DAYTONA STATE COLLEGE PARAMEDIC PROGRAM … Guidelines 01102018.pdfDaytona State College Paramedic...
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Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 1
DAYTONA STATE COLLEGE PARAMEDIC PROGRAM
TREATMENT GUIDELINES
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 2
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 3
These treatment guidelines have been developed to assist the
paramedic student with the management of various emergencies. They
are designed for use within the paramedic program skills lab classes.
While operating in the clinical setting, (i.e. hospital emergency
department, ambulance and fire department ride along, etc.), the
student is expected to follow the treatments outlined to them by their
respective field training officer or preceptor.
These treatment guidelines have been developed as a teaching
tool for the student to understand the interventions and sequencing
needed to manage various emergencies. Many options are presented
throughout, such as drugs for pain management. We recognize that
many different systems use different pieces of equipment and
medications. While the intent is to provide the student with options
and hopefully a better understanding of the management of various
emergencies, this book is not intended to list every option available.
These guidelines reflect the most current research available from
the American Heart Association, National Association of Emergency
Medical Technicians, Traumatic Brain Foundation, and the American
Academy of Pediatrics.
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 4
Contents AIRWAY MANAGEMENT ........................................................................................................................... 7
General Management Algorithm .......................................................................................................... 7
Pharmacology Assisted Intubation ....................................................................................................... 8
Rapid Sequence Induction with Paralysis ............................................................................................. 9
ADULT RESPIRATORY EMERGENCIES ...................................................................................................... 10
Airway Obstruction ............................................................................................................................. 10
Bronchospasm..................................................................................................................................... 11
CHF / Pulmonary Edema ..................................................................................................................... 12
Hyperventilation ................................................................................................................................. 13
ADULT CARDIAC DYSRHYTHMIAS ........................................................................................................... 14
Asystole ............................................................................................................................................... 14
Bradycardia ......................................................................................................................................... 15
Narrow Complex Tachycardia ............................................................................................................. 16
Premature Ventricular Contractions ................................................................................................... 17
Pulseless Electrical Activity ................................................................................................................. 18
Wide Complex Tachycardia ................................................................................................................. 19
Wide Complex Tachycardia without a pulse and Ventricular Fibrillation ........................................... 20
OTHER CARDIAC EMERGENCIES .............................................................................................................. 21
Cardiogenic Shock ............................................................................................................................... 21
Chest Pain / AMI / ACS ........................................................................................................................ 22
ADULT NEUROGENIC EMERGENCIES ...................................................................................................... 23
Acute Psychosis ................................................................................................................................... 23
Altered Mental Status ......................................................................................................................... 24
STROKE / TIA ....................................................................................................................................... 25
Seizures ............................................................................................................................................... 26
Syncope / Weakness ........................................................................................................................... 27
ADULT TOXICOLOGICAL EMERGENCIES .................................................................................................. 28
Suspected Overdose / Poisoning ........................................................................................................ 28
Suspected Overdose / Poisoning (continued) ..................................................................................... 29
ADULT OB/GYN EMERGENCIES ............................................................................................................... 32
Normal Labor and Delivery ................................................................................................................. 32
Childbirth with Complications ............................................................................................................. 33
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Third Trimester Bleeding..................................................................................................................... 34
Toxemia of Pregnancy (Eclampsia) ..................................................................................................... 35
OTHER ADULT MEDICAL EMERGENCIES ................................................................................................. 36
Abdominal Pain ................................................................................................................................... 36
Allergic Reactions ................................................................................................................................ 37
GI Bleed ............................................................................................................................................... 38
Hyperglycemia/HONK/HHNC .............................................................................................................. 39
Hypoglycemia ...................................................................................................................................... 40
Nausea and Vomiting .......................................................................................................................... 41
SEPSIS Emergencies ............................................................................................................................ 42
Sickle Cell Emergencies ....................................................................................................................... 43
Suspected Kidney Stones .................................................................................................................... 44
ADULT ENVIRONMENTAL EMERGENCIES ............................................................................................... 45
SCUBA Diving Emergencies ................................................................................................................. 45
Cold Related Emergencies .................................................................................................................. 46
Heat Related Emergencies .................................................................................................................. 47
Drowning/Submersion ........................................................................................................................ 48
ADULT TRAUMATIC EMERGENCIES......................................................................................................... 49
Abdominal/Pelvic Trauma ................................................................................................................... 49
Burns (Thermal) .................................................................................................................................. 50
Burns (Chemical) ................................................................................................................................. 50
Burns (Electrical) ................................................................................................................................. 50
Chest Trauma ...................................................................................................................................... 51
Closed Head Trauma ........................................................................................................................... 52
Extremity Trauma................................................................................................................................ 53
Shock ................................................................................................................................................... 54
