{ "schemaVersion": 1, "compared": "2026-11-14", "releaseDate": "2026-10-27", "sourceRevision": "2026-10-01", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "implementationDeadline": "2027-04-27", "indexAndPdfLabel": "2027-04-01", "scope": "Complete previous/released I-15 and I-20 chart comparison; related procedures remain in clinical reconciliation.", "sources": [ { "code": "I-15", "version": "previous", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf", "sha256": "6ffb2bc0dede760f961532c27417a32161fba60849b9859107484b10d2ec868a", "pages": 5, "textCharacters": 80, "file": "evidence/drug-guide-reconciliation/sources/i-15-previous.pdf" }, { "code": "I-15", "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf", "sha256": "d66da1fb7139bc5c61cac98afdd422a8318cc845a50aa927329f015c9d1b9848", "pages": 10, "textCharacters": 161, "file": "evidence/drug-guide-reconciliation/sources/i-15-released.pdf" }, { "code": "I-20", "version": "previous", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf", "sha256": "f86293b4ea6bac31dbb6da9445ef0a43f810b11ad346f3b0772d5374dc99a2cb", "pages": 10, "textCharacters": 161, "file": "evidence/drug-guide-reconciliation/sources/i-20-previous.pdf" }, { "code": "I-20", "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf", "sha256": "0cdb41a44dbc25618853c5b30c2b758a252836953603ab8f5e4c661a078e9490", "pages": 10, "textCharacters": 161, "file": "evidence/drug-guide-reconciliation/sources/i-20-released.pdf" } ], "contraindications": [ { "id": "adenosine", "medication": "Adenosine", "source": "I-15", "pages": [ 1 ], "population": "Adult / adolescent", "context": "Regular narrow-complex tachycardia", "checks": [ "Heart rate below 150 beats/minute.", "Wide-complex rhythm.", "Irregular rhythm." ], "clinicalReview": "Confirm the complete rhythm, stability and administration criteria in SO-C-025. A rate of 150 alone does not establish eligibility. These exclusions are newly explicit in the chart, not necessarily new to the standing order.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "adenosine" ], "additionalGuides": [], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "guideSlugs": [ "narrow-complex-tachycardia", "intraosseous-infusion", "adenosine" ] }, { "id": "push-dose-epinephrine", "medication": "Push-dose epinephrine", "source": "I-15", "pages": [ 2 ], "population": "Adult / adolescent", "context": "Adult push-dose shock / perfusion pathway", "checks": [ "Hemorrhagic shock." ], "clinicalReview": "Released PR-230 confirms the adult push-dose indications, preparation and hemorrhagic-shock exclusion. PR-205 separately confirms the pediatric exclusion and mandatory base order. These findings do not create a blanket exclusion for anaphylaxis or arrest epinephrine. Clinical sign-off and agency adoption remain pending.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "push-dose", "push dose" ], "additionalGuides": [ "epinephrine", "adult-cardiac-arrest", "bradycardia", "sepsis", "shock", "base-contact" ], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=2", "guideSlugs": [ "adult-cardiac-arrest", "base-contact", "bradycardia", "sepsis", "shock", "epinephrine", "normal-saline" ], "sourceStatus": "source-resolved", "clinicalReviewStatus": "pending" }, { "id": "fentanyl", "medication": "Fentanyl", "source": "I-15", "pages": [ 3 ], "population": "Adult / adolescent", "context": "Adult IV, IM and IN analgesia", "checks": [ "Systolic BP below 90 mmHg." ], "clinicalReview": "Check the condition order and perfusion before initial and repeat doses. The chart’s below-90 exclusion does not prove eligibility at exactly 90 when a condition order requires BP above 90.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "fentanyl" ], "additionalGuides": [], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=3", "guideSlugs": [ "abdominal-pain", "burns", "chest-pain", "trauma", "fentanyl", "ketamine", "ketorolac" ] }, { "id": "oral-glucose", "medication": "Oral glucose", "source": "I-15", "pages": [ 3 ], "population": "Adult / adolescent", "context": "Oral glucose administration", "checks": [ "Airway reflexes are not intact." ], "clinicalReview": "Retain the BLS/ALS pathway’s responsiveness and swallowing requirements; the adult chart does not expand EMT scope or supply pediatric authorization.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "oral glucose", "glucose gel", "glucose paste" ], "additionalGuides": [ "oral-glucose", "bls-oral-glucose", "altered-mental-status" ], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=3", "guideSlugs": [ "altered-mental-status", "bls-oral-glucose", "bls-scope-of-practice", "poisoning", "seizures", "glucagon", "oral-glucose" ] }, { "id": "ketamine", "medication": "Ketamine", "source": "I-15", "pages": [ 3, 4 ], "population": "Adult / adolescent", "context": "Adult analgesia: IV, IM and IN", "checks": [ "History of psychosis.", "Pregnancy.", "Known ketamine allergy.", "Age below 15 years.", "GCS below 14.", "Concurrent alcohol or drug intoxication is a relative contraindication. The chart allows authorization after base-hospital contact only when intoxication is not significant and the patient is neither lethargic nor otherwise impaired." ], "clinicalReview": "Verify the full analgesia procedure and base-hospital exception before use. The relative intoxication exception does not waive the other exclusions or authorize a different ketamine indication.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "ketamine" ], "additionalGuides": [], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=3", "guideSlugs": [ "ketamine" ] }, { "id": "ketorolac", "medication": "Ketorolac", "source": "I-15", "pages": [ 5 ], "population": "Adult / adolescent", "context": "Adult analgesia: IV, IO and IM", "checks": [ "Trauma-center designation.", "Snake envenomation.", "Age above 65 years.", "NSAID hypersensitivity or allergy.", "Active peptic ulcer disease, or GI bleeding or perforation within the preceding 3 months.", "Concurrent NSAIDs and/or anticoagulants.", "Major surgery within the preceding 6 weeks, or scheduled major surgery.", "Renal disease or renal transplant.", "Pregnancy, suspected pregnancy, or breastfeeding." ], "clinicalReview": "The earlier PR-075 summary includes an age-below-2 exclusion, suspected cardiac pain and a low-dose-aspirin exception. The released adult chart does not repeat all of that wording. Do not infer that omissions remove exclusions or resolve the aspirin exception; reconcile PR-075 and the product label.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "ketorolac", "toradol" ], "additionalGuides": [ "trauma" ], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=5", "guideSlugs": [ "trauma", "ketorolac" ] }, { "id": "magnesium-obstetric", "medication": "Magnesium sulfate", "source": "I-15", "pages": [ 6 ], "population": "Adult / adolescent", "context": "Obstetric IV / IM rows", "checks": [ "The source prints “Not pregnant or post partem.” in the contraindication column." ], "clinicalReview": "Source question resolved against released O-010 pages 1–2: pregnancy-related disease includes postpartum eclampsia up to 6 weeks after delivery. Do not read the compressed I-15 wording as excluding all postpartum patients. Base contact and the full O-010 criteria apply. Clinical sign-off and adoption remain pending.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "magnesium" ], "additionalGuides": [ "imminent-childbirth" ], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=6", "guideSlugs": [ "imminent-childbirth" ], "sourceStatus": "source-resolved", "clinicalReviewStatus": "pending" }, { "id": "magnesium-arrest", "medication": "Magnesium sulfate", "source": "I-15", "pages": [ 6 ], "population": "Adult / adolescent", "context": "Torsades de pointes with cardiac arrest", "checks": [ "Not for routine ventricular fibrillation, pulseless ventricular tachycardia, or monomorphic ventricular tachycardia." ], "clinicalReview": "C-010 page 2 confirms torsades-only use, not routine VF/pulseless VT/monomorphic VT. Keep this separate from the obstetric pathway. Clinical sign-off and adoption remain pending.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "magnesium" ], "additionalGuides": [ "adult-cardiac-arrest", "wide-complex-tachycardia" ], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=6", "guideSlugs": [ "adult-cardiac-arrest", "wide-complex-tachycardia" ], "sourceStatus": "source-resolved", "clinicalReviewStatus": "pending" }, { "id": "midazolam", "medication": "Midazolam", "source": "I-15", "pages": [ 6, 7 ], "population": "Adult / adolescent", "context": "Adult seizure, pacing, airway and behavioral rows", "checks": [ "Systolic BP below 90 mmHg." ], "clinicalReview": "Reconcile indication-specific BP, route, repeat and base-contact requirements. Pacing/airway indications also use BP above 90, so exactly 90 is not automatically eligible. The new chart’s shorter seizure wording does not remove a standing-order base-contact requirement.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "midazolam", "versed" ], "additionalGuides": [ "seizures", "transcutaneous-pacing", "supraglottic-airway", "endotracheal-intubation" ], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=6", "guideSlugs": [ "bradycardia", "seizures", "transcutaneous-pacing", "supraglottic-airway", "endotracheal-intubation", "midazolam" ] }, { "id": "morphine", "medication": "Morphine sulfate", "source": "I-15", "pages": [ 7, 8 ], "population": "Adult / adolescent", "context": "Adult analgesia: all listed preparations and routes", "checks": [ "Systolic BP below 90 mmHg." ], "clinicalReview": "Retain the selected condition order’s perfusion criteria and formulation-specific dose. A chart exclusion below 90 is not evidence of eligibility at exactly 90.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "morphine" ], "additionalGuides": [], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=7", "guideSlugs": [ "abdominal-pain", "bls-scope-of-practice", "burns", "chest-pain", "trauma", "morphine" ] }, { "id": "nitroglycerin", "medication": "Nitroglycerin", "source": "I-15", "pages": [ 8, 9 ], "population": "Adult / adolescent", "context": "Adult sublingual chest-pain / pulmonary-rales pathways", "checks": [ "Systolic BP below 100 mmHg." ], "clinicalReview": "Keep SO-C-015 and SO-M-035 boundary wording separate, including the higher-dose pulmonary-edema branch. This is not the PR-225 interfacility infusion stop threshold. Retain the existing drug-interaction and other source exclusions.