Visio Bradycardia ALS vsd

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					            Marquette County EMS Medical Control Authority
                                                                                                         Part 1 Section 1

Cardiac Problems - Bradycardia/Heart Block                                                                        ALS
                                                                                                                  Protocol
     This Protocol may be used in conjuction
         with the Cardiac Arrest Protocol

                                                                        Special Considerations:
Utilize Universal Precautions                                           -TCP should not be delayed while attempting IV or
Evaluate/maintain airway. Provide oxygen per Airway                     awaiting Atropine to take effect.
Procedure                                                               -Lidocaine is usually contraindicated for ectopy in
Assess adequacy of perfusion; LOC, pulse, b/p, capillary                bradycardia, the ectopy is usually secondary to the
refill                         and signs of CHF.                        bradycardia.
Obtain Baseline history; IPS; & Allergies/'monitor EKG and              -In peds, bradycardia is usually a result of hypoxia
pt.



                     Heart rate < 60                  No                   Go to Shock Protocol

                            Yes

                                                        Consider CPR/Intubation per Airway Procedure
               Unstable with serious signs
                                                Yes     Transcutaneous Pacemaker; See Electrical Therapy Procedure
                     or symptoms1
                                                        Obtain IV access/Consider Sedation for TCP 5 mg Valium IVP
                                                        Atropine 1 mg IVP or ET (2 mg ET) in adult;
                                                                  For peds, [0.02 mg/kg IVP (0.2 ml/kg) Min dose 0.1 mg;
                                                        max dose 1.0 mg]
                                    No                  Repeat Atropine every 3-5 min to a total of 0.04 mg/kg in adult; 3mg
                                                        max.


                             Transport Position of Comfort
                                  Monitor vitals & patient
                         Obtain IV access if not previously done
                     Transport in manner as to not alarm the patient.




                                                                 Possible Post Contact Orders:
                                     Contact                     -Dopamine IV drip; start at 3 mcg/kg/min; titrate to rate and b/p
                                     Medical                     -Epi drip; 1 mg of 1:1,000 into 250 D5W (4mcg/ml) run at 2-10
                                                                 mcg/min
                                     Control
                                                                 -Peds, 0.1 mg/kg of Epi 1:1,000(max of 2mg) diluted to 1ml/kg
                                                                 with NS to max of 10ml; Epi drip not to be used in peds.




Notes:    Treat only symptomatic bradycardia.
1. Serious s/s must be related to the slow rate. Associated
symptoms such as chest pain, dizziness, SOB, fainting, abdominal
pain, sudden or gradual onset of palpitations, proceed with
treatment for bradycardia.
2. Pulse oximetry and CO2 monitoring in low perfusion states may
be unreliable.




                                                 Authentication And Approval:




                                                 Marquette County EMS Medical Director                                   Date:
                                                 Effective Date: 10/19/89; Revision Date: 5/5/98

				
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