Central East Prehospital Care Program For Reference Only · Never try to talk the survivors out of...
42
Reference Material Acute Stroke Protocol – Prompt Card ............................................................................................................. R - 2 Burn Chart “Rule of Nines” .............................................................................................................................. R - 3 Death Notification Tips .................................................................................................................................... R - 4 Dopamine Infusion .......................................................................................................................................... R - 5 ECG Basics ..................................................................................................................................................... R - 6 End-tidal CO 2 .................................................................................................................................................. R - 8 Field Trauma Triage Guidelines .................................................................................................................... R - 10 Intra Muscular Injection Landmarking and Needle Selection......................................................................... R - 12 Medication List - ALSPCS ............................................................................................................................. R - 13 Medication List CBRNE ................................................................................................................................ R - 25 Overdose Levels ........................................................................................................................................... R - 29 Toxidromes Reference .................................................................................................................................. R - 31 Pediatric Vital Signs ...................................................................................................................................... R - 32 Pediatric Glasgow Coma Scale ..................................................................................................................... R - 33 Recognition of Death / Termination of Resuscitation Guidleines................................................................... R - 34 ETT Closed Suctioning and Tracheostomy ................................................................................................... R - 35 Emergency Tracheostomy Reinsertion ......................................................................................................... R - 36 ETT and Suction Catheter Sizes ................................................................................................................... R - 37 Provincial STEMI bypass .............................................................................................................................. R - 38 PRHC STEMI Bypass Protocol ..................................................................................................................... R - 40 Central East Prehospital Care Program For Reference Only Reference Material R - 1
Transcript of Central East Prehospital Care Program For Reference Only · Never try to talk the survivors out of...
Ref
eren
ce M
ater
ial
Acu
te S
troke
Pro
toco
l – P
rom
pt C
ard
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......
. R -
2 B
urn
Cha
rt “R
ule
of N
ines
” ....
......
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......
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......
.. R
- 3
Dea
th N
otifi
catio
n Ti
ps ..
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.... R
- 4
Dop
amin
e In
fusi
on ..
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.... R
- 5
EC
G B
asic
s ....
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. R -
6 E
nd-ti
dal C
O2 .
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. R -
8 Fi
eld
Trau
ma
Tria
ge G
uide
lines
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... R
- 10
In
tra M
uscu
lar I
njec
tion
Land
mar
king
and
Nee
dle
Sel
ectio
n ....
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... R
- 12
M
edic
atio
n Li
st -
ALS
PC
S ..
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... R
- 13
M
edic
atio
n Li
st C
BRN
E ...
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R -
25
Ove
rdos
e Le
vels
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.. R
- 29
To
xidr
omes
Ref
eren
ce ..
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.. R
- 31
P
edia
tric
Vita
l Sig
ns ..
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R -
32
Ped
iatri
c G
lasg
ow C
oma
Sca
le ...
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R -
33
Rec
ogni
tion
of D
eath
/ Te
rmin
atio
n of
Res
usci
tatio
n G
uidl
eine
s ....
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... R
- 34
E
TT C
lose
d S
uctio
ning
and
Tra
cheo
stom
y ....
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R -
35
Em
erge
ncy
Trac
heos
tom
y R
eins
ertio
n ...
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R -
36
ETT
and
Suc
tion
Cat
hete
r Siz
es ..
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R -
37
Pro
vinc
ial S
TEM
I byp
ass
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R -
38
PR
HC
STE
MI B
ypas
s P
roto
col .
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.. R
- 40
Central East Prehospital Care Program For Reference Only
Reference Material R - 1
Acu
te S
trok
e Pr
otoc
ol –
Pro
mpt
Car
d In
dica
tions
for P
atie
nt R
edire
ct o
r Tra
nspo
rt U
nder
Str
oke
Prot
ocol
Red
irect
tran
spor
t to
a D
esig
nate
d St
roke
Cen
tre*
will
be
cons
ider
ed fo
r pat
ient
s w
ho:
Pre
sent
with
a n
ew o
nset
of a
t lea
st o
ne o
f the
follo
win
g sy
mpt
oms
sugg
estiv
e of
the
onse
t of a
n ac
ute
stro
ke:
U
nila
tera
l arm
/leg
wea
knes
s or
drif
t
Slu
rred
spe
ech
or in
appr
opria
te w
ords
or m
ute
U
nila
tera
l fac
ial d
roop
A
ND
C
an b
e tra
nspo
rted
to a
rrive
at a
Des
igna
ted
Stro
ke C
entre
with
in 4
.5 h
ours
of a
cle
arly
det
erm
ined
tim
e of
sym
ptom
on
set o
r the
tim
e th
e pa
tient
was
“las
t see
n in
a u
sual
sta
te o
f hea
lth”.
* Not
e: A
Des
igna
ted
Stro
ke C
entre
is a
Reg
iona
l Stro
ke C
entre
, Dis
trict
Stro
ke C
entre
or a
Tel
estro
ke C
entre
. C
ontr
aind
icat
ions
for P
atie
nt R
edire
ct o
r tra
nspo
rt U
nder
Str
oke
Prot
ocol
A
ny o
f the
follo
win
g co
nditi
ons
excl
ude
a pa
tient
from
bei
ng tr
ansp
orte
d un
der t
he S
trok
e Pr
otoc
ol
C
TAS
Lev
el 1
and
/or u
ncor
rect
ed A
irway
, Bre
athi
ng o
r Circ
ulat
ory
prob
lem
Sym
ptom
s of
the
stro
ke re
solv
ed p
rior t
o a
para
med
ic a
rriva
l or a
sses
smen
t **
B
lood
Sug
ar <
3 m
mol
/L
S
eizu
re a
t ons
et o
f sym
ptom
s or
obs
erve
d by
par
amed
ic
G
lasg
ow C
oma
Sca
le <
10
Te
rmin
ally
ill o
r pal
liativ
e ca
re p
atie
nt
D
urat
ion
of o
ut o
f ho
spita
l tra
nspo
rt w
ill ex
ceed
two
(2) h
ours
CA
CC
/AC
S w
ill au
thor
ize
the
trans
port
once
not
ified
of t
he p
atie
nt’s
nee
d fo
r red
irect
or t
rans
port
unde
r the
Acu
te
Stro
ke P
roto
col
**
Not
e: A
pat
ient
who
se s
ympt
oms
impr
ove
sign
ifica
ntly
or r
esol
ve d
urin
g tra
nspo
rt w
ill co
ntin
ue to
be
trans
porte
d to
a D
esig
nate
d S
troke
Cen
tre.
Min
istry
of H
ealth
and
Lon
g Te
rm C
are,
Em
erge
ncy
Hea
lth S
ervi
ces
Bra
nch
Ver
sion
2.0
Feb
ruar
y 20
11
Central East Prehospital Care Program For Reference Only
Reference Material R - 2
7.5
7.5
155
55
515
12
2
7.5
7.5
7.5
7.5
Bur
n C
hart
“R
ule
of N
ines
”
13
13
10
10
5
5
5
5
1
7 7
7
1.5
1.
5
7
Adu
lt
Hea
d (B
ack
& F
ront
) – 4
½
Trun
k (B
ack
& F
ront
) – 1
8 A
rms
(Bac
k &
Fro
nt) –
4 ½
Le
gs (B
ack
& F
ront
) – 9
G
enita
ls -
1
9 9
99
1
4.5
4
.5
4.5
4
.5
4.5
4.5
1
8 1
8
Chi
ld
Hea
d (B
ack
& F
ront
) – 7
½
Trun
k (B
ack
& F
ront
) – 1
5 A
rms
(Bac
k &
Fro
nt) –
5
Legs
(Bac
k &
Fro
nt) –
7 ½
B
utto
cks
– 2
each
G
enita
ls -
1
Infa
nt
Hea
d (B
ack
& F
ront
) – 1
0 Tr
unk
(Bac
k &
Fro
nt) –
13
Arm
s (B
ack
& F
ront
) – 5
Le
gs (B
ack
& F
ront
) – 7
B
utto
cks
– 2
½ e
ach
Gen
itals
- 1
Central East Prehospital Care Program For Reference Only
Reference Material R - 3
Dea
th N
otifi
catio
n Ti
ps
S
urvi
vors
are
vic
tims
N
on-v
erba
l com
mun
icat
ion
is im
porta
nt
o
Eye
con
tact
with
out s
tarin
g o
S
ame
leve
l as
surv
ivor
Be
awar
e of
you
r app
eara
nce
- tak
e of
f PP
E
U
se a
‘D’ w
ord
such
as
‘dea
d’ o
r has
‘die
d’
P
ause
s an
d si
lenc
e ar
e ok
ay!
A
void
clic
hés
N
ever
try
to ta
lk th
e su
rviv
ors
out o
f the
ir gr
ief
B
e co
mpa
ssio
nate
Be
care
ful n
ot to
impo
se o
ur p
erso
nal r
elig
ious
bel
iefs
Em
pow
er th
e su
rviv
ors
to ta
ke o
n th
eir o
wn
grie
f and
pai
n o
G
ive
as m
uch
info
rmat
ion
as p
ossi
ble
o
List
en to
them
and
ans
wer
que
stio
ns a
s be
st y
ou c
an
Central East Prehospital Care Program For Reference Only
Reference Material R - 4
Dop
amin
e In
fusi
on
SIN
GLE
STR
ENG
TH 8
00 u
g/m
l D
opam
ine
infu
sion
rate
(ml/h
r or g
tts/m
in w
hen
usin
g a
60 g
tts/m
l set
)
Wei
ght
(Kg)
D
osag
e (m
cg/k
g/m
in)
Wei
ght
(Kg)
D
osag
e (m
cg/k
g/m
in)
5 10
15
20
5
10
15
20
40
15
30
45
60
85
32
64
96
12
8 45
17
34
51
68
9
0
34
68
101
135
50
19
38
56
75
95
36
71
10
7 14
3 55
21
41
62
83
1
00
38
75
11
3 15
0 60
23
45
68
90
1
05
39
79
11
8 15
8 65
24
49
73
98
1
10
41
83
12
4 16
5 70
26
53
79
10
5 1
15
43
86
12
9 17
3 75
28
56
84
11
3 1
20
45
90
13
5 18
0 80
30
60
90
12
0 1
25
47
94
14
1 18
8 D
OU
BLE
STR
ENG
TH 1
600
ug/m
L D
opam
ine
infu
sion
rate
(ml/h
r or g
tts/m
in w
hen
usin
g a
60 g
tts/m
l set
)
Wei
ght
(Kg)
D
osag
e (m
cg/k
g/m
in)
Wei
ght
(Kg)
D
osag
e (m
cg/k
g/m
in)
5 10
15
20
5
10
15
20
40
8 15
23
30
85
16
32
48
64
45
8
17
25
34
90
17
34
51
68
50
9 19
28
38
95
18
36
53
71
55
10
21
31
41
10
0 19
38
56
75
60
11
23
34
45
10
5 20
39
59
79
65
12
24
37
49
11
0 21
41
62
83
70
13
26
39
53
11
5 22
43
65
86
75
14
28
42
56
12
0 23
45
68
90
80
15
30
45
60
12
5 24
47
70
94
Central East Prehospital Care Program For Reference Only
Reference Material R - 5
ECG
Bas
ics
Nor
mal
EC
G P
aram
eter
s
P w
ave
QR
S C
ompl
ex
T w
ave
PR in
terv
al
ST S
egm
ent
QT
Inte
rval
Typi
cally
pos
itive
< 0.