Spine Trauma ...................................................................................................................................... 55
Traumatic Cardiac Arrest .................................................................................................................... 56
PEDIATRIC PROTOCOLS ........................................................................................................................... 57
PEDIATRIC Airway Obstruction ........................................................................................................... 57
PEDIATRIC Asthma / Bronchiolitis ....................................................................................................... 58
PEDIATRIC Croup / Epiglottitis ............................................................................................................ 59
PEDIATRIC Asystole ............................................................................................................................. 60
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PEDIATRIC Bradycardia ....................................................................................................................... 61
PEDIATRIC Narrow Complex Tachycardia ........................................................................................... 62
PEDIATRIC Pulseless Electrical Activity ............................................................................................... 63
PEDIATRIC Wide Complex Tachycardia ............................................................................................... 64
PEDIATRIC Wide Complex Tachycardia without a pulse and Ventricular Fibrillation ......................... 65
PEDIATRIC Altered Mental Status ....................................................................................................... 66
PEDIATRIC Seizures ............................................................................................................................. 67
PEDIATRIC Toxicology ............................................................................................................................. 68
Suspected Overdose / Poisoning ........................................................................................................ 68
Suspected Overdose / Poisoning (continued) ..................................................................................... 69
PEDIATRIC Bites and Envenomation ................................................................................................... 70
PEDIATRIC Abdominal Pain ................................................................................................................. 71
PEDIATRIC Allergic Reaction................................................................................................................ 73
PEDIATRIC GI Bleed ............................................................................................................................. 74
PEDIATRIC Hyperglycemia ................................................................................................................... 75
PEDIATRIC Hypoglycemia .................................................................................................................... 76
PEDIATRIC Nausea and Vomiting ........................................................................................................ 77
PEDIATRIC Sickle Cell Emergencies ..................................................................................................... 78
PEDIATRIC Cold Related Emergencies................................................................................................. 79
PEDIATRIC Heat Related Emergencies ................................................................................................ 80
PEDIATRIC Drowning ........................................................................................................................... 81
PEDIATRIC Abdominal/Pelvic Trauma ................................................................................................. 82
PEDIATRIC Burns ..................................................................................................................................... 83
Burns (Thermal) .................................................................................................................................. 83
Burns (Chemical) ................................................................................................................................. 83
Burns (Electrical) ................................................................................................................................. 83
PEDIATRIC Chest Trauma .................................................................................................................... 84
PEDIATRIC Closed Head Trauma ......................................................................................................... 85
PEDIATRIC Extremity Trauma .............................................................................................................. 86
PEDIATRIC Spine Trauma .................................................................................................................... 87
PEDIATRIC Shock ................................................................................................................................. 88
PEDIATRIC Traumatic Cardiac Arrest .................................................................................................. 89
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AIRWAY MANAGEMENT General Management Algorithm
BVM as needed
o Consider use of a simple adjunct such as an OPA or NPA
Suction as needed
Intubation as needed
o Maximum of TWO attempts
o Confirm placement with all of the following
Negative gastric sounds
Positive bilateral breath sounds
Positive waveform capnography (preferred) or colormetric
capnometry
o Secure with a commercially made device
o Consider placing a cervical color on the patient to limit head movement
o Consider placement of an OG/NG tube to prevent/relieve gastric distension
If intubation is unsuccessful:
o Consider placement of one of the following:
Combitube
LMA
King LTA
I-gel
o Confirm placement with all of the following
Negative gastric sounds
Positive bilateral breath sounds
Positive waveform capnography (preferred) or colormetric
capnometry
o Secure with a commercially made device
o Consider placing a cervical collar on the patient to limit head movement
o If you are still unable to secure the airway AND the patient cannot be
ventilated adequately perform a needle Cricothyrotomy
You may skip directly to this step after an intubation attempt for
conditions such as airway closure due to toxic gas inhalation, severe refractory asthma, or severe allergic reactions
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 8
Pharmacology Assisted Intubation YOU MUST BE ABLE TO MANAGE THE AIRWAY WITH A BVM PRIOR TO
ATTEMPTING PHARMACOLOGY ASSISTED INTUBATION
Prepare Equipment
Pre-oxygenate the patient for at least two minutes
Pretreat as necessary
o Lidocaine 1 mg/kg IV/IO (if suspected ICP issues) 2-5 minutes prior to
intubation
o Opioid (if needed to assist with sedation)
Fentanyl 1 mcg/kg IV/IO SLOWLY over 2-3 minutes
o Sedate the patient (pick one and allow at least two minutes for drug to take
effect)
Ativan (Lorazepam) 2-4 mg IV/IO/IM
Versed (Midazolam) 2-2.5 mg IV/IO
Etomidate 0.2-0.6 mg/kg IV/IO
Ketamine 1-2 mg/kg IV/IO
Protect the airway
o BURP maneuver
o Position the patient
Placement of the ET tube
Post Intubation management
o Confirm placement with all of the following
Negative gastric sounds
Positive bilateral breath sounds
Positive waveform capnography (preferred) or colormetric
capnometry
o Secure with a commercially made device
o Consider placing a cervical collar on the patient to limit head movement o Consider placement of an OG/NG tube to prevent/relieve gastric distension
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Rapid Sequence Induction with Paralysis YOU MUST BE ABLE TO MANAGE THE AIRWAY WITH A BVM PRIOR TO
ATTEMPTING RAPID SEQUENCE INDUCTION
Prepare Equipment
o Assess LEMON
Pre-oxygenate the patient for at least two minutes
Pretreat as necessary
o Lidocaine 1 mg/kg IV/IO (if suspected ICP issues) 2-5 minutes prior to
intubation
o Opioid (if needed to assist with sedation)
Fentanyl 1 mcg/kg IV/IO SLOWLY over 2-3 minutes
o Sedate the patient (pick one and allow at least two minutes for drug to take
effect)
Ativan (Lorazepam) 2-4 mg IV/IO/IM
Versed (Midazolam) 2-2.5 mg IV/IO
Etomidate (Amidate) 0.2-0.6 mg/kg IV/IO
Ketamine 1-2 mg/kg IV/IO
Paralyze the patient
o Succinylcholine (Anectine) 1-2 mg/kg RAPID IV/IO
Protect the airway
o BURP maneuver
o Position the patient
Placement of the ET tube
Post Intubation management
o Confirm placement with all of the following
Negative gastric sounds, Positive bilateral breath sounds
Positive waveform capnography (preferred) or colormetric
capnometry
o Secure with a commercially made device
o Consider placing a cervical collar on the patient to limit movement
o Consider placement of an OG/NG tube to prevent/relieve gastric distension
o Administers long lasting paralytic
Pancuronium 0.06-0.1 mg/kg
Vecuronium 0.1-0.2 mg/kg
Rocuronium 0.6-1.2 mg/kg
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 10
ADULT RESPIRATORY EMERGENCIES Airway Obstruction
Follow current AHA standards for relief of foreign body (Heimlich maneuver)
Attempt use of Magill forceps using direct visualization of airway as needed
If unable to remove obstruction and respiratory compromise is severe, consider
needle Cricothyrotomy o See airway management guidelines
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Bronchospasm Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Administer a bronchodilator (choose one)
o Albuterol (Proventil) 2.5 mg nebulized
