY OF CONDITIONS MASQUERADING AS EMD WHICH REQUIRE IMMEDIATE IN-HOSPITAL TREATMENT SUCH AS SEVERE SHOCK, TRAUMATIC CARDIAC ARREST, PERICARDIAL TAMPONADE, HYPOVOLEMIA, ETC.

1. Perform Endotracheal Intubation. Oxygenate via Bag-Valve-Device or a manually operated resuscitator.

2. Begin an IV infusion of Dextrose 5 % in water (D5W) to keep vein open.

3. Administer Epinephrine 1.0 mg (10 ml of a 1:10,000 solution), IV bolus. As long as there is no change in the rhythm, repeat Epinephrine 1.0 mg (10 ml of a 1:10,000 solution), IV bolus, every 5 minutes.

4. If the patient's heart rate is below 50 beats/min, administer Atropine Sulfate 0.5 mg, IV bolus. If there is no change in the rhythm in 5 minutes, repeat Atropine Sulfate 0.5 mg, IV bolus. (Maximum total dosage is 2.0 mg.)

5. Transportation decision.

6. If there is no improvement in hemodynamic status, contact Medical Control for implementation of one or more of the following options:

MEDICAL CONTROL OPTIONS

OPTION A:

Repeat any of the above Standing Orders.

OPTION B:

Administer Calcium Chloride 250 mg, IV bolus.

OPTION C:

Administer Sodium Bicarbonate 88 mEq, IV bolus. Repeat doses of Sodium Bicarbonate 44 mEq, IV bolus, may be given every 10 minutes.

OPTION D:

Administer Dopamine 5.0 mcg/kg/min, IV drip. If there is insufficient improvement in hemodynamic status, the infusion rate may be increased until desired therapeutic effects are achieved or adverse effects appear. (Maximum dose is 10 mcg/kg/min, IV drip.)

OPTION E:

Administer Isoproterenol 2.0 mcg/min, IV drip. If there is insufficient improvement in hemodynamic status, the infusion rate may be increased until desired therapeutic effects are achieved or adverse effects appear. (Maximum rate is 10 mcg/min, IV drip.)

OPTION F:

Apply and inflate MAST, if no contraindications are present.

OPTION G:

Administer Dextrose 25 gm (50 ml of a 50% solution), IV bolus.

OPTION H:

Administer Naloxone 2. 0 mg, IV bolus

OPTION I:

Administer Glucagon 1. 0 mg, IV bolus.

OPTION J:

Administer Dexamethasone 100 mg, IV bolus.

OPTION K:

Administer Lidocaine 1.0 mg/kg, IV bolus. Repeat doses of Lidocaine 0.5-1.0 mg/kg, IV bolus, may be given every 5 minutes up to a maximum dosage of 3.0 mg/kg, and may be followed by an IV drip at a rate of 1.0-4.0 mg/min. (Maximum individual dose is 100 mg and maximum total dosage is 225 mg.)

OPTION L:

Perform Thump Pacing.

OPTION M:

Begin rapid IV infusion of Ringer's Lactate (RL), up to 3.0 liters.

OPTION N:

Transportation decision.

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