12 s
ec
May
be
nega
tive
in V
1
0.12
– 0
.2 s
ec
C
ompa
red
to T
P
<
½ th
e pr
eced
ing
RR
inte
rval
Central East Prehospital Care Program For Reference Only
Reference Material R - 6
Rat
e C
alcu
latio
n
C
hoos
e a
QR
S c
ompl
ex th
at fa
lls o
n th
e th
ick
line
and
coun
t to
your
righ
t unt
il yo
u re
ach
the
next
com
plex
(div
ide
300
by
the
num
ber b
oxes
to d
eter
min
e th
e ra
te)
Q W
aves
Pa
thol
ogic
al: S
ign
of M
I (m
ay b
e ne
w o
r old
) o
H
eigh
t is
>¼ th
e ac
com
pany
ing
R w
ave
and/
or d
urat
ion
> 0.
04 s
ec (1
sm
box
)
Phys
iolo
gica
l Q w
aves
: N
orm
al o
ccur
renc
e o
C
omm
only
foun
d in
lead
s I,
aVL,
V5
and
V6
and
may
be
foun
d in
III a
nd a
VR
o
Le
ss th
an 0
.04
sec
in d
urat
ion
Central East Prehospital Care Program For Reference Only
Reference Material R - 7
End-
tidal
CO
2 C
apno
grap
hy is
the
mon
itorin
g of
the
conc
entra
tion
or p
artia
l pre
ssur
e of
Car
bon
Dio
xide
(CO
2).
Wav
efor
m c
apno
grap
hy is
a g
raph
ic d
ispl
ay o
f exh
aled
CO
2 ove
r tim
e. W
ith th
e nu
mer
ical
sca
le a
pplie
d (s
ee g
raph
be
low
) it p
rovi
des
a qu
antit
ativ
e m
easu
re o
f ETC
O2 (
as re
fere
nced
in th
e A
LS P
CS
).
End
-tida
l CO
2 (E
TCO
2) is
the
conc
entra
tion
of c
arbo
n di
oxid
e (C
O2)
in th
e ex
hale
d ga
s at
the
end
of e
xhal
atio
n. A
nor
mal
ra
nge
of E
TCO
2 is
30 –
40
mm
Hg.
40
A
– B
Res
pira
tory
Bas
elin
e - e
arly
exh
alat
ion
of g
as fr
ee o
f CO
2 co
ntai
ned
in d
ead
spac
e fro
m c
ondu
ctin
g ai
rway
s B
– C
Exp
irato
ry U
pstr
oke
- exh
alat
ion
of d
ead
spac
e an
d al
veol
ar g
ases
C
– D
ETC
O2 -
End
-tida
l CO
2
D –
E I
nspi
rato
ry D
owns
trok
e - i
nhal
atio
n of
CO
2 fre
e ga
s
A
B
CD
E0
Central East Prehospital Care Program For Reference Only
Reference Material R - 8
Sudd
en lo
ss o
f ETC
O2 or
dro
p to
zer
o
A
irway
dis
conn
ecte
d
ET
tube
dis
lodg
ed, k
inke
d or
obs
truct
ed
M
alfu
nctio
n of
ven
tilat
or
E
soph
agea
l int
ubat
ion
Sudd
en d
ecre
asin
g ET
CO
2 with
loss
of p
late
au
E
T cu
ff le
aky
or d
efla
ted
P
artia
l obs
truct
ion
of a
irway
Loss
of E
TCO
2 Pl
atea
u
B
ronc
hosp
asm
Muc
ous
plug
ging
Inco
mpl
ete
or o
bstru
cted
exh
alat
ion
E
T tu
be p
artia
lly k
inke
d
Sudd
en d
ecre
ase
in E
TCO
2 lev
els
C
heck
tube
pla
cem
ent
P
ulm
onar
y em
bolis
m
D
rop
or lo
ss o
f blo
od c
ircul
atio
n
Hyp
othe
rmia
Dec
reas
ed m
etab
olis
m
Low
, sus
tain
ed n
orm
al w
avef
orm
H
yper
vent
ilatio
n
Dec
reas
ed m
etab
olis
m
H
ypot
herm
ia
Elev
ated
, sus
tain
ed n
orm
al w
avef
orm
Hyp
oven
tilat
ion
M
alig
nant
hyp
erth
erm
ia
In
crea
sed
met
abol
ism
Res
pira
tory
dep
ress
ants
40 -
0 -
40 -
0 -
40 -
0 -
40 -
0 -
40 -
0 -
40 -
0 -
Central East Prehospital Care Program For Reference Only
Reference Material R - 9
Fiel
d Tr
aum
a Tr
iage
Gui
delin
es
Central East Prehospital Care Program For Reference Only
Reference Material R - 10
Central East Prehospital Care Program For Reference Only
Reference Material R - 11
Intr
a M
uscu
lar I
njec
tion
Land
mar
king
and
Nee
dle
Sele
ctio
n
This
is th
e pr
efer
red
site
for p
atie
nts
grea
ter t
han
2 ye
ars
of a
ge.
Rec
omm
ende
d N
eedl
e Le
ngth
:
1” –
1.5
” for
adu
lts (d
epen
ding
on
amou
nt o
f sub
cuta
neou
s tis
sue
arou
nd in
ject
ion
site
) La
ndm
arki
ng:
With
elb
ow b
ent l
ocat
e th
e lo
wer
edg
e of
the
acro
miu
m p
roce
ss. V
isua
lize
an in
verte
d tri
angl
e w
ith th
e ap
ex ju
st b
elow
the
axilla
. U
pper
edg
e is
2-3
fin
ger w
idth
s be
low
the
acro
miu
m p
roce
ss, a
nd th
e lo
wer
edg
e ju
st a
bove
th
e ax
illa. T
he in
ject
ion
site
is in
the
mid
dle
of th
is tr
iang
le.
Com
plic
atio
ns:
1.
dam
age
to a
xilla
ry n
erve
2.
da
mag
e to
pos
terio
r circ
umfle
x hu
mer
al v
esse
ls
3.
dam
age
to ra
dial
ner
ve
4.
infe
ctio
n
This
is th
e pr
efer
red
site
for c
hild
ren
unde
r the
age
of 2
yea
rs.
Rec
omm
ende
d N
eedl
e Le
ngth
s:
1”
for i
nfan
ts a
nd to
ddle
rs
1.
5” fo
r adu
lts if
this
site
is u
sed
Land
mar
king
: P
alpa
te th
e gr
eate
r tro
chan
ter o
f the
fem
ur a
nd th
e la
tera
l bor
der o
f the
pa
tella
. Div
ide
the
thig
h in
to th
irds.
The
bel
ly o
f the
vas
tus
late
ralis
lies
in
the
ante
rola
tera
l asp
ect o
f the
mid
dle
third
. C
ompl
icat
ions
: 1.
da
mag
e to
fem
oral
ner
ve o
r arte
ry
2.
infe
ctio
n 3.
m
uscl
e co
ntra
ctur
e
Central East Prehospital Care Program For Reference Only
Reference Material R - 12
Med
icat
ion
List
– A
LS-P
CS
Ace
tam
inop
hen
CLA
SS
Ana
lges
ic
AC
TIO
N
Alth
ough
not
fully
elu
cida
ted,
bel
ieve
d to
inhi
bit t
he s
ynth
esis
of p
rost
agla
ndin
s in
the
cent
ral n
ervo
us s
yste
m a
nd w
ork
perip
hera
lly to
blo
ck p
ain
impu
lse
gene
ratio
n.
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
10
– 3
0 m
inut
es
45 m
inut
es
4 ho
urs
MET
AB
OLI
SM
Hep
atic
A
t tox
ic d
oses
(as
little
as
4 g
daily
) glu
tath
ione
con
juga
tion
beco
mes
insu
ffici
ent t
o m
eet t
he m
etab
olic
dem
and
caus
ing
an in
crea
se in
NA
PQ
I con
cent
ratio
ns, w
hich
may
cau
se h
epat
ic c
ell n
ecro
sis
O
ral a
dmin
istra
tion
is s
ubje
ct to
firs
t pas
s m
etab
olis
m
Hal
f-life
is a
ppro
xim
atel
y 2
hour
s.
Ade
nosi
ne
CLA
SS
Ant
iarr
hyth
mic
A
CTI
ON
S
low
s co
nduc
tion
time
thro
ugh
the
AV
nod
e, in
terru
ptin
g th
e re
-ent
ry p
athw
ays
thro
ugh
the
AV
nod
e, re
stor
ing
norm
al
sinu
s rh
ythm
in p
atie
nts
with
nar
row
com
plex
sup
rave
ntric
ular
tach
ycar
dia
incl
udin
g W
olf-P
arki
nson
-Whi
te S
yndr
ome
(WP
W).
O
NSE
T PE
AK
EFF
ECT
DU
RA
TIO
N
Rap
id
Less
than
60
seco
nds
1 –
2 m
inut
es
MET
AB
OLI
SM
Occ
urs
in c
ircul
atio
n
Hal
f-life
is le
ss th
an 1
0 se
cond
s.
Central East Prehospital Care Program For Reference Only
Reference Material R - 13
Ant
ibio
tic O
intm
ent
CLA
SS
Ant
ibio
tic
AC
TIO
N
A c
ombi
natio
n of
ant
ibio
tics
that
are
bac
teric
idal
, hel
ps p
reve
nt in
fect
ion.