o Levalbuterol (Xopenex) 2.5 mg nebulized
May add Atrovent (Ipratropium) 0.5 mg to Albuterol or Levalbuterol
May repeat as needed as long as heart rate remains below 140
Administer a Steroid (choose one):
o Solu-medrol (Methylprednisolone) 1-2 mg/kg
o Solu-Cortef (Hydrocortisone) 4 mg/kg IV
o Decadron (Dexamethasone) 10-100 mg SLOW IV
Consider the use of CPAP
o Use a setting of 5 cm H2O
If bronchospasm persists after three breathing treatments, consider Magnesium
Sulfate 1-2 gm over 15-30 minutes IV infusion
If bronchospasm persists or worsens consider Epinephrine 1:1000 0.3-0.5 mg IM
and prepare to intubate
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CHF / Pulmonary Edema Provide supplemental oxygen as needed to maintain SpO2 above 94%
o Usually this will require high concentrations of oxygen (i.e. NRBM)
o If necessary, assist ventilations with BVM
Administer Nitroglycerin 0.4mg SL
o Blood pressure must be above 90 mmHg systolic
o Assure no Phosphodiesterase-5 inhibitor (Viagra or Levitra) use within 24
hours
o Assure no Cialis use within 48 hours
o May repeat up to three doses administered as needed
If CPAP has been applied, the CPAP mask SHOULD NOT BE REMOVED
to give additional nitroglycerin
As soon as possible and if available apply CPAP
o Use a setting of 7.5-10 cm H2O
o Consider intubation if patient will not tolerate CPAP
Administer Lasix (Furosemide) 0.5-1.0 mg/kg IV
o Blood pressure must be above 90 mmHg systolic
o Assure patient does not have pulmonary infection (i.e. pneumonia)
If patient does not improve, call for: (choose one)
o Morphine Sulfate 2-4 mg IV/IO
Blood pressure must be above 90 mmHg systolic
May repeat up to a maximum of 10 mg administered as needed
o Fentanyl 1mcg/kg to a maximum of 50 mcg IV/IO/IN
May be repeated once as needed
If hypotension occurs, (SBP < 90 mmHg)
o Establish a Dopamine (Intropin) infusion at 5-20 mcg/kg/min
Titrate infusion to maintain a systolic BP between 90 and 100 mmHg
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Hyperventilation Provide supplemental oxygen as needed to maintain SpO2 above 94%
Continuous monitoring of SpO2, EtCO2, and ECG is necessary
Search for underlying causes of hyperventilation
o Airway closure / obstruction
o Metabolic acidosis
o Toxic gas inhalation o Cellular hypoxia
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ADULT CARDIAC DYSRHYTHMIAS Asystole
Initiate CPR; continuous CPR is the key
Epinephrine 1mg IV/IO 1:10,000 every 3-5 minutes
Consider possible etiology
o Hypoxemia
Assure ventilation with 100% oxygen
o Hypovolemia
Administer fluid boluses (Start at 500 cc)
o Hydrogen ions (Acidosis)
Correct ventilator insufficiency, then
Consider Sodium Bicarbonate 1 mEq/kg IV/IO
o Hyper/Hypokalemia
For Hyperkalemia, administer Sodium Bicarbonate 1 mEq/kg IV/IO
and Calcium Chloride 1 gm IV/IO
o Hypoglycemia
Administer Dextrose 50% 25 gm IV/IO if BGL is less than 60 gm/dL
o Hypothermia
Active rewarming
o Toxins
Follow appropriate Poisoning/Overdose treatment
o Cardiac tamponade
Perform pericardiocentesis
o Tension pneumothorax
Perform pleural decompression
o Pulmonary or coronary thrombus
Rapid transport
o Trauma
Treat as appropriate
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 15
Bradycardia If hemodynamically STABLE
o Obtain 12-lead ECG
o Observe
If hemodynamically UNSTABLE
o Consider Atropine 0.5 mg IV/IO
May skip to transcutaneous pacing if high degree heart block
o If Atropine does not work attempt one of the following:
Transcutaneous pacing
Consider premedication prior to procedure (choose one)
o Lorazepam (Ativan) 2-4 mg IV/IO/IM
Can be given IV if diluted 50:50
o Midazolam (Versed) 2-2.5 mg IV/IO/IN
o Diazepam (Valium) 5-15 mg IV/IO
Set to normal heart rate (60-80 bpm)
Set to lowest mA (10-20mA)
Start pacing
Adjust pacer output (mA) up until electrical capture is attained
Verify mechanical capture
Epinephrine Infusion 2-10 mcg/min
Dopamine (Intropin) infusion 5-20 mcg/kg/min
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Narrow Complex Tachycardia Obtain 12-lead ECG
o A-Fib/A-Flutter
If hemodynamically STABLE
Consider vagal maneuvers
Cardizem 0.25 mg/kg IV/IO
If no changes within 15 minutes Cardizem 0.35 mg/kg IV/IO
If hemodynamically UNSTABLE
Cardioversion (don’t forget to SYNC)
o A-Fib
120-200J or manufacturer’s recommendation
Repeat as necessary with escalating doses
o A-Flutter
50-100J or manufacturer’s recommendation
Repeat as necessary with escalating doses
Consider premedication prior to procedure (choose one)
o Lorazepam (Ativan) 2-4 mg IV/IO/IM
Can be given IV if diluted 50:50
o Midazolam (Versed) 2-2.5 mg IV/IO/IN
o Diazepam (Valium) 5-15 mg IV/IO
o SVT
If hemodynamically STABLE
Consider vagal maneuvers
Adenosine 6 mg IV/IO (rapid)
If no changes within 5 minutes Adenosine 12 mg IV/IO (rapid)
If no changes within 5 minutes Cardizem 0.25 mg/kg IV/IO
If no changes within 15 minutes Cardizem 0.35 mg/kg IV/IO
If hemodynamically UNSTABLE
Cardioversion (don’t forget to SYNC)
o SVT
50-100J or manufacturers recommendation
Repeat as necessary with escalating doses
Consider premedication prior to procedure (choose one)
o Lorazepam (Ativan) 2-4 mg IV/IO/IM
Can be given IV if diluted 50:50
o Midazolam (Versed) 2-2.5 mg IV/IO/IN
o Diazepam (Valium) 5-15 mg IV/IO
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 17
Premature Ventricular Contractions SYMPTOMATIC (PVCs causing hemodynamic instability) with
Couplets or more
Runs of V-tach
Multifocal
R on T phenomenon
o Administer Lidocaine 1.0-1.5 mg/kg IV/IO
Repeat doses of Lidocaine 0.5-0.75 mg/kg IV/IO, every 5-10 minutes if
rhythm persists to a maximum of 3 mg/kg o Once eliminated establish a Lidocaine infusion at 1-4 mg/min
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 18
Pulseless Electrical Activity Initiate CPR; continuous CPR is the key
Administer Epinephrine 1mg IV/IO 1:10,000 every 3-5 minutes
Consider possible etiology
o Hypoxemia
Assure ventilation with 100% oxygen
o Hypovolemia
Administer fluid boluses (Start at 500 cc)
o Hydrogen ions (Acidosis)
Correct ventilator insufficiency, then
Consider Sodium Bicarbonate 1 mEq/kg IV/IO
o Hyper/Hypokalemia
For Hyperkalemia, administer Sodium Bicarbonate 1 mEq/kg IV/IO
and Calcium Chloride 1 gm IV/IO
o Hypoglycemia
Administer Dextrose 50% 25 gm IV/IO if BGL is less than 60 gm/dL
o Hypothermia
Active rewarming
o Toxins
Follow appropriate Poisoning/Overdose treatment
o Cardiac tamponade
Perform pericardiocentesis
o Tension pneumothorax
Perform pleural decompression
o Pulmonary or coronary thrombus
Rapid transport
o Trauma
Treat as appropriate
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 19
Wide Complex Tachycardia If hemodynamically STABLE
o Obtain 12-lead ECG prior to treatment
o Consider vagal maneuvers
o Administer one of the following:
Lidocaine 1.0-1.5 mg/kg IV/IO
Repeat doses of Lidocaine 0.5-0.75 mg/kg IV/IO, every 5-10
minutes if rhythm persists to a maximum of 3 mg/kg
Once converted establish a Lidocaine infusion at 1-4 mg/min
Amiodarone 150 mg IV over 10 minutes (15mg/min)
Continue with Amiodarone 360 mg over 6 hours (1mg/min)
Finish with 540 mg over 18 hours (0.5 mg/min)
Procainamide 20 mg/min IV Infusion
Once converted, follow with a maintenance infusion of 1-4
mg/min
If TORSADES is suspected
Magnesium Sulfate 1-2 grams over 10 minutes
If hemodynamically UNSTABLE
o Attempt to obtain 12-lead ECG
o Cardioversion (don’t forget to SYNC)
VT (wide complex, regular)
100J or manufacturers recommendation
Repeat as necessary with escalating doses
Torsades (wide complex, irregular)
Defibrillate 360J (120-200J if biphasic)
o Consider premedication prior to procedure (choose one)
Lorazepam (Ativan) 2-4 mg IV/IO/IM
Can be given IV if diluted 50:50
Midazolam (Versed) 2-2.5 mg IV/IO/IN Diazepam (Valium) 5-15 mg IV/IO
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 20
Wide Complex Tachycardia without a pulse and Ventricular Fibrillation If witnessed IMMEDIATE Defibrillation
o 360J or manufacturers recommendations (120-200J biphasic)
Initiate CPR; continuous CPR is the key; only stop for electrical therapy
Epinephrine 1mg IV/IO 1:10,000
Repeat every 3-5 minutes throughout cardiac arrest OR
Defibrillate 360J or manufacturers recommendations (120-200J biphasic)
Give an antidysrhythmic (PICK ONE ONLY)
o Lidocaine 1.0-1.5 mg/kg IV/IO
o Amiodarone 300 mg IV
o Magnesium Sulfate 1-2 grams over 1-2 minutes if TORSADES is suspected
Defibrillate 360J or manufacturers recommendations (120-200J biphasic)
Repeat Epinephrine 1mg IV/IO 1:10,000
Defibrillate 360J or manufacturers recommendations (120-200J biphasic)
Repeat antidysrhythmic (USE SAME ONE AS EARLIER)
o Lidocaine 0.5-0.75 mg/kg IV/IO, every 5-10 minutes if rhythm persists to
a maximum of 3 mg/kg
o Amiodarone 150 mg
Defibrillate 360J or manufacturers recommendations (120-200J biphasic)
If the patient is converted to a perfusing rhythm hang an infusion of whichever
antidysrhythmic was used to convert the rhythm
o Lidocaine 1-4 mg/min
o Amiodarone 1 mg/min for the first 6 hours
0.5 mg/min for the next 18 hours
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 21
OTHER CARDIAC EMERGENCIES Cardiogenic Shock
Support respirations as appropriate
Fix arrhythmia problems as appropriate
IF LUNG SOUNDS ARE CLEAR, administer a fluid bolus of 500 ml of Normal Saline
o May repeat up to 1000cc total
Dopamine (Intropin) infusion at 5-20 mcg/kg/min
o Titrate infusion to maintain a systolic BP between 90 and 100 mmHg
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 22
Chest Pain / AMI / ACS Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Monitor SpO2, EtCO2, ECG
Administer Aspirin 162-325mg PO
Obtain 12-lead ECG as quickly as possible
o If right ventricular involvement is suspected (Inferior Wall), obtain right side
12-lead or at a minimum V4R
o Initiate STEMI alert
Must have ST Elevation is identified in two or more anatomically
contiguous leads
No imposters present
Time frame from onset is < 12 hours
Administer Nitroglycerin 0.4mg SL
