ValleyProtocolBook

The Valley Hospital Mobile ICU

17

Standing Orders / Communications Failure Orders

5.

(b) If after three sublingual doses of Nitroglycerin, the patient continues to have chest pain, administer Morphine Sulfate 0.1 mg/kg to a maximum of 10mg per dose or administer Fentanyl 1 mcg/kg to a maximum of 100mcg per dose. These may be and repeated one time in ten minutes as long as the systolic blood pressure is at least 100 mmHg.

(c) If the patient experiences any relief of pain, administer Nitroglycerin 1 inch transdermal as long as the systolic blood pressure is 100 mmHg.

8:41-7.12 Standing orders for sustained stable wide-complex tachycardia

(a) The following orders are authorized in the event that an adult patient presents with a stable wide- complex tachycardia

1. Assess and secure airway;

2. Establish vascular access;

3. Obtain 12-lead electrocardiogram tracing;

4. Continue to assess the patient and monitor the cardiac rhythm

5. If sustained wide-complex tachycardia, administer Amiodarone 150mg via vascular access over ten minutes; and

6. Contact the medical command

Communications Failure Orders for sustained stable wide-complex tachycardia

(a) If the rhythm converts, administer continuous Amiodarone infusion at 1 mg/min IV/IO.

(b) If the patient continues to have wide-complex tachycardia that does not respond to Amiodarone, or if the patient becomes hemodynamically unstable, refer to the Standing Orders and Communications Failure Orders for unstable wide-complex tachycardia.