Per Dr. Marriott, GMVEMSC Medical Director and Chair, Region 3 RPAB:
Due to a nationwide shortage of Amiodarone, some GMVEMSC drug bags MAY NOT contain Amiodarone now or in the future. In those circumstances ONLY, this JITSO is to be followed authorizing use of Lidocaine as below. Lidocaine infusions will not be utilized. As always, if there are concerns, contact Medical Control.
CARDIAC ARREST: V-FIB or PULSELESS V-TACH
· If in arrest, initiate quality CPR and proceed to first defibrillation as soon as possible.
· First Defib:
A 360 J for monophasic or use manufacturer’s recommendations for biphasic.
R 2 J/kg or biphasic equivalent.
· CPR for 1-2 minutes
· Repeat cycles of CPR - shock - drug
· Second Defib:
A 360 for monophasic or use manufacturer’s recommendations for biphasic.
R 4 J/kg or biphasic equivalent.
A Epinephrine 1 mg 1:10,000, IV or IO, repeat every 3-5 minutes.
R Epinephrine (1:10,000) 0.01 mg/kg, IV or IO, repeat every 3-5 minutes.
· CPR for 1-2 minutes
· Third Defib:
A 360 for monophasic or use manufacturer’s recommendations for biphasic.
R 6 J/kg or biphasic equivalent.
· Amiodarone:
A 300 mg, IV or IO
R 5 mg/kg IV or IO (max first dose 300 mg)
***IF AMIODARONE NOT AVAILBLE USE LIDOCAINE***
· Lidocaine:
A 150 mg, IV/IO
· 1.0 mg/kg IV/IO (Max first dose 100 mg)
· CPR for 1-2 minutes
· Fourth Defib:
A 360 for monophasic or use manufacturer’s recommendations for biphasic.
· 8 J/kg or biphasic equivalent.
A Epinephrine 1 mg 1:10,000, IV or IO, repeat every 3-5 minutes.
· Epinephrine (1:10,000) 0.01 mg/kg, IV or IO, repeat every 3-5 minutes.
· Continue CPR and repeat treatment as indicated
· Fifth Defib:
A 360 for monophasic or use manufacturer’s recommendations for biphasic.
· 8 J/kg or biphasic equivalent.
A Epinephrine 1 mg 1:10,000, IV or IO, repeat every 3-5 minutes.
· Epinephrine (1:10,000) 0.01 mg/kg, IV or IO, repeat every 3-5 minutes.
· Continue CPR and repeat treatment as indicated
· Sixth Defib:
A 360 for monophasic or use manufacturer’s recommendations for biphasic.
· Fifth and successive defibrillations will be at 10 J/kg or biphasic equivalent
· Repeat Amiodarone, IV or IO after approximately10 minutes:
A 150 mg IV or IO
R 5 mg/kg, (max second dose 150 mg)
***IF AMIODARONE NOT AVAILBLE USE LIDOCAINE ***
· Repeat Lidocaine, IV/IO after 10 minutes:
A 75 mg, IV/IO
R 1.0 mg/kg, (Max second dose 100 mg)
· {12-lead EKG}
· Consider treatable causes.
A If patient converts with ROSC from a ventricular arrhythmia and no anti-arrhythmic has been given, then administer Amiodarone 150 mg in 250 ml NS, IV over 10 minutes using 60 drop/ml tubing.
TACHYCARDIA: ADULT ONLY
A Obtain {12-lead EKG}.
Stable:
A Narrow Complex - Regular
o Vagal maneuvers
o Adenosine 6 mg rapid IVP
§ If patient has history of Paroxysmal Supraventricular Tachycardia (PSVT) and advises it takes 12 mg of Adenosine, then skip the 6 mg dose.
o May repeat Adenosine 12 mg rapid IVP x 2.
A Wide Complex – Regular or Irregular
o Amiodarone 150 mg in 250 cc NS, IV over 10 minutes using 60 drop tubing wide open with 18 gauge needle.
***IF AMIODARONE NOT AVAILBLE USE LIDOCAINE***
o Lidocaine 150 mg IV/IO
Unstable:
An unstable patient is defined as a patient who is hypotensive or unconscious when the hypotension or altered mental status is thought to be due to the patient’s tachycardia. Do not cardiovert patients without hemodynamic changes or patients whose hemodynamic changes have other apparent causes (e.g., blood loss).
A Consider Midazolam 2 mg slow IV prior to cardioversion.
A Cardioversion: 100, 200, 300, 360 J for monophasic or biphasic equivalent
NOTE: The current Pediatric Tachycardia Protocol does NOT include Amiodarone OR Lidocaine and is unaffected by this JITSO.
David N. Gerstner, President
Greater Miami Valley EMS Council
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