ValleyProtocolBook

The Valley Hospital Mobile ICU

9

Standing Orders / Communications Failure Orders

(h) If the patient has a return of spontaneous circulation, performing the following steps:

1. Reassess vital signs. Continue positive pressure ventilation as required by clinical presentation. If the patient has not been intubated, proceed with appropriate airway management as dictated by the clinical presentation. Titrate to a pulse oximetry >94% and end-tidal CO2 of 35-45mmHg.

2. If the systolic blood pressure is <90mmHg, administer Normal Saline to a maximum of one liter.

3. Administer a continuous infusion of Amiodarone 1 mg/min IV/IO.

4. Acquire a 12-lead Electrocardiogram.

5. Establish secondary IV/IO access if possible.

6. If, after a total of one liter the patient remains hypotensive with a systolic blood pressure <90mHg, administer Dopamine 5 mcg/kg/min IV/IO drip. This may be titrated to a maximum dose of 20 mcg/kg/min. A second liter of Normal Saline shall be administered simultaneously.

8:41-7.6 Standing orders for Asystole/PEA:

(a) The following standing orders are authorized in the event that an adult patient presents with cardiac arrest with the rhythm determined to be Asystole or PEA:

1. Initiate or continue CPR;

i. If Asystole confirm in a second lead;

2. During CPR;

ii. Assess and secure airway. Once an advanced airway has been established, perform continuous compressions at a rate of at least 100 per minute while giving ventilations at a rate of 8 to 10 times per minute, for 2-minute cycles.

iii. Establish vascular access and administer 500 mL normal saline via vascular access;

iv. Administer Epinephrine 1 mg 1:10,000 via vascular access or 2 mg 1:10,000 through the endotracheal tube. May be repeated every three to five minutes while continuing protocol, or administer Vasopressin 40 units via vascular access one time only and continue CPR;

3. Search for reversible causes;