Emergency Cardiac Care for BLS Algorithm
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What is the initial step in the Universal Algorithm for Pediatric Emergency Cardiac Care for BLS?

  • Provide oxygen as needed (correct)
  • Ventilate as needed with a target ventilation rate of 20 bpm
  • Perform a detailed assessment of vital signs and history
  • Attach AED with pediatric capability

    • What is the compression rate for High-Performance CPR (HPCPR) in pediatric emergency cardiac care?

  • 140-160 compressions/minute
  • 80-100 compressions/minute
  • 100-120 compressions/minute (correct)
  • 120-140 compressions/minute

    • When should you refer to the Newly Born Protocol in pediatric emergency cardiac care?

  • If the patient is greater than 1 hour old
  • If the patient is greater than 13 years old
  • If the patient is less than 1 hour old (correct)
  • If the patient is less than 13 years old

    • What is the target ventilation rate for ventilation in pediatric emergency cardiac care?

    <p>20 bpm</p> Signup and view all the answers

    What is the indication for the Adult Bradycardia Algorithm?

    <p>Slow heart rate, less than 60 bpm</p> Signup and view all the answers

    What should you assess and treat for in the Adult Bradycardia Algorithm?

    <p>Hypotension or hypoperfusion</p> Signup and view all the answers

    What is the indication for the Pediatric Bradycardia Algorithm?

    <p>Slow heart rate, refer to Normal Vital Signs Chart</p> Signup and view all the answers

    How often should you reassess vital signs in the Adult Bradycardia Algorithm?

    <p>Every 5 minutes</p> Signup and view all the answers

    When should you begin CPR for a pediatric patient with bradycardia?

    <p>If HR is less than 60 with signs of poor perfusion despite oxygenation and ventilation</p> Signup and view all the answers

    What is the initial action for a patient in cardiac arrest?

    <p>Perform high-quality uninterrupted chest compressions as soon as possible</p> Signup and view all the answers

    When should you transport a patient in cardiac arrest?

    <p>After five two-minute cycles of chest compressions and rhythm interpretation</p> Signup and view all the answers

    What is an exemption from on-scene resuscitation for a patient in cardiac arrest?

    <p>Physical barriers prevent resuscitation</p> Signup and view all the answers

    What should be done for a pregnant patient in cardiac arrest?

    <p>Provide constant left lateral uterine displacement</p> Signup and view all the answers

    What is the primary goal of on-scene resuscitation for a patient in cardiac arrest?

    <p>To perform a minimum of five two-minute cycles of chest compressions and rhythm interpretation</p> Signup and view all the answers

    How often should vital signs be reassessed for a patient with bradycardia?

    <p>Every 5 minutes</p> Signup and view all the answers

    What should be done for a patient who is in cardiac arrest and has a traumatic etiology?

    <p>Provide treatments for reversible causes per Trauma Protocol</p> Signup and view all the answers

    What is the primary responsibility of BLS clinicians for a patient in cardiac arrest?

    <p>To resuscitate the patient in place without transporting</p> Signup and view all the answers

    What should be done during the rhythm analysis periods and during shocks for a patient in cardiac arrest?

    <p>Limit breaks in compressions to 10 seconds or less</p> Signup and view all the answers

    What is the recommended minimum number of two-minute cycles of chest compressions and rhythm interpretation for patients with a medical etiology in cardiac arrest?

    <p>15 cycles</p> Signup and view all the answers

    What is the primary focus of the Pediatric High-Performance CPR (HPCPR) algorithm?

    <p>Chest compressions and rhythm interpretation</p> Signup and view all the answers

    When can clinicians transport a patient in cardiac arrest?

    <p>After the initial on-scene resuscitation is complete</p> Signup and view all the answers

    What is the recommended depth of chest compressions for pediatric patients less than 1 year old?

    <p>1 ½ inches (4 cm)</p> Signup and view all the answers

    What is the role of Clinician #2 in the Pediatric HPCPR team?

