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The Valley Hospital Mobile ICU
Standing Orders / Communications Failure Orders
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5. If the patient does not improve after the epinephrine, administer Epinephrine 1:1000 1-10
mcg/min IV/IO drip.
6. If the patient develops severe respiratory failure or respiratory arrest, refer to the Standing
Orders and Communications Failure Orders for Advanced Airway Management
(b) The following Communications Failure Orders are authorized in the event that the patient is
presenting with an exacerbation of COPD:
1. Administer Methylprednisolone Sodium Succinate 125 mg or Dexamethasone Sodium
Phosphate 10 mg IV/IO over one to two minutes.
2. Administer Normal Saline 500 mL IV/IO bolus.
3. If the patient presents in moderate to severe respiratory distress or respiratory failure that
does not respond to initial therapy, initiate Continuous Positive Airway Pressure (CPAP)
and establish secondary IV/IO access if possible.
a. Use with caution and frequently re-examine patient. If a tension pneumothorax
develops, refer to the Standing Orders and Communications Failure Orders for
Advanced Airway Management
4. If the patient develops severe respiratory failure or respiratory arrest, refer to the Standing
Orders and Communications Failure Orders for Advanced Airway Management