O
NSE
T PE
AK
EFF
ECT
DU
RA
TIO
N
Unk
now
n U
nkno
wn
Unk
now
n M
ETA
BO
LISM
S
low
ly e
xcre
ted
by th
e ki
dney
s
Ace
tyls
alic
ylic
aci
d (A
SA)
CLA
SS
Non
-Ste
roid
al A
nti-I
nfla
mm
ator
y D
rug.
Ana
lges
ic a
nd p
late
let a
ggre
gatio
n in
hibi
tor
AC
TIO
N
Ana
lges
ia a
nd p
late
let i
nhib
ition
is th
roug
h irr
ever
sibl
e in
activ
atio
n of
cyc
loxy
gena
se (C
OX
) dec
reas
es th
e pr
oduc
tion
of
pros
tagl
andi
ns re
sulti
ng in
dec
reas
ed s
ensi
tivity
of p
ain
rece
ptor
s an
d th
rom
boxa
nes
whi
ch d
ecre
ases
blo
od c
lotti
ng.
Red
uces
mor
bidi
ty/m
orta
lity
in a
dult
patie
nts.
O
NSE
T PE
AK
EFF
ECT
DU
RA
TIO
N
15 –
30
min
utes
1-
2 ho
urs
Dos
e de
pend
ent
MET
AB
OLI
SM
Hyd
roly
zed
to s
alic
ylat
e (a
ctiv
e) b
y es
tera
ses
in G
I muc
osa,
red
bloo
d ce
lls, s
ynov
ial f
luid
, and
blo
od
Met
abol
ism
of s
alic
ylat
e oc
curs
prim
arily
by
hepa
tic c
onju
gatio
n
Met
abol
ic p
athw
ays
can
be s
atur
ated
.
Central East Prehospital Care Program For Reference Only
Reference Material R - 14
CO
MM
ON
NSA
IDS
(Incl
udin
g bu
t not
lim
ited
to)
OVE
R-T
HE-
CO
UN
TER
Asp
irin
Ib
upro
fen
(Mot
rin IB
, Adv
il, N
uprin
, Ruf
en)
K
etop
rofe
n (A
ctro
n, O
rudi
s K
T)
N
apro
xen
(Ale
ve)
PRES
CR
IPTI
ON
Ibup
rofe
n (M
otrin
)
Indo
met
haci
n (In
doci
n)
To
lmet
in (T
olec
tin)
K
etop
rofe
n (O
rudi
s, O
ruva
il)
N
apro
xen
(Nap
rosy
n, A
napr
ox)
D
iclo
fena
c (V
olta
ren,
Cat
afla
m, S
olar
aze)
Atr
opin
e C
LASS
P
aras
ympa
thol
ytic
, ant
icho
liner
gic
AC
TIO
N
Blo
cks
the
actio
n of
ace
tylc
holin
e at
par
asym
path
etic
site
s in
sm
ooth
mus
cle,
sec
reto
ry g
land
s, a
nd th
e C
NS
. Inc
reas
es
cond
uctio
n ve
loci
ty a
nd h
eart
rate
in s
ympt
omat
ic b
rady
card
ia to
incr
ease
car
diac
out
put.
Drie
s se
cret
ions
. Atro
pine
re
vers
es th
e m
usca
rinic
effe
cts
of c
holin
ergi
c po
ison
ing.
The
prim
ary
goal
in c
holin
ergi
c po
ison
ings
is re
vers
al o
f br
onch
orrh
ea a
nd b
ronc
hoco
nstri
ctio
n. A
tropi
ne h
as n
o ef
fect
on
the
nico
tinic
rece
ptor
s re
spon
sibl
e fo
r mus
cle
wea
knes
s, fa
scic
ulat
ions
, and
par
alys
is.
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
R
apid
2
– 10
min
utes
3
hour
s M
ETA
BO
LISM
H
epat
ic.
Wid
ely
dist
ribut
ed th
roug
hout
the
body
; cro
sses
the
plac
enta
; tra
ce a
mou
nts
ente
r bre
ast m
ilk; c
ross
es b
lood
-bra
in
barri
er.
Central East Prehospital Care Program For Reference Only
Reference Material R - 15
Cal
cium
Glu
cona
te
CLA
SS
Cal
cium
Sal
t, el
ectro
lyte
sup
plem
ent
AC
TIO
N
Mod
erat
es n
erve
and
mus
cle
perfo
rman
ce v
ia a
ctio
n po
tent
ial t
hres
hold
regu
latio
n. U
sed
as a
car
dio-
prot
ectiv
e ag
ent i
n hy
perk
alem
ia. D
ecre
ases
the
exci
tabi
lity
of c
ardi
omyo
cyte
s, w
ithou
t alte
ring
the
amou
nt o
f pot
assi
um in
the
bloo
d.
In h
ydro
gen
fluor
ide
expo
sure
s, c
alci
um g
luco
nate
pro
vide
s a
sour
ce o
f cal
cium
ions
to c
ompl
ex fr
ee fl
uorid
e io
ns a
nd
prev
ent o
r red
uce
toxi
city
; adm
inis
tratio
n al
so h
elps
to c
orre
ct fl
uorid
e-in
duce
d hy
poca
lcem
ia.
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
5
min
utes
30
min
utes
2
hour
s M
ETA
BO
LISM
E
xcre
ted
unch
ange
d m
ainl
y (7
5%) i
n fe
ces
and
rem
aind
er in
urin
e
D
extr
ose
10%
or 5
0% in
Wat
er
CLA
SS
Car
bohy
drat
e (C
alor
ic S
uppl
emen
t) A
CTI
ON
R
eple
nish
es b
lood
glu
cose
leve
ls re
vers
ing
hypo
glyc
emia
. O
NSE
T PE
AK
EFF
ECT
DU
RA
TIO
N
Less
than
1 m
inut
e de
pend
ent u
pon
seve
rity
of
hypo
glyc
aem
ia
depe
nden
t upo
n se
verit
y of
hy
pogl
ycem
ia
MET
AB
OLI
SM
Met
abol
ized
to c
arbo
n di
oxid
e an
d w
ater
.
Central East Prehospital Care Program For Reference Only
Reference Material R - 16
Dim
enhy
drin
ate
(Gra
vol)
CLA
SS
Ant
iem
etic
A
CTI
ON
C
ompe
tes
with
his
tam
ine
for H
1-re
cept
or s
ites
on e
ffect
or c
ells
in th
e ga
stro
inte
stin
al tr
act,
bloo
d ve
ssel
s, a
nd re
spira
tory
tra
ct; b
lock
s ch
emor
ecep
tor t
rigge
r zon
e, d
imin
ishe
s ve
stib
ular
stim
ulat
ion,
and
dep
ress
es la
byrin
thin
e fu
nctio
n th
roug
h its
ce
ntra
l ant
icho
liner
gic
activ
ity. E
xerts
ant
ihis
tam
inic
effe
cts
as w
ell.
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
1-
5 m
inut
es (I
V)
15-3
0 m
inut
es (I
M)
1-2
hour
s
3-6
hour
MET
AB
OLI
SM
Hep
atic
.
D
iphe
nhyd
ram
ine
(Ben
adry
l) C
LASS
A
ntih
ista
min
e A
CTI
ON
C
ompe
tes
with
his
tam
ine
for H
1-re
cept
or s
ites
on e
ffect
or c
ells
in th
e ga
stro
inte
stin
al tr
act,
bloo
d ve
ssel
s, a
nd re
spira
tory
tra
ct; a
ntic
holin
ergi
c an
d se
dativ
e ef
fect
s ar
e al
so s
een.
Exe
rts a
ntie
met
ic e
ffect
s as
wel
l. O
NSE
T PE
AK
EFF
ECT
DU
RA
TIO
N
1-5
min
utes
(IV
) 30
–60
min
utes
(IM
) 1-
3 ho
urs
(ora
l)
1-2
hour
s (IV
and
IM)
2-
4 ho
urs
(ora
l)
4-8
hour
s (IV
and
IM)
4-
6 ho
urs
(ora
l) M
ETA
BO
LISM
H
epat
ic a
nd re
nal.
Central East Prehospital Care Program For Reference Only
Reference Material R - 17
Dop
amin
e C
LASS
S
ympa
thom
imet
ic
AC
TIO
N
Stim
ulat
es b
oth
adre
nerg
ic a
nd d
opam
iner
gic
rece
ptor
s, lo
wer
dos
es a
re m
ainl
y do
pam
iner
gic
stim
ulat
ing
and
prod
uce
rena
l and
mes
ente
ric v
asod
ilatio
n, h
ighe
r dos
es a
lso
are
both
dop
amin
ergi
c an
d be
ta1-
adre
nerg
ic s
timul
atin
g an
d pr
oduc
e ca
rdia
c st
imul
atio
n an
d re
nal v
asod
ilatio
n; la
rge
dose
s st
imul
ate
alph
a-ad
rene
rgic
rece
ptor
s.
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
Le
ss th
an 1
0 m
inut
es
Less
than
10
min
utes
Le
ss th
an 1
0 m
inut
es
MET
AB
OLI
SM
Ren
al, h
epat
ic a
nd p
lasm
a, 7
5% to
inac
tive
met
abol
ites
by m
onoa
min
e ox
idas
e an
d 25
% to
nor
epin
ephr
ine.
Ep
inep
hrin
e 1:
1,00
0 an
d 1:
10,0
00
CLA
SS
Sym
path
omim
etic
A
CTI
ON
S
timul
ates
alp
ha-,
beta
1-, a
nd b
eta2
-adr
ener
gic
rece
ptor
s re
sulti
ng in
rela
xatio
n of
sm
ooth
mus
cle
of th
e br
onch
ial t
ree,
ca
rdia
c st
imul
atio
n (in
crea
sing
myo
card
ial o
xyge
n co
nsum
ptio
n), a
nd d
ilatio
n of
ske
leta
l mus
cle
vasc
ulat
ure;
sm
all d
oses
ca
n ca
use
vaso
dila
tion
via
beta
2-va
scul
ar re
cept
ors;
larg
e do
ses
may
pro
duce
con
stric
tion
of s
kele
tal a
nd v
ascu
lar
smoo
th m
uscl
e th
roug
h al
pha
rece
ptor
s.
