Treatment Protocol 4102 - REMSA.US

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Treatment Protocol 4102 Effective April 1, 2021 Expires March 31, 2022 Policy: Calculation Chart Approval: Medical Director Reza Vaezazizi, MD Signature Applies To: PSP, EMT, AEMT, EMT-P, MICN, BHP, EMS System Approval: REMSA Administrator Trevor Douville Signature 4102 — Calculation Chart (4/1/21 - 15:37) 1 of 18 PURPOSE The purpose of this policy is to standardize medication dosages and volumes, airway sizes, and energy settings for cardioversion and defibrillation. AUTHORITY California Health and Safety Code - Division 2.5: Emergency Medical Services [1797. - 1799.207.] California Code of Regulations, Title 22. Social Security, Division 9. Prehospital Emergency Medical Services Required Equipment A commercially available, standardized Length Based Resuscitation Tape with colors / kgs corresponding to this chart, and a laminated copy of this treatment protocol, are required field equipment. This chart must be color printed, front and back, at full size, and carried in each first response and transport vehicle. Determining Age, Weight, and Height Determine a patient’s age, weight, and height: 1. Age by written record, report by patient or parent, or estimate by EMS 2. Weight by measurement, written record, report by patient or parent, Length Based Resuscitation Tape, or estimate by EMS 3. Height by measurement, written record, report by patient or parent, or estimate by EMS Pediatric Patient A pediatric patient is defined as a person appearing, or known to be, 14 years of age or less Calculation Chart Orders are not obtained from the Calculation Chart, they are obtained through an indicated treatment protocol, or a base hospital order (BHO). This chart is to be used when calculating medication dosing, airway adjunct size, and cardioversion/defibrillation energy settings. The process is: 1. Determine the patient’s age, weight, and height 2. Utilize a Length Based Resuscitation Tape to determine the appropriate color in the pediatric patient 3. As directed by an indicated treatment protocol, or a BHO, use this chart to calculate medication dosage and volume: a. Obtain the order, route, and any adjustments through an indicated treatment protocol or a BHO b. Use only REMSA authorized medications in the required concentrations as found in policy #3301 (Drug and Equipment List) c. Use a 1 mL syringe, graduated in tenths and hundredths, for indicated volumes less than 1 mL d. When available, have a second qualified person verify dosage prior to administration

Transcript of Treatment Protocol 4102 - REMSA.US

Page 1: Treatment Protocol 4102 - REMSA.US

Treatment Protocol 4102 Effective

April 1, 2021 Expires

March 31, 2022 Policy:

Calculation Chart Approval: Medical Director

Reza Vaezazizi, MD Signature

Applies To: PSP, EMT, AEMT, EMT-P, MICN, BHP, EMS

System Approval: REMSA Administrator

Trevor Douville Signature

4102 — Calculation Chart (4/1/21 - 15:37) 1 of 18

PURPOSE The purpose of this policy is to standardize medication dosages and volumes, airway sizes, and energy settings for cardioversion and defibrillation.

AUTHORITY California Health and Safety Code - Division 2.5: Emergency Medical Services [1797. - 1799.207.] California Code of Regulations, Title 22. Social Security, Division 9. Prehospital Emergency Medical Services Required Equipment A commercially available, standardized Length Based Resuscitation Tape with colors / kgs corresponding to this chart, and a laminated copy of this treatment protocol, are required field equipment. This chart must be color printed, front and back, at full size, and carried in each first response and transport vehicle. Determining Age, Weight, and Height Determine a patient’s age, weight, and height:

1. Age by written record, report by patient or parent, or estimate by EMS 2. Weight by measurement, written record, report by patient or parent, Length Based Resuscitation Tape, or

estimate by EMS 3. Height by measurement, written record, report by patient or parent, or estimate by EMS

Pediatric Patient A pediatric patient is defined as a person appearing, or known to be, 14 years of age or less Calculation Chart Orders are not obtained from the Calculation Chart, they are obtained through an indicated treatment protocol, or a base hospital order (BHO). This chart is to be used when calculating medication dosing, airway adjunct size, and cardioversion/defibrillation energy settings. The process is:

1. Determine the patient’s age, weight, and height 2. Utilize a Length Based Resuscitation Tape to determine the appropriate color in the pediatric patient 3. As directed by an indicated treatment protocol, or a BHO, use this chart to calculate medication dosage and

volume: a. Obtain the order, route, and any adjustments through an indicated treatment protocol or a BHO b. Use only REMSA authorized medications in the required concentrations as found in policy #3301 (Drug

and Equipment List) c. Use a 1 mL syringe, graduated in tenths and hundredths, for indicated volumes less than 1 mL d. When available, have a second qualified person verify dosage prior to administration

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4. Notice the following annotations: a. Specific routes and relationships may be identified on the Calculation Chart by an attached annotation

as follows: i. “CPAP” identifies a dose related only to administration of CPAP by mask

ii. “IV”, “IM”, “IN”, “TD”, and “SL” identify the corresponding route 1. “IV” may refer to IV and IO; push, bolus, or drip; as indicated by the actual order

iii. “IM x 2” identifies a dose given twice by the IM route, once per site, as a single dose iv. “IN x 2” identifies a dose given twice by the IN route, once per nostril, as a single dose

b. Volumes given to the hundredth are identified by black underline as seen with Diazepam, Epinephrine 1:1,000, Fentanyl, Lorazepam, Midazolam, and Morphine Sulfate

5. For Push Dose Epinephrine dosing. Create the required dilution of epinephrine by:

a. Utilizing aseptic technique obtain 1mL of epinephrine (0.1 mg/mL) preparation b. Utilizing aseptic techniques obtain 9 mL of normal saline c. Mix the 1 mL of the 0.1 mg/mL epinephrine with the 9 mL of normal saline in an aseptic manner. d. Label the new concentration of epinephrine as 0.01 mg/mL and utilize per protocol. e. For pediatric patients administer 0.1 mL/kg of the diluted epinephrine; for adults administer 1 mL of the

diluted epinephrine per protocol.

