Paramedic Mega Codes

1. BSI

2. Scene Safety

3. Number & Location of Patients

4. General Impression

5. MOI/NOI (look for any obvious bleeds or signs of death)

6. C Spine (If pt. is lying supine check back for DCAP-BTLS before rolling over)

7. AVPU/GCS

8. Airway - Patency, suction if needed

9. Breathing - Rate, Rhythm, Quality, Lung Sounds (Infant: 30-60; Toddler: 24-40; Preschooler:
22-34; School Age: 18-30; Adolescent: 12-20)

10. Circulation - Rate, Rhythm, Quality (Newborn: 85-205; 3mo. - 2yrs: 80 - 160; 2-10yrs: 60-
140; Adult: 60-100)

11. Decision - Stay & Play or Load & Go (If load and go use the Rapid Trauma assesment)

12. Expose/Emote - expose any obvious bleeds that were not life threatening

13. Focused Exam

14. Vital Signs:

a. BP: Neonate(1-28 days) - >60mm Hg; Infants(1-12mo.) - >70mm Hg; Child (1-10yrs.)
>70mm Hg + (Age in years x 2); Adults > 90mm Hg

b. Gluc.:

c. Pulse Ox.: Normal range is 95% - 100%

d. Heart Sounds:

e. EKG:

f. Temp:

15. SAMPLE
a. Signs/Symptoms ( ask for pertinent negatives not included in Chief Complaint like:
Chest Pain, LOC, Altered Mental, etc.

b. Allergies (ask what happens when you take it)

c. Medications (ask what they take it for)

d. Past Hx. (always ask this even with the previous info)

e. Last Intake
 f. Events

16. OPQRST
Onset (fast or gradual)
Provocation (What makes it better or worse)
Quality (Sharp, Dull, etc.)
Radiation
Severity (Scale of 1-10)
Time (How long has this been going on?)

17. Treatment

Treatment Protocols

CHF
Signs/Symptoms
Crackles/Rales, Wheezes are possible, Pale, Cool, Diaphoretic, High BP, Pedal Edema

Tx:
O - O2, CPAP, Intubate
N - Nitro .4mg (equal to one spray) Make sure BP is above 100 and no viagra
F - Furosemide 1mg/kg
M - Morphine 2-10 mg IV over 1-5 minutes (increment of 2mg up to 10mg)

Notes:
Be sure to diagnose properly so not to worsen COPD

COPD
Signs/Symptoms
Wheezes, Low BP, Tachycardia

Tx:
O - O2
A - Albuterol 2.5mg in 3cc of saline Run the Nebulizer at 6-8 liters per min.
M - Morphine 2 - 10 mg over 1-5 minutes (increments of 2mg up to 10mg max)

Notes:
Make sure not to treat like CHF

Chest Pain
Signs/Symptoms
Pain in Chest

Tx:
M - Morphine 2-10mg over 5:00 in 2mg increments
O - O2
N - Nitro .4mg up to 3x (equal to 1 spray)
A - Asparin (325mg per tab, 4 tabs)

Stable Bradycardia
Signs/Symptoms
Normal sinus rhythm with a heart rate less than 60

Tx:
- If Symptomatic consider atropine if 12 lead MI is not present at .5mg max dose is 3mg
- If pacing remember to use either 5mg of valium or 2mg of lorazepam before paincing set at 80
BPM and at 40mA till you get capture and then check for for mechanical capture at the Femoral

Notes:
If patient has a perfusing rhythm and stable vitals just monitor them.

Unstable Bradycardia, Wenchebach, 1st degree block

Signs/Symptoms
Unstable Symptoms: Chest Pain, SOB, Altered Mentation, LOC, High BP

Tx:
All - Atropine .5 - 1mg IV may repeat every 3-5 min. Max dose is 3mg or 3 doses (Double dose if
administered through ET Tube)

Tits - Transcutaneous Pacing use either 5mg of valium or 2mg of lorazepam or 2mg of Versed
before paincing set at 80 BPM and at 40mA till you get capture and then check for mechanical
capture

Droop - Dopamine Drip 5-15mcg/kg/min.

Eventually - Epi Drip 2-10mcg/min.

Notes: Remember to get a 12 lead before administering atropine to rule out an MI

2nd Degree Type 2 & 3rd Degree Blocks

Tx:
Omit Atropine and treat same as above

Stable SVT (pulse present)

Signs/Symptoms
Undeterminable Rhythm

Tx:
V - Vagal Manuevers

A - Adenosine 6mg Rapid IVP follow with a 20 cc flush, 2 nd & 3rd dose are 12mg same process

C - Cardizem/Dialantizem .25mg/kg IV bolus over 2:00, may repeat in 15:00 @ .35mg/kg

C - Cardioversion - administer 5mg of Valium/Diazepam or 2mg of Versed/Midazolam or 2mg of

Lorazepam/Ativan before attempting to Cardiovert. Set shocks in the following order: 100, 200,
300, 360 joules. Remember to press sync on the monitor

Notes;
Check Hx. Before administering drugs to ensure there is no WPW, etc.

Unstable SVT
Signs/Symptoms
Same as above with unstable criteria: High BP, Chest Pain, LOC, SOB, etc.