o Blood pressure must be above 90 mmHg systolic
o Assure no Viagra use within 24 hours
o Assure no Cialis or Levitra use within 48 hours
o May repeat up to three doses administered as needed
Administer Morphine Sulfate 2-4 mg IV/IO (up to 10 mg total) if patient still has
chest pain after three nitroglycerin (Use with caution in the patient with RV
involvement)
If Morphine is not effective, considers the use of Fentanyl 1 mcg/kg or Ketamine 0.5
mg/kg
For patients with vomiting administer one of the following:
o Ondansetron (Zofran) 4 mg IV/IO SLOWLY
o Metoclopramide (Reglan) 10 mg IV/IO SLOWLY
o Promethazine (Phenergan) 12.5 mg IV/IO SLOWLY
o Prochloroperazine (Compazine) 2.5-10 mg IV/IO SLOWLY
o Vistaril (Hydroxyzine) 25 mg IM ONLY
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 23
ADULT NEUROGENIC EMERGENCIES Acute Psychosis
SAFETY IS PARAMOUNT
o Try to keep the patient calm
Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
If sedation is necessary, administer one of the following:
o Haldol (Haloperidol) 2-5 mg IM (repeat as needed)
o Ativan (Lorazepam) 2-4 mg IV/IO/IM
o Versed (Midazolam) 2.5 mg IM mixed with the Haldol (Haloperidol) o Geodon (Ziprasidone) 10 mg IM
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 24
Altered Mental Status Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Consider the possible causes of Altered Mental Status and follow the appropriate
protocol
o Alcohol intoxication
o Epilepsy (Seizures)
o Insulin (Hyper- or Hypoglycemia)
o Overdose
o Uremia (Renal failure)
o Trauma
o Infection
o Psychosis o Stroke / Shock
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 25
STROKE / TIA Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Spinally immobilize the patient if suspicion of fall or significant trauma
Monitor SpO2, EtCO2, BGL, ECG, 12-lead ECG
o Only treat hypoglycemia if BGL is < 50 mg/dL
Assess for facial droop, arm drift, grip strength, slurred speech
o If any one criteria are found to be abnormal, initiate a Stroke Alert
Symptom onset must be less than 5 hours
No seizure activity
No trauma
Initial BGL > 50 mg/dL
For patients with vomiting administer one of the following:
o Ondansetron (Zofran) 4 mg IV/IO SLOWLY
o Metoclopramide (Reglan) 10 mg IV/IO SLOWLY
o Promethazine (Phenergan) 12.5 mg IV/IO SLOWLY
o Prochloroperazine (Compazine) 2.5-10 mg IV/IO SLOWLY
o Vistaril (Hydroxyzine) 25 mg IM ONLY
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 26
Seizures Take deliberate measures to protect the patient from injury during the seizure
Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Administer an anticonvulsant (choose one):
o Valium (Diazepam) 5-10 mg IV/IO
o Ativan (Lorazepam) 2-4 mg IV/IO/IM
o Versed (Midazolam) 2-2.5 mg IV/IO/IN
If seizure is due to eclampsia, administer Magnesium Sulfate 2-4 grams IV over 20-
30 minutes
Consider spinal immobilization if suspicion of fall or significant trauma
Obtain SpO2, EtCO2, BGL, and ECG
o Treat any abnormalities found by appropriate guideline
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 27
Syncope / Weakness Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Obtain SpO2, EtCO2, BGL, ECG, and 12-lead ECG
o Treat any abnormalities found by appropriate guideline
Perform a stroke assessment
Consider orthostatic vital signs
Consider spinal immobilization if suspicion of fall or significant trauma
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 28
ADULT TOXICOLOGICAL EMERGENCIES Suspected Overdose / Poisoning
Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Obtain SpO2, EtCO2, BGL, and ECG
o Treat any abnormalities found by appropriate guideline
If antipsychotic overdose is suspected (dystonic reaction)
o Administer Diphenhydramine (Benadryl) 25-50 mg IV/IO/IM
If benzodiazepine overdose is suspected and respirations are compromised
o Administer Flumazenil (Romazicon) 0.2 mg IV/IO
o If no changes within 5 minutes administer 0.3 mg IV/IO
o If no changes within 5 minutes administer 0.5mg IV/IO
If beta blocker overdose (bradycardia, AV blocks, hypotension, decreased LOC) is
suspected
o Administer Atropine 0.5 mg IV/IO
May repeat up to 3 doses
o If no response, administer Glucagon 5 mg IV/IO
o If no response, begin transcutaneous pacing
If calcium channel blocker (bradycardia, AV blocks, hypotension, decreased LOC)
overdose is suspected
o Administer Atropine 0.5 mg IV/IO
May repeat up to 3 doses
o If no response, administer Calcium Chloride 500-1000 mg IV/IO
o If no response, administer Glucagon 5 mg IV/IO
o If no response, begin transcutaneous pacing
If carbon monoxide poisoning is suspected
o This patient will require 100% oxygen regardless of SpO2 readings
o Transport patient to a facility with a hyperbaric chamber
If CNS stimulant overdose (dilated pupils, agitation, paranoia, tachycardia,
hypertension, hyperthermia, seizures) is suspected
o Keep the patient calm
o Treat seizure per seizure guidelines
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 29
Suspected Overdose / Poisoning (continued) If cyanide poisoning (headache, confusion, short of breath, hypertension,
hypotension, seizures, coma) is suspected
o Call for orders to administer Cyanokit (Hydroxocobalamin) 5 gm IV/IO over
15 minutes
If digitalis toxicity (bradycardia, AV blocks with RVR, SVT, VT, wide PR intervals,
peaked t-waves) is suspected and
o Tachycardic dysrhythmias present, follow tachycardia algorithm
o Bradycardia present with wide QRS, administer Sodium Bicarbonate 1
mEq/kg IV/IO and follow bradycardia algorithm
If opioid/opiate overdose is suspected and respirations are compromised
o Administer Naloxone (Narcan) 0.4 – 2.0 mg IV/IO/IM/IN until breathing is
adequate
If organophosphate overdose is suspected
o Administer Atropine Sulfate 2-4 mg IV/IO until atropinization occurs
o Administer Pralidoxime Chloride (2-PAM) 1-2 grams IV infusion over 10-30
minutes
o May use MARK I kits in the immediate setting
If tricyclic or tetracyclic antidepressant overdose (hypotension, anticholinergic
effects, AV blocks, prolonged QT interval, widened QRS, VT, VF) is suspected
o Administer Sodium Bicarbonate 1 mEq/kg IV/IO
If selective serotonin reuptake inhibitor overdose (hypertension, tachycardia,
agitation, tremors, muscle rigidity, hyperthermia) is suspected
o Administer Sodium Bicarbonate 1 mEq/kg IV/IO
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 01/10/2018 Page 30
Antipsychotics:
Haloperidol (Haldol)
Prolixin
Thorazine
Prochloroperazine (Compazine)
Promethazine (Phenergan)
Ziprasidone (Geodon)
Benzodiazepines:
Alprazolam (Xanax)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Diazepam (Valium)
Flunitrazepam (Rohypnol)
Lorazepam (Ativan)
Midazolam (Versed)
Triazolam (Halcion)
Beta Blockers:
Propranolol (Inderal)
Atenolol (Tenormin)
Metroprolol (Lopressor)
Nadolol (Corgard)
Labetalol (Trandate)
Esmolol (Brevibloc)
Calcium Channel Blockers:
Amlodipine (Norvasc)
Nicardipine (Cardene)
Nifedipine (Procardia)
Verapamil (Calan)
Diltiazem (Cardizem)
CNS Stimulants:
Amphetamine
Methamphetamine
Ecstasy
Cocaine
Crack
Digitalis:
Digoxin (Lanoxin)
Digitoxin (Crystodigin)
Opioids / Opiates:
Codeine
Butorphanol (Stadol)
Dextromethorphan
Diacetylmorphine (Heroin)
Fentanyl (Sublimaze, Duragesic)
Hydromorphone (Dilaudid)
Hydrocodone (Lortab, Vicodin)
Meperidine (Demerol)
Methadone (Dolophine)
Morphine (Astramorph, Duramorph, Roxanol)
Nalbuphine (Nubain)
Oxycodone (Percodan, Percocet, Tylox, Roxicodone)
Pentazocine (Talwin)
Propoxyphene (Darvon)
Sedative hypnotics:
Estazolam (Prosom)
Etomidate (Amidate)
Propofol (Diprivan)
Zolpidem (Ambien)
Selective Serotonin Reuptake Inhibitors:
Citalopram (Celexa)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Tricyclic and other antidepressants:
Doxepin (Adapin, Sinequan, Zonalon, Triadapin)
Amitriptyline (Elavil, Endep)
Protriptyline (Vivactil)
Chlordiazepoxide & amitriptyline (Limbitrol)
Clomipramine (Anafranil)
Amoxapine (Asendin)
Disepramine (Norpramin)
Nortriptyline (Pamelor)
Bupropion (Wellbutrin)
Bites and Envenomation
Provide supplemental oxygen as needed to maintain SpO2 above 94%
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 31
o If necessary, assist ventilations with BVM
o If allergic reaction develops, follow allergic reaction treatment guidelines
For SNAKE BITES:
o Cleanse wound
o Splint affected extremity
o Remove jewelry on affected limb
o Mark edematous area with a pen
Reassess and mark every 15 minutes
o Attempt to identify snake if it is safe to do so
o Contact Poison Control for further directions (1-800-222-1222)
For MARINE ENVENOMATIONS:
o Cleanse wound with seawater or hot water
o Irrigate with vinegar if available
o Splint affected extremity
o Remove jewelry on affected limb
o Mark edematous area with a pen
Reassess and mark every 15 minutes
o Contact Poison Control for further directions (1-800-222-1222)
For SPIDER / SCORPION BITES:
o Cleanse wound
o Splint affected extremity
o Remove jewelry on affected limb
o Mark edematous area with a pen
Reassess and mark every 15 minutes
o Call for orders for a benzodiazepine for severe muscle spasms
o Contact Poison Control for further directions (1-800-222-1222)
For INSECT STINGS:
o Cleanse wound
o Remove stinger by scraping it away
Do not pull or squeeze
o Splint affected extremity
o Remove jewelry on affected limb
o Mark edematous area with a pen
Reassess and mark every 15 minutes
o Contact Poison Control for further directions (1-800-222-1222)
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 32
ADULT OB/GYN EMERGENCIES Normal Labor and Delivery
Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
If contractions are less than 5 minutes apart, prepare to deliver at the scene
If presenting part is not the head, immediately begin transport to the nearest OB
equipped facility
Control the delivery with gentle pressure on the baby’s head
If the amniotic sac has not ruptured, gently pinch it between your fingers and
remove it from around the baby’s head
Check for nuchal cord
o If present, gently slip cord over head
