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A comprehensive overview of paramedic protocols for various medical emergencies, including allergic reactions, cardiac arrest, and abdominal pain. it details dosages and treatment algorithms for adults and pediatrics, covering medications like adenosine, albuterol, amiodarone, atropine, and more. the protocols are presented in a clear, concise format, making them suitable for both educational and practical use in emergency medical settings. The information is valuable for students and professionals alike.
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Adenosine
Protocols:
Action:
Dose: (Adult & Peds) for (SVT-Unstable/Stable)
Contraindications: ✔✔Protocols:
Action:
Adult:
6mg or 12mg RIVP
(Stable SVT: 6mg, 12mg)
Peds:
0.1-0.2 mg/kg RIVP never to exceed 12mg
(Stable SVT: 0.1mg/kg not to exceed 6mg; 0.2mg/kg not to exceed 12mg)
(Unstable SVT: 0.2mg/kg not to exceed 12mg)
Contraindications:
Albuterol
Protocols:
Dose: (Adult & Peds) ✔✔Protocols:
(Cardiac Arrest) 300mg initial; 150mg after 5th shock
(Stable/Unstable - Wide Tachycardia) 150mg in 50cc NS over 10 minutes
Pediatric:
(Cardiac Arrest) 5mg/kg; may repeat once after 5th shock
(Stable/Unstable- Wide Tachycardia) 5mg/kg in 50cc NS over 20 minutes
Contraindications:
Atropine
Protocols:
Class:
Action:
Dose: ✔✔Protocols
Class
Action
Adult
(Bradycardia) 0.5mg IVP; q 3-5 minutes; Max dose 3mg
(Organophosphate Toxicity) 2.0mg IV; q 15 minutes as needed
Peds
(Bradycardia) 0.02mg/kg; minimum dose 0.1mg; q x1 in 5 minutes
(Organophosphate Toxicity) 0.02mg/kg; minimum dose 0.1mg; q as needed
Calcium Chloride
Protocols:
Class:
NS Bolus for Adult Trauma (no palpable pulse) ✔✔1 Liter NS bolus
When should treatment be performed ✔✔Enroute when possible; do not delay transport
NS bolus for pediatric trauma (no palpable pulse) ✔✔NS 20mg/kg bolus
NS Bolus Adult (Abdominal Flank Pain Nausea & Vomiting) ✔✔500 ml NS bolus; may repeat up to 2 liters
Nausea or Vomiting Medications (Adult Abd. Flank/Pain N/V) ✔✔Ondansetron: 4.0mg ODT/IM/IV/IO or
Droperidol: 1.25mg IM/IV/IO or
Metoclopromide: 10mg slow IV bolus over 1-2 minutes or IM; or
Prochlorperazine: up to 10mg IV/IM/IO
Pain Management (Adult Abd/Flank Pain, N/V) ✔✔Ketamine (Not for CP/Susp. ACS or SEMI Protocols): 0.2mg/kg IM/IN/IV/IO No repeat dose
Morphine: 0.1mg/kg IM/IV/IO; max single dose 10mg. May repeat dose every 10 minutes until pain relieved or respiratory depression occurs
Fentanyl: 1.0 mcg/kg IN/IM/IV/IO; max single dose 100mcg. May repeat dose after 10 minutes.
Hydromorphone: 0.1mg/kg IM/IV/IO; max single dose 1.0mg ; May repeat dose after 10 minutes
Meds for Nausea Vomiting after pain administration (Adult Pain Management) ✔✔Ondansetron: 4.0mg ODT/IM/IV/IO or
Droperidol: 1.25mg IM/IV/IO
Metoclopramide: 10mg slow IV bolus over 1-2 minutes or IM; or
Prochlorperazine: up to 10mg IV/IM/IO
Neuro Disorders or signs of hypoperfusion/shock in the presence of abdominal pain may indicate what? ✔✔aneurysm
Pediatric Hypovolemia or witnessed vomiting NS dose ✔✔20mL/kg ; may repeat up to 60mL/kg
if suspicion of DKA do not exceed 20mL/kg
Adult Allergic Reaction; in Shock (drugs and algorithm) ✔✔Albuterol: 2.5mg SVN as needed
IV Access
500mL bolus may repeat up to 2 Liters
Diphenhydramine: 50mg
Push-Dose Epinephrine: 1:100,00 5.0mcg-10.0mcg IV/IO may repeat every 2-5 minutes to maintain SBP >
Consider Dopamine for hypotension refractory to administration of Epinephrine: 5- 20mcg/kg/min titrated to SBP>
Notify Receiving Hospital
Pediatric Allergic Reaction evidence of airway involvement/breathing difficulties (treatment algorithm) ✔✔Epinephrine 1:1,000 0.01mg/kg IM; max single dose 0.5 mg may repeat every 5 minutes up to max of 1.5mg
Albuterol 2.5mg SVN repeat as needed
ventilation management; cardiac monitor, IV access
20mL/kg NS bolus may repeat up to 60mL/kg
Diphenhydramine 1.0mg/kg IM/IV; max 50mg. PO: <6yo: 12.5mg; 6-12yo: 25mg; >12yo 50mg
Adult Altered Mental Status/Syncope (BGL >60) NS Bolus ✔✔Consider 500mL IV; may repeat up to 2 Liters
Adult Altered Mental Status/Syncope (BGL <60) D10 dose ✔✔25g (250mL of 10% solution) may repeat x1 in 5 minutes
Adult Altered Mental Status/Syncope (BGL <60) Glucagon Dose ✔✔1.0mg IM for no IV access
Adult Behavioral Emergency (Possible Causes) 1-5 ✔✔Hypoxia
Intoxication/Overdose
Hypoglycemia/Electrolytes
Head Injury
Post-ictal State
Adult Behavioral Emergency (Suspected Excited Delirium) ✔✔Ketamine: 2.0mg/kg IV/IO or 2- 4mg/kg IM
Adult Behavioral Emergency (Threat to others persistent risk) ✔✔Midazolam: 0.1mg/kg IN/IM/IV/IO may repeat every 5 minutes at 0.05mg/kg; or
Diazepam: 5.0mg IV/IO may repeat every 5 minutes; or
Droperidol: 1.25mg IM/IV/IO followed by saline flush or bolus; may repeat dose every 5 minutes
Dystonic Reaction Typically an adverse reaction to ✔✔Haloperidol
Dystonic Reaction Diphenhydramine dose ✔✔50mg IM/IV/IO
