On behalf of GMVEMSC Standing Orders Chairperson, John Russell and Dr. Marriott, Region 3 RPAB Chair, a Just in Time Standing Order (JITSO) is now in effect. Paramedics are authorized to use either Calcium Chloride or Calcium Gluconate, whichever is available. See below for the full JITSO.
Subject: CALCIUM GLUCONATE JITSO
We are experiencing a critical shortage of CALCIUM CHLORIDE, and therefore CALCIUM GLUCONATE may be in any drug bag. Please refer to page 72 (below) of the Standing Orders.
This email serves as notice that the CALCIUM GLUCONATE "Just In Time Standing Order" is now in effect. If calcium is indicated, and CALCIUM GLUCONATE is in the drug bag, this JITSO is to be followed.
CALCIUM GLUCONATE
(JITSO)
PACKAGED: 1 gram in 10 ml vial, 100 mg/ml
INDICATIONS: Renal dialysis patient in cardiac arrest or ♦ bradycardia. Calcium Channel Blocker OD Hydrofluoric Acid exposure with tetany OR cardiac arrest. Tetany may present as: overactive neurological reflexes, spasms of the hands and feet, cramps, and laryngospasm. Prophylactically, after exposure to Hydrofluoric Acid Crush syndrome
ADULT: Cardiac Arrest, CCB OD and Hydrofluoric Acid exposure with tetany or cardiac arrest: 1 g (10 ml) IV Hydrofluoric Acid Exposure Prophylaxis: 400 mg IV (4 ml) Crush: 1 gm
PEDI: Cardiac Arrest & OD: 20 mg/kg IV (max dose 500 mg in Calcium Channel Blocker OD) ♦ Crush:
THERAPEUTIC ACTION: Antagonizes cardiac toxicity in hyperkalemia associated with dialysis patients. Reverses symptoms of Calcium Channel Blocker
CONTRAINDICATIONS:
PRECAUTIONS AND SIDE EFFECTS: Bradycardia (may cause asystole), hypotension, metallic taste, severe local necrosis and sloughing following IV infiltration; may produce vasospasm in coronary and cerebral arteries. Hypertension and bradycardia may occur with rapid administration. Do not administer with Sodium Bicarbonate because if the two substances are mixed, a precipitate develops. Flush tubing between drugs.
REQUIRES MCP: ADULT: Arrest--No Calcium Channel Blocker OD—Yes Renal dialysis patient in bradycardia - Yes Hydrofluoric Acid Exposure—Yes Prophylaxis—Yes Crush syndrome--Yes PEDI: Arrest—No Calcium Channel Blocker OD—Yes Crush syndrome—Yes
David N. Gerstner, President
Greater Miami Valley EMS Council
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