o If unable to do so, clamp the cord and cut between clamps
Check for meconium
o Be ready to perform tracheal suctioning and secure the airway with an
endotracheal tube as needed (depressed neonate)
Suction the airway with a bulb syringe (mouth, then nose)
Clamp cord in two places about 8” from the baby
o Cut the cord between the clamps
Following delivery, follow newborn resuscitation treatment guidelines
o Dry, warm, and tactile stimulation
o Blow by oxygen
o BVM
o CPR
o Medications
Assess APGAR scores at 1 and 5 minutes
o Appearance
o Pulse
o Grimace
o Respirations
o Activity
Allow for normal delivery of the placenta
To control excessive post-partum hemorrhage
o Perform fundal massage
o Allow baby to nurse
o Call for orders to administer Oxytocin (Pitocin) 20-40 milliunits/min
Mix 10 units into a 1000cc IV bag and infuse at 2-4cc/min
Maximum cumulative dose is 10 units
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 33
Childbirth with Complications Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Breech (feet first)
o Allow for normal delivery
DO NOT PULL
o If head has not delivered within 3 minutes of shoulders, insert a gloved hand
into the vagina and create a “V” to allow for the baby to breathe
Breech (all other presentations)
o DO NOT ATTEMPT DELIVERY IN THE FIELD
o Immediately begin transport to the nearest OB equipped facility
Prolapsed Umbilical Cord
o Place patient supine
o Encourage the patient to pant (prevents bearing down)
o Insert a gloved hand to gently push the baby off the cord
You need to maintain this position throughout transport
o Wrap exposed portion of cord with moist saline dressings
o Immediately begin transport to the nearest OB equipped facility
Multiple Births
o Follow normal delivery procedure
o Expect smaller babies
o There may be more than one placenta
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 34
Third Trimester Bleeding Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Loosely dress the vaginal opening to stop blood flow
Place patient supine
o Elevate the legs if signs of shock are present
Administer fluid boluses of Normal Saline to maintain normal blood pressure
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 35
Toxemia of Pregnancy (Eclampsia) Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
First stop the seizure (Pick One)
o Valium (Diazepam) 5-10 mg IV/IO
o Ativan (Lorazepam) 2-4 mg IV/IO/IM
o Versed (Midazolam) 2-2.5 mg IV/IO/IN
Then
o Magnesium Sulfate 2-4 grams over 20-30 minutes
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 36
OTHER ADULT MEDICAL EMERGENCIES Abdominal Pain
Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Obtain 12-lead ECG for any abdominal pain above the umbilicus
For patients with vomiting administer one of the following:
o Ondansetron (Zofran) 4 mg IV/IO SLOWLY
o Metoclopramide (Reglan) 10 mg IV/IO SLOWLY
o Promethazine (Phenergan) 12.5 mg IV/IO SLOWLY
o Prochloroperazine (Compazine) 2.5-10 mg IV/IO SLOWLY o Vistaril (Hydroxyzine) 25 mg IM ONLY
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 37
Allergic Reactions Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Mild (only cutaneous involvement)
o Benadryl 25-50 mg IV/IO/IM
Moderate (cutaneous and minor respiratory involvement)
o Albuterol 2.5 mg or Levalbuterol 0.63 mg nebulized (X3)
o Atrovent 250-500 mcg nebulized (X1)
o Steroids (Pick One):
Solu-medrol (Methylprednisolone) 1-2 mg/kg
Solu-Cortef (Hydrocortisone) 5 mg/kg IV
Decadron (Dexamethasone) 10-100 mg SLOW IV
o Benadryl (Diphenhydramine) 25-50 mg IV/IO/IM
Severe / Anaphylaxis (cutaneous, significant respiratory and circulatory involvement)
o Epinephrine 1:1000 0.3 mg IM
Can give 1:10,000 0.1 – 0.5 mg IV in EXTREME cases
o Fluid boluses as needed (up to 2-4 liters)
If fluids don’t work, consider
Dopamine 5 ug/kg/min and titrate to adequate perfusion
(generally a BP between 90-100 systolic)
o Albuterol 2.5 mg or Levalbuterol 0.63 mg nebulized (X3)
o Atrovent 250-500 mcg nebulized (X1) - may be mixed with Albuterol
o Steroids (Pick One):
Solu-medrol (Methylprednisolone) 1-2 mg/kg
Solu-Cortef (Hydrocortisone) 5 mg/kg IV
Decadron (Dexamethasone) 10-100 mg SLOW IV
o Histamine Blockers: Use one H1 and one H2
H1
Benadryl (Diphenhydramine) 25-50 mg IV/IO/IM
H2
Tagamet (Cimetidine) 300mg IV infusion over 10-15 minutes
Pepcid (Famotidine) 20mg IV infusion over 10-15 minutes
Zantac (Ranitidine) 50mg IV infusion over 10-15 minutes
o Consider Glucagon 1-2 mg IV/IM every 5 minutes if the patient is on Beta
blockers
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 38
GI Bleed Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
SpO2, EtCO2, ECG and 12-lead ECG monitoring are necessary
Treat for hypovolemic shock as needed
o Administer fluid boluses of 500 cc to maintain adequate perfusion (generally
a BP between 90-100 systolic) o VASOPRESSOR USE IS CONTRAINDICATED
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 39
Hyperglycemia/HONK/HHNC Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Call for fluid boluses of 500 cc
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 40
Hypoglycemia Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
If blood glucose is less than 60mg/dL (<50 mg/dL for suspected stroke)
o Oral Glucose 10 -25 gm PO if the patient is alert enough to self-administer
o Thiamine 100 mg IV/IO/IM if suspected malnourishment
o D50 12.5 - 25 gm IV/IO if unable to give Oral Glucose
o D10 250 mL infusion (25 gm) o Glucagon 1 mg IM if unable to give D50 or D10
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 41
Nausea and Vomiting Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
For patients with vomiting administer one of the following:
o Ondansetron (Zofran) 4 mg IV/IO SLOWLY
o Metoclopramide (Reglan) 10 mg IV/IO SLOWLY
o Promethazine (Phenergan) 12.5 mg IV/IO SLOWLY
o Prochloroperazine (Compazine) 2.5-10 mg IV/IO SLOWLY o Vistaril (Hydroxyzine) 25 mg IM ONLY
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 42
SEPSIS Emergencies Initiate a SEPSIS ALERT for patient with a suspected infection and:
A Systolic BP of less than 90mmHg
OR any two of the following criteria:
Heart rate > 90 beats per minute; Temperature < 96.8 degrees F or > 100 degrees F; Respiratory rate > 20 breaths per minute; Acute altered mental status; Increased serum lactate levels (> 4 mmol/L)
Treatment:
Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Establish at least one large bore IV and infuse NORMAL SALINE at 1 liter over 30
minutes
o Do not use Lactated Ringers (lactate with alter the lab tests)
o May administer up to two liters prehospital
May administer more as needed to maintain adequate perfusion
For patients with vomiting administer one of the following:
o Ondansetron (Zofran) 4 mg IV/IO SLOWLY
o Metoclopramide (Reglan) 10 mg IV/IO SLOWLY
o Promethazine (Phenergan) 12.5 mg IV/IO SLOWLY
o Prochloroperazine (Compazine) 2.5-10 mg IV/IO SLOWLY
o Vistaril (Hydroxyzine) 25 mg IM ONLY
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 43
Sickle Cell Emergencies Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
CALL FOR ONE:
o Morphine Sulfate 2-4 mg (up to 10 mg total)
o Demerol (Meperidine) 25-50 mg SLOW IV/IO
o Dilaudid (Hydromorphone) 0.25-0.5 mg SLOW IV/IO
o Fentanyl (Sublimaze) 1 mcg/kg IM/IN or SLOW IV/IO (up to 150 mcg)
o Butorphanol (Stadol) 0.5-2 mg IV/IO
o Ketamine (Ketalar) 0.5 mg/kg IV/IO or IM
o Nalbuphine (Nubain) 5-10 mg IV/IO
o Nitrous Oxide 50:50 mix self-administered
For patients with vomiting administer one of the following:
o Ondansetron (Zofran) 4 mg IV/IO SLOWLY
o Metoclopramide (Reglan) 10 mg IV/IO SLOWLY
o Promethazine (Phenergan) 12.5 mg IV/IO SLOWLY
o Prochloroperazine (Compazine) 2.5-10 mg IV/IO SLOWLY
o Vistaril (Hydroxyzine) 25 mg IM ONLY
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 44
Suspected Kidney Stones Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
CALL FOR ONE:
o Ketorolac (Toradol) 15-30 mg IV (30-60 mg IM/IN)
o Morphine Sulfate 2-4 mg (up to 10 mg total)
o Demerol (Meperidine) 25-50 mg SLOW IV/IO
o Dilaudid (Hydromorphone) 0.25-0.5 mg SLOW IV/IO
o Fentanyl (Sublimaze) 1 mcg/kg IM/IN or SLOW IV/IO (up to 150 mcg)
o Butorphanol (Stadol) 0.5-2 mg IV/IO
o Ketamine (Ketalar) 0.5 mg/kg IV/IO or IM
o Nalbuphine (Nubain) 5-10 mg IV/IO
o Nitrous Oxide 50:50 mix self-administered
For patients with vomiting administer one of the following:
o Ondansetron (Zofran) 4 mg IV/IO SLOWLY
o Metoclopramide (Reglan) 10 mg IV/IO SLOWLY
o Promethazine (Phenergan) 12.5 mg IV/IO SLOWLY
o Prochloroperazine (Compazine) 2.5-10 mg IV/IO SLOWLY o Vistaril (Hydroxyzine) 25 mg IM ONLY
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 45
ADULT ENVIRONMENTAL EMERGENCIES SCUBA Diving Emergencies
Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
For drowning follow drowning treatment guidelines
Be alert for a possible pneumothorax
Consider transport to a facility with a hyperbaric chamber
Reminder: Arterial Gas Emboli usually causes cerebral dysfunction (i.e. loss of
consciousness) within 10 minutes of surfacing. DCS usually will present muscular skeletal
(type I), or pulmonary, cardiovascular, or nervous system (usually spinal cord) (type II).
Treatment is the same.
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 46
Cold Related Emergencies Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Move patient to a warm environment
Monitor ECG for Osborn waves as needed
Superficial frostbite
o Passive rewarming of the affected areas
Deep frostbite
o Leave frozen
o Do NOT massage frozen parts o Rapid transport
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 47
Heat Related Emergencies Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Move patient to a cool environment
Remove excessive clothing
Use fans and/or cool water to lower body temperature
Monitor SpO2, EtCO2, BGL, and ECG due to possible electrolyte abnormalities
Administer oral electrolyte solutions unless the patient is vomiting or a decreased
LOC where they cannot follow commands.