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "nitroglycerin", "nitrostat" ], "additionalGuides": [], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=8", "guideSlugs": [ "bls-scope-of-practice", "chest-pain", "respiratory-distress", "fentanyl", "morphine", "nitroglycerin" ] }, { "id": "normal-saline", "medication": "Normal saline", "source": "I-15", "pages": [ 9 ], "population": "Adult / adolescent", "context": "Adult IV / IO fluid-bolus row", "checks": [ "Pulmonary rales.", "Suspected congestive heart failure." ], "clinicalReview": "Apply this to the adult fluid-bolus context. It is not a blanket prohibition on medication dilution, line flushes or pediatric nebulized saline. Check the condition-specific resuscitation order and reassess lungs and perfusion.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "normal saline", "fluid bolus", "fluid boluses" ], "additionalGuides": [ "hyperglycemia", "sepsis", "shock" ], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=9", "guideSlugs": [ "abdominal-pain", "bls-scope-of-practice", "hyperglycemia", "narrow-complex-tachycardia", "sepsis", "shock", "intraosseous-infusion", "epinephrine", "hydroxocobalamin", "normal-saline" ] }, { "id": "ondansetron", "medication": "Ondansetron", "source": "I-15", "pages": [ 9 ], "population": "Adult / adolescent", "context": "Adult ODT and IV antiemetic rows", "checks": [ "Known or suspected pregnancy." ], "clinicalReview": "This is the local adult chart exclusion, not a universal product-label contraindication. Check the relevant condition order and keep pediatric route/age questions separate.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "ondansetron", "zofran" ], "additionalGuides": [ "nausea-vomiting" ], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=9", "guideSlugs": [ "abdominal-pain", "chest-pain", "nausea-vomiting", "stroke", "ondansetron" ] }, { "id": "tranexamic-acid", "medication": "Tranexamic acid (TXA)", "source": "I-15", "pages": [ 10 ], "population": "Adult / adolescent", "context": "Adult hemorrhagic-shock pathway", "checks": [ "More than 3 hours since traumatic injury.", "More than 3 hours since vaginal delivery.", "Isolated neurogenic shock.", "Isolated extremity injury after bleeding has been controlled.", "Active thromboembolic event within the preceding 24 hours, including stroke, myocardial infarction, pulmonary embolism or DVT.", "History of TXA hypersensitivity or anaphylaxis.", "Traumatic arrest without ROSC.", "Drowning or hanging." ], "clinicalReview": "Released PR-080 confirms adult eligibility, exclusions and the premixed infusion. Preserve the separate injury and vaginal-delivery clocks; do not invent a miscarriage clock. Pediatric PR-081 uses a separate base-order pathway, with its age boundaries still flagged. Clinical sign-off and adoption remain pending.", "status": "released-source-transcribed; clinical-review-required", "aliases": [ "tranexamic", "txa" ], "additionalGuides": [ "trauma", "shock", "adult-cardiac-arrest", "imminent-childbirth", "drowning" ], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=10", "guideSlugs": [ "adult-cardiac-arrest", "drowning", "shock", "trauma", "imminent-childbirth" ], "sourceStatus": "source-resolved", "clinicalReviewStatus": "pending" } ], "findings": [ { "id": "adult-io-lidocaine", "source": "I-15", "pages": [ 5 ], "previousPages": [ 2 ], "title": "IO lidocaine dose and dwell time changed", "detail": "The previous chart lists 20 mg IO, repeat once after 3 minutes. The released chart lists 40 mg slow IO followed by 20 mg after 3 minutes, with a 60-second dwell before the saline flush.", "reviewAction": "Source question resolved. Clinical reviewer approval and agency adoption are still required.", "guideSlugs": [ "lidocaine", "intraosseous-infusion" ], "priority": "high priority", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=5", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=2", "sourceStatus": "source-resolved", "sourceResolution": { "id": "adult-io-lidocaine", "title": "IO lidocaine dose and dwell time changed", "sourceStatus": "source-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "PR-115 page 2 confirms 2% lidocaine 40 mg slowly IO for adults when IO is used outside cardiopulmonary arrest. Allow a 60-second dwell before the saline flush. The purpose is to address infusion pain before other medications or fluids enter the IO.", "If pain occurs with medication administration or flushing after the initial dose, PR-115 permits half the initial dose. I-15 specifies a 20 mg repeat after 3 minutes. Keep the pain trigger, dwell time and chart timing attached to the instruction." ], "remainingDecisions": [], "evidence": [ { "code": "PR-115", "pages": [ 2 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-115%20IO%20%2810-2026%29.pdf#page=2", "sha256": "3f84d34bb0a31e9a0a7e6a9c15df3a3f4e7373fcf16770b00bccc8ebba5eba3b", "file": "evidence/clinical-findings-resolution/sources/pr-115-released.pdf" }, { "code": "I-15", "pages": [ 5 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=5", "sha256": "d66da1fb7139bc5c61cac98afdd422a8318cc845a50aa927329f015c9d1b9848", "file": "evidence/drug-guide-reconciliation/sources/i-15-released.pdf" } ], "guideSlugs": [ "lidocaine", "intraosseous-infusion" ] }, "clinicalReview": "pending", "originalReviewAction": "Reconcile the full released PR-115, technique and device instructions before replacing the earlier procedural regimen." }, { "id": "adult-atropine-interval", "source": "I-15", "pages": [ 2 ], "previousPages": [ 1 ], "title": "Poisoning atropine repeat interval is now explicit", "detail": "The 2 mg IV/IM poisoning row now specifies a repeat after 5 minutes; the earlier chart allowed one repeat without printing that interval.", "reviewAction": "Source question resolved. Clinical reviewer approval and agency adoption are still required.", "guideSlugs": [ "atropine", "poisoning", "hazmat" ], "priority": "clinical review", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=2", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "source-resolved", "sourceResolution": { "id": "adult-atropine-interval", "title": "Poisoning atropine repeat interval is now explicit", "sourceStatus": "source-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "The released I-15 poisoning row specifies atropine 2 mg IV or IM with one repeat after 5 minutes. The currently indexed SO-M-050 and BH-M-050 permit one repeat but do not give an interval in that row. This is a newly explicit chart interval, not permission for unlimited repeat doses.", "Use the organophosphate pathway for the exposure and presentation. Do not carry its dose or repeat timing into the separate bradycardia indication." ], "remainingDecisions": [], "evidence": [ { "code": "I-15", "pages": [ 2 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=2", "sha256": "d66da1fb7139bc5c61cac98afdd422a8318cc845a50aa927329f015c9d1b9848", "file": "evidence/drug-guide-reconciliation/sources/i-15-released.pdf" }, { "code": "SO-M-050", "pages": [ 2 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf#page=2", "sha256": "d5edd1f2add207b3112bca6cbc4f583423897b7fa95b88643a2706f23b758389", "file": "evidence/clinical-findings-resolution/sources/so-m-050-current-index.pdf" }, { "code": "BH-M-050", "pages": [ 3 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-09/BH-M-50%20OD-Poisoning%20%288-2024%29.pdf#page=3", "sha256": "919228849ecbff63b8f9d68bbe8dce4aed6ca5958469838deaa36b6c30f9a1cb", "file": "evidence/clinical-findings-resolution/sources/bh-m-050-current-index.pdf" } ], "guideSlugs": [ "atropine", "poisoning", "hazmat" ] }, "clinicalReview": "pending", "originalReviewAction": "Check SO-M-050 and the exposure-specific pathway before changing the repeat timing in treatment lessons." }, { "id": "adult-epinephrine-pathways", "source": "I-15", "pages": [ 2 ], "previousPages": [ 1, 2 ], "title": "Epinephrine indication wording changed", "detail": "The released IM/IV allergy rows say anaphylaxis; the push-dose row explicitly includes bradycardia refractory to atropine and pacing and deterioration with unknown shock etiology. Hemorrhagic shock is excluded from the adult push-dose row.", "reviewAction": "Source question resolved. Clinical reviewer approval and agency adoption are still required.", "guideSlugs": [ "epinephrine", "anaphylaxis", "shock", "sepsis", "bradycardia", "adult-cardiac-arrest", "base-contact" ], "priority": "clinical review", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=2", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "source-resolved", "sourceResolution": { "id": "adult-epinephrine-pathways", "title": "Epinephrine indication wording changed", "sourceStatus": "source-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "PR-230 confirms the released adult push-dose pathway: ROSC, shock unresponsive to the initial fluid bolus, bradycardia refractory to atropine and pacing, or deterioration with unknown shock etiology. Hemorrhagic shock is contraindicated. Its preparation is 10 mcg/mL, with 1 mL (10 mcg) IV/IO every 3 minutes, titrated to SBP >90. Condition-specific base-contact requirements still apply.", "M-015 makes epinephrine first-line for anaphylaxis; diphenhydramine and albuterol are adjuncts. Its initial dose is 0.5 mg IM using 1 mg/mL; do not duplicate that initial dose when epinephrine was self-administered before arrival. After 5 minutes, persistent hypotension, respiratory distress or impending airway obstruction leads to 0.5 mg IM OR 0.3 mg IV/IO using 0.1 mg/mL. Base Hospital contact is required for anaphylaxis.", "The indication tells you which preparation belongs in the syringe. Push-dose, anaphylaxis and arrest epinephrine are separate pathways; their concentrations and doses are not interchangeable." ], "remainingDecisions": [], "evidence": [ { "code": "PR-230", "pages": [ 1 