    <p>Ventilate at 2 breaths:15 compressions and attach AED</p> Signup and view all the answers

    What is the indication for continuing to support ventilations in a patient who has achieved ROSC?

    <p>Patient is still apneic</p> Signup and view all the answers

    What is the recommended rate of chest compressions in the Pediatric HPCPR algorithm?

    <p>100-120 per minute</p> Signup and view all the answers

    What is the exemption from on-scene resuscitation for patients who are physically trapped?

    <p>Do not resuscitate the patient</p> Signup and view all the answers

    What is the primary focus of the Cardiac Arrest – Pediatric algorithm?

    <p>Chest compressions and rhythm interpretation</p> Signup and view all the answers

    What is the recommendation for left lateral uterine displacement in pregnant patients greater than 20 weeks gestation in cardiac arrest?

    <p>Perform left lateral uterine displacement constantly</p> Signup and view all the answers

    What should EMS clinicians do if they believe that resuscitation or further resuscitative efforts are futile?

    <p>Initiate the Termination of Resuscitation protocol</p> Signup and view all the answers

    What is the significance of a verbal revocation by the patient?

    <p>It is only valid for the current response</p> Signup and view all the answers

    In pediatric patients resuscitated from traumatic arrest, which of the following is an independent predictor of mortality?

    <p>Asystole</p> Signup and view all the answers

    What should EMS clinicians do if they find a MOLST form or other acceptable EMS/DNR Order?

    <p>Do not initiate resuscitative measures</p> Signup and view all the answers

    When can BLS clinicians terminate resuscitation for adult patients?

    <p>If the patient has received a minimum of 15 two-minute cycles of HPCPR and during the five AED analyses immediately prior to TOR there was 'no shock advised'</p> Signup and view all the answers

    Who can revoke an EMS/DNR Order verbally?

    <p>Only the patient</p> Signup and view all the answers

    What should EMS clinicians do if they encounter an EMS/DNR patient who is conscious and able to communicate?

    <p>Treat and transport the patient as appropriate</p> Signup and view all the answers

    Which of the following patients should not be terminated from resuscitation efforts?

    <p>All of the above</p> Signup and view all the answers

    What should be done for pediatric patients who have been revived from cardiac arrest due to a medical etiology?

    <p>All of the above</p> Signup and view all the answers

    What is the scope of interventions permissible under Option A-1, MOLST?

    <p>Full scope of interventions, including intubation</p> Signup and view all the answers

    What should EMS clinicians do if they encounter a patient on an outpatient ventilator who is not in cardiac arrest?

    <p>Maintain ventilator support during transport</p> Signup and view all the answers

    When can TOR be considered for pediatric traumatic arrest patients?

    <p>If the patient is under 15 years old and meets specific criteria</p> Signup and view all the answers

    What is the role of the authorized decision-maker in revoking an EMS/DNR Order?

    <p>They must void or withhold all EMS/DNR Order devices</p> Signup and view all the answers

    What is the focus of treatment for traumatic arrest patients?

    <p>Identifying and treating reversible causes during the resuscitative window</p> Signup and view all the answers

    What should EMS clinicians do if they are unsure about the validity of an EMS/DNR Order?

    <p>Consult with a Base Station</p> Signup and view all the answers

    Which of the following is NOT an exclusion for termination of resuscitation?

    <p>Patients in cardiac arrest due to medical etiology</p> Signup and view all the answers

    What is the significance of documenting the revocation of an EMS/DNR Order?

    <p>It is necessary to document the revocation thoroughly</p> Signup and view all the answers

    What should be done for patients who have been revived from cardiac arrest due to a medical etiology?

    <p>Continue to support ventilations and frequently reassess vital signs</p> Signup and view all the answers

    Which of the following is a criterion for terminating resuscitation efforts for adult patients?

    <p>All of the above</p> Signup and view all the answers

    According to the Maryland law, what is the definition of death?