Establish IV
o Administer fluid blouses of up to 500cc if dehydration is suspected
If decreased LOC is present (Heat Stroke suspected)
o Rapid cooling of the patient
o Place cold packs near groin, axilla
o Avoid overcooling (prevent shivering)
Treat seizures according to seizure treatment guidelines
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 48
Drowning/Submersion Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Follow cardiac arrest management as needed
Spinal immobilization is indicated if unknown or suspicious mechanism
ALL “Drowning” patients need to be evaluated at the emergency department
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 49
ADULT TRAUMATIC EMERGENCIES Abdominal/Pelvic Trauma
Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Spinal immobilization is necessary
SpO2, EtCO2, BGL and ECG monitoring are necessary
Establish vascular access
o At least one large bore IV
DO NOT REMOVE IMPALED OBJECTS
o Stabilize in place with bulky dressings
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 50
Burns (Thermal) Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Use moist dressings on minor (small) burns
Use dry sterile dressings on 2nd degree burns greater than 15% BSA
Use dry sterile dressings on all 3rd degree burns
For pain management call for one of the following:
o Morphine Sulfate 2-4 mg (up to 10 mg total)
o Demerol (Meperidine) 25-50 mg SLOW IV/IO
o Dilaudid (Hydromorphone) 0.25-0.5 mg SLOW IV/IO
o Fentanyl (Sublimaze) 1 mcg/kg IM/IN or SLOW IV/IO (up to 150 mcg)
o Ketamine (Ketalar) 0.5 mg/kg IV/IO or IM
o Butorphanol (Stadol) 0.5-2 mg IV/IO
o Nalbuphine (Nubain) 5-10 mg IV/IO
o Nitrous Oxide 50:50 mix self-administered
For patients with vomiting administer one of the following:
o Ondansetron (Zofran) 4 mg IV/IO SLOWLY
o Metoclopramide (Reglan) 10 mg IV/IO SLOWLY
o Promethazine (Phenergan) 12.5 mg IV/IO SLOWLY
o Prochloroperazine (Compazine) 2.5-10 mg IV/IO SLOWLY
o Vistaril (Hydroxyzine) 25 mg IM ONLY
Burns (Chemical) Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
If it is a dry chemical brush it off
If it is a wet chemical irrigate with copious amounts of water
Follow appropriate toxicological protocol
Burns (Electrical) Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Monitor for and treat any dysrhythmias found
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 51
Chest Trauma Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Spinal immobilization as necessary (blunt chest trauma or confirmed neurological
deficit)
SpO2, EtCO2, BGL and ECG monitoring are necessary
o Obtain 12-lead ECG
Stabilize flail segments with bulky dressings
Dress all open wounds with occlusive dressings
Frequently reassess for developing tension pneumothorax
o Decompress as necessary
Treat for shock as needed
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 52
Closed Head Trauma Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
o TAKE DELIBERATE MEASURES NOT TO HYPERVENTILATE
Spinal immobilization is necessary
SpO2, EtCO2, BGL and ECG monitoring are necessary
Only if brain herniation is suspected (unilateral dilated, non-reactive pupil, abrupt
decrease in LOC, decorticate or decerebrate posturing)
o Hyperventilate at a rate of 20 breaths per minute
Maintain EtCO2 between 30 and 40 mmHg
o This is only a temporary measure
For seizures follow the seizure treatment guidelines
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 53
Extremity Trauma Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Splint with appropriate materials
For pain management call for one of the following:
o Morphine Sulfate 2-4 mg (up to 10 mg total)
o Demerol (Meperidine) 25-50 mg SLOW IV/IO
o Dilaudid (Hydromorphone) 0.25-0.5 mg SLOW IV/IO
o Fentanyl (Sublimaze) 1 mcg/kg IM/IN or SLOW IV/IO (up to 150 mcg)
o Ketamine (Ketalar) 0.5 mg/kg IV/IO or IM
o Butorphanol (Stadol) 0.5-2 mg IV/IO
o Nalbuphine (Nubain) 5-10 mg IV/IO
o Nitrous Oxide 50:50 mix self-administered
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 54
Shock Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Establish IV
For Hypovolemic, Distributive, and Obstructive shock
o IF LUNG SOUNDS ARE CLEAR, administer a fluid bolus of 500 ml of Normal
Saline
Repeat as needed
Typically, will not exceed 2000cc (1000cc in chest trauma)
For Cardiogenic shock
o IF LUNG SOUNDS ARE CLEAR, administer a fluid bolus of 100-200 ml of
Normal Saline
May repeat once
o Start Dopamine (Intropin) infusion at 5 mcg/kg/min
Titrate infusion to maintain adequate perfusion (usually a systolic BP between 90 and 100 mmHg)
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 55
Spine Trauma Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Spinal immobilization is indicated
SpO2, EtCO2, BGL and ECG monitoring are necessary
Frequently reassess dermatomes and mark level of paralysis on the patient
Frequently reassess distal PMS in all extremities
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 56
Traumatic Cardiac Arrest Follow ACLS treatment for cardiac arrest
Spinal Immobilization
Look for correctable causes such as airway obstruction, tension pneumothorax, or
hypovolemia
Most traumatic cardiac arrests are a futile effort, consider termination of
resuscitation if no response to aggressive treatment within a few minutes
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 57
PEDIATRIC PROTOCOLS PEDIATRIC Airway Obstruction
Follow current AHA standards for relief of foreign body (Heimlich maneuver)
Attempt use of Magill forceps using direct visualization of airway as needed
If unable to remove obstruction and respiratory compromise is severe, consider
needle airway o See airway management guidelines
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 58
PEDIATRIC Asthma / Bronchiolitis Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Administer a bronchodilator (choose one)
o Albuterol (Proventil) 2.5 mg nebulized
o Levalbuterol (Xopenex) 0.63 mg nebulized
May add Atrovent (Ipratropium) 250-500 mcg to Albuterol or
Levalbuterol
May repeat as needed as long as heart rate remains below 180
Administer a Steroid (choose one):
o Solu-medrol (Methylprednisolone) 1-2 mg/kg
o Solu-Cortef (Hydrocortisone) 1 mg/kg IV
o Decadron (Dexamethasone) 0.25-1 mg/kg SLOW IV
If bronchospasm persists after three breathing treatments, call for Magnesium
Sulfate 25-50 mg/kg over 10-20 minutes IV infusion
If bronchospasm persists or worsens call for Epinephrine 1:1000 0.01 mg/kg IM
and prepare to intubate
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 59
PEDIATRIC Croup / Epiglottitis Allow child to remain in a position of comfort
Takes deliberate action NOT to upset the child
Provide supplemental oxygen as needed to maintain SpO2 above 94%
o BLOW-BY humidified oxygen is preferred
Administers either:
o Racemic Epinephrine 5 mL nebulized in 5 mL saline (preferred) OR
o Epinephrine 2.5 mL 1:1000 nebulized with 3 mL saline
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 60
PEDIATRIC Asystole Initiate CPR; continuous CPR is the key
Epinephrine 0.01mg/kg (0.1mL/kg) IV/IO 1:10,000 every 3-5 minutes
Consider possible etiology
o Hypoxemia
Assure ventilation with 100% oxygen
o Hypovolemia
Administer fluid boluses 10-20 cc/kg
o Hydrogen ions (Acidosis)
Administer Sodium Bicarbonate 1 mEq/kg 8.4% (4.2% if less than 1
month old) IV/IO
o Hyper/Hypokalemia
For Hyperkalemia, administer Sodium Bicarbonate 1 mEq/kg 8.4%
(4.2% if less than 1 month old) IV/IO
Calcium Chloride 20 mg/kg IV/IO
o Hypoglycemia (BGL less than 60)
For children > 2 years old, administer Dextrose 50%, 1mL/kg IV/IO
For children > 1 month, administer Dextrose 25%, 2mL/kg IV/IO
For infants <1 month old, administer Dextrose 10%, 5mL/kg IV/IO
NOTE: D10 is acceptable for all age groups
o Hypothermia
Active rewarming
o Toxins
Follow appropriate Poisoning/Overdose treatment
o Cardiac tamponade
Perform pericardiocentesis
o Tension pneumothorax
Perform pleural decompression
o Pulmonary or coronary thrombus
Rapid transport
o Trauma Treat as appropriate
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 61
PEDIATRIC Bradycardia If hemodynamically STABLE
o Observe
If hemodynamically UNSTABLE and heart rate <60
o Aggressive oxygenation and ventilation
o If heart rate remains <60, begin CPR
o Epinephrine 0.01 mg/kg (0.1 mL/kg) 1:10,000 IV/IO
Repeat doses of epinephrine, every 3-5 minutes if rhythm persists
o Consider Atropine 0.02mg/kg if suspected increased vagal tone
May not work in infants due to lack of Vagus nerve innervation
o If Epinephrine does not work attempt transcutaneous pacing
Consider premedication prior to procedure (choose one)
Lorazepam (Ativan) 0.05 mg/kg IV/IO/IM
o Can be given IV if diluted 50:50
Diazepam (Valium) 0.2-0.5 mg/kg IV/IO
Set to normal heart rate (100 bpm)
Set to lowest mA (10-20mA)
Start pacing
Adjust pacer output (mA) up until electrical capture is attained
Verify mechanical capture
o If transcutaneous pacing does not work:
Epinephrine infusion 2-10 mcg/min OR
Dopamine (Intropin) infusion 5-20 mcg/kg/min
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 62
PEDIATRIC Narrow Complex Tachycardia SVT
o For an INFANT SVT is defined as a sustained rate of 220 with a narrow QRS
o For a CHILD SVT is defined as a sustained rate of 180 with a narrow QRS
o If hemodynamically STABLE
Consider vagal maneuvers
Adenosine 0.1 mg/kg IV/IO (rapid)
If no changes within 5 minutes Adenosine 0.2 mg/kg IV/IO (rapid)
o If hemodynamically UNSTABLE
May attempt vagal maneuvers or Adenosine without significant delay
Cardioversion (don’t forget to SYNC)