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-230%20PDE%20%2810-2026%29.pdf#page=1", "sha256": "439820d66070fb191ac5be2227d75ea3957227911c8da8c86faa44482e432b74", "file": "evidence/clinical-findings-resolution/sources/pr-230-released.pdf" }, { "code": "M-015", "pages": [ 1, 2 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/M-015%20Allergic%20Reaction%20%2810-2026%29.pdf#page=1", "sha256": "83646bbfe8e44188de70f4faa0ccef8998d6a7c451adb082bb09b0ed6176f231", "file": "evidence/clinical-findings-resolution/sources/m-015-released.pdf" }, { "code": "I-15", "pages": [ 2, 3 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=2", "sha256": "d66da1fb7139bc5c61cac98afdd422a8318cc845a50aa927329f015c9d1b9848", "file": "evidence/drug-guide-reconciliation/sources/i-15-released.pdf" } ], "guideSlugs": [ "epinephrine", "anaphylaxis", "shock", "sepsis", "bradycardia", "adult-cardiac-arrest", "base-contact" ] }, "clinicalReview": "pending", "originalReviewAction": "Reconcile M-015 and PR-230; retain distinct allergy, arrest and push-dose routes, concentrations and authority." }, { "id": "adult-new-entries", "source": "I-15", "pages": [ 2, 6, 10 ], "previousPages": [ 1, 2, 3, 4, 5 ], "title": "Calcium, magnesium and TXA need complete guide coverage", "detail": "Calcium gluconate, magnesium sulfate and TXA appear in the released adult chart but not the earlier five-page chart. OCMedic has no dedicated medication guide for these entries.", "reviewAction": "Source question resolved. Clinical reviewer approval and agency adoption are still required.", "guideSlugs": [ "adult-cardiac-arrest", "wide-complex-tachycardia", "imminent-childbirth", "trauma", "shock" ], "priority": "clinical review", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=2", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "source-resolved", "sourceResolution": { "id": "adult-new-entries", "title": "Calcium, magnesium and TXA need complete guide coverage", "sourceStatus": "source-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "C-010 supplies the missing context for calcium gluconate and magnesium. Calcium gluconate 10% 3 g IV/IO is a targeted adjunct for the listed causes (hyperkalemia, hypocalcemia, calcium-channel-blocker overdose or hypermagnesemia), not a routine medication for every arrest. Confirm secure access and do not mix calcium and bicarbonate in the same line.", "The C-010 magnesium pathway is torsades-specific: 25 mg/kg IV/IO, maximum 2 g, over 2 minutes; may repeat once. It does not establish routine use in VF, pulseless VT or monomorphic VT.", "O-010 explicitly includes postpartum eclampsia up to 6 weeks after delivery. The compressed I-15 obstetric wording must not be read as excluding all postpartum patients. Magnesium is first-line for eclamptic seizures; the source gives 4 g in 100 mL saline IV over 15–20 minutes OR 10 g IM split between the gluteal muscles. Base contact is required; do not place an IO solely for magnesium. Watch for respiratory depression with rapid infusion and stop the infusion/support the patient/contact base if toxicity occurs.", "PR-080 ties adult TXA to traumatic or miscarriage/postpartum hemorrhagic shock, SBP <90 or shock index >1, and significant ongoing bleeding despite basic control measures. It specifies 1 g in a 100 mL premixed bag IV/IO over 10 minutes, with IV preferred. Check the full contraindications, continue bleeding control and transport, and communicate administration to base and the trauma center.", "These source questions are resolved in the existing arrest, obstetric and trauma lessons. Dedicated medication guides for calcium, magnesium and TXA are still a coverage gap; source reconciliation does not imply that new standalone guides were created." ], "remainingDecisions": [], "evidence": [ { "code": "C-010", "pages": [ 2, 3 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/C-010%20Cardiac%20Arrest%20%2810-2026%29.pdf#page=2", "sha256": "4f9f9ef4d262b7f5001f1e6403981f33440354a8596294cf99beeef72dabcf52", "file": "evidence/clinical-findings-resolution/sources/c-010-released.pdf" }, { "code": "O-010", "pages": [ 1, 2 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/O-010%20Hypertensive%20Disorders%20of%20Pregnancy%20%2810-2026%29.pdf#page=1", "sha256": "e55e871946ec7839ebcd651006622586162bb224e3d0926f0993337d2dac6d60", "file": "evidence/clinical-findings-resolution/sources/o-010-released.pdf" }, { "code": "PR-080", "pages": [ 1 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-080%20TXA%20%2810-2026%29.pdf#page=1", "sha256": "9ca3426ac3d92e29a29ba634fe3a70c38479a9da4ce04a116a74a4fbf37bb29b", "file": "evidence/clinical-findings-resolution/sources/pr-080-released.pdf" }, { "code": "SO-ALS", "pages": [ 1, 2, 3 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/SO-ALS%20General%20%2810-2026%29.pdf#page=1", "sha256": "852fe42dc1802ece9b596fe2dc6908144bb47ed13f044c9dd9d697fec17ab33e", "file": "evidence/clinical-findings-resolution/sources/so-als-released.pdf" }, { "code": "I-15", "pages": [ 2, 6, 10 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=2", "sha256": "d66da1fb7139bc5c61cac98afdd422a8318cc845a50aa927329f015c9d1b9848", "file": "evidence/drug-guide-reconciliation/sources/i-15-released.pdf" } ], "guideSlugs": [ "adult-cardiac-arrest", "wide-complex-tachycardia", "imminent-childbirth", "trauma", "shock" ] }, "clinicalReview": "pending", "originalReviewAction": "Complete C-010, O-010 and PR-080 reconciliation, preparation/contraindication checks and clinical review before authoring standalone administration guides. Chart addition alone does not establish newly granted scope." }, { "id": "adult-shortened-instructions", "source": "I-15", "pages": [ 1, 5, 6, 7 ], "previousPages": [ 1, 2, 3 ], "title": "Shorter repeat and route text needs the full order", "detail": "Adenosine repeat wording is shorter; lidocaine antiarrhythmic repeat timing is printed as after 3 minutes rather than 3–5. Midazolam seizure IV/IO wording now specifies access already present for other treatments and does not repeat the earlier continued-seizure base-contact note.", "reviewAction": "Source question resolved. Clinical reviewer approval and agency adoption are still required.", "guideSlugs": [ "adenosine", "lidocaine", "midazolam", "seizures", "narrow-complex-tachycardia", "wide-complex-tachycardia", "base-contact" ], "priority": "clinical review", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "source-resolved", "sourceResolution": { "id": "adult-shortened-instructions", "title": "Shorter repeat and route text needs the full order", "sourceStatus": "source-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "Short chart rows do not replace treatment sequence. SO-C-025 retains adenosine after attempted Valsalva in the regular narrow-complex pathway, with one repeat after 3 minutes. SO-C-040 places antiarrhythmic repeats within the unsuccessful-cardioversion sequence for unstable pulsed wide-complex tachycardia.", "C-010 permits one half-dose lidocaine repeat after approximately 3–5 minutes in arrest; the I-15 3-minute wording falls within that interval. It does not authorize repeated half-doses without a limit.", "SO-M-040 retains 10 mg IM midazolam once as the preferred seizure route, before starting IV/IO. Its alternate 5 mg IV/IN/IO pathway applies if IM cannot be delivered or access is already present, with one repeat after approximately 3 minutes. Base contact is required if seizure continues 5 minutes after the first IM or second alternate-route dose (10 mg total). Keep that escalation instruction even though the chart is shorter." ], "remainingDecisions": [], "evidence": [ { "code": "SO-C-025", "pages": [ 1, 2 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/34670.pdf#page=1", "sha256": "1b9a2d84a1b8bffd4ad35bb7353e498d83c87a6b865773b35d94d196622b68a9", "file": "evidence/clinical-findings-resolution/sources/so-c-025-current-index.pdf" }, { "code": "SO-C-040", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-C-40%20VT%20with%20Pulse%20%2810-2025%29.pdf#page=1", "sha256": "abdcbe5e634d975bac2b51f4b6572eb88df9881000ccfed7e69d317da913ca3d", "file": "evidence/clinical-findings-resolution/sources/so-c-040-current-index.pdf" }, { "code": "SO-M-040", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-M-040%207-15-21.pdf#page=1", "sha256": "a511c2f86eabbbc6510928af2e99aae879058eee3540d8f21760f97bf3231e9f", "file": "evidence/clinical-findings-resolution/sources/so-m-040-current-index.pdf" }, { "code": "C-010", "pages": [ 2 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/C-010%20Cardiac%20Arrest%20%2810-2026%29.pdf#page=2", "sha256": "4f9f9ef4d262b7f5001f1e6403981f33440354a8596294cf99beeef72dabcf52", "file": "evidence/clinical-findings-resolution/sources/c-010-released.pdf" }, { "code": "I-15", "pages": [ 1, 5, 6, 7 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "sha256": "d66da1fb7139bc5c61cac98afdd422a8318cc845a50aa927329f015c9d1b9848", "file": "evidence/drug-guide-reconciliation/sources/i-15-released.pdf" } ], "guideSlugs": [ "adenosine", "lidocaine", "midazolam", "seizures", "narrow-complex-tachycardia", "wide-complex-tachycardia", "base-contact" ] }, "clinicalReview": "pending", "originalReviewAction": "Do not infer unlimited repeats, a waived clinical condition or a removed base-contact requirement. Reconcile the condition order and complete procedure." }, { "id": "adult-bicarbonate", "source": "I-15", "pages": [ 10 ], "previousPages": [ 5 ], "title": "Bicarbonate timing and concentration need reconciliation", "detail": "The released arrest indication no longer prints the earlier after-10-minutes condition. It explicitly lists both 7.5% (44.6 mEq/50 mL) and 8.4% (1 mEq/mL) preparations; a 50 mL volume does not mean the same mEq for both.", "reviewAction": "Obtain a controlling OCEMS clarification for adult bicarbonate indication, formulation, dose units, initial timing, repeat timing/limit and standing-order versus base-order authority. Reconcile C-010 pages 2, 3, 6 and 8 with I-15 page 10.", "guideSlugs": [ "sodium-bicarbonate", "adult-cardiac-arrest" ], "priority": "high priority", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=10", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=5", "sourceStatus": "unresolved", "sourceResolution": { "id": "adult-bicarbonate", "title": "Bicarbonate