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
Le
ss th
an 2
min
utes
(IV
) 3-
10 m
inut
es (I
M)
3-5
min
utes
(NE
B)
Up
to 2
0 m
inut
es (I
V)
20 m
inut
es (I
M)
20 m
inut
es (N
EB
)
5-10
min
utes
(IV
) 20
-30
min
utes
(IM
) U
p to
3 h
ours
(NE
B)
MET
AB
OLI
SM
Take
n up
into
the
adre
nerg
ic n
euro
n an
d m
etab
oliz
ed b
y m
onoa
min
e ox
idas
e an
d ca
tech
ol-o
-met
hyltr
ansf
eras
e;
circ
ulat
ing
drug
hep
atic
ally
met
abol
ized
.
Central East Prehospital Care Program For Reference Only
Reference Material R - 18
Furo
sem
ide
CLA
SS
Loop
Diu
retic
A
CTI
ON
B
lock
s th
e ab
sorp
tion
of s
odiu
m, c
hlor
ide
and
wat
er fr
om th
e fil
tere
d flu
id in
the
kidn
ey tu
bule
s. T
his
caus
es a
pro
foun
d in
crea
se in
urin
e ou
tput
to e
limin
ate
wat
er a
nd s
alt f
rom
the
body
. O
NSE
T PE
AK
EFF
ECT
DU
RA
TIO
N
5 m
inut
es
30 m
inut
es
2 ho
urs
MET
AB
OLI
SM
Prim
arily
rena
l glu
curo
nida
tion
and
smal
l am
ount
hep
atic
.
G
luca
gon
CLA
SS
Hyp
ergl
ycem
ic a
gent
A
CTI
ON
S
timul
ates
ade
nyla
te c
ycla
se to
pro
duce
incr
ease
d cy
clic
AM
P, w
hich
pro
mot
es h
epat
ic g
lyco
geno
lysi
s an
d gl
ucon
eoge
nesi
s, re
sulti
ng in
incr
ease
d bl
ood
gluc
ose
leve
ls.
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
10
-15
min
utes
(IM
) 30
min
utes
U
p to
60
min
utes
(IM
) M
ETA
BO
LISM
P
rimar
ily h
epat
ic, s
ome
inac
tivat
ion
occu
rrin
g re
nal a
nd in
pla
sma.
Central East Prehospital Care Program For Reference Only
Reference Material R - 19
Ibup
rofe
n C
LASS
N
SAID
Ana
lges
ic
AC
TIO
N
CO
X-2
inhi
bito
r whi
ch d
ecre
ases
the
synt
hesi
s of
pro
stag
land
ins
invo
lved
in m
edia
ting
infla
mm
atio
n, p
ain,
feve
r and
sw
ellin
g.
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
30
-60
min
utes
1-
2 ho
urs
4-6
hour
s M
ETA
BO
LISM
H
epat
ic: M
etab
oliz
ed b
y ox
idat
ion
to 2
inac
tive
met
abol
ites:
(+)-
2[4´
-(2-
hydr
oxy-
2-m
ethy
lpro
pyl)p
heny
l]pro
pion
ic a
cid
and
(+)-2
-[4´-(
2-ca
rbox
ypro
pyl)p
heny
l]pro
pion
ic a
cid.
Ver
y sm
all a
mou
nts
of 1
-hyd
roxy
ibup
rofe
n an
d 3-
hydr
oxyi
bupr
ofen
hav
e be
en re
cove
red
from
urin
e. C
ytoc
hrom
e P
450
2C9
is th
e m
ajor
cat
alys
t in
the
form
atio
n of
oxi
dativ
e m
etab
olite
s.
Oxi
dativ
e m
etab
olite
s m
ay b
e co
njug
ated
to g
lucu
roni
de p
rior t
o ex
cret
ion.
K
etor
olac
C
LASS
N
SA
ID a
nalg
esic
A
CTI
ON
B
lock
s pr
osta
glan
din
form
atio
n th
ereb
y de
crea
sing
noc
icep
tor s
timul
atio
n O
NSE
T PE
AK
EFF
ECT
DU
RA
TIO
N
10 m
inut
es
2–3
hour
s 6–
8 ho
urs
MET
AB
OLI
SM
Prim
arily
hep
atic
. Les
s th
an 5
0% o
f a d
ose
is m
etab
oliz
ed. T
he m
ajor
met
abol
ites
are
a gl
ucur
onid
e co
njug
ate,
whi
ch
may
als
o be
form
ed in
the
kidn
ey, a
nd p
-hyd
roxy
ket
orol
ac. N
eith
er m
etab
olite
has
sig
nific
ant a
nalg
esic
act
ivity
.
Central East Prehospital Care Program For Reference Only
Reference Material R - 20
Lido
cain
e in
ject
able
and
topi
cal s
pray
C
LASS
C
lass
Ib a
ntia
rrhy
thm
ic, t
opic
al a
nest
hetic
A
CTI
ON
S
uppr
esse
s au
tom
atic
ity o
f con
duct
ion
tissu
e, b
y bl
ocki
ng s
odiu
m c
hann
els
and
incr
easi
ng e
lect
rical
stim
ulat
ion
thre
shol
d of
ven
tricl
e, H
is-P
urki
nje
syst
em, a
nd s
pont
aneo
us d
epol
ariz
atio
n of
the
vent
ricle
s du
ring
dias
tole
by
a di
rect
act
ion
on th
e tis
sues
; blo
cks
both
the
initi
atio
n an
d co
nduc
tion
of n
erve
impu
lses
by
decr
easi
ng th
e ne
uron
al m
embr
ane'
s pe
rmea
bilit
y to
sod
ium
ions
, whi
ch re
sults
in in
hibi
tion
of d
epol
ariz
atio
n w
ith re
sulta
nt b
lock
ade
of c
ondu
ctio
n. T
opic
al a
ctio
n oc
curs
by
stab
ilizi
ng th
e ne
uron
al m
embr
ane
by in
hibi
ting
the
ioni
c flu
xes
requ
ired
for
initi
atio
n an
d co
nduc
tion
of im
puls
es
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
45
-90
seco
nds
(IV/IO
) 1-
2 m
inut
es (E
TT)
Less
than
2 m
inut
es (T
OP
)
2–7
min
utes
(IV
/IO)
Less
than
5 m
inut
es (E
TT)
Less
than
5 m
inut
es (T
OP
)
10-2
0 m
inut
es (I
V/IO
) 10
-20
min
utes
(ETT
) 10
-20
min
utes
(TO
P)
MET
AB
OLI
SM
90%
Hep
atic
M
orph
ine
CLA
SS
Opi
oid
anal
gesi
c A
CTI
ON
B
inds
to o
piat
e re
cept
ors
in th
e C
NS
, cau
sing
inhi
bitio
n of
asc
endi
ng p
ain
path
way
s, a
lterin
g th
e pe
rcep
tion
of a
nd
resp
onse
to p
ain;
pro
duce
s ge
nera
lized
CN
S d
epre
ssio
n.
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
R
apid
(IV
) 2
0 m
inut
es (S
C)
20 m
inut
es (I
V)
50-9
0 m
inut
es (S
C)
4-5
hour
s (IV
) 4-
5 ho
urs
(SC
) M
ETA
BO
LISM
H
epat
ic
Central East Prehospital Care Program For Reference Only
Reference Material R - 21
Mid
azol
am
CLA
SS
Ben
zodi
azep
ine,
ant
icon
vuls
ant,
seda
tive
AC
TIO
N
Bin
ds to
ste
reos
peci
fic b
enzo
diaz
epin
e re
cept
ors
on th
e po
stsy
napt
ic G
AB
A n
euro
n at
sev
eral
site
s w
ithin
the
cent
ral
nerv
ous
syst
em, i
nclu
ding
the
limbi
c sy
stem
, ret
icul
ar fo
rmat
ion.
Enh
ance
men
t of t
he in
hibi
tory
effe
ct o
f GA
BA
on
neur
onal
exci
tabi
lity
resu
lts b
y in
crea
sed
neur
onal
mem
bran
e pe
rmea
bilit
y to
chl
orid
e io
ns. T
his
shift
in c
hlor
ide
ions
resu
lts in
hy
perp
olar
izat
ion
(a le
ss e
xcita
ble
stat
e) a
nd s
tabi
lizat
ion.
O
NSE
T PE
AK
EFF
ECT
DU
RA
TIO
N
1-5
min
utes
(IV
) 5-
15 m
inut
es (I
M)
Rap
id (I
N)
Unk
now
n (B
UC
CA
L)
1.5-
5 m
inut
es (I
V)
5-15
min
utes
(IM
) R
apid
(IN
) U
nkno
wn
(BU
CC
AL)
Up
to 4
hou
rs
MET
AB
OLI
SM
Ext
ensi
vely
hep
atic
Nal
oxon
e C
LASS
O
pioi
d A
ntag
onis
t A
CTI
ON
C
ompe
titiv
e op
ioid
ant
agon
ist.
Dis
plac
es m
edic
atio
n bo
und
to o
piat
e re
cept
or s
ites
reve
rsin
g th
eir e
ffect
s.
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
2-
5 m
inut
es (S
C)
2-5
min
utes
(IM
) 8-
13 m
inut
es (I
N)
Less
than
1 m
inut
e (IV
)
Dep
ende
nt u
pon
amou
nt o
f opi
oid
in
the
body
U
p to
45
min
utes
, but
dep
ende
nt u
pon
amou
nt o
f opi
oid
in th
e bo
dy
MET
AB
OLI
SM
Prim
arily
hep
atic
Central East Prehospital Care Program For Reference Only
Reference Material R - 22
N
itrog
lyce
rin
CLA
SS
Cor
onar
y va
sodi
lato
r, an
ti-an
gina
l A
CTI
ON
P
rodu
ces
a va
sodi
lato
r effe
ct o
n th
e pe
riphe
ral v
eins
and
arte
ries
with
mor
e pr
omin
ent e
ffect
s on
the
vein
s. P
rimar
ily
redu
ces
card
iac
oxyg
en d
eman
d by
dec
reas
ing
prel
oad
(left
vent
ricul
ar e
nd-d
iast
olic
pre
ssur
e); m
ay m
odes
tly re
duce
af
terlo
ad; d
ilate
s co
rona
ry a
rterie
s an
d im
prov
es c
olla
tera
l flo
w to
isch
emic
regi
ons.
In s
moo
th m
uscl
e, n
itric
oxi
de
activ
ates
gua
nyla
te c
ycla
se w
hich
incr
ease
s gu
anos
ine
3’5’
mon
opho
spha
te (c
GM
P) l
eadi
ng to
dep
hosp
hory
latio
n of
m
yosi
n lig
ht c
hain
s an
d sm
ooth
mus
cle
rela
xatio
n.