0.5-1 J/kg or manufacturers recommendation
Repeat as necessary with escalating doses
Consider premedication prior to procedure (choose one)
Lorazepam (Ativan) 0.05 mg/kg IV/IO/IM
o Can be given IV if diluted 50:50
Diazepam (Valium) 0.05-0.5 mg/kg IV/IO
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 63
PEDIATRIC Pulseless Electrical Activity Initiate CPR; continuous CPR is the key
Epinephrine 0.01mg/kg (0.1mL/kg) IV/IO 1:10,000 every 3-5 minutes
Consider possible etiology
o Hypoxemia
Assure ventilation with 100% oxygen
o Hypovolemia
Administer fluid boluses 10-20 cc/kg
o Hydrogen ions (Acidosis)
Administer Sodium Bicarbonate 1 mEq/kg 8.4% (4.2% if less than 1
month old)IV/IO
o Hyper/Hypokalemia
For Hyperkalemia, administer Sodium Bicarbonate 1 mEq/kg 8.4%
(4.2% if less than 1 month old) IV/IO
Calcium Chloride 20 mg/kg IV/IO
o Hypoglycemia (BGL less than 60)
For children > 2 years old, administer Dextrose 50%, 1mL/kg IV/IO
For children > 1 month, administer Dextrose 25%, 2mL/kg IV/IO
For infants <1 month old, administer Dextrose 10%, 5mL/kg IV/IO
NOTE: D10 is acceptable for all age groups
o Hypothermia
Active rewarming
o Toxins
Follow appropriate Poisoning/Overdose treatment
o Cardiac tamponade
Perform pericardiocentesis
o Tension pneumothorax
Perform pleural decompression
o Pulmonary or coronary thrombus
Rapid transport
o Trauma Treat as appropriate
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 64
PEDIATRIC Wide Complex Tachycardia If hemodynamically STABLE
o Obtain 12-lead ECG prior to treatment
o Consider vagal maneuvers
o Consider Adenosine 0.1mg/kg if possible aberrancy
o Seek expert consultation
If hemodynamically UNSTABLE
o Attempt to obtain 12-lead ECG
o Cardioversion (don’t forget to SYNC)
VT (wide complex, regular)
1J/kg
Repeat as necessary with escalating doses
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 65
PEDIATRIC Wide Complex Tachycardia without a pulse and Ventricular Fibrillation
If witnessed IMMEDIATE Defibrillation
o 2J/kg or manufacturers recommendations
Initiate CPR; continuous CPR is the key; only stop for electrical therapy
Administer Epinephrine 0.01mg/kg (0.1mL/kg) IV/IO 1:10,000
o Repeat every 3-5 minutes throughout cardiac arrest
Defibrillate 4J/kg or manufacturers recommendations
Administer an antidysrhythmic
o Amiodarone 5 mg/kg IV/IO OR
o Lidocaine 1 mg/kg IV/IO
Defibrillate 4-10J/kg or manufacturers recommendations
Administer Epinephrine 0.01mg/kg (0.1mL/kg) IV/IO 1:10,000
Defibrillate 4-10J/kg or manufacturers recommendations
Administer previous antidysrhythmic
o Amiodarone 5 mg/kg IV/IO
o Lidocaine 1 mg/kg IV/IO
Defibrillate 4-10J/kg or manufacturers recommendations
Administer Epinephrine 0.01mg/kg (0.1mL/kg) IV/IO 1:10,000
Defibrillate 4-10J/kg or manufacturers recommendations
Administer previous antidysrhythmic
o Amiodarone 5 mg/kg IV/IO
o Lidocaine 1 mg/kg IV/IO
Defibrillate 4-10J/kg or manufacturers recommendations
Administer Epinephrine 0.01mg/kg (0.1mL/kg) IV/IO 1:10,000
Defibrillate 4-10J/kg or manufacturers recommendations
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 66
PEDIATRIC Altered Mental Status Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Consider the possible causes of Altered Mental Status and follow the appropriate
protocol
o Alcohol intoxication
o Epilepsy (Seizures)
o Insulin (Hyper- or Hypoglycemia)
o Overdose
o Uremia (Renal failure)
o Trauma
o Infection
o Psychosis o Stroke / Shock
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 67
PEDIATRIC Seizures Take deliberate measures to protect the patient from injury during the seizure
Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Administer an anticonvulsant (choose one):
o Valium (Diazepam) 0.5-1 mg/kg IV/IO/IM
o Ativan (Lorazepam) 0.05 mg/kg IV/IO/IM
Spinally immobilize the patient if suspicion of fall or significant trauma
Obtain SpO2, EtCO2, BGL, and ECG
o Treat any abnormalities found by appropriate guideline
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 68
PEDIATRIC Toxicology Suspected Overdose / Poisoning
Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Obtain SpO2, EtCO2, BGL, and ECG
o Treat any abnormalities found by appropriate guideline
If antipsychotic overdose is suspected (dystonic reaction)
o Administer Diphenhydramine (Benadryl) 1-2 mg/kg IV/IO/IM (MAX 50 mg)
If benzodiazepine overdose is suspected and respirations are compromised
o Provide airway and ventilator support as needed
If beta blocker overdose (bradycardia, AV blocks, hypotension, decreased LOC) is
suspected
o Administer Atropine 0.02 mg/kg IV/IO (minimum dose 0.1 mg)
May repeat up to 3 doses
o If no response, begin transcutaneous pacing
If calcium channel blocker (bradycardia, AV blocks, hypotension, decreased LOC)
overdose is suspected
o Administer Atropine 0.02 mg/kg IV/IO (minimum dose 0.1 mg)
May repeat up to 3 doses
o If no response, administer Calcium Chloride 20 mg/kg IV/IO
o If no response, begin transcutaneous pacing
If carbon monoxide poisoning is suspected
o This patient will require high concentrations of oxygen (i.e. NRBM)
regardless of SpO2 readings
o Transport patient to a facility with a hyperbaric chamber
If CNS stimulant overdose (dilated pupils, agitation, paranoia, tachycardia,
hypertension, hyperthermia, seizures) is suspected
o Keep the patient calm o Treat seizure per seizure guidelines
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 69
Suspected Overdose / Poisoning (continued) If cyanide poisoning (headache, confusion, short of breath, hypertension,
hypotension, seizures, coma) is suspected
o Call for orders to administer Cyanokit (Hydroxocobalamin) 70 mg/kg IV/IO
over 15 minutes
If digitalis toxicity (bradycardia, AV blocks with RVR, SVT, VT, wide PR intervals,
peaked t-waves) is suspected and
o Tachycardic dysrhythmias present, follow tachycardia algorhythm
o Bradycardia present with wide QRS, administer Sodium Bicarbonate 1
mEq/kg 8.4% (4.2% if less than 1 month old) IV/IO
If opioid/opiate overdose is suspected and respirations are compromised
o Administer Naloxone (Narcan) 0.1 mg/kg IV/IO/IM/IN (Maximum dose
0.8mg)
If organophosphate overdose is suspected
o Administer Atropine Sulfate 0.02 mg/kg IV/IO until atropinization occurs
o Administer Pralidoxime Chloride (2-PAM) 20-40 mg/kg IV infusion over 10-
30 minutes
If tricyclic or tetracyclic antidepressant overdose (hypotension, anticholinergic
effects, AV blocks, prolonged QT interval, widened QRS, VT, VF) is suspected
o Administer Sodium Bicarbonate 1 mEq/kg 8.4% (4.2% if less than 1 month
old) IV/IO
If selective serotonin reuptake inhibitor overdose (hypertension, tachycardia,
agitation, tremors, muscle rigidity, hyperthermia) is suspected
o Administer Sodium Bicarbonate 1 mEq/kg 8.4% (4.2% if less than 1 month
old) IV/IO
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 70
Antipsychotics:
Haloperidol (Haldol)
Prolixin
Thorazine
Prochloroperazine (Compazine)
Promethazine (Phenergan)
Ziprasidone (Geodon)
Benzodiazepines:
Alprazolam (Xanax)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Diazepam (Valium)
Flunitrazepam (Rohypnol)
Lorazepam (Ativan)
Midazolam (Versed)
Triazolam (Halcion)
Beta Blockers:
Propranolol (Inderal)
Atenolol (Tenormin)
Metroprolol (Lopressor)
Nadolol (Corgard)
Labetalol (Trandate)
Esmolol (Brevibloc)
Calcium Channel Blockers:
Amlodipine (Norvasc)
Nicardipine (Cardene)
Nifedipine (Procardia)
Verapamil (Calan)
Diltiazem (Cardizem)
CNS Stimulants:
Amphetamine
Methamphetamine
Ecstasy
Cocaine
Crack
Digitalis:
Digoxin (Lanoxin)
Digitoxin (Crystodigin)
Opioids / Opiates:
Codeine
Butorphanol (Stadol)
Dextromethorphan
Diacetylmorphine (Heroin)
Fentanyl (Sublimaze, Duragesic)
Hydromorphone (Dilaudid)
Hydrocodone (Lortab, Vicodin)
Meperidine (Demerol)
Methadone (Dolophine)
Morphine (Astramorph, Duramorph, Roxanol)
Nalbuphine (Nubain)
Oxycodone (Percodan, Percocet, Tylox, Roxicodone)
Pentazocine (Talwin)
Propoxyphene (Darvon)
Sedative hypnotics:
Estazolam (Prosom)
Etomidate (Amidate)
Propofol (Diprivan)
Zolpidem (Ambien)
Selective Serotonin Reuptake Inhibitors:
Citalopram (Celexa)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Tricyclic and other antidepressants:
Doxepin (Adapin, Sinequan, Zonalon, Triadapin)
Amitriptyline (Elavil, Endep)
Protripytline (Vivactil)
Chlordiazepoxide & amitriptyline (Limbitrol)
Clomipramine (Anafranil)
Amoxapine (Asendin)
Disepramine (Norpramin)
Nortriptyline (Pamelor)
Bupropion (Wellbutrin)
PEDIATRIC Bites and Envenomation Provide supplemental oxygen as needed to maintain SpO2 above 94%
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 71
o If necessary, assist ventilations with BVM
o If allergic reaction develops, follow allergic reaction treatment guidelines
For SNAKE BITES:
o Cleanse wound
o Splint affected extremity
o Remove jewelry on affected limb
o Mark edematous area with a pen
Reassess and mark every 15 minutes
o Attempt to identify snake if it is safe to do so
o Contact Poison Control for further directions (1-800-222-1222)
For MARINE ENVENOMATIONS:
o Cleanse wound
o Irrigate with vinegar if available
o Splint affected extremity
o Remove jewelry on affected limb
o Mark edematous area with a pen
Reassess and mark every 15 minutes
o Contact Poison Control for further directions (1-800-222-1222)
For SPIDER / SCORPION BITES:
o Cleanse wound
o Splint affected extremity
o Remove jewelry on affected limb
o Mark edematous area with a pen
Reassess and mark every 15 minutes
o Call for orders for a benzodiazepine for severe muscle spasms
o Contact Poison Control for further directions (1-800-222-1222)
