Nebraska EMS protocols,
in your pocket.

• 80–100 compressions per minute
• ✓ 100–120 compressions per minute
• 120–140 compressions per minute
• 60–80 compressions per minute

The protocol's Initial Resuscitation Priorities explicitly state to 'Begin manual chest compressions (Rate 100-120/min).' This is also reinforced in the Code Commander Checklist, which directs providers to confirm continuous compressions are ongoing at 100–120 beats per minute.

• Immediately terminate resuscitation and document time of death in the PCR
• ✓ Contact the Medical Director (preferred) or closest hospital, provide pertinent information, and request a physician or advanced practice provider order
• Initiate transport to the nearest emergency department and notify the hospital en route
• Continue resuscitation for an additional 30 minutes regardless of criteria being met

Per Protocol 10, even when all 5 ALS termination criteria are met, the provider must contact the Medical Director (preferred) or the closest hospital, provide pertinent patient history, history of arrest, and interventions attempted, and then request a physician or advanced practice provider order to terminate resuscitation. Termination cannot occur without that order.

• Magnesium Sulfate 2g and Sodium Bicarbonate 50 mEq; they must never be given via the same route
• ✓ Calcium Gluconate 1g and Sodium Bicarbonate 50 mEq; they are incompatible and the line must be flushed between administrations
• Calcium Gluconate 1g and Magnesium Sulfate 2g; they must be diluted before administration
• Sodium Bicarbonate 50 mEq and Epinephrine 1 mg; they cancel each other's effects if given simultaneously

The protocol specifies Calcium Gluconate 1g IV/IO and Sodium Bicarbonate 50 mEq IV/IO for renal failure, dialysis, or suspicion of hyperkalemia (wide QRS, tall T-waves, bradycardia). The Pearls section explicitly warns that Calcium Gluconate and Sodium Bicarbonate are NOT compatible and that the line must be flushed between drug administration.

• Increase the respiratory rate immediately to bring EtCO2 into the normal range
• ✓ Maintain the current respiratory rate of 6–12/min and avoid hyperventilation, as EtCO2 may remain elevated initially
• Administer sodium bicarbonate to correct the underlying acidosis
• Switch from BVM to a non-rebreather mask to reduce CO2 retention

The protocol explicitly states 'DO NOT HYPERVENTILATE' and notes that initial EtCO2 may be elevated immediately post-resuscitation but will usually normalize. The checklist reinforces: 'Do not try to obtain a normal EtCO2 by increasing respiratory rate.' The correct response is to maintain 6–12 breaths/min and allow the EtCO2 to trend down naturally.

• Administer Diltiazem 0.25 mg/kg IV slow push
• ✓ Administer Adenosine 6 mg IV/IO rapid push with fluid bolus
• Perform synchronized cardioversion at 150-200 Joules
• Administer Adenosine 12 mg IV/IO rapid push with fluid bolus

Per Protocol 15, after vagal maneuvers fail to convert a regular narrow-complex tachycardia (SVT), the next step is Adenosine 6 mg IV/IO as a rapid push followed by a fluid bolus. The 12 mg dose is reserved for a second attempt if the 6 mg dose produces no rhythm change. Diltiazem and synchronized cardioversion come later in the algorithm.

• Administer a third dose of Atropine 1 mg IV
• ✓ Initiate Transcutaneous Pacing
• Administer Midazolam 2 mg IV immediately
• Administer a Normal Saline bolus of 1 liter and reassess

The protocol states that Transcutaneous Pacing should be used if the patient is non-responsive to atropine, and that the maximum dose of Atropine is 2 mg (two 1 mg doses). Since both doses have been given without effect, the next step is Transcutaneous Pacing. The protocol also notes it may be considered first-line therapy for severe symptoms.