timing and concentration need reconciliation", "sourceStatus": "unresolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "The complete released C-010 confirms a source conflict, rather than supplying one consistent replacement regimen. Page 2 and the page 8 flowchart use 50 mL of 7.5% or 8.4% solution and include 10-minute arrest timing; page 3 describes targeted use, 50 mEq and a repeat after 10 minutes; page 6 gives a base-hospital renal-failure/hyperkalemia repeat after 5 minutes if there is a response.", "A volume is not automatically the same dose across those formulations. The website does not merge the competing branches into a new bedside regimen." ], "remainingDecisions": [ "Obtain a controlling OCEMS clarification for adult bicarbonate indication, formulation, dose units, initial timing, repeat timing/limit and standing-order versus base-order authority. Reconcile C-010 pages 2, 3, 6 and 8 with I-15 page 10." ], "evidence": [ { "code": "C-010", "pages": [ 2, 3, 6, 8 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/C-010%20Cardiac%20Arrest%20%2810-2026%29.pdf#page=2", "sha256": "4f9f9ef4d262b7f5001f1e6403981f33440354a8596294cf99beeef72dabcf52", "file": "evidence/clinical-findings-resolution/sources/c-010-released.pdf" }, { "code": "I-15", "pages": [ 10 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=10", "sha256": "d66da1fb7139bc5c61cac98afdd422a8318cc845a50aa927329f015c9d1b9848", "file": "evidence/drug-guide-reconciliation/sources/i-15-released.pdf" } ], "guideSlugs": [ "sodium-bicarbonate", "adult-cardiac-arrest" ] }, "clinicalReview": "pending", "originalReviewAction": "Verify C-010 timing and product selection before changing field instructions; retain formulation-specific units." }, { "id": "adult-oxygen-wording", "source": "I-15", "pages": [ 9 ], "previousPages": [ 5 ], "title": "Oxygen indication list is shorter", "detail": "The released chart retains decompression sickness but no longer explicitly lists SCUBA accidents/air embolism in the oxygen row.", "reviewAction": "Source question resolved. Clinical reviewer approval and agency adoption are still required.", "guideSlugs": [ "oxygen" ], "priority": "clinical review", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=9", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=5", "sourceStatus": "source-resolved", "sourceResolution": { "id": "adult-oxygen-wording", "title": "Oxygen indication list is shorter", "sourceStatus": "source-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "E-010 is explicitly the decompression sickness / air embolism guideline and retains early 100% oxygen by mask in its BLS interventions, with Base Hospital contact required. The omission of air embolism from the short drug-chart row is not removal of that indication.", "Teach the condition-specific oxygen objective and delivery method. A general chart flow entry does not replace E-010’s 100% oxygen instruction." ], "remainingDecisions": [], "evidence": [ { "code": "E-010", "pages": [ 1 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/E-010%20Decompression%20Sickness%20%2810-2026%29.pdf#page=1", "sha256": "64d2bace5519591ce7c03eb339db7eda1a3cdbbc6388fdd0b307bc5bb1dde6cf", "file": "evidence/clinical-findings-resolution/sources/e-010-released.pdf" }, { "code": "I-15", "pages": [ 9 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=9", "sha256": "d66da1fb7139bc5c61cac98afdd422a8318cc845a50aa927329f015c9d1b9848", "file": "evidence/drug-guide-reconciliation/sources/i-15-released.pdf" } ], "guideSlugs": [ "oxygen" ] }, "clinicalReview": "pending", "originalReviewAction": "Do not treat a shortened chart list as withdrawal of a condition-specific indication; compare E-010." }, { "id": "pediatric-routes", "source": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "title": "Several pediatric routes changed", "detail": "Across the released weight bands, diphenhydramine changes from IV/IO/IM to IV/IM; fentanyl from IN/IV/IM to IV/IM; pulsed-VT amiodarone from IV to IV/IO; toxic-delirium midazolam from IN/IM to IV/IO. The pink epinephrine arrest and push-dose rows also gain IO.", "reviewAction": "Clarify pediatric fentanyl IN availability despite the I-20 omission; midazolam toxic-delirium route and dose; amiodarone IO and its pulsed-VT indication/authority; and whether diphenhydramine IO remains permitted for the SO-P-085 extrapyramidal-reaction pathway. Keep each indication separate.", "guideSlugs": [ "diphenhydramine", "fentanyl", "amiodarone", "midazolam", "epinephrine", "pediatric-anaphylaxis", "pediatric-poisoning", "pediatric-trauma", "pediatric-burns", "pediatric-cardiac-arrest", "pediatric-bradycardia", "pediatric-shock" ], "priority": "high priority", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "partially-resolved", "sourceResolution": { "id": "pediatric-routes", "title": "Several pediatric routes changed", "sourceStatus": "partially-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "Epinephrine IO is supported in the pediatric arrest and bradycardia orders and explicitly in released PR-205 for push-dose use. PR-205 still requires Base Hospital contact AND an order; an IO route printed in I-20 does not waive that requirement.", "P-060 supports IM diphenhydramine for an isolated allergic reaction and IM/IV as an anaphylaxis adjunct after epinephrine. That resolves the allergy-context chart question. It does not settle IO use for dystonia: SO-P-085 lists IM/IV diphenhydramine but also permits all drugs in that order by IO.", "Released P-015 still explicitly includes IN fentanyl for trauma, whereas I-20 omits IN. SO-P-070/BH-P-070 use 0.2 mg/kg IM/IN midazolam for toxic delirium, while I-20 prints IV/IO. BH-P-050’s pulsed-VT amiodarone instruction is IV under base authority in a specific AICD scenario; the chart’s IO entry alone does not establish broader pulsed-VT authorization." ], "remainingDecisions": [ "Clarify pediatric fentanyl IN availability despite the I-20 omission; midazolam toxic-delirium route and dose; amiodarone IO and its pulsed-VT indication/authority; and whether diphenhydramine IO remains permitted for the SO-P-085 extrapyramidal-reaction pathway. Keep each indication separate." ], "evidence": [ { "code": "P-060", "pages": [ 2, 3 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-060%20Ped%20Allergic%20Reaction%20%2810-2026%29.pdf#page=2", "sha256": "c7c9c3e5970c51749447e17e294dc94ab3fd1f40fa0f64d634255b227e4ab3e6", "file": "evidence/clinical-findings-resolution/sources/p-060-released.pdf" }, { "code": "P-015", "pages": [ 3 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-015%20Ped%20General%20Injury%20%2810-2026%29.pdf#page=3", "sha256": "d6d8953f3b03cdf4412aa6ef6b6a981745620de5600929ceca69b8eb7a2c21cd", "file": "evidence/clinical-findings-resolution/sources/p-015-released.pdf" }, { "code": "SO-P-070", "pages": [ 2 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/SO-P-070%20Peds%20Behavioral%2004-2026.pdf#page=2", "sha256": "dab11c4ccf9da99b636d8f8b4e8aaa38b35a2b6098d50ef22a43bca4162381c1", "file": "evidence/clinical-findings-resolution/sources/so-p-070-current-index.pdf" }, { "code": "BH-P-070", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-01/BH-P-70%20Ped%20Behavioral%201-2026.pdf#page=1", "sha256": "5b2a5572a59c94e361d0f99499ee9c7f57c53b15f641008805489449cb5fb4e5", "file": "evidence/clinical-findings-resolution/sources/bh-p-070-current-index.pdf" }, { "code": "BH-P-050", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-09/BH-P-050%20V-tach%20with%20pulse%208-2024.pdf#page=1", "sha256": "375d7678ac1a697611669c88e683c17b030a6d1d4e67f307303e45347d554c18", "file": "evidence/clinical-findings-resolution/sources/bh-p-050-current-index.pdf" }, { "code": "SO-P-085", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf#page=1", "sha256": "68f3d92b95fedf03bd13d484c2ca90910a2c8b9ec31b2bf8b08bcf204dbdeb45", "file": "evidence/clinical-findings-resolution/sources/so-p-085-current-index.pdf" }, { "code": "SO-P-040", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf#page=1", "sha256": "96f016323beab843cb16093e58d01fa69590c639e05d298735f234f246347f6c", "file": "evidence/clinical-findings-resolution/sources/so-p-040-current-index.pdf" }, { "code": "SO-P-045", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-45%20Bradycardia%20peds.pdf#page=1", "sha256": "44206894b45ce04ab45dbf1599a27365866b97cff2b3983783d519dc7679c6f2", "file": "evidence/clinical-findings-resolution/sources/so-p-045-current-index.pdf" }, { "code": "PR-205", "pages": [ 1 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-205%20Ped%20PDE%20%2810-2026%29.pdf#page=1", "sha256": "1073d326a203b01b93880108c607607d0e82ac46b73ef1043941b4bfd3005270", "file": "evidence/clinical-findings-resolution/sources/pr-205-released.pdf" }, { "code": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "sha256": "0cdb41a44dbc25618853c5b30c2b758a252836953603ab8f5e4c661a078e9490", "file": "evidence/drug-guide-reconciliation/sources/i-20-released.pdf" } ], "guideSlugs": [ "diphenhydramine", "fentanyl", "amiodarone", "midazolam", "epinephrine", "pediatric-anaphylaxis", "pediatric-poisoning", "pediatric-trauma", "pediatric-burns", "pediatric-cardiac-arrest", "pediatric-bradycardia", "pediatric-shock" ] }, "clinicalReview": "pending", "originalReviewAction": "Resolve each against the complete pediatric condition order and procedure before replacing routes. Do not transfer an adult route into pediatric care." }, { "id": "pediatric-ondansetron", "source": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "title": "Pediatric IV ondansetron added; ODT age wording changed", "detail": "The released chart adds IV ondansetron values in the pink through black bands, with N/A for the neonate. The white 3–4-year band no longer repeats the earlier age-at-least-4 ODT qualifier. The cited SO-P-090 summary remains ODT from age 4 with no routine IV regimen.", "reviewAction": "Clarify eligibility at exactly 3 months and exactly 4 years, ODT below age 4, the parenteral maximum dose (including the chart’s 4 mg upper band), IV versus IO, and whether parenteral dosing applies outside trauma.", "guideSlugs": [ "ondansetron", "pediatric-nausea-vomiting", "nausea-vomiting", "pediatric-trauma" ], "priority": "high