    <p>Irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem</p> Signup and view all the answers

    When can EMS clinicians pronounce the death of a patient?

    <p>When one or more of the following criteria have been met: decapitation, rigor mortis, decomposition, dependent lividity, or pulseless, apneic patient in a multi-casualty incident</p> Signup and view all the answers

    What should EMS clinicians do when a patient is an organ donor and law enforcement has released the body to the family?

    <p>Assist the family in calling Infinite Legacy</p> Signup and view all the answers

    What is required for an obviously pregnant female patient who is pulseless and apneic?

    <p>Initiation of resuscitation and transportation to the closest appropriate facility</p> Signup and view all the answers

    What is MOLST A-1?

    <p>Do not attempt resuscitation (no CPR) prior to arrest, and maximal restorative efforts including intubation prior to arrest</p> Signup and view all the answers

    What is required when a MOLST Form or Acceptable EMS DNR Order is presented to EMS?

    <p>Honoring the patient's wishes as stated in the MOLST Form or Acceptable EMS DNR Order</p> Signup and view all the answers

    What is an acceptable DNR Order?

    <p>Out-of-state EMS/DNR Form</p> Signup and view all the answers

    How can an EMS/DNR Order be revoked?

    <p>By verbal statement by the patient made directly to EMS clinicians requesting resuscitation or palliative care only</p> Signup and view all the answers

    What is the procedure when death is pronounced during transport?

    <p>Both A and B</p> Signup and view all the answers

    What should EMS clinicians do when a patient is found to be pulseless and apneic in a multi-casualty incident?

    <p>Pronounce the patient dead and prioritize living patients</p> Signup and view all the answers

    What should be done if VAD batteries require changing?

    <p>Only change one battery at a time</p> Signup and view all the answers

    What should be documented in the patient care report for suspected child or vulnerable adult abuse or neglect?

    <p>The patient's statements and the environment's condition</p> Signup and view all the answers

    What is the primary goal when dealing with a patient with mild agitation symptoms?

    <p>Attempt verbal de-escalation and provide emotional support</p> Signup and view all the answers

    Who should be contacted in case of a VAD-related complication?

    <p>The VAD coordinator or a VAD-trained companion</p> Signup and view all the answers

    What should be done when suspecting child or vulnerable adult abuse or neglect?

    <p>Report the case directly to the local police or social service agency</p> Signup and view all the answers

    What should be done when dealing with a patient who is physically violent and presents an immediate threat to themselves or others?

    <p>Call law enforcement for assistance and maintain scene safety</p> Signup and view all the answers

    What should be documented in the patient care report for agitation cases?

    <p>All of the above</p> Signup and view all the answers

    What should be done when dealing with a patient who has mild agitation symptoms and is cooperative?

    <p>Attempt verbal de-escalation and provide emotional support</p> Signup and view all the answers

    What is the primary responsibility of BLS clinicians when dealing with a VAD patient?

    <p>To recognize and report any complications</p> Signup and view all the answers

    What should be done when transporting a patient with a VAD-related complication?

    <p>Transport the patient to the medical facility where the VAD was placed</p> Signup and view all the answers

    What should be done with a patient's IV lines during transport for pain control or symptom management?

    <p>Maintain them in place</p> Signup and view all the answers

    What should be done with a patient's DNR or Medical Alert Bracelets or Necklaces after death?

    <p>Leave them with the patient</p> Signup and view all the answers

    What should be done if the patient loses spontaneous respirations or palpable pulse during transport?

    <p>Withdraw resuscitative efforts</p> Signup and view all the answers

    What should be done for a patient with uncontrolled pain or symptoms?

    <p>Initiate the Pain Management protocol</p> Signup and view all the answers

    What should be done if a patient's MOLST or EMS/DNR Order is unclear or unreadable?

    <p>Obtain medical consultation</p> Signup and view all the answers

    What should be done for a patient with chest pain or discomfort?