6. In the absence of Atropine in prefilled syringes, Atropine 1 mg / 1 mL may be diluted at the point of care: a. Dilute to Atropine 1 mg in 10 mL

i. Draw up 1 mL Atropine 1 mg / 1 mL ii. Draw up additional 9 mL Normal saline (NS)

iii. Yields Atropine 1 mg in 10 mL

7. In the absence of Dextrose 10% or Dextrose 25%, Dextrose 50% (D50) may be diluted at the point of care: a. Dilute to Dextrose 10% (5 g in 50 mL)

i. Expel 40 mL from the 50mL prefilled syringe of Dextrose 50% (D50) ii. Draw up 40 mL Normal saline (NS)

iii. Yields 5 g Dextrose 10% in 50 mL b. Dilute to Dextrose 25% (12.5 g in 50 mL)

i. Expel 25 mL from the 50mL prefilled syringe of Dextrose 50% (D50) ii. Draw up 25 mL Normal saline (NS)

iii. Yields 12.5 g Dextrose 25% in 50 mL

8. In the absence of Epinephrine 1:10,000 in prefilled syringes, Epinephrine 1:1,000 1 mg / 1 mL may be diluted at the point of care:

a. Dilute to Epinephrine 1:10,000 1 mg in 10 mL i. Draw up 1 mL Epinephrine 1:1,000 1 mg / 1 mL

ii. Draw up additional 9 mL Normal saline (NS) iii. Yields Epinephrine 1:10,000 1 mg in 10 mL

9. As directed by an indicated treatment protocol, or a BHO, use this chart to calculate energy settings and airway

adjunct size

10. Contact a base hospital for orders in case of atypical presentation, circumstance, or uncertainty. This includes pediatric patients less than 3 kg, and adult patients less than 36 kg (80 lbs) / 4 feet 10 inches.

11. In case of a nerve agent attack and/or deployment of a CDC CHEMPACK:

a. Patient classification: i. Classify atypical pediatric patients less than 3 kg as Length Based Resuscitation Tape Grey

ii. Classify atypical adult patients less than 36 kg (80 lbs) / 4 feet 10 inches using the Length Based Resuscitation Tape

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b. Pralidoxime Chloride: i. For IM use reconstitute Pralidoxime Chloride with only 5 mL sterile water to 1000 mg / 5 mL

1. DO NOT GIVE THIS CONCENTRATION IV/IO! ii. For IV use reconstitute Pralidoxime Chloride with the full 20 mL sterile water to 1000 mg / 20 mL

1. When given IV/IO, Pralidoxime should be given as a bolus drip in 50 mL over 10 minutes! Pralidoxime Chloride is distributed as 1000 mg powder in a 20 mL vial requiring reconstitution with sterile water; note the varying concentrations of Pralidoxime Chloride in the chart that follows:

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Preferred Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Activated Charcoal PO PO PO PO PO PO PO PO PO PO 50 g 25 g 4.2 g 6.3 g 8.3 g 10.4 g 12.5 g 16.7 g 20.8 g 27 g 33.3 g 50 g

240 mL 120 mL 20 mL 30 mL 40 mL 50 mL 60 mL 80 mL 100 mL 130 mL 160 mL 240 mL Adenosine IV IV IV IV IV IV IV IV IV IV

12 mg 6 mg 0.6 mg 1.2 mg 1.8 mg 1.8 mg 2.4 mg 3 mg 4.2 mg 5.4 mg 6.6 mg 12 mg 4 mL 2 mL 0.2 mL 0.4 mL 0.6 mL 0.6 mL 0.8 mL 1 mL 1.4 mL 1.8 mL 2.2 mL 4 mL

Albuterol 0.083% NEB NEB NEB NEB NEB NEB NEB NEB NEB NEB 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 3 mL 3 mL 3 mL 3 mL 3 mL 3 mL 3 mL 3 mL 3 mL 3 mL 3 mL

Amiodarone (OHCA) IV IV IV IV IV IV IV IV IV IV 150 mg 900 mg 20 mg 35 mg 45 mg 50 mg 65 mg 85 mg 105 mg 135 mg 165 mg 300 mg

3 mL 18 mL 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3.3 mL 6 mL Amiodarone IV IV IV IV IV IV IV IV IV IV

(OHCA) Repeat 20 mg 35 mg 45 mg 50 mg 65 mg 85 mg 105 mg 135 mg 150 mg 150 mg 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3 mL 3 mL

Amiodarone (BHO) VT or SVT w/ pulses IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB 150 mg 900 mg 20 mg 35 mg 45 mg 50 mg 65 mg 85 mg 105 mg 135 mg 150 mg 150 mg

3 mL 18 mL 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3.0 mL 3 mL Aspirin PO 81 mg None None None None None None None None None 324 mg

1 tablet 4 tablets Atropine IV IV IV IV IV IV IV IV IV IV

1 mg 0.5 mg 0.08 mg 0.13 mg 0.17 mg 0.2 mg 0.26 mg 0.33 mg 0.42 mg 0.5 mg 0.5 mg 0.5 mg 10 mL 5 mL 0.8 mL 1.3 mL 1.7 mL 2 mL 2.6 mL 3.3 mL 4.2 mL 5 mL 5 mL 5 mL

Atropine (MDV) IM IM IM IM IM IM IM IM x 2 IM x 2 IM x 2 8 mg 0.2 mg 0.32 mg 0.44 mg 0.52 mg 0.64 mg 0.84 mg 1 mg 0.68 mg 0.84 mg 1 mg 20 mL 0.5 mL 0.8 mL 1.1 mL 1.3 mL 1.6 mL 2.1 mL 2.5 mL 1.7 mL 2.1 mL 2.5 mL

Calcium Chloride 10% IV IV IV IV IV IV IV IV IV IV 1 g 80 mg 130 mg 170 mg 200 mg 260 mg 330 mg 420 mg 540 mg 660 mg 1 g

10 mL 0.8 mL 1.3 mL 1.7 mL 2 mL 2.6 mL 3.3 mL 4.2 mL 5.4 mL 6.6 mL 10 mL Dextrose 10% IV IV IV IV IV IV IV IV IV IV