priority", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "partially-resolved", "sourceResolution": { "id": "pediatric-ondansetron", "title": "Pediatric IV ondansetron added; ODT age wording changed", "sourceStatus": "partially-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "P-015 page 3 confirms a parenteral pediatric ondansetron pathway in trauma: 0.1 mg/kg IV/IO once for age >3 months, and 4 mg ODT once for age >4 years with intact airway reflexes. SO-P-090/BH-P-090 still describe 4 mg ODT at age 4 years or greater for general nausea/vomiting.", "I-20 includes a 3-month IV row, ODT in the 3–4-year band and a 4 mg upper-band IV entry. The trauma order’s existence does not authorize extrapolating IV/IO treatment to every pediatric vomiting encounter." ], "remainingDecisions": [ "Clarify eligibility at exactly 3 months and exactly 4 years, ODT below age 4, the parenteral maximum dose (including the chart’s 4 mg upper band), IV versus IO, and whether parenteral dosing applies outside trauma." ], "evidence": [ { "code": "P-015", "pages": [ 3 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-015%20Ped%20General%20Injury%20%2810-2026%29.pdf#page=3", "sha256": "d6d8953f3b03cdf4412aa6ef6b6a981745620de5600929ceca69b8eb7a2c21cd", "file": "evidence/clinical-findings-resolution/sources/p-015-released.pdf" }, { "code": "SO-P-090", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-90%20vomiting.pdf#page=1", "sha256": "41ccadf53b395278cc6ebe71ab462615fa2ffc92eb880f346fdb6cdeba30534d", "file": "evidence/clinical-findings-resolution/sources/so-p-090-current-index.pdf" }, { "code": "BH-P-090", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/63556.pdf#page=1", "sha256": "232ba2b3747b60a72c610cf613c6ee237b79e43dcbaab0eebb4eeea5d0e5c83e", "file": "evidence/clinical-findings-resolution/sources/bh-p-090-current-index.pdf" }, { "code": "I-20", "pages": [ 3, 6, 10 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=3", "sha256": "0cdb41a44dbc25618853c5b30c2b758a252836953603ab8f5e4c661a078e9490", "file": "evidence/drug-guide-reconciliation/sources/i-20-released.pdf" } ], "guideSlugs": [ "ondansetron", "pediatric-nausea-vomiting", "nausea-vomiting", "pediatric-trauma" ] }, "clinicalReview": "pending", "originalReviewAction": "Reconcile the full current/adopted SO-P-090 and obtain clarification before publishing IV dosing or extending ODT to a 3-year-old. Weight-band presence is not age eligibility." }, { "id": "pediatric-morphine-volume", "source": "I-20", "pages": [ 10 ], "previousPages": [ 10 ], "title": "Black-band morphine dose and volume disagree", "detail": "For the 4 mg/mL formulation, the previous black band prints 4 mg / 1 mL; the release prints 4.5 mg / 1 mL. At 4 mg/mL those printed values do not agree. Other black-band formulations retain 4.5 mg.", "reviewAction": "Obtain the corrected black-band morphine dose/volume pair for the 4 mg/mL presentation and the approved rounding/measuring instruction.", "guideSlugs": [ "morphine", "pediatric-trauma", "pediatric-burns" ], "priority": "high priority", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=10", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf#page=10", "sourceStatus": "unresolved", "sourceResolution": { "id": "pediatric-morphine-volume", "title": "Black-band morphine dose and volume disagree", "sourceStatus": "unresolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "The released I-20 black-band 4 mg/mL morphine cell pairs 4.5 mg with 1 mL. Those values are not equivalent. P-015’s 0.1 mg/kg explains 4.5 mg at the representative 45 kg weight, but does not establish that 1 mL is an approved rounding choice.", "Arithmetic check only: 4.5 mg divided by 4 mg/mL is 1.125 mL. This calculation is evidence of the discrepancy, not an authorized replacement volume." ], "remainingDecisions": [ "Obtain the corrected black-band morphine dose/volume pair for the 4 mg/mL presentation and the approved rounding/measuring instruction." ], "evidence": [ { "code": "I-20", "pages": [ 10 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=10", "sha256": "0cdb41a44dbc25618853c5b30c2b758a252836953603ab8f5e4c661a078e9490", "file": "evidence/drug-guide-reconciliation/sources/i-20-released.pdf" }, { "code": "P-015", "pages": [ 3 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-015%20Ped%20General%20Injury%20%2810-2026%29.pdf#page=3", "sha256": "d6d8953f3b03cdf4412aa6ef6b6a981745620de5600929ceca69b8eb7a2c21cd", "file": "evidence/clinical-findings-resolution/sources/p-015-released.pdf" } ], "guideSlugs": [ "morphine", "pediatric-trauma", "pediatric-burns" ] }, "clinicalReview": "pending", "originalReviewAction": "Request clinical/source clarification; do not silently choose the dose or volume or use the mismatched row to generate a calculator." }, { "id": "pediatric-lidocaine-rounding", "source": "I-20", "pages": [ 1 ], "previousPages": [ 1 ], "title": "Neonatal IO lidocaine dose/volume question persists", "detail": "Both charts print 2 mg and 0.15 mL for neonatal IO-infusion pain at 20 mg/mL. The nominal conversion gives 3 mg for 0.15 mL; both charts also note rounded volumes.", "reviewAction": "Obtain a corrected gray-band lidocaine dose/volume pair and a clinically approved small-volume rounding and measurement method.", "guideSlugs": [ "lidocaine", "intraosseous-infusion" ], "priority": "high priority", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "unresolved", "sourceResolution": { "id": "pediatric-lidocaine-rounding", "title": "Neonatal IO lidocaine dose/volume question persists", "sourceStatus": "unresolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "PR-115 confirms pediatric IO analgesia with 2% lidocaine 0.5 mg/kg, maximum 40 mg, slowly IO with a 60-second dwell. I-20’s gray-band cell pairs 2 mg with 0.15 mL.", "Arithmetic check only: 2% is 20 mg/mL, so 2 mg corresponds to 0.10 mL and 0.15 mL contains 3 mg. The full procedure confirms the weight-based dose but does not resolve the chart cell or authorize a rounding rule." ], "remainingDecisions": [ "Obtain a corrected gray-band lidocaine dose/volume pair and a clinically approved small-volume rounding and measurement method." ], "evidence": [ { "code": "PR-115", "pages": [ 2 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-115%20IO%20%2810-2026%29.pdf#page=2", "sha256": "3f84d34bb0a31e9a0a7e6a9c15df3a3f4e7373fcf16770b00bccc8ebba5eba3b", "file": "evidence/clinical-findings-resolution/sources/pr-115-released.pdf" }, { "code": "I-20", "pages": [ 1 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "sha256": "0cdb41a44dbc25618853c5b30c2b758a252836953603ab8f5e4c661a078e9490", "file": "evidence/drug-guide-reconciliation/sources/i-20-released.pdf" } ], "guideSlugs": [ "lidocaine", "intraosseous-infusion" ] }, "clinicalReview": "pending", "originalReviewAction": "Clarify the intended rounding and measurable volume with clinical reviewers. This is a carried-forward discrepancy, not a newly changed dose." }, { "id": "pediatric-txa", "source": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "title": "Pediatric TXA added in every band", "detail": "The release adds TXA IV/IO over 10 minutes with a base-hospital-order asterisk in all ten bands and a 1 g/10 mL stock preparation.", "reviewAction": "Clarify which TXA SBP/shock-index threshold applies at exactly 1, 3 and 5 years. Confirm the implementation teaching follows the explicit 10 mL final-syringe steps, rather than reading the page 3 footer as administration of undiluted stock volume.", "guideSlugs": [ "pediatric-trauma", "pediatric-shock", "base-contact" ], "priority": "high priority", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "partially-resolved", "sourceResolution": { "id": "pediatric-txa", "title": "Pediatric TXA added in every band", "sourceStatus": "partially-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "PR-081 resolves the preparation question: pediatric TXA is Base Hospital order only, 15 mg/kg IV/IO over 10 minutes, maximum 1 g. The stock vial is 100 mg/mL. Draw the calculated stock volume, then add saline to a TOTAL syringe volume of 10 mL; give that entire syringe evenly over 10 minutes (1 mL/min). Do not confuse stock withdrawal volume with final administration volume.", "The source’s 20 kg example is 300 mg: 3 mL stock plus 7 mL saline, final volume 10 mL. The procedure calls for a line flush, blood-pressure monitoring, documentation and communication to base and the trauma center.", "PR-081 requires traumatic hemorrhagic shock and ongoing bleeding despite basic control. Its printed age intervals overlap at 1, 3 and 5 years. Those boundaries need clarification; the separate normal-vital-sign table is not authority to silently rewrite TXA eligibility." ], "remainingDecisions": [ "Clarify which TXA SBP/shock-index threshold applies at exactly 1, 3 and 5 years. Confirm the implementation teaching follows the explicit 10 mL final-syringe steps, rather than reading the page 3 footer as administration of undiluted stock volume." ], "evidence": [ { "code": "PR-081", "pages": [ 1, 2, 3 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-081%20Ped%20TXA%20%2810-2026%29.pdf#page=1", "sha256": "90d9a12b27ae2b39ab8384c91ac58d4425b67ed5b20030a4e919c722155521ec", "file": "evidence/clinical-findings-resolution/sources/pr-081-released.pdf" }, { "code": "P-015", "pages": [ 5 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-015%20Ped%20General%20Injury%20%2810-2026%29.pdf#page=5", "sha256": "d6d8953f3b03cdf4412aa6ef6b6a981745620de5600929ceca69b8eb7a2c21cd", "file": "evidence/clinical-findings-resolution/sources/p-015-released.pdf" }, { "code": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "sha256": "0cdb41a44dbc25618853c5b30c2b758a252836953603ab8f5e4c661a078e9490", "file": "evidence/drug-guide-reconciliation/sources/i-20-released.pdf" } ], "guideSlugs": [ "pediatric-trauma", "pediatric-shock", "base-contact" ] }, "clinicalReview": "pending", "originalReviewAction": "Reconcile PR-081 eligibility, exclusions, dilution, final infusion volume and base orders. Printed stock volumes must not be assumed to be ready-to-infuse volumes." }, { "id": "pediatric-hydroxocobalamin", "source": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "title": "Hydroxocobalamin