    <p>All of the above</p> Signup and view all the answers

    What should be done if a patient meets the 'Pronouncement of Death' criteria?

    <p>Do not attempt resuscitation</p> Signup and view all the answers

    What should be done for a patient with external bleeding?

    <p>All of the above</p> Signup and view all the answers

    What should be done with a patient's MOLST or EMS/DNR Order during transport?

    <p>Transport it with the patient to the emergency department or inpatient hospice facility</p> Signup and view all the answers

    Who should be notified in the case of sudden or unanticipated death?

    <p>Both law enforcement and medical examiner's office</p> Signup and view all the answers

    What is the maximum number of doses of nitroglycerin that can be given to a patient?

    <p>3</p> Signup and view all the answers

    What is the indication for implantable cardioverter defibrillator (ICD) malfunction?

    <p>Three or more distinct ICD shocks and obvious device malfunction</p> Signup and view all the answers

    What is the EKG criterion for ST Elevation Myocardial Infarction (STEMI)?

    <p>New ST elevation of 1 mm in two or more anatomically contiguous leads</p> Signup and view all the answers

    What is the initial assessment for a patient with a ventricular assist device (VAD)?

    <p>Assess level of consciousness and vitals, noting that most VAD patients will not have a palpable pulse or detectable systolic and diastolic blood pressures</p> Signup and view all the answers

    What should be done if the patient has altered mental status but has other signs of adequate perfusion?

    <p>Assess for causes of altered mental status</p> Signup and view all the answers

    What should be done if the patient is unresponsive and has abnormal perfusion?

    <p>Initiate manual chest compressions and ventilations</p> Signup and view all the answers

    What should be assessed during the care of a patient with a VAD?

    <p>All of the above</p> Signup and view all the answers

    What is the normal range for mean arterial pressure (MAP) in a patient with a VAD?

    <p>60-90 mmHg</p> Signup and view all the answers

    What should be done for a patient with a VAD who has symptoms of cardiovascular compromise or cardiac arrest?

    <p>Assess level of consciousness and vitals, noting that most VAD patients will not have a palpable pulse or detectable systolic and diastolic blood pressures</p> Signup and view all the answers

    What is the contraindication for nitroglycerin administration?

    <p>Both A and B</p> Signup and view all the answers

    What is the dosage of nebulized albuterol for pediatric patients less than 2 years of age with wheezing, bronchospasm, or shortness of breath?

    <p>1.25 mg</p> Signup and view all the answers

    What is the indication for administering epinephrine auto-injector to a pediatric patient?

    <p>Acute onset of severe illness after exposure to a known allergen with two or more of the following: urticaria, respiratory compromise, hypotension, or GI symptoms</p> Signup and view all the answers

    What should be assessed in a patient with suspected anaphylaxis?

    <p>Pulse, vital signs, and blood glucose</p> Signup and view all the answers

    What is the dosage of epinephrine for a pediatric patient less than 5 years of age with anaphylaxis?

    <p>0.15 mg IM</p> Signup and view all the answers

    When should additional doses of epinephrine, albuterol, ipratropium, or diphenhydramine be administered?

    <p>Only after medical consultation</p> Signup and view all the answers

    What is the indication for administering albuterol inhaler to an adult patient with anaphylaxis?

    <p>Wheezing, bronchospasm, or shortness of breath</p> Signup and view all the answers

    What should be reassessed in a patient with anaphylaxis after administering epinephrine and antihistamines?

    <p>Vital signs, blood glucose, and pulse oximetry</p> Signup and view all the answers

    What is the dosage of epinephrine auto-injector for an adult patient with anaphylaxis?

    <p>0.3 mg IM</p> Signup and view all the answers

    What should be done if blood pressure goals are not met upon reaching epinephrine infusion rate of 2 mL/min?

    <p>Obtain medical consultation</p> Signup and view all the answers

    What should be done for a pediatric patient with anaphylaxis who does not respond to initial treatment?

