EMT STANDING ORDERS

• Routine Patient Care.
• Consider and treat the underlying causes of bradycardia (e.g., hypoxia, hypoglycemia and hypothermia).
• If serious signs or symptoms (hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, or acute heart failure); Call for Paramedic intercept, if available.
• Obtain 3 lead ECG if available.
• Establish IV access KVO.
• Call for AEMT / Paramedic intercept if needed. & Assisst AEMT/Parmedic in patient care.

AEMT/PARAMEDIC STANDING ORDER:

If the patient is hemodynamically unstable:

• Consider transcutaneous pacing. (As per protocol)
• Consider procedural sedation prior to or during pacing:
  • Midazolam: 2-5 mg slow IV/IO, may repeat once in 5 minutes OR
  • Diazepam:5 mg slow IV/IO, may repeat 5 mg once in 5 minutes.
• Consider Atropine IV/IO 1 mg, every 3-5 minutes, maximum dose of 3 mg while preparing for TCP.
• If TCP is ineffective/not available:
• Consider Epinephrine infusion at 2 - 10 mcg/min IV/IO, OR Dopamine infusion at 5-20 mcg/kg/min, titrated to patient response.
• Acquire and transmit 12-lead ECG, if available.
• Ask for expert consultation.

Note: Never delay TCP in symptomatic patient while awaiting IV/IO access or atropine.