ValleyProtocolBook

The Valley Hospital Mobile ICU

10

Standing Orders / Communications Failure Orders

v. If the blood glucose test indicates a level less than 60 mg/dL, administer 25 g of 50 percent Dextrose in water intravenously. If unable to establish vascular access, administer 1 mg Glucagon intramuscularly;

vi. If suspected opiate overdose administer Naloxone 2 mg through an approved route of administration;

4. Reassess the cardiac rhythm every two minutes; and

vii. If the cardiac rhythm ventricular fibrillation or pulseless ventricular tachycardia follow standing orders for ventricular fibrillation / pulseless ventricular tachycardia as outline in N.J.A.C. 8:41-7.5.

5. Contact the medical command

(b) Consider termination of efforts only with the input of the medical command physician if Asystole/Agonal rhythms continue after successful advanced airway placement and initial medications. The time interval since arrest shall also be considered.

(c) Follow each medication given via vascular access with a 20 mL fluid bolus

(d) Total amount of solutions given via ET not to exceed 50 mL.

Communications Failure Orders for Asystole/PEA

(a) Continue two minute cycles of CPR followed by a rhythm check and if ventricular fibrillation or pulseless ventricular tachycardia occurs, defibrillate and 360 joules or manufacturer’s suggested biphasic equivalent and immediately resume CPR; then follow the Communications Failure Orders for Ventricular Fibrillation or Pulseless Ventricular Tachycardia.

(b) Administer an additional Normal Saline 500 ml bolus, repeated to a maximum of two liters. If patient is moderately to severely hypothermic, administer warmed IV fluids.

(c) If the provider suspects increased vagal tone involvement and the patient is in Asystole or PEA with a ventricular rate <60, administer Atropine 1mg IV/IO push repeated every three to five minutes to a maximum of 3mg. (d) If the provider suspects a severe pre-existing acidosis based on available clinical history and exam, administer Sodium Bicarbonate 50 mEq IV/IO. This may be repeated one time in fifteen minutes.

(e) If the provider suspects hyperkalemia, administer Calcium Chloride 1 gram IV/IO push followed by a 20 ml fluid bolus. Then administer Sodium Bicarbonate 50 mEq IV/IO push.