1 g 2 g 3 g 4 g 5 g 6.5 g 8 g 10.5 g 13.5 g 16.5 g 25 g 10 mL 20 mL 30 mL 40 mL 50 mL 65 mL 80 mL 105 mL 135 mL 165 mL 250 mL

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Preferred Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Dextrose 25% IV IV IV IV IV IV IV IV IV 2.5 g None 3.25 g 4.25 g 5 g 6.5 g 8.25 g 10.5 g 13.5 g 16.5 g 25 g

10 mL 13 mL 17 mL 20 mL 26 mL 33 mL 42 mL 54 mL 66 mL 100 mL Dextrose 50% IV IV IV IV IV

25 g None None None None None 8.25 g 10.5 g 13.5 g 16.5 g 25 g 50 mL 16.5 mL 21 mL 27 mL 33 mL 50 mL

Diphenhydramine IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM 50 mg 5 mg 5 mg 10 mg 10 mg 15 mg 15 mg 20 mg 25 mg 35 mg 50 mg 1 mL 0.1 mL 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 1 mL

Epinephrine 1:1,000 IM IM IM IM IM IM IM IM IM IM 1 mg 30 mg 0.04 mg 0.07 mg 0.09 mg 0.1 mg 0.1 mg 0.2 mg 0.2 mg 0.3 mg 0.3 mg 0.3 mg 1 mL 30 mL 0.04 mL 0.07 mL 0.09 mL 0.1 mL 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.3 mL

Epinephrine 1:10,000 IV IV IV IV IV IV IV IV IV IV 1 mg 0.04 mg 0.07 mg 0.09 mg 0.1 mg 0.13 mg 0.17 mg 0.21 mg 0.27 mg 0.33 mg 1 mg

10 mL 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3.3 mL 10 mL Epinephrine 1:100,000 Push IV IV IV IV IV IV IV IV IV IV

0.01 mg Dose 0.004 mg 0.007 mg 0.009 mg 0.01mg 0.01mg 0.01mg 0.01mg 0.01mg 0.01mg 0.01mg 1 mL Epi 0.4 mL 0.7 mL 0.9 mL 1 mL 1 mL 1 mL 1 mL 1 mL 1 mL 1 mL

Fentanyl IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM 100 mcg 4 mcg 6.5 mcg 8.5 mcg 10 mcg 15 mcg 15 mcg 20 mcg 25 mcg 30 mcg 50 mcg

2 mL 0.08 mL 0.13 mL 0.17 mL 0.2 mL 0.3 mL 0.3 mL 0.4 mL 0.5 mL 0.6 mL 1 mL Fentanyl - IN IN IN IN IN IN IN IN IN IN x 2 IN

4 mcg 6.5 mcg 8.5 mcg 10 mcg 15 mcg 15 mcg 20 mcg 25 mcg 15 mcg 50 mcg 0.08 mL 0.13 mL 0.17 mL 0.2 mL 0.3 mL 0.3 mL 0.4 mL 0.5 mL 0.3 mL 1 mL

Glucagon IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM 1 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 1 mg 1 mg 1 mg 1 mg 1 mg 1 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 1 mL 1 mL 1 mL 1 mL 1 mL

Glucose Gel PO PO PO PO PO PO PO PO PO PO 1 Tube 4 mL 7 mL 9 mL 10 mL 13 mL 1 tube 1 tube 1 tube 1 Tube 1 Tube

Ipratropium Bromide NEB NEB NEB NEB NEB NEB NEB NEB NEB NEB 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL

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Preferred Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Ketamine - IVPB IVPB

50 mg 500 mg Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

0.3 mg/kg

1 mL 5 mL +IVPB NS Ketamine - IN IN

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

0.5 mg/kg

Lidocaine 2% IV IV IV IV IV IV IV IV IV IV

100 mg 400 mg 4 mg 6 mg 8 mg 10 mg 14 mg 16 mg 22 mg 28 mg 34 mg 100 mg 5 mL 20 mL 0.2 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 0.8 mL 1.1 mL 1.4 mL 1.7 mL 5 mL

Lidocaine Repeat IV IV IV IV IV IV IV IV IV IV 4 mg 6 mg 8 mg 10 mg 14 mg 16 mg 22 mg 28 mg 34 mg 50 mg 0.2 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 0.8 mL 1.1 mL 1.4 mL 1.7 mL 2.5 mL

Conscious IO Pain IO IO IO IO IO IO IO IO IO IO 2 mg 4 mg 4 mg 6 mg 8 mg 8 mg 12 mg 14 mg 18 mg 50 mg 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.4 mL 0.4 mL 0.6 mL 0.7 mL 0.9 mL 2.5 mL

Magnesium Sulfate IV IV IV IV IV IV IV IV IV IV 5 g 1 g 0.2 g 0.35 g 0.45 g 0.5 g 0.65 g 0.85 g 1.05 g 1.35 g 1.65 g 2 g

10 mL 2 mL 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3.3 mL 4 mL IVPB

Pre-Eclampsia/Eclampsia None None None None None None None None None 5 g In 50 mL over 10 min. 10 mL

Pre-Eclampsia/ IM x 2 Eclampsia IM None None None None None None None None None 2.5 g

5 mL Midazolam IV IV IV IV IV IV IV IV IV IV

5 mg 10 mg 0.2 mg 0.35 mg 0.45 mg 0.5 mg 0.5 mg 1 mg 1 mg 1.5 mg 1.5 mg 2.5 mg 1 mL 2 mL 0.04 mL 0.07 mL 0.09 mL 0.1 mL 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.5 mL

Midazolam – IM/IN IM/IN IM/IN IM/IN IM/IN IM/IN IM/IN IM/IN IM/IN IM/IN IM/IN 0.4 mg 0.7 mg 0.9 mg 1 mg 1 mg 2 mg 2 mg 3 mg 3 mg 5 mg 0.08 mL 0.14 mL 0.18 mL 0.2 mL 0.2 mL 0.4 mL 0.4 mL 0.6 mL 0.6 mL 1 mL