rows omitted", "detail": "Hydroxocobalamin appears in the earlier ten-band chart but is absent from the release.", "reviewAction": "Obtain explicit OCEMS clarification of pediatric hydroxocobalamin availability/authorization, indication, dose, dilution, infusion instructions and base-order requirements. Do not infer either withdrawal or continued pediatric authorization from the omission alone.", "guideSlugs": [ "hydroxocobalamin", "pediatric-poisoning", "pediatric-burns", "burns", "hazmat" ], "priority": "clinical review", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "unresolved", "sourceResolution": { "id": "pediatric-hydroxocobalamin", "title": "Hydroxocobalamin rows omitted", "sourceStatus": "unresolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "Hydroxocobalamin is omitted from the released I-20. Released PR-130 is labeled Adult/Adolescent and supplies an adult/adolescent 5 g preparation under Base Hospital order; it does not establish a pediatric weight-based replacement.", "The current pediatric poisoning standing order supplies supportive measures for suspected cyanide exposure but does not provide a pediatric hydroxocobalamin regimen. An adult procedure cannot fill that pediatric authorization gap." ], "remainingDecisions": [ "Obtain explicit OCEMS clarification of pediatric hydroxocobalamin availability/authorization, indication, dose, dilution, infusion instructions and base-order requirements. Do not infer either withdrawal or continued pediatric authorization from the omission alone." ], "evidence": [ { "code": "PR-130", "pages": [ 1, 2 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-130%20Hydroxocobalamin%20%2810-2026%29.pdf#page=1", "sha256": "099cfcf835eb914b1c9bd16b280d06e36fcb785b31c8690c74aea2b41a18a2ee", "file": "evidence/clinical-findings-resolution/sources/pr-130-released.pdf" }, { "code": "SO-P-085", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf#page=1", "sha256": "68f3d92b95fedf03bd13d484c2ca90910a2c8b9ec31b2bf8b08bcf204dbdeb45", "file": "evidence/clinical-findings-resolution/sources/so-p-085-current-index.pdf" }, { "code": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "sha256": "0cdb41a44dbc25618853c5b30c2b758a252836953603ab8f5e4c661a078e9490", "file": "evidence/drug-guide-reconciliation/sources/i-20-released.pdf" } ], "guideSlugs": [ "hydroxocobalamin", "pediatric-poisoning", "pediatric-burns", "burns", "hazmat" ] }, "clinicalReview": "pending", "originalReviewAction": "Check PR-130 and exposure orders; omission from I-20 is not proof the treatment is withdrawn. Retain earlier source attribution pending review." }, { "id": "pediatric-electrical", "source": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "title": "Defibrillation sequences are now printed explicitly", "detail": "The release replaces defibrillation ranges with three specified energies per band. Cardioversion energies are retained, but the earlier header’s base-order notation is absent.", "reviewAction": "Source question resolved. Clinical reviewer approval and agency adoption are still required.", "guideSlugs": [ "pediatric-cardiac-arrest", "synchronized-cardioversion", "base-contact" ], "priority": "high priority", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "source-resolved", "sourceResolution": { "id": "pediatric-electrical", "title": "Defibrillation sequences are now printed explicitly", "sourceStatus": "source-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "For the initial VF/pulseless-VT branch, SO-P-040 supports the I-20 first/second/third defibrillation sequence of 2, 4 and 4 J/kg, while retaining the source’s manufacturer/programmed-setting option. Follow the actual arrest branch and device guidance; a color-band entry is not a substitute for the complete sequence.", "PR-095 explicitly requires Base Hospital contact AND an order for pediatric synchronized cardioversion. BH-P-050/BH-P-055 provide the condition-specific base pathways. The missing chart-header marker does not remove that authority requirement." ], "remainingDecisions": [], "evidence": [ { "code": "SO-P-040", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf#page=1", "sha256": "96f016323beab843cb16093e58d01fa69590c639e05d298735f234f246347f6c", "file": "evidence/clinical-findings-resolution/sources/so-p-040-current-index.pdf" }, { "code": "PR-095", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/hca/files/import/data/files/38135.pdf#page=1", "sha256": "e07a2c7d05bef1d7b7947551519cc320a75f18fae96253a7400f21f1a00cc6cf", "file": "evidence/clinical-findings-resolution/sources/pr-095-current-index.pdf" }, { "code": "BH-P-050", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-09/BH-P-050%20V-tach%20with%20pulse%208-2024.pdf#page=1", "sha256": "375d7678ac1a697611669c88e683c17b030a6d1d4e67f307303e45347d554c18", "file": "evidence/clinical-findings-resolution/sources/bh-p-050-current-index.pdf" }, { "code": "BH-P-055", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2024-09/BH-P-055%20SVT%208-2024.pdf#page=1", "sha256": "a0970c8ee8ea4b6f3409dac9680d75bc52b39c11d5eee5c2fad51483c8ccfa6b", "file": "evidence/clinical-findings-resolution/sources/bh-p-055-current-index.pdf" }, { "code": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "sha256": "0cdb41a44dbc25618853c5b30c2b758a252836953603ab8f5e4c661a078e9490", "file": "evidence/drug-guide-reconciliation/sources/i-20-released.pdf" } ], "guideSlugs": [ "pediatric-cardiac-arrest", "synchronized-cardioversion", "base-contact" ] }, "clinicalReview": "pending", "originalReviewAction": "Reconcile SO-P-040 and PR-095; do not infer that a missing marker waives a base order or recompute the printed bands from a different representative weight." }, { "id": "pediatric-age-authority", "source": "I-20", "pages": [ 1, 2, 3, 4, 5 ], "previousPages": [ 1, 2, 3, 4, 5 ], "title": "Analgesic base-order markers need age clarification", "detail": "Fentanyl and morphine show base-order asterisks through the yellow age-2 band. The earlier text specifies base orders for age below 2.", "reviewAction": "Source question resolved. Clinical reviewer approval and agency adoption are still required.", "guideSlugs": [ "fentanyl", "morphine", "pediatric-trauma", "pediatric-burns", "base-contact" ], "priority": "clinical review", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "source-resolved", "sourceResolution": { "id": "pediatric-age-authority", "title": "Analgesic base-order markers need age clarification", "sourceStatus": "source-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "Released P-015 page 3 explicitly requires a Base Hospital order for fentanyl or morphine when the trauma patient is younger than 2 years. Use the child’s actual age and the condition-specific order, not the presence or absence of a marker across a whole chart band.", "This resolves the trauma age-marker question. It does not waive separate base-contact requirements for trauma criteria or establish a new analgesia rule for every other pediatric indication." ], "remainingDecisions": [], "evidence": [ { "code": "P-015", "pages": [ 3 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-015%20Ped%20General%20Injury%20%2810-2026%29.pdf#page=3", "sha256": "d6d8953f3b03cdf4412aa6ef6b6a981745620de5600929ceca69b8eb7a2c21cd", "file": "evidence/clinical-findings-resolution/sources/p-015-released.pdf" }, { "code": "I-20", "pages": [ 4, 5 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=4", "sha256": "0cdb41a44dbc25618853c5b30c2b758a252836953603ab8f5e4c661a078e9490", "file": "evidence/drug-guide-reconciliation/sources/i-20-released.pdf" } ], "guideSlugs": [ "fentanyl", "morphine", "pediatric-trauma", "pediatric-burns", "base-contact" ] }, "clinicalReview": "pending", "originalReviewAction": "Confirm the exact age boundary in P-015 and the condition order; a weight/color band cannot replace the patient’s actual age." }, { "id": "pediatric-preparation", "source": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "title": "Preparation labels and dilution notes changed", "detail": "The release drops the explicit 10 mcg/mL label from push-dose epinephrine and the earlier bicarbonate concentration/dilution notes, including the small-child 1:1 dilution notes. The black-band D10 label is now 10%, replacing the earlier inconsistent 0.1 mg/mL label.", "reviewAction": "Confirm pediatric bicarbonate indication and authority, stock and final concentrations, whether dilution is required, and whether each I-20 volume means stock withdrawal or final administered solution. Do not infer a universal dilution rule or its removal.", "guideSlugs": [ "epinephrine", "sodium-bicarbonate", "dextrose", "pediatric-cardiac-arrest", "pediatric-shock", "pediatric-altered-mental-status", "pediatric-seizures" ], "priority": "high priority", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "partially-resolved", "sourceResolution": { "id": "pediatric-preparation", "title": "Preparation labels and dilution notes changed", "sourceStatus": "partially-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "PR-205 explicitly preserves push-dose epinephrine at 10 mcg/mL: 0.1 mL/kg IV/IO, maximum 1 mL per dose, with repeat dosing every 3 minutes to its age-based SBP targets. Base Hospital contact and order are required before administration. The abbreviated chart’s missing preparation label does not change the concentration.", "Released P-065 and P-075 confirm 10% dextrose, 5 mL/kg IV/IO, maximum 250 mL, within their hypoglycemia pathways. D10 is 100 mg/mL; the earlier 0.1 mg/mL chart label was not a usable concentration. The patient’s condition, glucose criterion and route remain part of the order.", "The indexed pediatric arrest standing and base orders do not supply the missing bicarbonate preparation pathway. The omission of old dilution notes from I-20 is not a new preparation instruction." ], "remainingDecisions": [ "Confirm pediatric bicarbonate indication and authority, stock and final concentrations, whether dilution is required, and whether each I-20 volume means stock withdrawal or final administered solution. Do not infer a universal dilution rule or its removal." ], "evidence": [ { "code": "PR-205", "pages": [ 1 