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

Per protocol C004, for supraventricular tachycardia (narrow-complex) that does not convert with Valsalva/vagal maneuvers, the first pharmacologic step is Adenosine 6 mg IV push. The 12 mg dose is only used if there is no conversion after 1–2 minutes. Diltiazem is a later option if Adenosine fails, and Amiodarone is reserved for wide-complex monomorphic tachycardia.

• 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
• ✓ STEMI Receiving Center
• Stroke Response Coordinator
• Surgical Resuscitation Center

According to the WV OEMS Approved Abbreviations (Appendix E), 'SRC' stands for 'STEMI Receiving Center.' This is a critical destination decision abbreviation used when transporting patients with suspected ST-elevation myocardial infarction.

• Immediate synchronized cardioversion at 100 J
• Adenosine 6 mg IV push
• ✓ Diltiazem 0.25 mg/kg slow IVP to a max dose of 20 mg
• Amiodarone 150 mg IV over 10 minutes

Protocol C004 states that for Atrial Fibrillation or Atrial Flutter with a rate >150 and a systolic BP >100, Diltiazem 0.25 mg/kg slow IVP to a max dose of 20 mg should be considered. Synchronized cardioversion is reserved for unstable patients (BP <90 mmHg or altered LOC). Adenosine is used for SVT, not A-fib, and Amiodarone is for wide-complex monomorphic tachycardia.

• 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.