Anxiety related to the use None None None None None None None None None

1 mg of CPAP 0.2 mL

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Preferred Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Midazolam - Anxiety s/p BHO

ROSC & hyperthermia Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted 1 mg

induced shivering 0.2 mL Naloxone IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM

2 mg 0.4 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 2 mL 0.4 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL

Naloxone - IN IN x 2 IN IN IN IN IN IN IN IN IN 0.2 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg

0.2 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL Nitroglycerin SL

0.4 mg Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted 0.4 mg

1 tablet or Spray 1 tablet Nitro Paste 2% TD

1 g 30 or 60g Not

permitted Not

permitted Not

permitted Not

permitted Not

permitted Not

permitted Not

permitted Not

permitted Not

permitted 1 g

1 inch 1 Tube 1 inch Normal saline 0.9% IV IV IV IV IV IV IV IV IV IV

IV Solution 80 mL 130 mL 170 mL 200 mL 250 mL 250 mL 250 mL 250 mL 250 mL 250 mL 1 Bolus 1 Bolus 1 Bolus 1 Bolus 1 Bolus 1 Bolus 1 Bolus 1 Bolus 1 Bolus 1 Bolus

Ondansetron ODT ODT ODT ODT ODT ODT ODT ODT 4 mg BHO BHO BHO 4 mg 4 mg 4 mg 4 mg 4 mg 4 mg 4 mg

1 tablet 1 tablet 1 tablet 1 tablet 1 tablet 1 tablet 1 tablet 1 tablet Ondansetron IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM

4 mg 0.4 mg 0.6 mg 0.8 mg 1 mg 1.4 mg 1.6 mg 2.2 mg 2.8 mg 3.4 mg 4 mg 2 mL 0.2 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 0.8 mL 1.1 mL 1.4 mL 1.7 mL 2 mL

Sodium Bicarb. 8.4% IV IV IV IV IV IV IV IV IV IV 50 mEq 10 mEq 4 mEq 6.5 mEq 8.5 mEq 10 mEq 13 mEq 16.5 mEq 21 mEq 27 mEq 33 mEq 50 mEq 50 mL 10 mL 4 mL 6.5 mL 8.5 mL 10 mL 13 mL 16.5 mL 21 mL 27 mL 33 mL 50 mL

Tranexamic Acid IVPB

1 gram Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted 1 gram

10 mL 10 mL

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Energy Settings Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Cardioversion Initial Shock 4j 7j 9j 10j 15j 20j 30j 30j 50j 100j

Subsequent Shocks 8j 15j 20j 20j 30j 50j 50j 70j 70j 150j, 200j Defibrillation

Initial Shock 8j 15j 20j 20j 30j 50j 50j 70j 70j Per Manu.

Subsequent Shocks 20j 30j 50j 50j 70j 70j 100j 120j 150j Per Manu.

Suction Catheter 6–8 Fr. 8 Fr. 8 Fr. 10 Fr. 10 Fr. 10 Fr. 10 Fr. 10 Fr. 10–12 Fr. 14–18 Fr. Oropharyngeal Airway 50 mm/0 50 mm/0 50 mm/0 60 mm/1 60 mm/1 60 mm/1 70 mm/2 80 mm/3 80 mm/3 90 mm/4

100mm/5 Nasopharyngeal Airway 14 Fr. 14 Fr. 16 Fr. 18 Fr. 20 Fr. 22 Fr. 24 Fr. 26 Fr. 28 Fr. 30–36 Fr.

Endotracheal Tube Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted 6.0-9.0

.

Cont

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Alternative Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Activated Charcoal PO PO PO PO PO PO PO PO PO PO 50 g 25 g 4.2 g 6.3 g 8.3 g 10.4 g 12.5 g 16.7 g 20.8 g 27 g 33.3 g 50 g

240 mL 120 mL 20 mL 30 mL 40 mL 50 mL 60 mL 80 mL 100 mL 130 mL 160 mL 240 mL Adenosine IV IV IV IV IV IV IV IV IV IV

12 mg 6 mg 0.6 mg 1.2 mg 1.8 mg 1.8 mg 2.4 mg 3 mg 4.2 mg 5.4 mg 6.6 mg 12 mg 4 mL 2 mL 0.2 mL 0.4 mL 0.6 mL 0.6 mL 0.8 mL 1 mL 1.4 mL 1.8 mL 2.2 mL 4 mL

Albuterol 0.083% NEB NEB NEB NEB NEB NEB NEB NEB NEB NEB 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 2.5 mg 3 mL 3 mL 3 mL 3 mL 3 mL 3 mL 3 mL 3 mL 3 mL 3 mL 3 mL

Albuterol MDI MDI MDI MDI MDI MDI 90 mcg None None None None None 180 mcg 180 mcg 180 mcg 180 mcg 180 mcg

1 Metered Dose (Puff) 2 Puffs 2 Puffs 2 Puffs 2 Puffs 2 Puffs Amiodarone IV IV IV IV IV IV IV IV IV IV

150 mg 900 mg 20 mg 35 mg 45 mg 50 mg 65 mg 85 mg 105 mg 135 mg 165 mg 300 mg 3 mL 18 mL 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3.3 mL 6 mL

Amiodarone Repeat IV IV IV IV IV IV IV IV IV IV 20 mg 35 mg 45 mg 50 mg 65 mg 85 mg 105 mg 135 mg 150 mg 150 mg 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3 mL 3 mL

Amiodarone (BHO) VT or SVT w/ pulses IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB 150 mg 900 mg 20 mg 35 mg 45 mg 50 mg 65 mg 85 mg 105 mg 135 mg 150 mg 150 mg

3 mL 18 mL 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3.0 mL 3 mL Aspirin PO 81 mg None None None None None None None None None 324 mg