    <p>Obtain medical consultation for further guidance</p> Signup and view all the answers

    What is the correct concentration of epinephrine for the IM route only?

    <p>1 mg/mL</p> Signup and view all the answers

    What is the indication for pediatric epinephrine infusion?

    <p>Refractory anaphylactic shock</p> Signup and view all the answers

    What is the age range for an apparent life-threatening event/brief resolved unexplained event (ALTE/BRUE)?

    <p>Less than 2 years old</p> Signup and view all the answers

    What should be assessed during the medical history for an ALTE/BRUE patient?

    <p>Current medications, chronic diseases, current or recent infections, evidence of seizure activity, gastro-esophageal reflux, or recent trauma</p> Signup and view all the answers

    What should be done if the parent or guardian refuses medical care or transport for an ALTE/BRUE patient?

    <p>Consult with a Pediatric Base Station physician</p> Signup and view all the answers

    What is the primary goal for an ALTE/BRUE patient?

    <p>To identify the underlying cause of the event</p> Signup and view all the answers

    What should be done during transport for an ALTE/BRUE patient?

    <p>Support ventilation and provide oxygen</p> Signup and view all the answers

    Why should all suspected ALTE/BRUE patients be transported for further medical evaluation?

    <p>Because they may have a serious underlying illness or injury</p> Signup and view all the answers

    What is the primary concern for patient or clinician safety in a patient with agitation?

    <p>No immediate concern</p> Signup and view all the answers

    What is the initial action in a patient with mild agitation?

    <p>Verbal de-escalation</p> Signup and view all the answers

    What is the indication for epinephrine auto-injector in a pediatric patient with an allergic reaction?

    <p>History of life-threatening allergic reaction to same allergen</p> Signup and view all the answers

    What is the dose of epinephrine auto-injector for a pediatric patient less than 5 years old with an allergic reaction?

    <p>0.15 mg IM</p> Signup and view all the answers

    What is the indication for albuterol inhaler in a patient with an allergic reaction?

    <p>Moderate symptoms such as hives and mild wheezing</p> Signup and view all the answers

    What is the recommended route of administration for epinephrine in a patient with an allergic reaction?

    <p>IM</p> Signup and view all the answers

    What should be reassessed prior to administration of epinephrine in a patient with an allergic reaction?

    <p>Dosing and concentration of epinephrine</p> Signup and view all the answers

    What is the recommended action for a patient with an allergic reaction who requires additional doses of epinephrine beyond the initial dose?

    <p>Consult with medical control</p> Signup and view all the answers

    What is the significance of pharyngeal swelling in a patient with an allergic reaction?

    <p>Severe symptom</p> Signup and view all the answers

    What is the indication for nebulized albuterol in a patient with an allergic reaction?

    <p>Moderate symptoms such as hives and mild wheezing</p> Signup and view all the answers

    Study Notes

    Adult Emergency Cardiac Care for BLS – Algorithm

    • Indications for adult emergency cardiac care include slow heart rate, bradycardic patients, and patients with serious signs and symptoms such as chest pain, shortness of breath, and hypotension.
    • Assess and treat for shock, if indicated, and continuously monitor airway and reassess vital signs every 5 minutes.
    • Begin CPR if HR is less than 60 with signs of poor perfusion despite oxygenation and ventilation.

    Pediatric Emergency Cardiac Care for BLS – Algorithm

    • Indications for pediatric emergency cardiac care include slow heart rate, bradycardia, and patients with serious signs and symptoms such as chest pain, shortness of breath, and hypotension.
    • If less than 1 hour old, refer to the Newly Born Protocol.
    • Oxygen as needed, ventilate as needed, target ventilation rate to 20 bpm, and attach AED with pediatric capability.
    • Defibrillate one time and resume CPR immediately for 2 minutes.

