When administering a fluid bolus to a cardiogenic shock patient, what is our targeted systolic blood pressure? Is it similar to that of a ROSC to target 90 mmHg, or reversing hypotension and targeting 100 mmHg?

Has SWORBHP considered push dose epinephrine for ACP’s? This treatment is being used for a variety of indications in many paramedic services throughout the globe and has literature supporting it. I know this was brought up in 2017 and one of the concerns was “anytime drawing up medications, there is a risk for medication error”. There was a code epinephrine shortage in 2019/2020 and ACP’s were reconstituting epinephrine from 1:1,000 to 1:10,000 during active cardiac arrest situations without complications.

Question: In a patient presenting with respiratory distress, crackles and a relevant cardiac history, I would assume that left ventricular failure/infarct would be a fair working assessment. If 12-lead indicated LV involvement occurring with hypotension that would place the Cardiogenic Shock and CPAP Directives out of parameters.

Crackles = no bolus, hypotension = no CPAP. Other than vitals/cardiac monitoring, oxygenation/ventilatory support as needed, it seems like a situation such as this one may limit pre-hospital management, as far as a PCP scope goes. Any comments or suggestions?

Question: On our ROSC protocol, the ONLY route that we are allowed to give a fluid bolus/dopamine is via an IV. Please confirm that we are NOT allowed to do so via IO or CVAD? This does vary from the IV and Fluid Therapy protocol which allows us to do so.

Question: When treating a patient with suspected cardiac ischemia, should I acquire a 12-Lead ECG before giving nitro or ASA? If the patient is hypotensive, should I bolus at 20 ml/kg, or 10 ml/kg as per the cardiogenic shock directive? And how do I know if the patient has a right ventricular infarct? (Updated)

Question: If I have a patient that appears to be in cardiogenic shock with a STEMI ECG should I be calling for a BH patch to have an order for aspirin after initiating an IV bolus?

Question: ROSC Protocol states bolus 10ml/kg if under 12 check at 100ml and over 12 check at 250. Cardiogenic Shock Protocol (includes ROSC) -states bolus 10ml/kg -if 2 to 18 check at 100ml and over 18 check at 250ml. One states the 12 to 18 range at 250ml but the other 2 to 18 at 100ml. Can you clear this up for me please?

Question: I see that it says consider NaCl bolus in the cardiac arrest standing order. In the past we gave a bolus for PEA as well as Rosc’s. Can you confirm the exact circumstances we are to give the bolus as I find there to be a lot of gray areas in our orders.