1 tablet 4 tablets Atropine IV IV IV IV IV IV IV IV IV IV

1 mg 0.5 mg 0.08 mg 0.13 mg 0.17 mg 0.2 mg 0.26 mg 0.33 mg 0.42 mg 0.5 mg 0.5 mg 0.5 mg 10 mL 5 mL 0.8 mL 1.3 mL 1.7 mL 2 mL 2.6 mL 3.3 mL 4.2 mL 5 mL 5 mL 5 mL

Atropine (MDV) IM IM IM IM IM IM IM IM x 2 IM x 2 IM x 2 8 mg 0.2 mg 0.32 mg 0.44 mg 0.52 mg 0.64 mg 0.84 mg 1 mg 0.68 mg 0.84 mg 1 mg

20 mL 0.5 mL 0.8 mL 1.1 mL 1.3 mL 1.6 mL 2.1 mL 2.5 mL 1.7 mL 2.1 mL 2.5 mL Atropine - IV IV IV IV IV IV IV IV IV IV IV

0.2 mg 0.32 mg 0.44 mg 0.52 mg 0.64 mg 0.84 mg 1.04 mg 1.36 mg 1.64 mg 2 mg 0.5 mL 0.8 mL 1.1 mL 1.3 mL 1.6 mL 2.1 mL 2.6 mL 3.4 mL 4.1 mL 5 mL

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Alternative Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Atropine IM IM IM IM IM IM IM IM IM IM 1 mg 0.2 mg 0.3 mg 0.4 mg 0.5 mg 0.7 mg 0.8 mg 1.1 mg 1.4 mg 1.7 mg 2 mg 1 mL 0.2 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 0.8 mL 1.1 mL 1.4 mL 1.7 mL 2 mL

Atropine - IV IV IV IV IV IV IV IV IV IV IV 0.2 mg 0.3 mg 0.4 mg 0.5 mg 0.7 mg 0.8 mg 1.1 mg 1.4 mg 1.7 mg 2 mg 0.2 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 0.8 mL 1.1 mL 1.4 mL 1.7 mL 2 mL

Atropine Autoinjector IM 2 mg None None None None None None None None None 2 mg

1 Autoinjector (AI) 1 AI Atropine Autoinjector IM IM IM IM IM

1 mg None None None None None 1 mg 1 mg 1 mg 1 mg 1 mg 1 Autoinjector (AI) 1 AI 1 AI 1 AI 1 AI 2 AI

Atropine Autoinjector IM IM IM IM IM IM IM IM IM IM 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg

1 Autoinjector (AI) 1 AI 1 AI 1 AI 1 AI 1 AI 2 AI 2 AI 2 AI 2 AI 4 AI Calcium Chloride 10% IV IV IV IV IV IV IV IV IV IV

1 g 80 mg 130 mg 170 mg 200 mg 260 mg 330 mg 420 mg 540 mg 660 mg 1 g 10 mL 0.8 mL 1.3 mL 1.7 mL 2 mL 2.6 mL 3.3 mL 4.2 mL 5.4 mL 6.6 mL 10 mL

Dextrose 10% IV IV IV IV IV IV IV IV IV IV 1 g 2 g 3 g 4 g 5 g 6.5 g 8 g 10.5 g 13.5 g 16.5 g 25 g

10 mL 20 mL 30 mL 40 mL 50 mL 65 mL 80 mL 105 mL 135 mL 165 mL 250 mL Dextrose 25% None IV IV IV IV IV IV IV IV IV

2.5 g 3.25 g 4.25 g 5 g 6.5 g 8.25 g 10.5 g 13.5 g 16.5 g 25 g 10 mL 13 mL 17 mL 20 mL 26 mL 33 mL 42 mL 54 mL 66 mL 100 mL

Dextrose 50% IV IV IV IV IV 25 g None None None None None 8.25 g 10.5 g 13.5 g 16.5 g 25 g

50 mL 16.5 mL 21 mL 27 mL 33 mL 50 mL

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4102 — Calculation Chart (4/1/21 - 15:37) 11 of 18

Alternative Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Diazepam IV IV IV IV IV IV IV IV IV IV 10 mg 0.2 mg 0.35 mg 0.45 mg 0.5 mg 0.5 mg 1 mg 1 mg 1.5 mg 1.5 mg 2.5 mg 2 mL 0.04 mL 0.07 mL 0.09 mL 0.1 mL 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.5 mL

Diazepam - IM IM IM IM IM IM IM IM IM IM IM 0.4 mg 0.65 mg 0.85 mg 1 mg 1.5 mg 1.5 mg 2 mg 2.5 mg 3.5 mg 5 mg 0.08 mL 0.13 mL 0.17 mL 0.2 mL 0.3 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 1 mL

Diazepam CPAP Related to CPAP Mask None None None None None None None None None 1 mg

0.2 mL Diazepam Autoinjector IM

10 mg None None None None None None None None None 10 mg 1 Autoinjector (AI) 1 AI Diphenhydramine IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM

50 mg 5 mg 5 mg 10 mg 10 mg 15 mg 15 mg 20 mg 25 mg 35 mg 50 mg 1 mL 0.1 mL 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 1 mL

DuoDote (NAAK) IM 2.1 mg / 600 mg None None None None None None None None None 2.1 / 600

1 Autoinjector (AI) 1 AI Epinephrine 1:1,000 IM IM IM IM IM IM IM IM IM IM

1 mg 30 mg 0.04 mg 0.07 mg 0.09 mg 0.1 mg 0.1 mg 0.2 mg 0.2 mg 0.3 mg 0.3 mg 0.3 mg 1 mL 30 mL 0.04 mL 0.07 mL 0.09 mL 0.1 mL 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.3 mL

Epinephrine 1:10,000 IV IV IV IV IV IV IV IV IV IV 1 mg 0.04 mg 0.07 mg 0.09 mg 0.1 mg 0.13 mg 0.17 mg 0.21 mg 0.27 mg 0.33 mg 1 mg

10 mL 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3.3 mL 10 mL Epinephrine 1:100,000 Push IV IV IV IV IV IV IV IV IV IV

