Routine cardiac care smo

Routine Cardiac Care
First Responder Care
1. Routine Patient Care SMO.
2. Oxygen: If the patient has a known history of COPD, titrate oxygen to maintain
a PaO2 level of 90-93%. Otherwise, 15 L/min via non-rebreather mask or 6 L/min via nasal cannula if the patient cannot tolerate a mask. 3. Initiate ILS/ALS transport as soon as possible.
1. Aspirin (ASA): 324mg PO (4 tablets of 81mg chewable aspirin by mouth).
 Ask the patient specifically about any history of hypersensitivity to
 Do not give ASA to patients with active ulcer disease, asthma or known
allergy to ASA.
2. Nitroglycerin (NTG): 0.4mg SL. May repeat every 3-5 minutes for a total of
three doses (if systolic BP remains > 100mmHg).  NTG (& ASA) may be administered without contacting Medical Control if the patient is age 30 or older, has chest pain consistent with acute myocardial infarction (AMI) and has a systolic BP > 100mmHg. If the patient does not meet this criteria, consult Medical Control prior to administering NTG.  Contraindicated in patients who have used phosphodiesterase(Viagra, Cialis, etc) inhibitor for erectile dysfunction (eg, sildenafil and vardenafil within 24 hours: tadalafil within 48 hours) 3. Contact Medical Control or receiving hospital as soon as possible.
1. IV Fluid Therapy: Normal Saline (0.9% NaCl) KVO.
2. Nitroglycerin (NTG): 0.4mg SL. May repeat every 3-5 minutes (if systolic BP
 Contraindicated in patients who have used phosphodiesterase(Viagra, Cialis, etc) inhibitor for erectile dysfunction (eg, sildenafil and vardenafil within 24 hours: tadalafil within 48 hours) Routine Cardiac Care
ILS Care (continued)
 NTG (& ASA) may be administered without contacting Medical Control if the patient is age 30 or older, has chest pain consistent with acute myocardial infarction (AMI) and has a systolic BP > 100mmHg.  ILS & ALS may administer NTG when the patient’s systolic BP is between 90-100mmHg if IV access has been established. 3. Initiate ALS intercept if necessary and transport as soon as possible (transport can
be initiated at any time during this sequence).
4. Obtain 12-Lead EKG and transmit to Medical Control.

Fentanyl: 50mcg IV/IO/IN over 2 minutes for pain. Fentanyl 50mcg may be
repeated one time in 5 minutes to a total dose of 100mcg.

If patient allergic to Fentanyl or if Fentanyl unavailable:
Dilaudid: 0.5-1.0 mg IV/IO over 2-5 minutes, or 1-2mg IM, titrated to pain relief,
with a maximum dose of 2mg. Systolic blood pressure must be >100

5. Contact Medical Control or receiving hospital as soon as possible, regardless of
1. Nitropaste (Nitro-Bid): 1 inch to anterior chest wall if patient’s systolic BP is
greater than 100mmHg. If the patient’s systolic BP drops below 90mmHg, wipe the Nitropaste off. Fentanyl: 50mcg IV/IO/IN over 2 minutes for pain. Fentanyl 50mcg may be
repeated one time in 5 minutes to a total dose of 100mcg.

If patient allergic to Fentanyl:
Dilaudid: 0.5-1.0 mg IV/IO over 2-5 minutes, or 1-2mg IM, titrated to pain relief,
with a maximum dose of 2mg. Systolic blood pressure must be >100
3. Contact Medical Control or receiving hospital as soon as possible.

Source: http://www.proctor.org/docs/Routine%20Cardiac%20Care%203.13.pdf