ON
SET
PEA
K E
FFEC
TS
DU
RA
TIO
N
1-3
min
utes
(SL)
4-
10 m
inut
es (S
L)
Up
to 2
5 m
inut
es (S
L)
MET
AB
OLI
SM
Ext
ensi
ve fi
rst-p
ass
effe
ct; m
etab
oliz
ed h
epat
ical
ly to
gly
cero
l di-
and
mon
onitr
ate
met
abol
ites
via
liver
redu
ctas
e en
zym
e;
subs
eque
nt m
etab
olis
m to
gly
cero
l and
org
anic
nitr
ate;
non
hepa
tic m
etab
olis
m v
ia re
d bl
ood
cells
and
vas
cula
r wal
ls a
lso
occu
rs.
Sa
lbut
amol
(Ven
tolin
) C
LASS
S
ympa
thom
imet
ic, B
eta
2 ag
onis
t A
CTI
ON
R
elax
es b
ronc
hial
sm
ooth
mus
cle
by a
ctio
n on
bet
a2-r
ecep
tors
with
littl
e ef
fect
on
hear
t rat
e.
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
10
min
utes
(MD
I/NE
B)
1-2
hour
s (M
DI/N
EB
) 3-
4 ho
urs
(MD
I/NE
B)
MET
AB
OLI
SM
Hep
atic
to a
n in
activ
e su
lpha
te
Central East Prehospital Care Program For Reference Only
Reference Material R - 23
So
dium
Bic
arbo
nate
C
LASS
A
lkal
iniz
ing
Age
nt
AC
TIO
N
Rea
cts
with
hyd
roge
n io
ns to
form
wat
er a
nd C
O2.
Act
s as
a b
uffe
r aga
inst
aci
dosi
s by
rais
ing
bloo
d pH
O
NSE
T PE
AK
EFF
ECT
DU
RA
TIO
N
Imm
edia
te
Imm
edia
te
Up
to 1
-2 h
ours
, but
dep
ends
on
pH
MET
AB
OLI
SM
Occ
urs
in v
ascu
lar s
pace
to H
2O a
nd C
O2
Xylo
met
azol
ine
(Bal
imin
il)
CLA
SS
Sym
path
omim
etic
age
nt, t
opic
al v
asoc
onst
ricto
r A
CTI
ON
X
ylom
etaz
olin
e is
a n
asal
dec
onge
stan
t. It
stim
ulat
es th
e al
pha
1 an
d 2
rece
ptor
s in
the
nasa
l tis
sues
, cau
sing
con
stric
tion
of th
e bl
ood
vess
els
in th
e no
se a
nd s
inus
es le
ads
to a
dec
reas
e in
con
gest
ion.
O
NSE
T PE
AK
EFF
ECT
DU
RA
TIO
N
Imm
edia
te
Unk
now
n 10
-20
min
utes
M
ETA
BO
LISM
90
% H
epat
ic
Central East Prehospital Care Program For Reference Only
Reference Material R - 24
Med
icat
ion
List
CB
RN
E
Dia
zepa
m (C
BR
NE)
C
LASS
B
enzo
diaz
epin
e A
CTI
ON
U
sed
to p
reve
nt o
r red
uce
the
dura
tion
of s
eizu
res
in o
rgan
phos
phat
e po
ison
ings
. Als
o us
ed to
dec
reas
e m
uscl
e fa
sicu
latio
ns.
ON
SET
PEA
K E
FFC
T D
UR
ATI
ON
IV
1–5
min
utes
15
–30
min
utes
3
hour
s M
ETA
BO
LISM
H
epat
ic
O
bido
xim
e an
d Pr
alid
oxim
e (C
BR
NE)
C
LASS
O
xim
e, A
cety
lcho
lines
tera
se re
activ
ator
A
CTI
ON
R
ever
ses
the
bind
ing
of o
rgan
opho
spha
tes
and
acer
tylc
holin
este
rase
(AC
hE) r
elie
ving
mus
cle
cont
ract
ions
and
par
alys
is
ON
SET
PEA
K E
FFC
T D
UR
ATI
ON
IM
- un
know
n U
nkno
wn
Unk
now
n M
ETA
BO
LISM
R
enal
cle
aran
ce
Central East Prehospital Care Program For Reference Only
Reference Material R - 25
Atr
opin
e (C
BR
NE)
C
LASS
A
ntic
holin
ergi
c, a
ntim
usca
rinic
, ant
idot
e A
CTI
ON
B
lock
s th
e ac
tions
of a
cety
lcho
line
at th
e m
usca
rinic
rece
ptor
site
s, re
duci
ng th
e po
st s
ynap
tic a
ctio
ns. B
lock
s ac
tion
of
acet
ylch
olin
e at
par
asym
path
etic
site
s in
sec
reto
ry g
land
s, a
nd C
NS
; inh
ibits
sal
ivat
ion,
trac
heob
ronc
hial
sec
retio
ns,
brad
ycar
dia,
hyp
oten
sion
. O
NSE
T PE
AK
EFF
CT
DU
RA
TIO
N
IV -
rapi
d IM
- ra
pid
Imm
edia
te
3-5
min
utes
D
urat
ion
depe
nden
t upo
n ex
tent
of
pois
onin
g M
ETA
BO
LISM
Li
ver m
etab
olis
m a
nd re
nal c
lear
ance
.
A
nest
hetic
Eye
dro
ps (C
BR
NE)
C
LASS
To
pica
l ana
esth
etic
A
CTI
ON
A
naes
thet
ic a
ctio
n de
crea
ses
burn
/irrit
atio
n of
cor
nea
ON
SET
PEA
K E
FFC
T D
UR
ATI
ON
TO
P
Imm
edia
te
Dur
atio
n de
pend
ent u
pon
exte
nt o
f po
ison
ing
MET
AB
OLI
SM
Unk
now
n
Central East Prehospital Care Program For Reference Only
Reference Material R - 26
Cal
cium
Glu
cona
te (C
BR
NE)
C
LASS
C
alci
um s
alt,
antid
ote
AC
TIO
N
HF
diss
ocia
tes
into
Hyd
roge
n io
ns a
nd F
lour
ide
ions
, bot
h of
whi
ch c
ause
cel
lula
r dam
age.
Cal
cium
Glu
cona
te re
plen
ishe
s bo
dy c
alci
um to
neu
traliz
e th
e ef
fect
s of
Flo
urid
e io
ns.
ON
SET
PEA
K E
FFC
T D
UR
ATI
ON
TO
P
NEB
A
ctio
n be
gins
on
cont
act b
y ei
ther
ro
ute
and
is re
peat
ed a
s re
quire
d D
urat
ion
depe
nden
t upo
n ex
tent
of
pois
onin
g M
ETA
BO
LISM
R
enal
cle
aran
ce
H
ydro
xoco
bala
min
(CB
RN
E)
CLA
SS
Cya
nide
ant
idot
e A
CTI
ON
Fo
rm o
f vita
min
B12
, con
verte
d in
the
body
to a
usa
ble
form
of c
oenz
yme
B12
. It b
inds
to c
yani
de in
activ
atin
g it
and
allo
win
g it
to b
e ex
cret
ed in
the
urin
e.
ON
SET
PEA
K E
FFC
T D
UR
ATI
ON
IV
Im
med
iate
H
alf-l
ife is
app
roxi
mat
ely
30 h
ours
. D
urat
ion
depe
nden
t upo
n ex
tent
of
pois
onin
g M
ETA
BO
LISM
R
enal
cle
aran
ce
Central East Prehospital Care Program For Reference Only
Reference Material R - 27
Sodi
um T
hios
ulfa
te (C
BR
NE)
C
LASS
C
yani
de a
ntid
ote
AC
TIO
N
As
cyan
ide
diss
ocia
tes
from
met
hem
oglo
bin,
sod
ium
thio
sulfa
te fa
cilit
ates
its
conv
ersi
on b
y rh
odan
ese
to th
iocy
anat
e, a
le
ss to
xic
ion
ON
SET
PEA
K E
FFEC
T D
UR
ATI
ON
IV
Im
med
iate
H
alf-l
ife is
app
roxi
mat
ely
30 h
ours
. D
urat
ion
depe
nden
t upo
n ex
tent
of
pois
onin
g M
ETA
BO
LISM
P
rimar
ily re
nal c
lear
ance
Central East Prehospital Care Program For Reference Only
Reference Material R - 28
Ove
rdos
e Le
vels
Th
is c
hart
is in
tend
ed o
nly
as a
gui
de.
