[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-197892-105":3,"detail-sidebar-cat-1-en-105":80,"doc-detail-197892-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","als-pcs-v48-acp-stickers-clinical-considerations","ALS PCS V4.8 ACP Stickers - Clinical Considerations","","Clinical guidance for an Advanced Care Paramedic package, presented as medication and procedure stickers. Covers priority management for epinephrine dosing and administration routes, diphenhydramine dosing by weight and IV/IM use, and hydrocortisone dosing for treatment. Includes emergency tracheostomy reinsertion and suctioning parameters, with indications, contraindications, and patient assessment criteria. Addresses COVID-19 mild respiratory illness disposition and testing pathways, plus IV cannulation and 0.9% NaCl fluid bolus use with contraindications and transport considerations.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/als-pcs-v48-acp-stickers-clinical-considerations/197892/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/als-pcs-v48-acp-stickers-clinical-considerations/197892.png","ImageObject",442,249,{"name":42,"@type":43},"Caleb Sterling","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-10","2026-09-03",true,{"@type":52,"interactionType":53,"userInteractionCount":33},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What is the dosing priority and key epinephrine dosing parameters?","Question",{"text":62,"@type":63},"Epinephrine administration takes priority over IV access. Recommended concentration and route are provided, with weight-based dosing and a maximum single dose, plus a minimum dosing interval and maximum number of doses.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"What are the indications and contraindications for emergency tracheostomy reinsertion?",{"text":67,"@type":63},"Indications include patients with endotracheal or tracheostomy tubes and airway obstruction or increased secretions, and emergency reinsertion when the cannula has been removed and the patient has respiratory distress with inability to adequately ventilate. Contraindications include inability to landmark or visualize.",{"name":69,"@type":60,"acceptedAnswer":70},"When are COVID-19 related assessment and testing release criteria applicable?",{"text":71,"@type":63},"Criteria apply to confirmed or suspected COVID-19 with mild acute respiratory illness and additional conditions describing host community strain and patient status parameters. Contraindications include inability of the patient or substitute decision maker to demonstrate decision-making capacity and pregnancy, and disposition links to meeting COVID-19 testing criteria or local Public Health requests.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},197892,1788471886,{"code":4,"msg":81,"data":82},"success",[83,88,93,98,103,108,112,117,122],{"id":84,"doc_module":22,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},11,"Presentations",90,"presentations",{"id":89,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},12,"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":81,"data":127},{"doc_id":78,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":33,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":79,"read_time":22},962084925290,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","| Consider epinephrine   |  |\n| --- | --- |\n|  | Route   |\n|  | IM   |\n|  | Concentration   |\n|  | 1 mg/mL=1:1,000   |\n| Dose   | 0.01 mg/kg*   |\n| Max.single dose   | 0.5mg   |\n| Dosing interval   | Minimum 5 min   |\n| Max.\\#of doses   | 2   |\n\n*The epinephrine dose may be rounded to the nearest 0.05 mg  \n\n| Consider diphenhydramine   |  |  |\n| --- | --- | --- |\n|  | Weight   | Weight   |\n|  | ≥25kg to\u003C50kg   | ≥50kg   |\n|  | Route   | Route   |\n|  | IV/IM   | IV/IM   |\n| Dose   | 25mg   | 50mg   |\n| Max.singledose   | 25mg   | 50mg   |\n| Dosing interval   | NA   | NA   |\n| Max,\\#of doses   | 1   | 1   |\n\n# Clinical Considerations\n\nEpinephrine administration takes priority over IV access.  \nEndotracheal and TracheostomySuctioning &Reinsertion MedicalDirective  \nAn Advanced Care Paramedic may provide the treatment prescribed in this Medical Directive ifauthorized.  \n## Indications\n\nPatient with endotracheal or tracheostomy tube  \nAND  \nAirway obstruction or increased secretions.  \n\n| Conditions   |  |\n| --- | --- |\n|  |  |\n| Sucioning   |  |\n| Age   | N/A   |\n| LOA   | N/A   |\n| HR   | N/A   |\n| RR   | NA   |\n| SBP   | N/A   |\n| Other   | N/A   |\n\n\n| Emergency tracheostomy reinsertion   |  |\n| --- | --- |\n| Age   | NA   |\n| LOA   | NA   |\n| HR   | NA   |\n| RR   | NA   |\n| SBP   | NA   |\n| Other   | Patient with an existing tracheotomy  \u003Cbr>where the inner and/or outer   |\n|  | cannula(s)have been removed from  \u003Cbr>the airway AND   |\n|  | Respiratory distress AND   |\n|  | Inability to adequately ventilate  \u003Cbr>AND Paramedics are presented with  \u003Cbr>a tracheostomy cannula for the  \u003Cbr>identified patient.   |\n\n# Contraindications\n\n\n| Hydrocortisone   |\n| --- |\n| Allergy or sensitivity to  \u003Cbr>hydrocortisone   |\n\n# Treatment\n\n\n| Consider hydrocortisone   |  |\n| --- | --- |\n|  | Route   |\n|  | IM/IV/IO/CVAD   |\n| Dose   | 2 mg/kg   |\n| Max.single dose   | 100 mg   |\n| Dosing interval   | N/A   |\n| Max.\\#of doses   | 1   |\n\n*Dose should be rounded to the nearest 10 mgClinical ConsiderationsN/A  \n73Consider emergency tracheostomy reinsertionThe maximum number of attempts is 2Suctioning:  \n## Contraindications\n\n\n| Emergency tacheostomy reinserion   |\n| --- |\n| Inability to landmark or visualize   |\n\n\n| Suctioning   |\n| --- |\n| N/A   |\n\n## Treatment\n\n\n| Consider sucioning   |  |  |  |\n| --- | --- | --- | --- |\n| Age   | \u003C1 year   | ≥1 year to\u003C12 years   | ≥12 years   |\n| Dose   | suction at  \u003Cbr>60-100 mmHg   | suction at  \u003Cbr>100-120mmHg   | suction at  \u003Cbr>100-150mmHg   |\n| Max.single dose   | 10 scconds   | 10 seconds   | 10 seconds   |\n| Dosing interval   | 1 minute   | 1 minute   | 1 minute   |\n| Max,\\#of doses   | NA   | NA   | NA   |\n\n# Clinical Considerations\n\nPre-oxygenate with 100%oxygen.  \nIn an alert patient,whenever possible,have patient cough to clear airway prior to suctioning.Emergency Tracheostomy Reinsertion:  \nA reinsertion attempt is defined as the insertion of the cannula into the tracheostomy.A new replacement inner or outer cannula is preferred over cleaning and reusing an existing one.Utilize a family member or caregiver who is available and knowledgeable to replace thetracheostomy cannula.78  \n# Assessment of Patients with\n\nAn Advanced Care Paramedic may provide the treatment prescribed in this Medical Directive ifauthorized.  \n## Indications\n\nConfirmed COVID-19or suspected COVID-19with mild acute respiratory illness characterized by acombinationof2or moreofthe following:fever,new onsetofcough,worsening chroniccough,shortness of breath or difficulty breathing,sore throat,runny nose/nasal congestion(without anyknown cause).  \nAND  \nThe crisis is straining the resources of the host community  \n\n| Conditions   |  |\n| --- | --- |\n| Patient disposition   |  |\n| Age   | ≥18 years to\u003C65 years   |\n| LOA   | unaltered   |\n| HR   | \u003C110 bpm   |\n| RR   | \u003C22 breaths/min   |\n| SBP   | normotension   |\n| Other   | CTAS3,4or 5  \u003Cbr>SpO₂≥94%.  \u003Cbr>If temperature≥38°C,  \u003Cbr>does notappear  \u003Cbr>septic/unwell   |\n|  |  |\n|  |  |","cbCaicQnl4F3ENbV","https://ap.wps.com/l/cbCaicQnl4F3ENbV","pdf",1070703,"English","# Clinical Considerations\n## Indications\n## Contraindications\n## Treatment\n# Assessment of Patients with COVID-19\n## Indications\n## Contraindications\n# IV Medication and Fluid Therapy","[{\"question\":\"What is the dosing priority and key epinephrine dosing parameters?\",\"answer\":\"Epinephrine administration takes priority over IV access. Recommended concentration and route are provided, with weight-based dosing and a maximum single dose, plus a minimum dosing interval and maximum number of doses.\"},{\"question\":\"What are the indications and contraindications for emergency tracheostomy reinsertion?\",\"answer\":\"Indications include patients with endotracheal or tracheostomy tubes and airway obstruction or increased secretions, and emergency reinsertion when the cannula has been removed and the patient has respiratory distress with inability to adequately ventilate. Contraindications include inability to landmark or visualize.\"},{\"question\":\"When are COVID-19 related assessment and testing release criteria applicable?\",\"answer\":\"Criteria apply to confirmed or suspected COVID-19 with mild acute respiratory illness and additional conditions describing host community strain and patient status parameters. Contraindications include inability of the patient or substitute decision maker to demonstrate decision-making capacity and pregnancy, and disposition links to meeting COVID-19 testing criteria or local Public Health requests.\"}]","ALS PCS V4.8 ACP Stickers - Clinical Considerations | PDF"]