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-205%20Ped%20PDE%20%2810-2026%29.pdf#page=1", "sha256": "1073d326a203b01b93880108c607607d0e82ac46b73ef1043941b4bfd3005270", "file": "evidence/clinical-findings-resolution/sources/pr-205-released.pdf" }, { "code": "P-065", "pages": [ 1 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-065%20Ped%20Altered%20Mental%20Status%20%2810-2026%29.pdf#page=1", "sha256": "d9355d568fc62ebb5dff55c70e2e505a15388bde1d3ecaa007504767d0b504e8", "file": "evidence/clinical-findings-resolution/sources/p-065-released.pdf" }, { "code": "P-075", "pages": [ 2 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-075%20Ped%20Seizure%20%2810-2026%29.pdf#page=2", "sha256": "a9fb7ef63ee1d943fe0531ad3e1d5efac9038821e5cbed2b812dfba2c35ab99e", "file": "evidence/clinical-findings-resolution/sources/p-075-released.pdf" }, { "code": "SO-P-040", "pages": [ 1, 2 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf#page=1", "sha256": "96f016323beab843cb16093e58d01fa69590c639e05d298735f234f246347f6c", "file": "evidence/clinical-findings-resolution/sources/so-p-040-current-index.pdf" }, { "code": "BH-P-040", "pages": [ 1, 2, 3, 4 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-11/BH-P-040%20cardiac%20arrest%2012-2025.pdf#page=1", "sha256": "34fbdbba139205361d931344c5bd5c3ae01dc7044538b50f2fc8351add7f7d77", "file": "evidence/clinical-findings-resolution/sources/bh-p-040-current-index.pdf" }, { "code": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "sha256": "0cdb41a44dbc25618853c5b30c2b758a252836953603ab8f5e4c661a078e9490", "file": "evidence/drug-guide-reconciliation/sources/i-20-released.pdf" } ], "guideSlugs": [ "epinephrine", "sodium-bicarbonate", "dextrose", "pediatric-cardiac-arrest", "pediatric-shock", "pediatric-altered-mental-status", "pediatric-seizures" ] }, "clinicalReview": "pending", "originalReviewAction": "Verify PR-205, the arrest order and medication preparation instructions. Missing concentration/dilution text is not permission to omit preparation steps; distinguish stock and final volume." }, { "id": "pediatric-albuterol", "source": "I-20", "pages": [ 1 ], "previousPages": [ 1 ], "title": "Neonatal albuterol discrepancy remains unresolved", "detail": "Both chart editions list neonatal nebulized albuterol as 2.5 mg/3 mL. The existing OCMedic lesson already flags differing SO-P-035 wording.", "reviewAction": "Clarify whether 2.5 mg is the intended neonatal albuterol dose outside anaphylaxis and reconcile the general respiratory standing/base orders with I-20.", "guideSlugs": [ "albuterol", "pediatric-respiratory-distress", "pediatric-anaphylaxis" ], "priority": "clinical review", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "partially-resolved", "sourceResolution": { "id": "pediatric-albuterol", "title": "Neonatal albuterol discrepancy remains unresolved", "sourceStatus": "partially-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "Released P-060 explicitly gives 2.5 mg/3 mL for neonates 0–30 days and 5 mg/6 mL at 31 days or older in anaphylaxis-associated wheezing. Epinephrine remains first-line. This supports the new I-20 neonatal entry in that specific pathway.", "The indexed SO-P-035/BH-P-035 wheezing/suspected-asthma pathway still prints 5 mg/6 mL without that neonatal split. Do not silently apply the anaphylaxis-specific change to every neonatal respiratory presentation." ], "remainingDecisions": [ "Clarify whether 2.5 mg is the intended neonatal albuterol dose outside anaphylaxis and reconcile the general respiratory standing/base orders with I-20." ], "evidence": [ { "code": "P-060", "pages": [ 2 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-060%20Ped%20Allergic%20Reaction%20%2810-2026%29.pdf#page=2", "sha256": "c7c9c3e5970c51749447e17e294dc94ab3fd1f40fa0f64d634255b227e4ab3e6", "file": "evidence/clinical-findings-resolution/sources/p-060-released.pdf" }, { "code": "SO-P-035", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-35%20Respiratory%2010-2025.pdf#page=1", "sha256": "df8a8e76c3502d8f5c7b259133c7ee0191b1ddb622b4ec0be0172aba59f20e1a", "file": "evidence/clinical-findings-resolution/sources/so-p-035-current-index.pdf" }, { "code": "BH-P-035", "pages": [ 1 ], "version": "current-index", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2025-10/BH-P-035%20Resp%20distress%2010-2025.pdf#page=1", "sha256": "e49b593ee055916eb83271874af03f2fbf33b7c81052ef4762619608696dfdf0", "file": "evidence/clinical-findings-resolution/sources/bh-p-035-current-index.pdf" }, { "code": "I-20", "pages": [ 1, 2 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "sha256": "0cdb41a44dbc25618853c5b30c2b758a252836953603ab8f5e4c661a078e9490", "file": "evidence/drug-guide-reconciliation/sources/i-20-released.pdf" } ], "guideSlugs": [ "albuterol", "pediatric-respiratory-distress", "pediatric-anaphylaxis" ] }, "clinicalReview": "pending", "originalReviewAction": "Keep the specific neonatal conflict visible until the controlling source is clarified; do not call it resolved by the new chart." }, { "id": "pediatric-vitals", "source": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "title": "Vital-sign references require a separate cross-check", "detail": "Several normal-vital-sign entries change across the weight bands. A chart normal range is not automatically a shock-treatment threshold.", "reviewAction": "Source question resolved. Clinical reviewer approval and agency adoption are still required.", "guideSlugs": [ "pediatric-assessment", "pediatric-shock", "pediatric-bradycardia" ], "priority": "clinical review", "status": "clinical-review-required", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "previousUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf#page=1", "sourceStatus": "source-resolved", "sourceResolution": { "id": "pediatric-vitals", "title": "Vital-sign references require a separate cross-check", "sourceStatus": "source-resolved", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "confirmed": [ "B-003 and PR-006 supply explicit age boundaries for the new reference ranges: 0–30 days, 31 days to <1 year, 1 to <3 years, 3 to <5 years, 5 to <10 years, and ≥10 years. Their SBP reference values are >60, >60, >70, >75, >80 and >90 respectively.", "In the same age order, B-003/PR-006 list pulse ranges of 100–180, 100–160, 90–150, 80–140, 70–120 and 60–100, and respiratory rates of 30–60, 30–60, 24–40, 22–34, 18–30 and 12–16. Keep the exact age interval attached to each range.", "Released PR-205 explicitly points to that age-based table for push-dose epinephrine titration. Use those targets when working from the adopted released PR-205, rather than combining its preparation with an older target formula.", "These are source-specific reference ranges and PR-205 targets. They do not automatically replace every condition’s hypotension criteria; the overlapping age intervals in PR-081 remain a separate TXA review question." ], "remainingDecisions": [], "evidence": [ { "code": "B-003", "pages": [ 1 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/B-003%20Pediatric%20Vital%20Signs%20%2810-2026%29.pdf#page=1", "sha256": "271e6d5fe04ff33ad2af9e36569ef6148bdd18b7320a06629290ebfff3b8e5cc", "file": "evidence/clinical-findings-resolution/sources/b-003-released.pdf" }, { "code": "PR-006", "pages": [ 1 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-006%20Pediatric%20Vital%20Signs%20%2810-2026%29.pdf#page=1", "sha256": "965946829e6131f70492f81640a52ff6d80f9b74ffb69f602263fd1a304fe89d", "file": "evidence/clinical-findings-resolution/sources/pr-006-released.pdf" }, { "code": "PR-205", "pages": [ 1 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-205%20Ped%20PDE%20%2810-2026%29.pdf#page=1", "sha256": "1073d326a203b01b93880108c607607d0e82ac46b73ef1043941b4bfd3005270", "file": "evidence/clinical-findings-resolution/sources/pr-205-released.pdf" }, { "code": "I-20", "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "version": "released", "url": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1", "sha256": "0cdb41a44dbc25618853c5b30c2b758a252836953603ab8f5e4c661a078e9490", "file": "evidence/drug-guide-reconciliation/sources/i-20-released.pdf" } ], "guideSlugs": [ "pediatric-assessment", "pediatric-shock", "pediatric-bradycardia" ] }, "clinicalReview": "pending", "originalReviewAction": "Reconcile B-003 and PR-006 with the relevant condition order before changing pediatric assessment or shock criteria." } ], "medicationCoverage": [ { "source": "I-15", "medication": "Adenosine", "previousPages": [ 1 ], "pages": [ 1 ], "comparison": "Same 12 mg dose and one repeat; new 6 mg/2 mL stock option is a preparation, not a new 6 mg dose." }, { "source": "I-15", "medication": "Albuterol", "previousPages": [ 1 ], "pages": [ 1 ], "comparison": "Nebulized and MDI numerical regimens retained." }, { "source": "I-15", "medication": "Amiodarone", "previousPages": [ 1 ], "pages": [ 1 ], "comparison": "Pulsed and arrest numerical regimens retained; preparation presentation revised." }, { "source": "I-15", "medication": "Aspirin", "previousPages": [ 1 ], "pages": [ 1 ], "comparison": "324/325 mg single-dose options retained; blank contraindication cell does not remove SO-C-015 exclusions." }, { "source": "I-15", "medication": "Atropine", "previousPages": [ 1 ], "pages": [ 1, 2 ], "comparison": "Bradycardia regimen retained; poisoning repeat now states 5 minutes." }, { "source": "I-15", "medication": "Calcium gluconate", "previousPages": [], "pages": [ 2 ], "comparison": "Added chart entry; standalone guide coverage pending." }, { "source": "I-15", "medication": "Dextrose", "previousPages": [ 1 ], "pages": [ 2 ], "comparison": "D10 amount and route conditions retained." }, { "source": "I-15", "medication": "Diphenhydramine", "previousPages": [ 1 ], "pages": [ 2 ], "comparison": "50 mg and established-IO condition retained; once now explicit." }, { "source": "I-15", "medication": "Epinephrine", "previousPages": [ 1, 2 ], "pages": [ 2 ], "comparison": "Chart regimens retained; full PR-230/M-015 indication and preparation questions source-resolved; clinical sign-off pending." }, { "source": "I-15", "medication": "Fentanyl", "previousPages": [ 2 ], "pages": [ 3 ], "comparison": "Numerical adult regimens retained; explicit BP