Num
erou
s va
riabl
es in
fluen
ce to
xic
/ let
hal l
evel
s
ASA
A
dults
& c
hild
ren:
300
– 50
0 m
g/kg
is a
sev
ere
inge
stio
n
>500
mg/
kg m
ay b
e fa
tal
Ace
tam
inop
hen
A
dults
:
70 –
140
mg/
kg m
ay b
e to
xic
14
0 m
g/kg
can
be
fata
l C
hild
ren:
< 5
yrs
old
- 100
- 20
0 m
g/kg
may
be
toxi
c
>200
mg/
kg m
ay b
e fa
tal
Am
phet
amin
es
10
0 m
g (4
0 m
g in
chi
ldre
n)
Atr
opin
e
100
mg
Ben
adry
l (di
phen
hydr
amin
e)
20
-40
mg/
kg m
ay b
e fa
tal
Bar
bitu
rate
s
1 –
3 gm
B
enzo
diaz
epin
es
To
xici
ty ra
nges
from
500
– 1
500
mg’
s C
ocai
ne
(As
with
mos
t stre
et d
rugs
, im
purit
ies,
etc
m
ake
pred
ictin
g to
xic
leve
ls d
iffic
ult)
A
‘roc
k’ is
usu
ally
100
– 2
00 m
g
A ty
pica
l ‘lin
e’ is
usu
ally
20
– 30
mg
A
‘spo
on’ i
s us
ually
5 –
10
mg
C
odei
ne
2
– 25
mg/
kg c
an c
ause
toxi
c ef
fect
s
500
– 10
00 m
g ca
n be
fata
l D
emer
ol
1
gm m
ay b
e fa
tal
Dig
italis
Gly
cosi
des
D
igita
lis: 2
gm
may
be
fata
l
Dig
itoxi
n: 3
mg
may
be
fata
l
Dig
oxin
: 10
mg
may
be
fata
l
Central East Prehospital Care Program For Reference Only
Reference Material R - 29
Dila
ntin
20 m
g/kg
may
be
toxi
c G
HB
30 –
60
mg
may
be
toxi
c Ib
upro
fen
Adu
lts:
6
- 54
mg
may
be
toxi
c C
hild
ren:
200
– 40
0 m
g/kg
may
be
seve
re in
gest
ion
>4
00 m
g/kg
may
be
fata
l M
etha
done
50 m
g ca
n be
fata
l M
etha
mph
etam
ine
1
mg/
kg m
ay b
e fa
tal
Mor
hpin
e
200
– 25
0 m
g in
gest
ion
can
be fa
tal
Met
hano
l
30 –
240
ml m
ay b
e fa
tal
Mon
oam
ine
Oxi
dase
Inhb
itors
(M
AO
I’s)
2
– 3
mg/
kg is
life
thre
aten
ing
4 –
6 m
g/kg
is ty
pica
lly fa
tal
Tric
yclic
Ant
i-dep
ress
ants
(TC
A’s
)
20 –
35
mg/
kg m
ay b
e se
vere
35 –
40
mg/
kg m
ay b
e fa
tal
Valiu
m (D
iaze
pam
)
1 gm
may
be
fata
l
Central East Prehospital Care Program For Reference Only
Reference Material R - 30
Toxi
drom
es R
efer
ence
To
xidr
ome
Form
Pa
thw
ay
LOA
R
RH
RB
PPu
pils
EC
G
Com
men
ts
Ant
icho
liner
gic
(TC
A’s
, Gra
vol,
Ben
adry
l, A
ntih
ista
min
es
Pills
, liq
uids
P
O, S
C
Alte
r
N
o
D
ilate
d
Nau
sea,
war
m, w
et,
poss
ible
sei
zure
s
Coc
aine
/ C
rack
(S
imul
ant)
Diff
eren
t co
lour
ed
pow
ders
, Roc
k,
Cry
stal
Sno
rted,
IV
, S
mok
ed
D
ilate
d Ta
chy-
arrh
ythm
ia
Che
st p
ain,
Pro
ne to
M
I/CV
A, v
iole
nt
Ecs
tasy
P
ills, c
andy
fo
rm
PO
A
lter
D
ilate
d Ta
chy-
arrh
ythm
ia
Tem
pera
ture
, Tee
th
grin
ding
, Irr
atio
nal
GH
B
(Dep
ress
ant)
Liqu
id -
Wat
er
like
PO
, ofte
n m
ixed
w
ith
alco
hol
+
+
N
orm
/ D
ilate
d S
lugg
ish
Irreg
ular
N
ause
a, S
eizu
res
Her
oin
(Opi
ate
narc
otic
)
Ligh
t-Dar
k po
wde
rs, d
ark
tarr
y su
bsta
nce
Sno
rted,
IV
, SC
, S
mok
ed
Alte
r
+
+
+C
onst
ricte
dAr
rhyt
hmia
sN
onvi
olen
t, re
stle
ss,
seiz
ures
Inha
lant
s Fl
ue, p
aint
, pe
tro, a
eros
ols
Inha
led
Alte
r
Pos
sibl
y di
late
d A
rrhy
thm
ias
Slu
rred
spe
ech,
diz
zy,
hallu
cina
tions
Ket
amin
e (A
naes
thet
ic)
Cle
ar li
quid
, W
hite
Pow
der
Sno
rted,
IV
, PO
, S
mok
ed
Arr
hyth
mia
sS
wea
ty,
Te
mpe
ratu
re, N
ause
a
Mar
ijuan
a P
lant
mat
eria
l
Sm
oked
, M
ixed
w
ith fo
od,
Tea
Alte
r
N
orm
/ D
ilate
d S
lugg
ish
B
lood
shot
eye
s,
“Mun
chie
s”
Met
h (S
timul
ant)
Diff
eren
t co
lour
ed
pow
der,
Roc
k,
Cry
stal
Sno
rted,
IV
, PO
, S
mok
ed
Alte
r
D
ilate
d Ta
chy-
arrh
ythm
ia
Trem
ors,
Pos
sibl
e C
VA
, Sei
zure
s,
Te
mpe
ratu
re, S
wea
ty
Central East Prehospital Care Program For Reference Only
Reference Material R - 31
Pedi
atric
Vita
l Sig
ns
Age
Res
pira
tory
Rat
e H
eart
Rat
e N
orm
oten
sion
H
ypot
ensi
on
0-3
mon
ths
30-6
0 90
-180
90
70
3-6
mon
ths
30-6
0 80
-160
91
71
6-12
mon
ths
25-4
5 80
-140
92
72
1-3
year
s 20
-30
75-1
30
94
74
6 ye
ars
16-2
4 70
-110
10
0 82
10 y
ears
14
-20
60-9
0 10
0 90
Vita
l sig
n fo
rmul
as
Wei
ght =
(Age
x2)
+10
SB
P =
90+
(2x
Age
in y
rs)
SB
P =
70+(
2 x
Age
in y
rs)
NO
TE –
a H
eart
rate
of 6
0 or
less
in a
chi
ld is
an
omin
ous
findi
ng a
nd C
PR is
indi
cate
d if
sign
s of
po
or p
erfu
sion
are
pre
sent
.
Central East Prehospital Care Program For Reference Only
Reference Material R - 32
Pedi
atric
Gla
sgow
Com
a Sc
ale
< 2
Year
s of
age
≥ 2
Year
s of
age
EYE
OPE
NIN
G
EY
E O
PEN
ING
Spo
ntan
eous
4
S
pont
aneo
us
To S
peec
h 3
To
Spe
ech
To P
ain
2
To P
ain
Non
e 1
N
one
BES
T R
ESPO
NSE
TO
STI
MU
LUS:
A
UD
ITO
RY
/ VIS
UA
L B
EST
VER
BA
L R
ESPO
NSE
Orie
nts
to s
ound
s, fo
llow
s ob
ject
s, s
mile
s, c
oos,
bab
bles
5
Orie
nted
, app
ropr
iate
wor
ds
Crie
s ap
prop
riate
ly; w
hen
upse
t 4
Con
fuse
d, in
appr
opria
te w
ords
Inap
prop
riate
, per
sist
ent c
ry /
Scr
eam
3
Inap
prop
riate
, per
sist
ent c
ry /
scre
am
Agi
tate
d / r
estle
ss, g
runt
s, m
oans
2
Inco
mpr
ehen
sibl
e so
unds
, gru
nts
No
Res
pons
e 1
No
Res
pons
e
BES
T M
OTO
R R
ESPO
NSE
B
EST
MO
TOR
RES
PON
SE
Spo
ntan
eous
mov
emen
ts
6 S
pont
aneo
us m
ovem
ents
Loca
lizes
pai
n 5
Loca
lizes
pai
n
With
draw
s fro
m p
ain
4 W
ithdr
aws
from
pai
n
Abn
orm
al fl
exio
n (d
ecor
ticat
e)
3 A
bnor
mal
flex
ion
(dec
ortic
ate)
Abn
orm
al e
xten
sion
(dec
ereb
rate
) 2
Abn
orm
al e
xten
sion
(dec
ereb
rate
)
No
resp
onse
1
No
resp
onse
Central East Prehospital Care Program For Reference Only
Reference Material R - 33
Rec
ogni
tion
of D
eath
/ Te
rmin
atio
n of
Res
usci
tatio
n G
uidl
eine
s H
ere
are
som
e gu
idel
ines
to h
elp
with
the
dete
rmin
atio
n of
the
reco
gniti
on o
f dea
th a
nd/o
r the
term
inat
ion
of re
susc
itatio
n w
hen
pres
ente
d w
ith a
VS
A:
1.
Pat
ient
pre
sent
ing
as “O
bvio
usly
Dea
d”
a. D
ecap
itatio
n, tr
anse
ctio
n, v
isib
le d
ecom
posi
tion,
put
refa
ctio
n; o
r b.
Abs
ence
of v
ital s
igns
and
:
A g
ross
ly c
harre
d bo
dy; o
r
An
open
hea
d or
tors
o w
ound
s w
ith g
ross
out
pour
ing
of c
rani
al o
r vis
cera
l con
tent
s; o
r
Gro
ss ri
gor m
ortis
; or
Li
vidi
ty
2.
Pat
ient
with
out v
ital s
igns
and
the
subj
ect o
f a M
inis
try o
f Hea
lth a
nd L
ong-
Term
Car
e D
o N
ot R
esus
cita
te
Con
firm
atio
n Fo
rm.
Con
side
r hon
orin
g th
e D
NR
Con
firm
atio
n Fo
rm.
3.
Pat
ient
with
out v
ital s
igns
and
the
subj
ect o
f a “l
egal
look
ing’
doc
umen
t or t
he o
ld D
NR
Med
ical
Dire
ctiv
e an
d Fu
nera
l Hom
e Tr
ansf
er F
orm
, con
side
r cal
ling
the
BH
P to
rece
ive
term
inat
ion
of re
susc
itatio
n or
der.
4.
Pat
ient
with
out v
ital s
igns
and
the
subj
ect o
f the
pos
sibl
e ap
plic
atio
n of
the
TOR
Med
ical
Dire
ctiv
e (M
edic
al o
r Tr
aum
a). C
onsi
der c
allin
g th
e B
HP
for t
erm
inat
ion
of re
susc
itatio
n or
der.
In th
e ev
ent t
hat a
phy
sici
an o
n sc
ene
is w
illin
g to
ass
ume
care
and
resp
onsi
bilit
y of
the
patie
nt, p
rovi
de a
ssis
tanc
e as
pos
sibl
e w
ithin
yo
ur s
cope
of p
ract
ice.
* P
aram
edic
s m
ust c
aref
ully
con
side
r mat
ters
suc
h as
sce
ne in
tegr
ity, i
nves
tigat
ive
issu
es, f
amily
con
cern
s an
d di
spos
ition
of b
ody.
Central East Prehospital Care Program For Reference Only
Reference Material R - 34
ETT
Clo
sed
Suct
ioni
ng a
nd T
rach
eost
omy
ETT
Clo
sed
Suct
ioni
ng
Pre
p eq
uipm
ent f
or E
TT s
uctio
ning
1. U
se th
e di
scon
nect
ion
wed
ge p
rovi
ded
to d
isco
nnec
t all
com
pone
nts
of th
e B
VM
, inc
ludi
ng th
e fil
ter.
2. I
nsta
ll th
e cl
osed
suc
tion
cath
eter
pat
ient
por
t dire
ctly
ont
o th
e 15
mm
ada
ptor
of t
he E
TT
3. R
eatta
ched
BV
M, f
ilter
and
ETC
O2.
