What are the current paramedic consensus guidelines for various medical emergencies, including cardiac arrest, trauma, stroke, opioid overdose, and seizure patients?

From the Guidelines

Current paramedic consensus guidelines for major medical emergencies prioritize rapid assessment and evidence-based interventions to minimize morbidity, mortality, and improve quality of life. For cardiac arrest, guidelines emphasize high-quality CPR with minimal interruptions (rate 100-120/min, depth 2-2.4 inches), early defibrillation for shockable rhythms, and epinephrine administration (1mg IV/IO every 3-5 minutes) as stated in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. Advanced airway management should not delay compressions, and post-resuscitation care includes targeted temperature management. For trauma patients, the focus is on the "golden hour" concept with rapid transport, controlling hemorrhage, maintaining cervical spine immobilization when indicated, and following ABCDE assessment (Airway, Breathing, Circulation, Disability, Exposure). For stroke management, paramedics use stroke scales like FAST or LAPSS for identification, with emphasis on rapid transport to stroke centers within a 4.5-hour window for potential thrombolysis. Opioid overdose treatment centers on naloxone administration (0.4-2mg IV/IM/IN, repeatable every 2-3 minutes) while supporting ventilation, as recommended in the 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning 1. For seizures, benzodiazepines are first-line, with midazolam (5-10mg IM/IN) often preferred for its rapid onset and ease of administration outside hospital settings. Paramedics should position patients to protect airways, monitor vital signs, and provide oxygen as needed during seizures. These guidelines emphasize rapid assessment, early intervention, and transport to appropriate facilities while maintaining essential life support throughout patient care, as supported by the most recent evidence from the American Heart Association guidelines 1.

Some key points to consider in these guidelines include:

• The importance of high-quality CPR in cardiac arrest management, with a focus on minimal interruptions and proper technique 1.
• The use of naloxone in opioid overdose treatment, with an emphasis on supporting ventilation and administering the medication in a timely manner 1.
• The role of benzodiazepines in seizure management, with midazolam being a preferred option due to its rapid onset and ease of administration 1.
• The emphasis on rapid transport and targeted care in trauma and stroke management, with a focus on minimizing morbidity and mortality 1.

Overall, the current paramedic consensus guidelines prioritize evidence-based interventions and rapid assessment to improve patient outcomes and minimize morbidity and mortality.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Paramedic Consensus Guidelines for Medical Emergencies

The following are current paramedic consensus guidelines for various medical emergencies:

• Cardiac Arrest:
  • Epinephrine is a core component of guidelines, which recommend 1 mg in those with shockable rhythms if initial CPR and defibrillation are unsuccessful, while in nonshockable rhythms, guidelines recommend that epinephrine 1 mg be administered as soon as feasible 2.
  • Antiarrhythmics (e.g., amiodarone, lidocaine, procainamide) likely do not improve short-term or long-term survival or neurologic outcomes, though guidelines state that amiodarone may be used in those with cardiac arrest and refractory pulseless ventricular tachycardia (pVT)/ventricular fibrillation (VF) 2.
  • Beta-blockers may be considered in those with shock-resistant pVT/VF 2.
  • Amiodarone significantly improves survival to hospital admission, but neither survival to hospital discharge nor neurological outcome compared to placebo or nifekalant 3.
• Trauma:
  • No specific guidelines are provided in the given studies.
• Stroke:
  • No specific guidelines are provided in the given studies.
• Opioid Overdose:
  • No specific guidelines are provided in the given studies.
• Seizure Patients:
  • No specific guidelines are provided in the given studies.

Comparison of Antiarrhythmic Medications

• Amiodarone vs Lidocaine:
  • Lidocaine was associated with statistically significantly higher odds of return of spontaneous circulation (ROSC), 24-hour survival, survival to hospital discharge, and favorable neurologic outcome compared to amiodarone in patients with in-hospital cardiac arrest from ventricular tachycardia or ventricular fibrillation (VT/VF) 4.

Use of Beta-Blockers in Cardiac Arrest

• Beta-blockade:
  • Beta-blockade was associated with an increased rate of temporary ROSC, sustained ROSC, survival-to-admission, survival-to-discharge, and survival with a favorable neurologic outcome in patients with cardiac arrest due to refractory VF/VT 5.