    Adult Bradycardia Algorithm

    • Indications for adult bradycardia include slow heart rate, less than 60 bpm, and patients with serious signs and symptoms such as chest pain, shortness of breath, and hypotension.
    • Assess and treat for shock, if indicated, and continuously monitor airway and reassess vital signs every 5 minutes.
    • Begin CPR if HR is less than 60 with signs of poor perfusion despite oxygenation and ventilation.

    Pediatric Bradycardia Algorithm

    • Indications for pediatric bradycardia include slow heart rate, less than 60 bpm, and patients with serious signs and symptoms such as chest pain, shortness of breath, and hypotension.
    • If less than 1 hour old, refer to the Newly Born Protocol.
    • Assess and treat for shock, if indicated, and continuously monitor airway and reassess vital signs every 5 minutes.
    • Begin CPR if HR is less than 60 with signs of poor perfusion despite oxygenation and ventilation.

    Adult Tachycardia Algorithm – Irregular Rhythm

    • Indications for adult tachycardia include irregular heart rhythm, more than 100 bpm, and patients with serious signs and symptoms such as chest pain, shortness of breath, and hypotension.
    • Place patient in a position of comfort, assess and treat for shock, if indicated, and continuously monitor airway and reassess vital signs every 5 minutes.

    Adult Tachycardia Algorithm – Regular Rhythm

    • Indications for adult tachycardia include regular heart rhythm, more than 100 bpm, and patients with serious signs and symptoms such as chest pain, shortness of breath, and hypotension.
    • Place patient in a position of comfort, assess and treat for shock, if indicated, and continuously monitor airway and reassess vital signs every 5 minutes.

    Pediatric Tachycardia Algorithm

    • Indications for pediatric tachycardia include irregular heart rhythm, more than 100 bpm, and patients with serious signs and symptoms such as chest pain, shortness of breath, and hypotension.
    • If less than 1 hour old, refer to the Newly Born Protocol.
    • Assess and treat for shock, if indicated, and continuously monitor airway and reassess vital signs every 5 minutes.

    Cardiac Arrest – Adult

    • Indications for adult cardiac arrest include unconsciousness, apnea, and pulselessness.
    • Perform high-quality uninterrupted chest compressions, apply AED as soon as available, and follow machine prompts regarding rhythm analyses and shocks.
    • Limit breaks in compressions to 10 seconds or less for rhythm analysis periods and during shocks.

    Cardiac Arrest – Pediatric

    • Indications for pediatric cardiac arrest include unconsciousness, apnea, and pulselessness.
    • If less than 1 hour old, refer to the Newly Born Protocol.
    • Perform high-quality uninterrupted chest compressions, apply AED as soon as available, and follow machine prompts regarding rhythm analyses and shocks.
    • Limit breaks in compressions to 10 seconds or less for rhythm analysis periods and during shocks.

    Return of Spontaneous Circulation (ROSC) – Adult

    • Indications for ROSC include patients 18 years and older who have been revived from cardiac arrest.
    • Verify presence of a carotid pulse, and if apneic or with inadequate respirations, continue to support ventilations.
    • Frequently reassess vital signs, treat any abnormalities, and rendezvous with ALS or transport to the closest ED.

    Return of Spontaneous Circulation (ROSC) – Pediatric

    • Indications for ROSC include pediatric patients less than 18 years old who have been revived from cardiac arrest.
    • Verify presence of a carotid pulse, and if apneic or with inadequate respirations, continue to support ventilations.
    • Frequently reassess vital signs, treat any abnormalities, and rendezvous with ALS or transport to the closest ED.

    Termination of Resuscitation – Adult

    • Indications for termination of resuscitation include patients who are in cardiac arrest due to medical or traumatic etiology.
    • If the patient meets the criteria listed in the Pronouncement of Death in the Field protocol, EMS clinicians should terminate resuscitation efforts.

    Termination of Resuscitation – Pediatric

    • Indications for termination of resuscitation include patients who are in cardiac arrest due to medical or traumatic etiology.
    • If the patient meets the criteria listed in the Pronouncement of Death in the Field protocol, EMS clinicians should terminate resuscitation efforts.