4. S
uppo
rt el
bow
con
nect
or w
ith o
ne h
and
then
gra
sp th
e ca
thet
er th
roug
h th
e sl
eeve
. A
dvan
ce th
e ca
thet
er s
low
ly
until
the
coug
h re
flex
is s
timul
ated
or r
esis
tanc
e is
met
. 5.
With
draw
0.5
cm
bef
ore
initi
atin
g su
ctio
ning
. 6.
Eng
age
thum
b va
lve
and
gent
ly p
ull b
ack
until
the
suct
ion
cath
eter
is fu
lly re
tract
ed.
Do
not s
uctio
n fo
r lon
ger t
han
10 s
econ
ds (e
nsur
e th
at th
e co
lour
ed m
arki
ng ri
ng is
vis
ible
insi
de s
leev
e).
7. P
lace
thum
b va
lve
back
in th
e “lo
ck” p
ositi
on.
8. R
e-ox
ygen
ate
patie
nt.
Trac
heos
tom
y Su
ctio
ning
1.
If c
onsc
ious
, hav
e pa
tient
in s
ittin
g po
sitio
n (3
0 –
90
) PP
E.
2. E
xpla
in p
roce
dure
(if n
eces
sary
). 3.
Atta
ch S
pO2.
4. S
elec
t app
ropr
iate
siz
ed c
athe
ter (
Adu
lt =
12 –
14
Fr, C
hild
= 8
– 1
0 Fr
, Inf
ant 5
– 6
Fr)
5.
Set
suc
tion
pres
sure
and
atta
ch to
cat
hete
r (A
dult
= 10
0 –
150
mm
Hg,
Chi
ld =
100
– 1
20 m
mH
g, In
fant
= 6
0 –
100
mm
Hg)
sta
rt at
low
er e
nd.
6. P
re-o
xyge
nate
pat
ient
7.
Ins
ert s
uctio
n ca
thet
er in
to tr
ache
osto
my
until
cou
gh re
flex
or re
sist
ance
met
and
then
pul
l bac
k sl
ight
ly.
8. C
over
thum
b ho
le o
n su
ctio
n ca
thet
er w
hile
rem
ovin
g ca
thet
er s
low
ly a
nd ro
lling
it be
twee
n th
umb
and
fore
finge
r.
Max
10
seco
nds
Central East Prehospital Care Program For Reference Only
Reference Material R - 35
Emer
genc
y Tr
ache
osto
my
Rei
nser
tion
1.
Trac
heos
tom
y tu
be h
as b
een
unin
tent
iona
lly re
mov
ed.
2.
Ens
ure
adeq
uate
oxy
gena
tion/
vent
ilatio
n (s
ee b
elow
). 3.
B
est p
ract
ice
is to
pre
pare
a n
ew tr
ache
osto
my
tube
(pro
vide
d to
you
). If
a ne
w o
ne is
not
ava
ilabl
e, c
lean
the
trach
eost
omy
tube
on
hand
to th
e be
st o
f you
r abi
lity
(sal
ine
bath
). 4.
R
emov
e th
e in
ner c
annu
la, i
f pre
sent
. If
not
pre
sent
go
to #
6 5.
D
efla
te th
e cu
ff, if
pre
sent
. 6.
In
sert
the
obtu
rato
r int
o th
e ou
ter c
annu
la.
7.
Lubr
icat
e th
e en
d of
the
tube
with
wat
er b
ased
lubr
ican
t or s
alin
e (p
rovi
ded
to y
ou).
8.
Ext
end
the
neck
bac
k to
ope
n th
e st
oma.
9.
A
s th
e pa
tient
inha
les,
gen
tly in
sert
the
tube
into
the
stom
a us
ing
a cu
rved
upw
ard
mot
ion
(whi
le fa
cing
the
patie
nt).
Do
not f
orce
. 10
. Hol
d th
e tra
ch tu
be in
pla
ce a
nd re
mov
e th
e ob
tura
tor.
11. S
ecur
e th
e tra
cheo
stom
y us
ing
the
ties
prov
ided
. 12
. If p
revi
ousl
y pr
esen
t, in
sert
a ne
w in
ner c
annu
la (p
rovi
ded
to y
ou) i
nto
the
oute
r can
nula
. Tw
ist t
o lo
ck a
s re
quire
d.
13. I
f pre
sent
, inf
late
the
cuff
to th
e pr
oper
vol
ume
(app
rox.
8 m
ls o
f air)
.
If un
able
to re
inse
rt tr
ache
osto
my
and
the
patie
nt is
not
br
eath
ing
and/
or n
eeds
ven
tilat
ion
assi
stan
ce:
PCP:
Use
a p
edia
tric
face
mas
k ap
plie
d to
the
stom
a an
d ve
ntila
te w
ith a
BV
M (T
rach
eal-S
tom
a V
entil
atio
n),
or;
P
lug
or c
over
the
stom
a an
d us
e st
anda
rd o
ral
airw
ay m
aneu
vers
.
AC
P:
U
se a
ped
iatri
c fa
ce m
ask
appl
ied
to th
e st
oma
and
vent
ilate
with
a B
VM
(Tra
chea
l-Sto
ma
Ven
tilat
ion)
, or
;
Atte
mpt
intu
batio
n of
the
stom
a w
ith a
n un
cut E
TT
appr
oxim
atel
y 2
size
s sm
alle
r tha
n th
e st
oma,
or
;
Plu
g or
cov
er th
e st
oma
and
oral
ly in
tuba
te w
ith a
do
wns
ized
tube
to a
dvan
ce b
eyon
d th
e st
oma.
Central East Prehospital Care Program For Reference Only
Reference Material R - 36
ETT
and
Suct
ion
Cat
hete
r Siz
es
Age
ETT
Siz
e S
uctio
n C
athe
ter S
ize
Pre
mat
ure
2.5
– 3.
5 m
m
6 Fr
New
born
3.
0 m
m
6 Fr
6 m
onth
s ol
d 3.
5 m
m
6 Fr
18 m
onth
s ol
d 4.
0 m
m
6 Fr
3 ye
ars
old
4.5
mm
6
Fr
5 ye
ars
old
5.0
mm
10
Fr
6 ye
ars
old
5.5
mm
10
Fr
8 ye
ars
old
6.0
mm
10
Fr
12 y
ears
old
6.
5 m
m
10 F
r
16 y
ears
old
/ S
mal
l adu
lt fe
mal
e 7.
0 m
m
14 F
r
Adu
lt Fe
mal
e 8.
0 m
m
14 F
r
Adu
lt M
ale
9.0
mm
14
Fr
Central East Prehospital Care Program For Reference Only
Reference Material R - 37
Prov
inci
al S
TEM
I byp
ass
In s
ituat
ions
in w
hich
the
para
med
ic s
uspe
cts
that
the
patie
nt is
suf
ferin
g fr
om a
STE
MI,
the
para
med
ic s
hall:
1.
Ass
ess
the
patie
nt to
det
erm
ine
if th
ey m
eet a
ll of
the
follo
win
g in
dica
tions
: a.
≥18
yea
rs o
f age
; b.
Exp
erie
nce
ches
t pai
n or
equ
ival
ent c
onsi
sten
t with
car
diac
isch
emia
or m
yoca
rdia
l inf
arct
ion;
c.
The
tim
e fro
m o
nset
of t
he c
urre
nt e
piso
de o
f pai
n <1
2 ho
urs;
and
d.
The
12-
lead
EC
G in
dica
tes
an a
cute
AM
I/STE
MI,
as fo
llow
s:
i. A
t lea
st 2
mm
ST-
elev
atio
n in
lead
s V
1-V
3 in
at l
east
two
cont
iguo
us le
ads;
OR
ii.
At l
east
1 m
m S
T-el
evat
ion
in a
t lea
st tw
o ot
her a
nato
mic
ally
con
tiguo
us le
ads;
OR
iii
. 12-
lead
EC
G c
ompu
ter i
nter
pret
atio
n of
STE
MI a
nd p
aram
edic
agr
ees.
2.
If th
e pa
tient
mee
ts th
e cr
iteria
list
ed in
par
agra
ph 1
abo
ve, a
sses
s th
e pa
tient
to d
eter
min
e if
they
hav
e an
y of
th
e fo
llow
ing
cont
rain
dica
tions
: a.
The
pat
ient
is C
TAS
1 a
nd th
e pa
ram
edic
is u
nabl
e to
sec
ure
the
patie
nt’s
airw
ay o
r ven
tilat
e;
b. 1
2-le
ad E
CG
is c
onsi
sten
t with
a L
eft B
undl
e B
ranc
h B
lock
(LB
BB
), ve
ntric
ular
pac
ed rh
ythm
, or a
ny o
ther
S
TEM
I im
itato
r;
c. T
rans
port
to a
hos
pita
l cap
able
of p
erfo
rmin
g pe
rcut
aneo
us c
oron
ary
inte
rven
tion
(PC
I) ≥6
0 m
inut
es fr
om
patie
nt c
onta
ct;
d. T
he p
atie
nt is
exp
erie
ncin
g a
com
plic
atio
n re
quiri
ng P
CP
div
ersi
on, a
s fo
llow
s:
i. M
oder
ate
to s
ever
e re
spira
tory
dis
tress
or u
se o
f CP
AP
; ii.
Hem
odyn
amic
inst
abilit
y (e
.g. d
ue to
sym
ptom
atic
arr
hyth
mia
s or
any
ven
tricu
lar a
rrhy
thm
ia) o
r sy
mpt
omat
ic S
BP
<90
mm
Hg
at a
ny p
oint
; or
iii. V
SA
with
out R
OS
C.
e. T
he p
atie
nt is
exp
erie
ncin
g a
com
plic
atio
n re
quiri
ng A
CP
div
ersi
on, a
s fo
llow
s:
i. V
entil
atio
n in
adeq
uate
des
pite
ass
ista
nce;
ii.
Hem
odyn
amic
inst
abilit
y un
resp
onsi
ve to
AC
P tr
eatm
ent o
r not
am
enab
le to
AC
P m
anag
emen
t; or
iii.
VS
A w
ithou
t RO
SC
. 3.
