artman17847
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Pennsylvania Department of Health Cardiac 5002 – ALS – Adult
Effective 11/01/08 5002-1 of 2
CONGESTIVE HEART FAILURE
STATEWIDE ALS PROTOCOL
Treat any Dysrhythmias according to appropriate Cardiac Protocol or as Medical Command orders
Initial Patient Contact - see Protocol #201
Manage Airway/Ventilate, if indicated
SpO2 < 90% on High-flow Oxygen
Monitor ECG & Pulse Oximetry
Proceed to Appropriate
Dysrhythmia Protocol
Contact Medical Command
Initiate IV/IO NSS
SBP > 90 mmHg 1
If not using Viagra-type drugs 2,
Nitroglycerin 0.4 mg SL
(1-3 doses every 3-5 minutes 3,4 )
If patient already takes a diuretic, administer Furosemide 40-100 mg IV 5
YES
NO
Consider Cardiogenic Shock
Contact Medical Command
Apply CPAP (if available)
Unstable tachycardia / bradycardia present
If SBP = 70-90, Consider Dobutamine Drip (if available) 6
OR
If SBP < 90
Dopamine Drip 7
If wheezing or if possibility of reactive airway disease, consider Nebulized Bronchodilator
(using options in Asthma protocol #4022)
Systolic Blood Pressure
SBP > 100mmHg 1
SBP 90-100 mmHg 1
SBP < 90 mmHg 1
YES
High-flow Oxygen
CPAP/BiPAP (if available – CPAP/BiPAP required for ALS by 7/1/09) if respiratory distress
Effective 11/01/08 5002-1 of 2
CONGESTIVE HEART FAILURE
STATEWIDE ALS PROTOCOL
Treat any Dysrhythmias according to appropriate Cardiac Protocol or as Medical Command orders
Initial Patient Contact - see Protocol #201
Manage Airway/Ventilate, if indicated
SpO2 < 90% on High-flow Oxygen
Monitor ECG & Pulse Oximetry
Proceed to Appropriate
Dysrhythmia Protocol
Contact Medical Command
Initiate IV/IO NSS
SBP > 90 mmHg 1
If not using Viagra-type drugs 2,
Nitroglycerin 0.4 mg SL
(1-3 doses every 3-5 minutes 3,4 )
If patient already takes a diuretic, administer Furosemide 40-100 mg IV 5
YES
NO
Consider Cardiogenic Shock
Contact Medical Command
Apply CPAP (if available)
Unstable tachycardia / bradycardia present
If SBP = 70-90, Consider Dobutamine Drip (if available) 6
OR
If SBP < 90
Dopamine Drip 7
If wheezing or if possibility of reactive airway disease, consider Nebulized Bronchodilator
(using options in Asthma protocol #4022)
Systolic Blood Pressure
SBP > 100mmHg 1
SBP 90-100 mmHg 1
SBP < 90 mmHg 1
YES
High-flow Oxygen
CPAP/BiPAP (if available – CPAP/BiPAP required for ALS by 7/1/09) if respiratory distress