    Pronouncement of Death in the Field

    • Indications for pronouncement of death in the field include patients who have met the criteria for termination of resuscitation.
    • Confirm that the patient is unresponsive, pulseless, and apneic, and document the exact time and location of the pronouncement of death.

    EMS DNR/MOLST

    • Indications for EMS DNR/MOLST include patients who have a valid DNR order or MOLST form.
    • Resuscitation status is determined by the MOLST form or DNR order, and EMS clinicians must follow the instructions on the form or order.
    • If the patient is conscious and able to communicate directly to EMS clinicians, they may revoke the DNR order or MOLST form verbally.### MOLST and DNR Orders
    • If a patient has a MOLST or DNR order, do not initiate CPR or resuscitative efforts if the patient experiences respiratory or cardiac arrest
    • If resuscitative efforts were already in progress, withdraw them upon discovery of the MOLST or DNR order

    MOLST A-1 – Comprehensive Efforts

    • Prior to respiratory or cardiac arrest: provide full resuscitative efforts, including intubation
    • If respiratory or cardiac arrest occurs: do not attempt resuscitation

    MOLST A-2 – Comprehensive Efforts, excluding intubation

    • Prior to respiratory or cardiac arrest: provide full resuscitative efforts, excluding intubation
    • If respiratory or cardiac arrest occurs: do not attempt resuscitation

    MOLST B – Palliative Care

    • Prior to respiratory or cardiac arrest: provide supportive treatment, including:
      • Respiratory support: maintain airway, provide oxygen, and use suction as necessary
      • Cardiac support: continue ventilator support, and allow patient-controlled analgesia
      • Pain management: allow patient to receive pain medication, and initiate pain management protocol if necessary
      • Immobilize fractures and control bleeding
      • Transport to a specified inpatient hospice facility if requested

    DNR Flowchart

    • If a patient has a DNR order and is not in cardiac arrest, provide supportive care
    • If a patient is in cardiac arrest, do not attempt resuscitation
    • If a patient has a DNR order and is experiencing symptoms of a medical emergency, treat according to Maryland Protocols

    Cardiac Arrest

    • If a patient is in cardiac arrest, do not attempt resuscitation if a DNR order is present
    • If a patient is in cardiac arrest and no DNR order is present, provide CPR and use an AED as appropriate

    Chest Pain/Acute Coronary Syndrome

    • Indications: angina, chest pain, pressure or discomfort, pain or discomfort in the upper abdomen, arm, or jaw, shortness of breath, unexplained diaphoresis
    • Treatment: provide oxygen, administer aspirin, assist with administration of patient-prescribed nitroglycerin, and assess for shock

    Cardiac Emergencies: Implantable Cardioverter Defibrillator (ICD) Malfunction

    • Indications: three or more distinct ICD shocks, and obvious device malfunction with at least one EMS clinician-witnessed inappropriate shock
    • Treatment: provide supportive care, and assess for shock

    ST Elevation Myocardial Infarction (STEMI)

    • Indications: patient with acute coronary syndrome symptoms, and either new ST elevation or posterior MI
    • Treatment: not applicable; ALS protocol only

    Ventricular Assist Device (VAD) Protocol

    • Indications: adult patients with an implantable VAD, and symptoms of cardiovascular compromise or cardiac arrest
    • Treatment: assess level of consciousness and vitals, check for breathing and assist ventilation if necessary, and assess for perfusion

    Abuse/Neglect

    • Indications: injuries or burns in a pattern suggesting intentional infliction, injuries in various stages of healing, or malnutrition or extreme lack of cleanliness
    • Treatment: stabilize and treat injuries, document the situation, and report to the police or social service agency

    Agitation

    • Indications: mild, moderate, or severe symptoms of agitation
    • Treatment: maintain scene safety, assess patient's capacity and risk for self-harm, and attempt verbal de-escalation

