Requires good working IV. If tenuous or patient unstable, 2 IVs recommended with LR or NS
Administer LR or NS, avoid dextrose containing fluids
Continuous cardiac monitoring.
(after adequate sedation and analgesia)
Prehospital: SBP <220 and DBP <120
antihypertensives after 1x SBP >220 or DBP> 120
Interfacility: (confirmed by CT)
ICH: SBP 140-160
antihypertensives after 2x SBP >160
SAH: SBP 100-120
antihypertensives after 2x SBP >120
Prehospital: SBP <220 and DBP <120
antihypertensives after 1x SBP >220 or DBP> 120
Interfacility: (confirmed by CT)
ICH: SBP 140-160
antihypertensives after 2x SBP >160
SAH: SBP 100-120
antihypertensives after 2x SBP >120
antihypertensives after 1x SBP >220 or DBP> 120
ICH: SBP 140-160
antihypertensives after 2x SBP >160
SAH: SBP 100-120
antihypertensives after 2x SBP >120
antihypertensives after 2x SBP >160
antihypertensives after 2x SBP >120
Labetalol: short-acting β-blocker, quick onset, anti-hypertensive agent
Indication:
Flight < 30 minutes
Initial therapy while preparing nicardipine drip
HR > 60
Contraindications: HR < 60
Nicardipine: short-acting, titrateable, calcium channel blocker (vasodilator)
Indication:
Flight longer than 30 minutes
HR <60.
SBP <100: turn drip off and give IV bolus of 250-500ml crystalloid
Nitrates or nitroprusside initiated by referring facility for hypertension should be discontinued for transport. hypertension will be managed following guidelines above.
Indication:
Flight < 30 minutes
Initial therapy while preparing nicardipine drip
HR > 60
Contraindications: HR < 60
Flight < 30 minutes
Initial therapy while preparing nicardipine drip
HR > 60
Indication:
Flight longer than 30 minutes
HR <60.
SBP <100: turn drip off and give IV bolus of 250-500ml crystalloid
Flight longer than 30 minutes
HR <60.
SBP <100: turn drip off and give IV bolus of 250-500ml crystalloid
Discuss threshold for utilization of vasopressors (and type) with medical control even if the patient is normotensive. If on anti-hypertensive infusion, consider titrating or stopping medication.
Prehospital: If two consecutive systolic BP < 100, fluid bolus 250-500ml increments, if no immediate contact available with medical control. In discussion with medical control, consider phenylephrine or norepinephrine for BP unresponsive to fluids.
Interfacility: For systolic BP < 100, consider fluids as above and discuss addition of vasopressors as above with medical control. Maintain normothermia.
Prehospital: If two consecutive systolic BP < 100, fluid bolus 250-500ml increments, if no immediate contact available with medical control. In discussion with medical control, consider phenylephrine or norepinephrine for BP unresponsive to fluids.
Interfacility: For systolic BP < 100, consider fluids as above and discuss addition of vasopressors as above with medical control. Maintain normothermia.
Consider FFP and Vitamin K (IFT) if patient is excessively anti-coagulated( INR > 1.5, patient on ASA or clopidigrel. Consult with Medical Control.
Consider platelets if platelet count < 100K. Consult with Medical Control.
ALNW:Intracerebral Hemorrhage
Harbor Macros: Syncope
Harbor Macros: Pediatrics
Maine:Prehospital protocol pediatric seizure
Post-tPA Hemorrhage in CVA
SCVMC:Main
Harbor Macros: Back Pain
Harbor Macros: Chest Pain