0.01mg Dose 0.004 mg 0.007 mg 0.009 mg 0.01mg 0.01mg 0.01mg 0.01mg 0.01mg 0.01mg 0.01mg 1 mL Epi 0.4 mL 0.7 mL 0.9 mL 1 mL 1 mL 1 mL 1 mL 1 mL 1 mL 1 mL

Fentanyl IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM 100 mcg 4 mcg 6.5 mcg 8.5 mcg 10 mcg 15 mcg 15 mcg 20 mcg 25 mcg 30 mcg 50 mcg

2 mL 0.08 mL 0.13 mL 0.17 mL 0.2 mL 0.3 mL 0.3 mL 0.4 mL 0.5 mL 0.6 mL 1 mL Fentanyl - IN IN IN IN IN IN IN IN IN IN x 2 IN

4 mcg 6.5 mcg 8.5 mcg 10 mcg 15 mcg 15 mcg 20 mcg 25 mcg 15 mcg 50 mcg 0.08 mL 0.13 mL 0.17 mL 0.2 mL 0.3 mL 0.3 mL 0.4 mL 0.5 mL 0.3 mL 1 mL

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4102 — Calculation Chart (4/1/21 - 15:37) 12 of 18

Alternative Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Glucagon IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM 1 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 1 mg 1 mg 1 mg 1 mg 1 mg 1 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 1 mL 1 mL 1 mL 1 mL 1 mL

Glucose Gel PO PO PO PO PO PO PO PO PO PO 1 Tube 4 mL 7 mL 9 mL 10 mL 13 mL 1 Tube 1 Tube 1 Tube 1 Tube 1 Tube

Ipratropium Bromide NEB NEB NEB NEB NEB NEB NEB NEB NEB NEB 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL 2.5 mL

Ketamine IVPB

100 mg Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

0.3 mg/kg

1 mL +IVPB NS Ketamine IVPB

10 mg Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

0.3 mg/kg

1 mL +IVPB NS Ketamine - IN IN

50 mg 500 mg Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

Not permitted

0.5 mg/kg

1 mL 5 mL Lidocaine 2% IV IV IV IV IV IV IV IV IV IV

100 mg 400 mg 4 mg 6 mg 8 mg 10 mg 14 mg 16 mg 22 mg 28 mg 34 mg 100 mg 5 mL 20 mL 0.2 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 0.8 mL 1.1 mL 1.4 mL 1.7 mL 5 mL

Lidocaine Repeat IV IV IV IV IV IV IV IV IV IV 4 mg 6 mg 8 mg 10 mg 14 mg 16 mg 22 mg 28 mg 34 mg 50 mg

0.2 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 0.8 mL 1.1 mL 1.4 mL 1.7 mL 2.5 mL Conscious IO Pain IO IO IO IO IO IO IO IO IO IO

2 mg 4 mg 4 mg 6 mg 8 mg 8 mg 12 mg 14 mg 18 mg 50 mg 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.4 mL 0.4 mL 0.6 mL 0.7 mL 0.9 mL 2.5 mL

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4102 — Calculation Chart (4/1/21 - 15:37) 13 of 18

Alternative Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Lorazepam IV / IN IV / IN IV / IN IV / IN IV / IN IV / IN IV / IN IV / IN IV / IN IV / IN 4 mg 0.2 mg 0.2 mg 0.4 mg 0.4 mg 0.8 mg 0.8 mg 1.2 mg 1.2 mg 1.6 mg 2.4 mg 1 mL 0.05 mL 0.05 mL 0.1 mL 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.4 mL 0.6 mL

Lorazepam - IM IM IM IM IM IM IM IM IM IM IM 0.4 mg 0.8 mg 0.8 mg 1.2 mg 1.2 mg 1.6 mg 2 mg 2.8 mg 3.2 mg 5.2 mg

0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 0.8 mL 1.3 mL Lorazepam CPAP

Related to CPAP Mask None None None None None None None None None 1.2 mg 0.3 mL

Lorazepam IV IV IV IV IV IV IV IV IV IV 2 mg 0.2 mg 0.4 mg 0.4 mg 0.6 mg 0.6 mg 0.8 mg 1 mg 1.4 mg 1.6 mg 2.6 mg 1 mL 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 0.8 mL 1.3 mL

Lorazepam - IM IM IM IM IM IM IM IM IM IM IM 0.4 mg 0.6 mg 0.8 mg 1 mg 1.4 mg 1.6 mg 2 mg 2.8 mg 3.4 mg 5 mg 0.2 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 0.8 mL 1 mL 1.4 mL 1.7 mL 2.5 mL

Lorazepam - IN IN IN IN IN IN IN IN IN x 2 IN x 2 IN x 2 0.2 mg 0.4 mg 0.4 mg 0.6 mg 0.6 mg 0.8 mg 1 mg 0.8 mg 0.8 mg 1.4 mg 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.4 mL 0.5 mL 0.4 mL 0.4 mL 0.7 mL

Lorazepam CPAP Related to CPAP Mask None None None None None None None None None 1 mg

0.5 mL Magnesium Sulfate IV IV IV IV IV IV IV IV IV IV

5 g 1 g 0.2 g 0.35 g 0.45 g 0.5 g 0.65 g 0.85 g 1.05 g 1.35 g 1.65 g 2 g 10 mL 2 mL 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3.3 mL 4 mL

Eclampsia IVPB In 50 mL over 10 min. None None None None None None None None None 5 g

10 mL Eclampsia IM IM x 2

None None None None None None None None None 2.5 g 5 mL

Page 14: Treatment Protocol 4102 - REMSA.US

4102 — Calculation Chart (4/1/21 - 15:37) 14 of 18

Alternative Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Magnesium Sulfate IV IV IV IV IV IV IV IV IV IV 4 g 0.2 g 0.36 g 0.44 g 0.52 g 0.64 g 0.84 g 1.04 g 1.36 g 1.64 g 2 g

100 mL (IV Bag) 5 mL 9 mL 11 mL 13 mL 16 mL 21 mL 26 mL 34 mL 41 mL 50 mL Eclampsia IVPB

In 50 mL over 10 min None None None None None None None None None 4 g 100 mL

Mark I (NAAK) IM 2 mg / 600 mg None None None None None None None None None 2 / 600

