Sample guideline use approval



State of Wisconsin

Emergency Medical Services

Sample Medical Guidelines

|Guideline Use/Medical Director Approval |

|PEDIATRIC GUIDELINES |

| |Pediatric Allergy and Anaphylaxis |

| |Pediatric Asthma |

| |Pediatric Cardiac Arrest |

| |Pediatric Hyperglycemia |

| |Pediatric Hypoglycemia |

| |Pediatric Hypoglycemia |

| |Pediatric Hypovolemia and Shock |

| |Pediatric Respiratory Distress |

| |Pediatric Seizure |

| |Pediatric Toxic Exposure and Overdose |

| |

|ADULT/GENERAL GUIDELINES |

| |Agitated and Combative Patients |

| |Allergy and Anaphylaxis |

| |Altered Level of Consciousness |

| |Asthma and COPD |

| |Burns |

| |Cardiac Arrest |

| |Chest Pain |

| |Congestive Heart Failure |

| |Delivery of Newborns |

| |Eclampsia |

| |Female in Labor |

| |Heat Emergencies |

| |Hyperglycemia |

| |Hypothermia and Frostbite |

| |Hypovolemia and Shock |

| |Injection Guidelines |

| |Latex Sensitivity/Allergy |

| |Nausea and Vomiting |

| |Pain Management |

| |Respiratory Distress |

| |Routine Trauma Care |

| |Seizure |

| |Stroke |

| |Submersion |

| |Syncope |

| |Toxic Exposure and Overdose |

| |Vaginal Bleeding After Delivery |

| |Vaginal Bleeding Before Delivery |

| |Vertigo |

| | |

|PEDIATRIC ACLS GUIDELINES |

| |Pediatric Bradycardia |

| |Pediatric SVT |

| |Pediatric Wide Complex Tachycardia |

| | |

|ACLS GUIDELINES |

| |Bradycardia |

| |Narrow Complex Tachycardia |

| |Rapid Atrial Fibrillation |

| |Wide Complex Tachycardia |

The above marked guidelines are approved for use by ____________________________ (name of ambulance service) effective __________________, 20____. Any modifications to the standard State of Wisconsin Sample Guidelines are identified with “track changes” and copies are attached.

|Printed Name of Service Medical Director | |Medical Director Signature | |Date |

|Printed Name of Service Director | |Service Director Signature | |Date |

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