Tx:
Cardioversion - administer 5mg of Valium/Diazepam or 2mg of Versed/Midazolam or 2mg of
Lorazepam/Ativan before attempting to Cardiovert. Set shocks in the following order: 100, 200,
300, 360 joules. Remember to press sync on the monitor & look at your patient treat as if
shocking
Notes:
Get a 12 lead before treating

V-Fib & V-Tach without a Pulse

Tx:
- If witnessed immediately defibrilate (remember to get L.A.I.D.after every shock) before
beginning CPR

- If Unwitnessed Start CPR after two minutes of CPR Defib. Follow this cycle of 2:00 of CPR Then
Shock. During CPR is when you administer Drugs Alternating between Epi/Vasopressin &
Lidocaine. (Get LAID after every Shock) (When shocking clear everybody and look at your pt.)

L - Leads
A - Airway
I - IV
D - Drugs

Drug Doses:
Epi 1mg of 1:10,000 Packaged in 10cc's
Vasopressin 40 units in 2cc's
Lidocaine 1.5mg per kg

Notes:
Consider Sodium Bicarb if down time is prolonged greater than 10:00 or 5 cycles of
CPR(1mEQ/KG IV)
L.eads, A.irway, I.V, D.rugs = LAID

PEA & Asystole

Tx:
Asystole
1. Begin CPR
2. Confirm in 2 or more leads
3. Alternate the folloing Drugs during CPR Epi 1mg in 10cc and Atropine 1mg in 10cc
4. Consider H's & T's (Systematically eliminate in this order) Epi, one H or T, Atropine

Epi 1mg in 10cc 1:10,000

Probable Cause [H/T's]

a.) Hypovolemia,
b.) Tablets, (narcan)
c.) Hypoglycemia,
d.) Tension Pnuemo,
e.) Hypoxia/Hydrogen Ions,
f.) Thrombosis [Coronary & Pulmonary]
g.) Hypothermia,
h.) Tamponade,
i.) Hyper/Hypokelemia

Atropine 1mg in 10cc max dose 3mg or .04mg per kg

PEA
1. Begin CPR
2. Skip this step
3. Same as Asystole
4. Same as Asystole

Notes:
Consider Atropine 1mg Rapid IVP if BPM on the monitor is less than 60 (PEA) or pacing in PEA if
you have a bradycardic rhythm

A-Fib & A - Flutter

Tx:
Cardizem/Diltiazem .25mg/kg IV bolus, 2nd & 3rd dose is .35mg/kg
- If Drug thereapy is ineffective or Pt. has Unstable Criteria Pace

V- Tach with a Pulse

Tx:
Lido - 1 - 1.5 mg/kg Repeat ever 3-5:00 till max dose of 3mg or conversion
Or
Amiodorone - 150mg drip
Or
Mag Sulfate 1-2 g IV over 2:00 if patient has Torsades only.

Notes:
If pt. has unstable criteria Cardiovert them.

Diabetic Emergencies

Tx:
Blood sugar Low: Less than 60
Pt. Conscious - oral glucose & Thiamine 100mg IV/IM

Pt. Unconscious - 50ml of D50 slow IVP or 1 unit dose of Glucagon IM

Blood Sugar High: More than 300

- Fluid Challenge

MI (Right Side)
Tx
- Confirm by checking V4R
- Treat as Unstable Brady and Give fluids & Dopamine as per protocol book
- Avoid use of Nitrates

Allegic Reactions
Tx:
Benadryl (Diphenhydramine) 50mg IM or IV
Epi 1:1,000 .3mg Sub Q
- If Pt. remains in Respiratory distress use Albuterol 2.5mg in 3cc of NS
- If respiratory distress continues choose one of the following steriods Prednisone 60mg PO if
possible or 125mg of Solumedrol IV

Drip Calculations
Dopamine
1. Mix 400mg in 250ml
- Concentration = 1600 mcg/ml
- Dosage is 5-15mcg/kg/min.
2. Using Microdrip set :
15 gtt/min = 400mcg/min
30 gtt/min = 800mcg/min
45 gtt/min = 1200 mcg/min
60 gtt/min = 1600 mcg/min

4. Alternately Mix using 400 mg in 500ml

30 gtt/min = 400 mcg/min
60 gtt/min = 800 mcg/min
90 gtt/min = 1200 mcg/min
123 gtt/min = 1600 mcg/min

5. Quick Calc.
Pt. weighs 175 lb.
175 drop the last digit (5) = 17
17 - 2 = 15
5 mcg/kg/min 15 gtts/min
Add 3 drops for each additional mcg

Lidocaine
1. Mix 1 gm in 250 ml
Concentration 4mg/ml
Dosage 1-4mg/min
Using minidrop set
15 gtt/min. = 1mg/min
30 gtt/min. = 2mg/min
45 gtt/min. = 3mg/min
60 gtt/min. = 4mg/min

Epi Drip
1. Mix 1mg of 1:10,000 in 250ml bag
Concetration = 4mcg/ml
Dosage = 2-10mcg/min
15 = 1mcg
30 = 2mcg
45 = 3mcg
60 = 4mcg

Drug Check List

Color
Clarity
Sedimentation
Vessel Integrety
Expiration Date

6 Rights of Meds
Right Drug
Right Route
Right Pt.
Right Time
Right Dose
Right Documentation

IV Check
1. Open it up & Check for good flow
2. Follow it down to check for infiltration at the Site
3. Drop Bag below level of the heart and look for venous blood return

E.T. Tube Check

1. # @ the teeth
2. Bag Compliance
3. Condensation in the tube
4. Chest Rise
5. End tidal CO2 device (Paper or EDD)
6. Epigastric/Lung Sounds

Chronotropy - Heart Rate

Inotropy - Contractile Force
Dromotropy - Conduction Speed