Paramedic Kardex

The is a quick reference ONLY to the Policies and Guidelines set by OCEMSA.
All specific Treatment Guidelines questions should be directed to the OCEMSA Website.
Adult
Bradycardia
Algorithm
If symptomatic or deteriorating bradycardia with HR < 60 BPM
►Initiate Pacing (See Transcutaneous Pacing)
Transcutaneous Pacing
Set Rate at 70 BPM and mAto 0
Slowly increase mA until electrical (Monitor) and mechanical (Pulse) capture (max 120 mA) If still symptomatic increase the heart rate from 70 BPM (max of 100 BPM)
►Establish IV Access (Do not delay pacing to establish IV)
►250 mL NS bolus IV, repeat to max of 1 liter
If causing anxiety or extreme discomfort and BP greater than 90 systolic
►Versed (Midazolam): up to 5 mg IV titrate to attain sedation
If IV cannot be established and BP greater than 90 systolic
▼
►Versed (Midazolam): 5 mg IN (may repeat once after 3 minutes)
If Transcutaneous Pacing fails to capture and pace heart, stop pacing current and administer:
▼
►Atropine: 0.5 mg IV / IM approximately every 3 minutes as needed to correct bradycardia to a max of 3 mg
For systolic BP less than 90 (paced or not capture) or no response to Atropine; and Lungs clear:
▼
Establish IV
If BP < 90 systolic and lungs clear
▼
►250 mL NS bolus IV, may repeat 3 times to 1 liter
(assess lung sounds, discontinue fluid infusion if rales develop)
▼
OK to try Pacing again after admin of drugs and fluids
Obtain 12-Lead EKG if immediate pacing not required
BHC – Base Contact for all pacing pt’s for possible CVRC designation