Not
with
stan
ding
par
agra
phs
2(c)
, 2(d
), an
d 2(
e) a
bove
, atte
mpt
to d
eter
min
e if
the
inte
rven
tiona
l car
diol
ogy
prog
ram
at t
he P
CI c
entre
will
still
perm
it th
e tra
nspo
rt to
the
PC
I cen
tre;
4. If
the
patie
nt d
oes
not m
eet a
ny o
f the
con
train
dica
tions
list
ed in
par
agra
ph 2
abo
ve O
R th
e in
terv
entio
nal
card
iolo
gy p
rogr
am p
erm
its th
e tra
nspo
rt to
the
PC
I cen
tre a
s pe
r par
agra
ph 3
abo
ve, i
nfor
m th
e C
AC
C/A
CS
of t
he
need
to tr
ansp
ort t
o a
PC
I cen
tre;
Central East Prehospital Care Program For Reference Only
Reference Material R - 38
5. P
rovi
de th
e P
CI c
entre
the
follo
win
g in
form
atio
n as
soo
n as
pos
sibl
e:
a. th
at th
e pa
tient
is a
“STE
MI p
atie
nt”;
b.
the
patie
nt’s
initi
als;
c.
the
patie
nt’s
age
; d.
the
patie
nt’s
sex
; e.
the
para
med
ic’s
con
cern
s re
gard
ing
clin
ical
sta
bilit
y;
f. in
farc
t ter
ritor
y an
d/or
find
ings
on
the
qual
ifyin
g E
CG
; g.
est
imat
ed ti
me
of a
rriva
l; an
d
h. c
atch
men
t are
a of
the
patie
nt p
icku
p.
6. U
pon
arriv
al a
t the
PC
I cen
tre, i
n ad
ditio
n to
the
requ
irem
ents
list
ed in
the
Tran
sfer
of R
espo
nsib
ility
for P
atie
nt
Car
e S
tand
ard,
pro
vide
the
follo
win
g in
form
atio
n to
the
PC
I cen
tre s
taff:
a.
tim
e of
sym
ptom
ons
et;
b. ti
me
of R
OS
C, i
f app
licab
le;
c. h
emod
ynam
ic s
tatu
s;
d. m
edic
atio
ns g
iven
and
pro
cedu
re;
e. h
isto
ry o
f AM
I/PC
I/Cor
onar
y ar
tery
byp
ass
graf
t (C
AB
G),
if ap
plic
able
; f.
a co
py o
f the
qua
lifyi
ng E
CG
; and
g.
a c
opy
of th
e A
mbu
lanc
e C
all R
epor
t (A
CR
), w
here
pos
sibl
e.
*Not
e: O
nce
initi
ated
, con
tinue
to fo
llow
the
STEM
I Hos
pita
l Byp
ass
Prot
ocol
eve
n if
the
ECG
nor
mal
izes
afte
r the
in
itial
ass
essm
ent.
G
uide
line
1.
If in
trave
nous
acc
ess
is in
dica
ted
and
esta
blis
hed
as p
er th
e A
dvan
ced
Life
Sup
port
Pat
ient
Car
e S
tand
ards
, the
n th
e le
ft ar
m is
the
pref
erre
d si
te.
2. If
the
EC
G b
ecom
es S
TEM
I-pos
itive
enr
oute
to a
non
-PC
I des
tinat
ion,
the
patie
nt s
houl
d st
ill be
eva
luat
ed u
nder
this
S
TEM
I Hos
pita
l Byp
ass
Pro
toco
l.
3. If
, in
a ra
re c
ircum
stan
ce, t
he P
CI c
entre
indi
cate
s th
at it
can
not a
ccep
t the
pat
ient
(e.g
. equ
ipm
ent f
ailu
re, m
ultip
le
STE
MI p
atie
nts)
, the
n th
e pa
ram
edic
may
con
side
r tra
nspo
rt to
an
alte
rnat
ive
PC
I cen
tre a
s lo
ng a
s th
ey s
till m
eet t
he
STE
MI H
ospi
tal B
ypas
s P
roto
col.
Central East Prehospital Care Program For Reference Only
Reference Material R - 39
PRH
C S
TEM
I Byp
ass
Prot
ocol
N
orth
umbe
rland
, Pet
erbo
roug
h, K
awar
tha
and
Hal
ibur
ton
Par
amed
ics
This
pro
mpt
car
d pr
ovid
es a
qui
ck re
fere
nce
for t
he E
MS
mod
ified
STE
MI H
ospi
tal b
ypas
s P
roto
col.
It is
onl
y ap
plie
d w
hen
bypa
ssin
g pa
tient
s to
the
PR
HC
PC
I Cen
tre. F
or th
ose
patie
nts
whe
re th
e P
RH
C P
CI C
entre
is n
ot c
lose
st, t
he E
HS
S
TEM
I Hos
pita
l Byp
ass
Pro
toco
l con
tain
ed in
the
BLS
PC
S m
ust b
e us
ed. P
leas
e re
fer t
o th
e B
LS P
CS
for t
he fu
ll pr
otoc
ol E
HS
ver
sion
.
Indi
catio
ns u
nder
the
STEM
I PR
HC
Byp
ass
Prot
ocol
Tran
spor
t to
a P
CI C
entre
will
be c
onsi
dere
d fo
r pat
ient
s w
ho m
eet A
LL o
f the
follo
win
g:
1. ≥
18 y
ears
of a
ge.
2. C
hest
pai
n or
equ
ival
ent c
onsi
sten
t with
car
diac
isch
emia
/myo
card
ial i
nfar
ctio
n.
3. T
ime
from
ons
et o
f cur
rent
epi
sode
of p
ain
<12
hour
s.
4. 1
2-le
ad E
CG
indi
cate
s an
acu
te A
MI/S
TEM
I*:
a. A
t lea
st 2
mm
ST-
elev
atio
n in
lead
s V
1-V
3 in
at l
east
two
cont
iguo
us le
ads;
OR
b.
At l
east
1m
m S
T-el
evat
ion
in a
t lea
st tw
o ot
her a
nato
mic
ally
con
tiguo
us le
ads;
OR
c.
12
-lead
EC
G c
ompu
ter i
nter
pret
atio
n of
STE
MI a
nd p
aram
edic
agr
ees.
*Onc
e ac
tivat
ed, c
ontin
ue to
follo
w S
TEM
I Hos
pita
l Byp
ass
Pro
toco
l eve
n if
EC
G n
orm
aliz
es.
Con
trai
ndic
atio
ns u
nder
the
STEM
I Hos
pita
l Byp
ass
Prot
ocol
AN
Y of
the
follo
win
g ex
clud
e a
patie
nt fr
om b
eing
tran
spor
ted
unde
r the
STE
MI H
ospi
tal B
ypas
s P
roto
col:
1. C
TAS
1 a
nd th
e pa
ram
edic
is u
nabl
e to
sec
ure
patie
nt’s
airw
ay o
r ven
tilat
e.
2. 1
2-le
ad E
CG
is c
onsi
sten
t with
a L
BB
B, v
entri
cula
r pac
ed rh
ythm
, or a
ny o
ther
STE
MI i
mita
tor.
3. T
rans
port
to a
PC
I cen
tre ≥
60 m
inut
es fr
om p
atie
nt c
onta
ct.
4. P
atie
nt is
exp
erie
ncin
g an
y of
the
follo
win
g co
mpl
icat
ions
: a.
Hem
odyn
amic
inst
abili
ty u
nres
pons
ive
to tr
eatm
ent
b. V
SA
with
out R
OS
C
Central East Prehospital Care Program For Reference Only
Reference Material R - 40
c.
Ven
tilat
ion
inad
equa
te d
espi
te a
ssis
tanc
e.
STEM
I Pro
toco
l Com
mun
icat
ion
Proc
edur
e:
1. C
all P
RH
C s
witc
hboa
rd d
irect
ly: 7
05-8
76-5
067
2.
Iden
tify
your
self
and
stat
e: “
Act
ivat
e C
ode
STEM
I”
3. P
atch
to th
e P
RH
C E
D. S
tate
“We
are
trans
porti
ng a
Cod
e S
TEM
I pat
ient
to th
e ca
rdia
c ca
thet
er la
b”
4. N
otify
CA
CC
. The
y w
ill au
thor
ize
the
trans
port
once
not
ified
of t
he p
atie
nt’s
nee
d fo
r byp
ass
unde
r the
STE
MI H
ospi
tal
Byp
ass
Pro
toco
l. N
ote:
App
ly d
efib
rilla
tion
pads
to a
ll pa
tient
s w
ho h
ave
a S
TEM
I
Central East Prehospital Care Program For Reference Only
Reference Material R - 41
Ref
eren
ce L
ist:
Acu
te S
troke
Pro
toco
l – P
rom
pt C
ard
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
. R -
2 B
urn
Cha
rt “R
ule
of N
ines
” ....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.. R
- 3
Dea
th N
otifi
catio
n Ti
ps ..
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.... R
- 4
Dop
amin
e In
fusi
on ..
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.... R
- 5
EC
G B
asic
s ....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
. R -
6 E
nd-ti
dal C
O2 .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
. R -
8 Fi
eld
Trau
ma
Tria
ge G
uide
lines
.....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
... R
- 10
In
tra M
uscu
lar I
njec
tion
Land
mar
king
and
Nee
dle
Sel
ectio
n ....
......
......
......
......
......
......
......
......
......
......
......
... R
- 12
M
edic
atio
n Li
st -
ALS
PC
S ..
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
... R
- 13
M
edic
atio
n Li
st C
BRN
E ...
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.....
R -
25
Ove
rdos
e Le
vels
.....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.. R
- 29
To
xidr
omes
Ref
eren
ce ..
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.. R
- 31
P
edia
tric
Vita
l Sig
ns ..
......
......
......
......
......
......
......
......
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......
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......
R -
32
Ped
iatri
c G
lasg
ow C
oma
Sca
le ...
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
R -
33
Rec
ogni
tion
of D
eath
/ Te
rmin
atio
n of
Res
usci
tatio
n G
uidl
eine
s ....
......
......
......
......
......
......
......
......
......
......
... R
- 34
E
TT C
lose
d S
uctio
ning
and
Tra
cheo
stom
y ....
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.....
R -
35
Em
erge
ncy
Trac
heos
tom
y R
eins
ertio
n ...
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
R -
36
ETT
and
Suc
tion
Cat
hete
r Siz
es ..
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.....
R -
37
Pro
vinc
ial S
TEM
I byp
ass
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
R -
38
PR
HC
STE
MI B
ypas
s P
roto
col .
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
......
.. R
- 40
Central East Prehospital Care Program For Reference Only
Reference Material R - 42