1 Autoinjector (AI) 1 Kit Midazolam IV / IN IV / IN IV / IN IV / IN IV / IN IV / IN IV / IN IV / IN IV / IN IV / IN

5 mg 10 mg 0.2 mg 0.35 mg 0.45 mg 0.5 mg 0.5 mg 1 mg 1 mg 1.5 mg 1.5 mg 2.5 mg 1 mL 2 mL 0.04 mL 0.07 mL 0.09 mL 0.1 mL 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.5 mL

Midazolam - IM IM IM IM IM IM IM IM IM IM IM 0.4 mg 0.7 mg 0.9 mg 1 mg 1 mg 2 mg 2 mg 3 mg 3 mg 5 mg 0.08 mL 0.14 mL 0.18 mL 0.2 mL 0.2 mL 0.4 mL 0.4 mL 0.6 mL 0.6 mL 1 mL

Anxiety s/p ROSC, CPAP BHO & hyperthermia induced

shivering None None None None None None None None None 1 mg

0.2 mL Midazolam IV IV IV IV IV IV IV IV IV IV

5 mg 0.2 mg 0.3 mg 0.4 mg 0.5 mg 0.7 mg 0.8 mg 1.1 mg 1.4 mg 1.7 mg 2.5 mg 5 mL 0.2 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 0.8 mL 1.1 mL 1.4 mL 1.7 mL 2.5 mL

Midazolam - IM IM IM IM IM IM IM IM IM X 2 IM X 2 IM X 2 0.4 mg 0.7 mg 0.9 mg 1 mg 1.3 mg 1.7 mg 2.1 mg 1.4 mg 1.7 mg 2.5 mg 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 1.4 mL 1.7 mL 2.5 mL

Midazolam - IN IN IN IN IN IN x 2 IN x 2 IN x 2 IN x 2 IN x 2 IN x 2 0.2 mg 0.3 mg 0.4 mg 0.5 mg 0.4 mg 0.4 mg 0.5 mg 0.5 mg 0.5 mg 1 mg 0.2 mL 0.3 mL 0.4 mL 0.5 mL 0.4 mL 0.4 mL 0.5 mL 0.5 mL 0.5 mL 1 mL

Anxiety s/p ROSC, CPAP BHO & hyperthermia induced

shivering None None None None None None None None None 1 mg

1 mL

Page 15: Treatment Protocol 4102 - REMSA.US

4102 — Calculation Chart (4/1/21 - 15:37) 15 of 18

Alternative Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Morphine Sulfate IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM 10 mg 0.4 mg 0.7 mg 0.9 mg 1 mg 1 mg 2 mg 2 mg 3 mg 3 mg 5 mg 1 mL 0.04 mL 0.07 mL 0.09 mL 0.1 mL 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.5 mL

Morphine Sulfate IV IV IV IV IV IV IV IV IV IV 10 mg 0.4 mg 0.7 mg 0.9 mg 1 mg 1.3 mg 1.7 mg 2.1 mg 2.7 mg 3.3 mg 5 mg 10 mL 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3.3 mL 5 mL

Morphine Sulfate - IM IM IM IM IM IM IM IM IM x 2 IM x 2 IM x 2 0.4 mg 0.7 mg 0.9 mg 1 mg 1.3 mg 1.7 mg 2.1 mg 1.4 mg 1.7 mg 2.5 mg 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 1.4 mL 1.7 mL 2.5 mL

Naloxone IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM 2 mg 0.4 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 2 mL 0.4 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL

Naloxone - IN IN x 2 IN IN IN IN IN IN IN IN IN 0.2 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 1 mg 0.2 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 1 mL

Naloxone IV IV IV IV IV IV IV IV IV IV 4 mg 0.4 mg 0.4 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg

10 mL 1 mL 1 mL 1.25 mL 1.25 mL 1.25 mL 1.25 mL 1.25 mL 1.25 mL 1.25 mL 1.25 mL 1.25 mL Naloxone - IM IM IM IM IM IM IM IM IM IM IM

0.4 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 1 mL 1.25 mL 1.25 mL 1.25 mL 1.25 mL 1.25 mL 1.25 mL 1.25 mL 1.25 mL 1.25 mL

Naloxone - IN IN x 2 IN x 2 IN x 2 IN x 2 IN x 2 IN x 2 IN x 2 IN x 2 IN x 2 IN 0.2 mg 0.2 mg 0.2 mg 0.2 mg 0.2 mg 0.2 mg 0.2 mg 0.2 mg 0.2 mg 0.4 mg 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 0.5 mL 1 mL

Nitroglycerin SL 0.4 mg None None None None None None None None None 0.4 mg

1 tablet or Spray 1 tablet Nitro Paste 2% TD

1 g 30 or 60 g None None None None None None None None None 1 g

1 Inch 1 Tube 1 Inch Normal saline 0.9% IV IV IV IV IV IV IV IV IV IV

IV Solution 80 mL 130 mL 170 mL 200 mL 250 mL 250 mL 250 mL 250 mL 250 mL 250 mL 1 Bolus 1 Bolus 1 Bolus 1 Bolus 1 Bolus 1 Bolus 1 Bolus 1 Bolus 1 Bolus 1 Bolus

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4102 — Calculation Chart (4/1/21 - 15:37) 16 of 18

Alternative Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Ondansetron IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM IV / IM 4 mg 40 mg 0.4 mg 0.6 mg 0.8 mg 1 mg 1.4 mg 1.6 mg 2.2 mg 2.8 mg 3.4 mg 4 mg 2 mL 20 mL 0.2 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 0.8 mL 1.1 mL 1.4 mL 1.7 mL 2 mL

Ondansetron ODT ODT ODT ODT ODT ODT ODT ODT ODT ODT ODT 4 mg 4 mg 4 mg 4 mg 4 mg 4 mg 4 mg 4 mg 4 mg 4 mg 4 mg

1 tablet 1 tablet 1 tablet 1 tablet 1 tablet 1 tablet 1 tablet 1 tablet 1 tablet 1 tablet 1 tablet Pralidoxime IM IM IM IM IM IM IM IM IM IM

