M1 Medical

Establish 2 large bore IVs of Normal Saline or Lactated Ringers as necessary, to maintain a blood pressure greater than 90 mm/Hg systolic.

Interfacility

If systolic BP greater than 120, initiate antihypertensive

• Labetalol IV bolus dose is 0.25 mg/kg. This may be doubled in 10 minutes and then doubled again in 10 minutes with repeat doubling until a desired effect is reached or until cumulative dose of 300 mg has been given.
• Cardene 5mg/hr (50 ml/hr) may increase q 15 min by 2.5 mg/hr. No more than 15 mg/hr
• o If systolic BP is < 90, only initiate vasopressors if evidence of altered mental status or imminent cardiac arrest.

Fentanyl 1-2 mcg/kg IV every 10 minutes as needed for pain management. Hold if systolic BP <90.

Confirm dissection with CT of Chest/Abdomen, If unable to confirm dissection via CT do not follow this protocol

• Target systolic BP of < 120
• If systolic BP greater than 120, initiate Cardene 5mg/hr (50 ml/hr) may increase q 15 min by 2.5 mg/hr. No more than 15 mg/hr

If noted tachycardia or HR > 100 may administer 5mg of IV Lopressor, may repeat every 5 minutes; hold if systolic blood pressure is <90 or a heart rate <60 bpm

If systolic BP is < 90, Only Initiate Vasopressors if evidence of altered mental status or imminent cardiac arrest

May use Fentanyl 1-2 mcg/kg IV every 10 minutes as needed for pain management. Hold if systolic BP <90.

• Criteria for suspected sepsis and 2 or more of the following:
• Fever >100.5
• HR > 100
• RR >20 or PaCO2 < 32
• WBC <4000 or > 12000

• Fluid bolus 20 mg/kg in the first 2 hrs
• Repeat 500 ml boluses and reassess

Dopamine or Levophed 5-30 mcg/min

Blood glucose

Versed 1-2 mg IV repeat as necessary.

or

Ativan 2 mg IV/IM and 50 mg IV/IM Benadryl

Glucose > 250 mg/dL

Insulin 0.1 unit/kg IV followed by infusion of 0.1 unit/kg/hr

Mix 25 units in 250 ml NS= 1 unit/10 ml

Temp

Ice packs

Valium 2.5-5 mg IV for shivering

Cool NS 125 ml/hr unless hypotensive

lab value present > 6.0 or clinical suspicion

fluid replacement as needed

• 10 units insulin IV with 1 amp D50
• hold D50 if glucose > 250 mg/dL

Albuterol 10-20 mg in 4 ml inhalation

1 amp Sodium Bicarb, may repeat if QRS > 120 or absent p wave

1 gram Calcium Gluconate IV over 3 minutes with QRS > 120 or loss of P wave. May repeat every 5 min x 3 until ECG resolves....first line in unstable pts.

10-20 ml/kg LR or NS WO, repeat to maintain BP > 90.

In the setting of pulmonary edema consider vasopressors, refrain from fluid

Dopamine 5-30 mcg/kg/min

Levophed 2-30 mcg/min

ETCO2, monitor, SpO2, definitive airway

Normotensive BP >90

• Zemuron 1 mg/kg, IV x 1
• Fentanyl 1 mcg/kg IV every 10 as needed
• Versed 1-2 mg IV every 5, max 8mg in 1 hr

Hypotensive BP < 90

• Zemuron 1 mg/kg IV x 1
• Fentanyl 1 mcg/kg every 10 unless decrease in BP > 6 mmHg
• Ketamine 1 mg/kg every 10 as needed