1. Monitor vital signs every 2-3 minutes.

2. If chest pain persists, administer Nitroglycerine 1/150 gr. sublingually.
   • NOTE:
     NITROGLYCERINE MAY NOT BE ADMINISTERED TO PATIENTS WITH A SYSTOLIC BLOOD PRESSURE OF LESS THAN 120 mm Hg, UNLESS AN IV IS IN PLACE.

3. If chest pain or other evidence of myocardial ischemia still persists, contact Medical Control for implementation of one or more of the following options:

MEDICAL CONTROL OPTIONS

OPTION A:

Repeat Nitroglycerine 1/150 gr, sublingually.

OPTION B:

Administer Morphine Sulfate 2.0-5.0 mg, IV bolus. Repeat doses of Morphine Sulfate, 2.0-5.0 mg, IV bolus, may be given, up to a maximum dosage of 15 mg.

• NOTE:
  IF HYPOTENSION, HYPOVENTILATION, OR STUPOR DEVELOPS DURING ADMINISTRATION OF MORPHINE SULFATE, WITHHOLD MORPHINE SULFATE, ELEVATE THE LEGS, AND ADMINISTER NALOXONE 2.0 mg, IV BOLUS.

OPTION C:

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.)

• NOTE:
  LIDOCAINE MUST BE USED WITH CAUTION IN PATIENTS OVER 70 YEARS OF AGE AND PATIENTS SUFFERING FROM CONGESTIVE HEART FAILURE, LIVER DISEASE, SHOCK (OF ANY ETIOLOGY), AND/OR POSSIBLE PRIOR ALLERGIC RESPONSE. PARAMEDICS SHOULD ALERT MEDICAL CONTROL TO THESE CONDITIONS AS THE LIDOCAINE DOSAGE MAY NEED TO BE ADJUSTED ACCORDINGLY.

OPTION D:

Transportation decision.

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