1000 mg 80 mg 140 mg 180 mg 200 mg 260 mg 340 mg 420 mg 540 mg 600 mg 600 mg 5 mL (in 20 mL Vial) 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3 mL 3 mL

IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB 1000 mg 80 mg 140 mg 180 mg 200 mg 260 mg 340 mg 420 mg 540 mg 600 mg 600 mg

20 mL 1.6 mL 2.8 mL 3.6 mL 4 mL 5.2 mL 6.8 mL 8.4 mL 10.8 mL 12 mL 12 mL Sodium Bicarb. 8.4% IV IV IV IV IV IV IV IV IV IV

50 mEq 10 mEq 4 mEq 6.5 mEq 8.5 mEq 10 mEq 13 mEq 16.5 mEq 21 mEq 27 mEq 33 mEq 50 mEq 50 mL 10 mL 4 mL 6.5 mL 8.5 mL 10 mL 13 mL 16.5 mL 21 mL 27 mL 33 mL 50 mL

Tranexamic acid IVPB 1 gram None None None None None None None None None 1 gram 10 mL 10 mL

Page 17: Treatment Protocol 4102 - REMSA.US

4102 — Calculation Chart (4/1/21 - 15:37) 17 of 18

CDC Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Atropine (MDV) IM IM IM IM IM IM IM IM x 2 IM x 2 IM x 2 8 mg 0.2 mg 0.32 mg 0.44 mg 0.52 mg 0.64 mg 0.84 mg 1 mg 0.68 mg 0.84 mg 1 mg

20 mL 0.5 mL 0.8 mL 1.1 mL 1.3 mL 1.6 mL 2.1 mL 2.5 mL 1.7 mL 2.1 mL 2.5 mL Atropine (MDV) - IV IV IV IV IV IV IV IV IV IV IV

0.2 mg 0.32 mg 0.44 mg 0.52 mg 0.64 mg 0.84 mg 1.04 mg 1.36 mg 1.64 mg 2 mg 0.5 mL 0.8 mL 1.1 mL 1.3 mL 1.6 mL 2.1 mL 2.6 mL 3.4 mL 4.1 mL 5 mL

Atropine Autoinjector IM 2 mg None None None None None None None None None 2 mg

1 Autoinjector (AI) 1 AI Atropine Autoinjector IM IM IM IM IM

1 mg None None None None None 1 mg 1 mg 1 mg 1 mg 1 mg 1 Autoinjector (AI) 1 AI 1 AI 1 AI 1 AI 2 AI

Atropine Autoinjector IM IM IM IM IM IM IM IM IM IM 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg 0.5 mg

1 Autoinjector (AI) 1 AI 1 AI 1 AI 1 AI 1 AI 2 AI 2 AI 2 AI 2 AI 4 AI Diazepam IM IM IM IM IM IM IM IM IM IM

10 mg 0.4 mg 0.65 mg 0.85 mg 1 mg 1.5 mg 1.5 mg 2 mg 2.5 mg 3.5 mg 5 mg 2 mL 0.08 mL 0.13 mL 0.17 mL 0.2 mL 0.3 mL 0.3 mL 0.4 mL 0.5 mL 0.7 mL 1 mL

Diazepam - IV IV IV IV IV IV IV IV IV IV IV 0.2 mg 0.35 mg 0.45 mg 0.5 mg 0.5 mg 1 mg 1 mg 1.5 mg 1.5 mg 2.5 mg 0.04 mL 0.07 mL 0.09 mL 0.1 mL 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.5 mL

Diazepam AI IM 10 mg None None None None None None None None None 10 mg

1 Autoinjector (AI) 1 AI DuoDote (NAAK) IM 2.1 mg / 600 mg None None None None None None None None None 2.1 / 600

1 Autoinjector (AI) 1 AI Mark I (NAAK) IM 2 mg / 600 mg None None None None None None None None None 2 / 600

1 Autoinjector (AI) 1 Kit

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4102 — Calculation Chart (4/1/21 - 15:37) 18 of 18

CDC Medications Grey 3–5 kg

Pink 6-7 kg

Red 8-9 kg

Purple 10-11 kg

Yellow 12-14 kg

White 15-18 kg

Blue 19-23 kg

Orange 24-29 kg

Green 30-36 kg Adult

Midazolam (Seizalam) IV IV IV IV IV IV IV IV IV IV 5 mg 50 mg 0.2 mg 0.35 mg 0.45 mg 0.5 mg 0.5 mg 1 mg 1 mg 1.5 mg 1.5 mg 2.5 mg 1 mL 10 mL 0.04 mL 0.07 mL 0.09 mL 0.1 mL 0.1 mL 0.2 mL 0.2 mL 0.3 mL 0.3 mL 0.5 mL

Midazolam (Seizalam) IM/IN IM/IN IM/IN IM/IN IM/IN IM/IN IM/IN IM/IN IM/IN IM/IN IM/IN 0.4 mg 0.7 mg 0.9 mg 1 mg 1 mg 2 mg 2 mg 3 mg 3 mg 5 mg

0.08 mL 0.14 mL 0.18 mL 0.2 mL 0.2 mL 0.4 mL 0.4 mL 0.6 mL 0.6 mL 1 mL Pralidoxime IM IM IM IM IM IM IM IM IM IM

1000 mg 80 mg 140 mg 180 mg 200 mg 260 mg 340 mg 420 mg 540 mg 600 mg 600 mg 5 mL (in 20 mL Vial) 0.4 mL 0.7 mL 0.9 mL 1 mL 1.3 mL 1.7 mL 2.1 mL 2.7 mL 3 mL 3 mL Pralidoxime IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB IVPB

1000 mg 80 mg 140 mg 180 mg 200 mg 260 mg 340 mg 420 mg 540 mg 600 mg 600 mg 20 mL 1.6 mL 2.8 mL 3.6 mL 4 mL 5.2 mL 6.8 mL 8.4 mL 10.8 mL 12 mL 12 mL