West Virginia EMS protocols,
in your pocket.

• Adenosine 12 mg IV push
• ✓ Adenosine 6 mg IV push
• Diltiazem 0.25 mg/kg slow IVP to a max of 20 mg
• Amiodarone 150 mg IV over 10 minutes

In the C004 Supraventricular Tachycardia pathway (QRS < 0.12 sec), after Valsalva/vagal maneuvers the first medication is Adenosine 6 mg IV push; if no conversion, administer Adenosine 12 mg IVP. If there is still no conversion, consider Metoprolol (Lopressor). Diltiazem is not in this protocol, and Amiodarone 150 mg IV over 10 minutes is for wide complex tachycardia that is monomorphic and regular.

• PEA persists for > 10 minutes with no rhythm change confirmed in two leads
• ✓ PEA persists for > 20 minutes with no rhythm change confirmed in two leads
• PEA persists for > 30 minutes with no rhythm change confirmed in two leads
• PEA persists for > 15 minutes with no rhythm change confirmed in one lead

Per GL002, if CPR was started prior to EMS arrival, a full cycle of ALS treatment has been unsuccessful, and the patient remains in PEA or Asystole for greater than 20 minutes with no rhythm change confirmed in two (2) leads, criteria to cease field resuscitative efforts may be met.

• Specialty Receiving Clinic
• ✓ Approved Stroke Center
• Stroke Response Coordinator
• Surgical Resuscitation Center

According to the WV OEMS Approved Abbreviations (Appendix E), 'ASC' stands for 'Approved Stroke Center.'

• Immediate synchronized cardioversion at 200 J
• Adenosine 6 mg IV push
• ✓ Metoprolol (Lopressor): mix 15 mg in 100 ml NS and infuse at 1 mg/min; hold for HR < 60 or MAP < 65
• Amiodarone 150 mg IV over 10 minutes

Protocol C004 states that for Atrial Fibrillation/Atrial Flutter with a rate > 150 and a systolic BP > 100, consider Metoprolol (Lopressor): mix 15 mg in 100 ml NS, infuse at 1 mg/min, and hold for HR < 60 or MAP < 65. Do not use in patients with decompensated heart failure. Synchronized cardioversion is for HR typically > 150 with BP < 90 or altered LOC. Adenosine is for SVT, and Amiodarone 150 mg IV over 10 minutes is for wide complex tachycardia that is monomorphic and regular.

• Administer nitroglycerin 0.4 mg SL and establish one large-bore IV of normal saline.
• ✓ Establish two IV lines of normal saline, preferably 18 gauge or larger, and withhold nitroglycerin.
• Administer aspirin and nitroglycerin, then establish IV access.
• Obtain right-sided leads but defer IV access until arrival at the receiving facility.

Protocol C001 states that if right chest leads show ST-segment elevation (suggesting RV involvement), two IV lines of normal saline (preferably 18 gauge or larger) should be established. Additionally, because the patient's BP is less than 100 mmHg, nitroglycerin is explicitly contraindicated ('If patient has a BP < 100 DO NOT administer nitroglycerin').

• Withhold defibrillation until the patient is rewarmed above 86°F
• Defibrillate at the lowest available joule setting to protect the cold heart
• ✓ Defibrillate VF/VT at maximum joules
• Contact Medical Command before any defibrillation attempt

The Cold Exposure Protocol (E003) states: 'If defibrillation is indicated, defibrillate VF/VT at max joules.' This applies within the ALOC treatment pathway, meaning the medication withholding restriction does not apply to defibrillation.