    Allergic Reaction

    • Indications: mild, moderate, or severe symptoms of an allergic reaction
    • Treatment: provide epinephrine, albuterol, and additional doses as needed, and consult with a medical professional

    Altered Mental Status

    • Indications: acute onset of altered mental status, with or without a history of seizures
    • Treatment: assess vital signs, perform a physical exam, and check for signs of trauma, fever, or low blood pressure

    Anaphylaxis

    • Indications: acute onset of severe illness after exposure to a known allergen, with two or more symptoms

    • Treatment: provide epinephrine, albuterol, and additional doses as needed, and consult with a medical professional### Anaphylaxis - Adult

    • Indications: acute onset of severe illness after exposure to a known allergen with two or more of the following:

      • Urticaria (hives) or acute swelling of the mucosa (e.g., tongue, airway, stridor, lips)
      • Respiratory compromise
      • Hypotension
      • GI symptoms (e.g., persistent nausea/vomiting, abdominal pain, or diarrhea)

    • Indications: acute onset of severe illness after exposure to a known allergen with hypotension

    Anaphylaxis - Pediatric (4.5-P)

    • Indications: same as adult, with two or more of the following:
      • Urticaria (hives) or acute swelling of the mucosa (e.g., tongue, airway, stridor, lips)
      • Respiratory compromise
      • Hypotension
      • GI symptoms (e.g., persistent nausea/vomiting, abdominal pain, or diarrhea)

    Epinephrine (BLS) Administration

    • Less than 5 years of age: 0.15 mg IM in the lateral thigh
    • 5 years of age or greater: 0.3 mg IM in the lateral thigh
    • Alternative: BLS epinephrine OSP approved, epinephrine (BLS) (1 mg/mL) 0.15 mg IM in the lateral thigh (less than 5 years) or 0.5 mg IM in the lateral thigh (5 years or greater)

    Albuterol (BLS) Administration

    • Less than 2 years of age: albuterol (BLS) inhaler (2 puffs) inhaled or 1.25 mg nebulized
    • 2 years of age or greater: albuterol (BLS) inhaler (2 puffs) inhaled or 2.5 mg nebulized

    Additional Considerations

    • Additional doses of pediatric epinephrine auto-injector, epinephrine, albuterol, ipratropium, diphenhydramine beyond those listed above require medical consultation
    • Consider pediatric epinephrine infusion for refractory anaphylactic shock
    • Clinical Pearls:
      • Re-check dosing and concentration of epinephrine prior to administration
      • Epinephrine 1 mg/mL (previously known as 1:1,000) is appropriate for the IM route only
      • Epinephrine should never be given by IV route, except for an epinephrine infusion for patients in anaphylaxis or for patients in cardiac arrest

    Apparent Life-Threatening Event/Brief Resolved Unexplained Event (ALTE/BRUE)

    • Indications: infant or child less than 2 years of age, with an episode that is frightening to the observer, including:
      • Apnea
      • Skin color change (cyanosis, pallor, erythema)
      • Marked change in muscle tone
      • Choking or gagging not associated with feeding or witnessing foreign body aspiration
    • Assessment:
      • Perform assessment using the Pediatric Assessment Triangle
      • Obtain a description of the event, including nature, duration, and severity
      • Assess the environment for possible causes
      • When obtaining the medical history, include questions to identify any:
        • Current medications
        • Chronic diseases
        • Current or recent infections
        • Evidence of seizure activity
        • Gastro-esophageal reflux
        • Recent trauma
    • Clinical Pearls:
      • Most patients will appear stable upon assessment
      • This episode may be a sign of serious underlying illness or injury
      • All suspected ALTE/BRUE patients should be transported for further medical evaluation

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    Quiz on adult and pediatric emergency cardiac care protocols for BLS training, covering algorithm and treatment guidelines. Released on July 1, 2023, by MIEMSS.

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