Ask the Docs

No. Medications with respiratory depression are contraindicated in the field for treatment of respiratory distress. CPAP should be explained to patient and proper technique including coaching and reassurance used to ensure patient comfort. Sedation should not be necessary, and in general, when patients benefit from CPAP, they improve rapidly. Agitation is a common sign of critical hypoxia, so if patient is increasing agitated, this is a very concerning sign for impending respiratory arrest.

Amiodarone is indicated for shock-refractory VT/VF, so you would only give after shock has failed to convert. Having said that, you may give amiodarone at any time AFTER you have attempted shock and CPR with adequate ventilation. NEVER delay proven therapies such as CPR, defibrillation and appropriate oxygenation and ventilation for unproven therapies such as amiodarone, which has NOT been shown to improve long term survival or neurological outcome.

No, you may give opioid at any time. However, if you believe that pain is true angina, then nitro is the logical best choice, assuming no contraindication such as hypotension. Neither nitrates nor opioids have been shown to decrease mortality in acute coronary syndromes (ACS) and opioids have been associated with worse clinical outcomes in ACS, so are deemphasized in the treatment. The critical actions are to identify STEMI, treat hypotension and arrhythmias and administer aspirin for suspected ACS.

Don't cardiovert flutter in the field unless hemodynamically unstable, which is very rare. If so unstable that needs cardio version in field just shock at high energy. It's true that atrial flutter is very electrically sensitive, but its also very unlikely to make patients unstable to the point of requiring field cardio version