ValleyProtocolBook

The Valley Hospital Mobile ICU

8

Standing Orders / Communications Failure Orders

(b) Should ventricular fibrillation or pulseless ventricular tachycardia recur after contact is made with medical command, an ALS crewmember may follow step 2 through 4 until medical command can be re-established.

(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;

(e) Any treatments related to this protocol administered prior to ALS arrival should be considered as part of this standing order.

Communications Failure Orders for Ventricular Fibrillation and Pulseless Ventricular Tachycardia:

(a) Continue two minute cycles of CPR followed by a rhythm check and if ventricular fibrillation or pulseless ventricular tachycardia persists, defibrillate at 360 joules or manufacturer’s suggested biphasic equivalent and immediately resume CPR. If patient’s rhythm converts to PEA or Asystole, continue CPR and follow the Standing Orders and Communications Failure Orders for Asystole/PEA.

(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 there is no response to the above therapies or the presenting rhythm is Torsades de Pointes, administer Magnesium Sulfate 2 grams IV/IO over two minutes.

(d) Check blood glucose. If blood glucose is <60mg/dL, administer Dextrose 50%W 25 grams IV/IO push. If IV/IO access is not available, administer Glucagon 1 mg IM.

(e) 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.

(f) 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.

(g) If the provider suspects an overdose, treat according to suspected agents:

1. Opiate toxicity: Naloxone 2mg IV/IO push.

2. Benzodiazepine toxicity: Romazicon 0.3mg IV/IO push i. Hold Romazicon for any patient who may be chronically taking benzodiazepines

3. Tricyclic Antidepressant toxicity: Sodium Bicarbonate 50 mEq IV/IO push.

4. Beta Blocker: Glucagon 3mg IV/IO push.

5. Calcium Channel Blocker: Calcium Chloride 1 gram IV/IO push.