For INSECT STINGS:
o Cleanse wound
o Remove stinger by scraping it away
Do not pull or squeeze
o Splint affected extremity
o Remove jewelry on affected limb
o Mark edematous area with a pen
Reassess and mark every 15 minutes
o Contact Poison Control for further directions (1-800-222-1222)
PEDIATRIC Abdominal Pain Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Obtain 12-lead ECG for any abdominal pain above the umbilicus
For patients with vomiting administer one of the following:
o Ondansetron (Zofran) 0.15 mg/kg IV/IO SLOWLY
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 72
o Metoclopramide (Reglan) 0.1 mg/kg IV/IO SLOWLY
o Promethazine (Phenergan) 0.25-0.5 mg/kg IV/IO SLOWLY o Vistaril (Hydroxyzine) 0.5-1 mg/kg IM ONLY
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 73
PEDIATRIC Allergic Reaction Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Mild (only cutaneous involvement)
o Benadryl 1-2 mg/kg IV/IO/IM
Moderate (cutaneous and minor respiratory involvement)
o Albuterol 2.5 mg or Levalbuterol 0.63 mg nebulized (X3)
o Atrovent 250-500 mcg nebulized (X1)
o Steroids (Pick One):
Solu-medrol (Methylprednisolone) 1-2 mg/kg
Solu-Cortef (Hydrocortisone) 1 mg/kg IV
Decadron (Dexamethasone) 0.25-1 mg/kg SLOW IV
o Benadryl (Diphenhydramine) 1-2 mg/kg IV/IO/IM
Severe / Anaphylaxis (cutaneous, significant respiratory and circulatory involvement)
o Epinephrine 1:1000 0.01 mg/kg IM/SQ
Can give 1:10,000 0.01 mg/kg IV in EXTREME cases
o Fluid boluses as needed (up to 2-4 liters)
If fluids don’t work consider
Dopamine 5 ug/kg/min and titrate to adequate perfusion
o Albuterol 2.5 mg or Levalbuterol 0.63 mg nebulized (X3)
o Atrovent 250-500 mcg nebulized (X1) - may be mixed with Albuterol or
Levalbuterol
o Steroids (Pick One):
Solu-medrol (Methylprednisolone) 1-2 mg/kg
Solu-Cortef (Hydrocortisone) 1 mg/kg IV
Decadron (Dexamethasone) 0.25-1 mg/kg SLOW IV o Benadryl (Diphenhydramine) 1-2 mg/kg IV/IO/IM
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 74
PEDIATRIC GI Bleed Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
SpO2, EtCO2, ECG and 12-lead ECG monitoring are necessary
Treat for hypovolemic shock as needed
o Administer fluid boluses of 20 cc/kg to maintain adequate perfusion
May repeat up to 2 additional times o VASOPRESSOR USE IS CONTRAINDICATED
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 75
PEDIATRIC Hyperglycemia Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Call for fluid boluses of 20 cc/kg
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PEDIATRIC Hypoglycemia Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
If blood glucose is less than 60mg/dL
o Oral Glucose 10 -25 gm PO if the patient is alert enough to self-administer
o Thiamine 10-25 mg IV/IO/IM if suspected malnourishment
o Administer Dextrose
For children > 2 years old, administer Dextrose 50%, 1mL/kg IV/IO
For children > 1 month, administer Dextrose 25%, 2mL/kg IV/IO
For infants <1 month old, administer Dextrose 10%, 5mL/kg IV/IO
NOTE: D10 is acceptable for all age groups
o Glucagon 0.5-1 mg IM if unable to give Dextrose
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 77
PEDIATRIC Nausea and Vomiting Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
For patients with vomiting administer one of the following:
o Ondansetron (Zofran) 0.1 mg/kg IV/IO SLOWLY
o Metoclopramide (Reglan) 0.1 mg/kg IV/IO SLOWLY
o Promethazine (Phenergan) 1 mg/kg IV/IO SLOWLY
o Vistaril (Hydroxyzine) 0.5-1 mg/kg IM ONLY
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 78
PEDIATRIC Sickle Cell Emergencies Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
CALL FOR ONE:
o Morphine Sulfate 0.1 mg/kg (up to 5 mg total)
o Demerol (Meperidine) 1-2 mg/kg SLOW IV/IO
o Dilaudid (Hydromorphone) 0.005 mg/kg SLOW IV/IO
o Ketamine (Ketalar) 0.5 mg/kg IV/IO or IM
For patients with vomiting administer one of the following:
o Ondansetron (Zofran) 0.1 mg/kg IV/IO SLOWLY
o Metoclopramide (Reglan) 0.1 mg/kg IV/IO SLOWLY
o Promethazine (Phenergan) 1 mg/kg IV/IO SLOWLY
o Vistaril (Hydroxyzine) 0.5-1 mg/kg IM ONLY
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 79
PEDIATRIC Cold Related Emergencies Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Move patient to a warm environment
Monitor ECG for Osborne waves as needed
Superficial frostbite
o Passive rewarming of the affected areas
Deep frostbite
o Leave frozen
o Do NOT massage frozen parts o Rapid transport
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PEDIATRIC Heat Related Emergencies Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Move patient to a cool environment
Remove excessive clothing
Use fans and/or cool water to lower body temperature
Rehydrate with oral fluids if patient is able to follow commands
Monitor SpO2, EtCO2, BGL, and ECG due to possible electrolyte abnormalities
Establish IV
o Administer fluid blouses of up to 20 cc/kg if dehydration is suspected
If decreased LOC is present (Heat Stroke suspected)
o Rapid cooling of the patient
o Place cold packs near groin, axilla
o Avoid overcooling (prevent shivering)
Treat seizures according to seizure treatment guidelines
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 81
PEDIATRIC Drowning Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Follow cardiac arrest management as needed
Spinal immobilization is indicated if unknown or suspicious mechanism
ALL “Drowning” patients need to be evaluated at the emergency department
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PEDIATRIC Abdominal/Pelvic Trauma Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Spinal immobilization as necessary
SpO2, EtCO2, BGL and ECG monitoring are necessary
Establish vascular access
o At least one large bore IV
o Administer fluid boluses of 20 mL/kg if hypotension develops
DO NOT REMOVE IMPALED OBJECTS
o Stabilize in place with bulky dressings
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PEDIATRIC Burns Burns (Thermal)
Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Use moist dressings on minor (small) burns
Use dry sterile dressings on 2nd degree burns greater than 15% BSA
Use dry sterile dressings on all 3rd degree burns
For pain management call for one of the following:
o Morphine Sulfate 0.1 mg/kg (up to 5 mg total)
o Demerol (Meperidine) 1-2 mg/kg SLOW IV/IO
o Dilaudid (Hydromorphone) 5 mcg/kg SLOW IV/IO
o Ketamine (Ketalar) 0.5 mg/kg IV/IO or IM
Burns (Chemical) Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
If it is a dry chemical brush it off
If it is a wet chemical irrigate with copious amounts of water
Follow appropriate toxicological protocol
Burns (Electrical) Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Monitor for and treat any dysrhythmias found
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PEDIATRIC Chest Trauma Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Spinal immobilization as necessary
SpO2, EtCO2, BGL and ECG monitoring are necessary
o Obtain 12-lead ECG
Stabilize flail segments with bulky dressings
Dress all open wounds with occlusive dressings
Frequently reassess for developing tension pneumothorax
o Decompress as necessary
Treat for shock as needed
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PEDIATRIC Closed Head Trauma Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
o TAKE DELIBERATE MEASURES NOT TO HYPERVENTILATE
Spinal immobilization is necessary
SpO2, EtCO2, BGL and ECG monitoring are necessary
Only if brain herniation is suspected (unilateral dilated, non-reactive pupil, abrupt
decrease in LOC, decorticate or decerebrate posturing)
o Hyperventilate at a rate of 20 breaths per minute
Maintain EtCO2 between 30 and 40 mmHg
o This is only a temporary measure
For seizures follow the seizure treatment guidelines
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PEDIATRIC Extremity Trauma Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Splint with appropriate materials
For pain management call for one of the following:
o Morphine Sulfate 0.1 mg/kg (up to 5 mg total)
o Demerol (Meperidine) 1-2 mg/kg SLOW IV/IO
o Dilaudid (Hydromorphone) 5 mcg/kg SLOW IV/IO
o Ketamine (Ketalar) 0.5 mg/kg IV/IO or IM
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PEDIATRIC Spine Trauma Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Spinal immobilization is indicated
SpO2, EtCO2, BGL and ECG monitoring are necessary
Frequently reassess dermatomes
Frequently reassess distal PMS in all extremities
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PEDIATRIC Shock Provide supplemental oxygen as needed to maintain SpO2 above 94%
o If necessary, assist ventilations with BVM
Establish IV
For Hypovolemic, Distributive, and Obstructive shock
o IF LUNG SOUNDS ARE CLEAR, administer a fluid bolus of 20cc/kg of Normal
Saline (10cc/kg in newborns/neonates)
Repeat as needed up to three times
Call medical control for additional fluids
For Cardiogenic shock
o IF LUNG SOUNDS ARE CLEAR, administer a fluid bolus of 20cc/kg of Normal
Saline (10cc/kg in newborns/neonates)
May repeat once
o Start Dopamine (Intropin) infusion at 5 mcg/kg/min
Titrate infusion to maintain a radial pulses
Daytona State College Paramedic Program LAB Treatment Guidelines Revised 1/10/2018 Page 89
PEDIATRIC Traumatic Cardiac Arrest Follow ACLS treatment for cardiac arrest
Spinal Immobilization
Look for correctable causes such as airway obstruction, tension pneumothorax, or
hypovolemia
Most traumatic cardiac arrests are a futile effort, consider termination of
resuscitation if no response to aggressive treatment within a few minutes
o Consider the circumstances