EMT STANDING ORDERS

• Routine Patient Care.
• Place the patient in a semi-sitting or full-sitting position.
• Obtain 3 lead ECG if available.
• Establish IV access to KVO.
• Contact Medical Direction for an online order to facilitate the administration of the patient’s own nitroglycerin, while symptoms persist and systolic BP is ≥ 100 mmHg.
• Call for AEMT/Paramedic intercept. & Assisst AEMT/Paramedic in patient care.

AEMT/PARAMEDIC STANDING ORDER

• Acquire and transmit 12-lead ECG, if available.
• Place patient in position of comfort.
• Consider nitroglycerin 0.4 mg SL every 3 - 5 minutes, total dose 1.2 mg, reassess patient after every dose.
• If wheezing administer albuterol nebulizer 2.5mg in 3ml NS repeated as needed x3.
• Consider advance airway and ventilate as necessary (per protocol)
• In mild to severe pulmonary edema administer Furosemide
• 40-80 mg IV/IO. If patient on Furosemide double the patient daily dose Max 200mg.
• In Cardiogenic Shock (Bradycardia/Hypotensive): start dopamine infusion 5-20 mcg/kg/min IV/IO titrate to systolic BP of 90 mmHg.
• Consider Expert consultation as needed.

Note:  Don’t give Nitroglycerine to the patient who has used Viagra in the past 24 Hrs.