According to NYS Department of Health EMS Policy # 04-02 (issued 02/26/04):
It is allowable for an EMT-B to transport a patient with a secured saline lock device in place as long as no fluids or medication are attached to the port . However, the EMT-B must ensure the venous access site is secured and dressed prior to leaving the health care facility.
In the absence of intravenous access, Naloxone (Narcan) may be administered via the intranasal (IN) route when an appropriate atomizer device is available. The route of administration is contraindicated in patients with epistaxis
Available on all TransCare ALS levelambulances and can be ordered through logistics
PHARM TABLE REVISED >14 yrs of age under 40 kg in weight 5 mg/kg ADDED Amiodarone (new) 1 mEq/kg/dose Sodium Bicarbonate 1-2 mg/min REMOVED Lidocaine (infusion) 1.5 mg/kg/dose Lidocaine (bolus) 1 mg/kg/dose Furosemide (Lasix) 0.01 mg/kg/dose Epinephrine 0.02 mg/kg (min 0.1 mg) Atropine Sulfate
For infants and children with non-traumatic cardiac arrest, or infants and children <9 years of age with a HR <60 bpm (severe bradycardia) and signs of inadequate central perfusion ( decompensated shock )
Pediatric AED-capable pads and cables should be used for all pediatric patients aged 1 to 8 (<9 years of age)
Do Not delay or withhold AED for any reason who present in Non Traumatic Cardiac Arrest
CPR in an Infant/Child is performed utilizing compression to ventilation ratio of 15:2
Every application of an AED on a Pediatric patient (even if no shocks were delivered) the ACR will be reviewed by the Agency’s Medical Director and they are required to forward all documentation to REMAC for system wide QA purposes continuing until further notice
Assess the cardiac and respiratory status of the patient.
If both the cardiac and respiratory status of the patient are normal, initiate transport.
If either the cardiac or respiratory status of the patient is abnormal , proceed as follows:
If the patient is having severe respiratory distress or shock and has been prescribed a pediatric(0.15 mg) Epinephrine auto-injector, assist the patient in administering the Epinephrine.
If the patient’s auto-injector is not available or expired, and the EMS agency carries a pediatric (0.15mg) Epinephrine auto-injector, administer the Epinephrine as authorized by the agency’s Medical Director.
500 – Suspected Cyanide Toxicity Or Smoke Inhalation
This protocol should be utilized ONLY for the management of hypotensive patients with suspected cyanide toxicity when:
OLMC has been provided for the management of less than five patients .
At the scene of a mass casualty incident for which a class order issued by a FDNY-OMA Medical Director who is on-scene
or as relayed by an FDNY-OMA Medical Director through OLMC (Telemetry)
Administer, via separate IV lines , the following medications
500 – Suspected Cyanide Toxicity Or Smoke Inhalation NOTE: SODIUM THIOSULFATE, DOPAMINE, and DIAZEPAM MAY NOT BE administered via the same IV line as HYDROXOCOBALAMIN. MCO: Dopamine 5 ug/kg/min, IV/Saline Lock drip. If there is insufficient improvement in hemodynamic status, the infusion rate may be increased until the desired therapeutic effects are achieved or adverse effects appear. (Maximum dosage is 20 ug/kg/min, IV/Saline Lock drip
Cyanide is an extremely toxic poison. In the absence of rapid and adequate treatment, exposure to a high dose of cyanide can result in death within minutes due to the inhibition of cytochrome oxidase resulting in arrest of cellular respiration
Administer Etomidate 0.3 mg/kg, IV/Saline Lock bolus, over 30-60 seconds. (Maximum total dose is 20 mg.) After successful intubation, consider Diazepam 5 mg IV/Saline Lock bolus or Lorazepam 2 mg, IV/Saline Lock or IM, for continued sedation
Midazolam is removed p Etomidate and ∆ to Lorazepam
HYPOTENSION, HYPOVENTILATION, or STUPOR removed from text p morphine use
Mandatory QA Component For every application of CPAP on a patient the ACR will be reviewed by the Agency’s Medical Director and they are required to forward all documentation to REMAC for system wide QA purposes
Endotracheal Administration of Epinephrine completely removed .
AHA ACLS Studies (Circulations Dec. 2005)
some resuscitation drugs may be administered by the endotracheal route, multiple animal studies showed that epinephrine (among other meds) administered into the trachea results in lower blood concentrations than the same dose given intravascularly
Furthermore studies suggest that the lower epinephrine concentrations achieved when the drug is delivered by the endotracheal route may produce transient ß-adrenergic effects. These effects can be detrimental, causing hypotension, lower coronary artery perfusion pressure and flow, and reduced potential for return of spontaneous circulation (ROSC)
Morphine is a Standing Order now with a dosage change (weight based now)
For patients with a systolic blood pressure greater than 110 mmHg, administer Morphine Sulfate 0.1 mg/kg (not to exceed 5 mg), IV/Saline lock bolus. For continued pain, repeat dose of 0.1 mg/kg (not to exceed 5 mg) may be administered.
repeat epinephrine 0.1 mg/kg (0.1 ml/kg of a 1:1,000 sol) via the ETT q 3-5 min if no IV or IO has been established.
THE IV/SALINE LOCK OR IO DOSE OF EPINEPHRINE FOR PEDIATRIC PATIENTS IS 0.01 MG/KG (0.1 ML/KG OF A 1:10,000 SOL). THE ENDOTRACHEAL TUBE DOSE OF EPINEPHRINE FOR PEDIATRIC PATIENTS IS 0.1 MG/KG (0.1 ML/KG OF A 1:1,000 SOL).
Ipratropium Bromide 0.02% (one unit dose vial of 0.5 ml in children 6 years of age or older, one half unit dose vial of 0.5 ml in children under 6 years of age), by nebulizer, may be mixed (if available) with Albuterol Sulfate . (See broselow Tape or Appendix J)
Repeat Epinephrine 0.01 mg/kg (0.01 ml/kg of a 1:1,000 solution), IM, or Terbutaline 0.01 mg/kg, SC, 20 minutes after the initial dose.
Used for cyanide detoxification because it can convert cyanide to the relatively nontoxic thiocyanate ion
The rationale for using methemoglobin-inducers in cyanide poisoning is based on methemoglobin's ferric iron ability to bind cyanide, thus freeing the cytochrome and allowing aerobic cellular respiration to continue.
the IV sodium thiosulfate converts cyanmethemoglobin (converted by the Hydroxocobalamin ) to thiocyanate sulfite and hemoglobin. Thiocyanate is then excreted.
So, administration of sodium thiosulfate improves the ability of the hydroxycobalamin to detoxify cyanide poisoning