exclusion." }, { "source": "I-15", "medication": "Glucagon", "previousPages": [ 2 ], "pages": [ 3 ], "comparison": "1 mg IM once and glucose/access criteria retained." }, { "source": "I-15", "medication": "Oral glucose", "previousPages": [ 2 ], "pages": [ 3 ], "comparison": "Oral use with intact airway reflexes retained; explicit exclusion column." }, { "source": "I-15", "medication": "Ketamine", "previousPages": [ 2 ], "pages": [ 3, 4 ], "comparison": "Analgesia regimens retained; full contraindication column added." }, { "source": "I-15", "medication": "Ketorolac", "previousPages": [ 2 ], "pages": [ 5 ], "comparison": "15 mg IV/IO/IM once retained; full contraindication column added." }, { "source": "I-15", "medication": "Lidocaine", "previousPages": [ 2, 3 ], "pages": [ 5 ], "comparison": "IO initial dose/dwell changed; antiarrhythmic repeat wording changed." }, { "source": "I-15", "medication": "Magnesium sulfate", "previousPages": [], "pages": [ 6 ], "comparison": "Added chart entry; obstetric and arrest restrictions differ." }, { "source": "I-15", "medication": "Midazolam", "previousPages": [ 3 ], "pages": [ 6, 7 ], "comparison": "Principal numerical regimens retained; explicit BP exclusion and shorter route/base wording." }, { "source": "I-15", "medication": "Morphine", "previousPages": [ 3, 4 ], "pages": [ 7, 8 ], "comparison": "Formulation-specific adult regimens retained; explicit BP exclusion." }, { "source": "I-15", "medication": "Naloxone", "previousPages": [ 4 ], "pages": [ 8 ], "comparison": "Adult formulation/route options and respiratory-response repeats retained." }, { "source": "I-15", "medication": "Nitroglycerin", "previousPages": [ 4, 5 ], "pages": [ 8, 9 ], "comparison": "SL regimens retained; BP wording still needs condition-specific boundaries." }, { "source": "I-15", "medication": "Normal saline", "previousPages": [ 5 ], "pages": [ 9 ], "comparison": "250 mL bolus / 1 L chart pattern retained; explicit rales/CHF exclusions." }, { "source": "I-15", "medication": "Ondansetron", "previousPages": [ 5 ], "pages": [ 9 ], "comparison": "Adult ODT/IV regimens and pregnancy exclusion retained." }, { "source": "I-15", "medication": "Oxygen", "previousPages": [ 5 ], "pages": [ 9 ], "comparison": "Delivery flows retained; indication list shortened." }, { "source": "I-15", "medication": "Sodium bicarbonate", "previousPages": [ 5 ], "pages": [ 10 ], "comparison": "50 mL retained; concentration options explicit and arrest timing omitted." }, { "source": "I-15", "medication": "Tranexamic acid", "previousPages": [], "pages": [ 10 ], "comparison": "Added chart entry; eight explicit exclusions captured." }, { "source": "I-20", "medication": "Adenosine", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "Dose/volume, rapid-IV route and base-order markers retained." }, { "source": "I-20", "medication": "Albuterol", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "Numerical rows retained; neonatal cross-source discrepancy remains." }, { "source": "I-20", "medication": "Amiodarone", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "Pulsed-VT route adds IO; dose/volume retained." }, { "source": "I-20", "medication": "Atropine", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "Numerical doses, preparations and routes retained." }, { "source": "I-20", "medication": "Dextrose", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "Dose volumes retained; black-band concentration label corrected to 10%." }, { "source": "I-20", "medication": "Diphenhydramine", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "IO omitted from released routes; dose/volume retained." }, { "source": "I-20", "medication": "Epinephrine", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "IO pathways and push-dose preparation confirmed against the full orders; clinical sign-off pending." }, { "source": "I-20", "medication": "Fentanyl", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "IN omission remains a source conflict; trauma base-order age criterion confirmed as younger than 2 years." }, { "source": "I-20", "medication": "Glucagon", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "0.5 mg IM in all bands retained." }, { "source": "I-20", "medication": "Hydroxocobalamin", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [], "comparison": "Omitted from release; do not infer withdrawal." }, { "source": "I-20", "medication": "Ketorolac", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "Numerical values and N/A bands retained; generic name replaces Toradol." }, { "source": "I-20", "medication": "Lidocaine", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "Numerical entries retained; neonatal dose/volume question persists." }, { "source": "I-20", "medication": "Midazolam", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "Toxic-delirium route changed; other listed route families and numerical amounts retained." }, { "source": "I-20", "medication": "Morphine", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "Black-band dose/volume mismatch remains; trauma base-order age criterion confirmed as younger than 2 years." }, { "source": "I-20", "medication": "Naloxone", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "Numerical rows retained; preloaded spray dose now explicitly 4 mg / one spray." }, { "source": "I-20", "medication": "Normal saline", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "Numerical volumes retained; hypotension/croup indications labeled." }, { "source": "I-20", "medication": "Ondansetron", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "IV entries added; white-band ODT age qualifier omitted." }, { "source": "I-20", "medication": "Sodium bicarbonate", "previousPages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "Numerical entries retained; concentration and small-child dilution notes omitted." }, { "source": "I-20", "medication": "Tranexamic acid", "previousPages": [], "pages": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ], "comparison": "PR-081 confirms base order and dilution to a total 10 mL; exact age-boundary eligibility still needs clarification." } ], "notes": [ "All 35 PDF pages were rendered and visually compared; OCR was used to locate text, not as the authority for table alignment.", "The new I-15 contraindication column covers 13 medications in 14 indication-specific groups. Repeated route rows share a group only when the restrictions match.", "Newly printed chart restrictions are not necessarily newly introduced OCEMS clinical policy. Earlier condition-order and product-label exclusions remain relevant.", "I-20 has no dedicated contraindication column. N/A rows, routes, age limits, base-order markers and footnotes were reviewed separately. Adult restrictions are not automatically pediatric restrictions.", "Blank cells, omitted rows and shortened instructions do not waive eligibility, product-label warnings, scope, base orders or other source conditions.", "Released restrictions are presented alongside the earlier attributed reference, with unresolved conflicts flagged. No qualified clinical sign-off or agency adoption is claimed." ], "guideCoverage": [ { "slug": "abdominal-pain", "population": "Adult / adolescent", "matchedContraindications": [ "fentanyl", "morphine", "normal-saline", "ondansetron" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "adult-cardiac-arrest", "population": "Adult / adolescent", "matchedContraindications": [ "push-dose-epinephrine", "magnesium-arrest", "tranexamic-acid" ], "reviewFindings": [ "adult-epinephrine-pathways", "adult-new-entries", "adult-bicarbonate" ], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "altered-mental-status", "population": "Adult / adolescent", "matchedContraindications": [ "oral-glucose" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "anaphylaxis", "population": "Adult / adolescent", "matchedContraindications": [], "reviewFindings": [ "adult-epinephrine-pathways" ], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "base-contact", "population": "Adult & pediatric", "matchedContraindications": [ "push-dose-epinephrine" ], "reviewFindings": [ "adult-epinephrine-pathways", "adult-shortened-instructions", "pediatric-txa", "pediatric-electrical", "pediatric-age-authority" ], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "bls-naloxone", "population": "Adult and pediatric per OCEMS criteria", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "bls-oral-glucose", "population": "Adult and pediatric per OCEMS criteria", "matchedContraindications": [ "oral-glucose" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "bls-scope-of-practice", "population": "Adult / pediatric — follow each procedure’s criteria", 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"matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "drowning", "population": "Adult / adolescent", "matchedContraindications": [ "tranexamic-acid" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "gcs", "population": "Adult & pediatric", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "heat-illness", "population": "Adult / adolescent", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "hyperglycemia", "population": "Adult / adolescent", "matchedContraindications": [ "normal-saline" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "hypothermia", "population": "Adult / adolescent", "matchedContraindications": [], 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"pediatric-electrical", "pediatric-preparation" ], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "pediatric-drowning", "population": "Pediatric", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "pediatric-nausea-vomiting", "population": "Pediatric", "matchedContraindications": [], "reviewFindings": [ "pediatric-ondansetron" ], "adultRulesExcludedForScope": [ "oral-glucose", "ondansetron" ], "directDrugChartReference": false }, { "slug": "pediatric-poisoning", "population": "Pediatric", "matchedContraindications": [], "reviewFindings": [ "pediatric-routes", "pediatric-hydroxocobalamin" ], "adultRulesExcludedForScope": [ "oral-glucose" ], "directDrugChartReference": false }, { "slug": "pediatric-respiratory-distress", "population": "Pediatric", "matchedContraindications": [], "reviewFindings": [ "pediatric-albuterol" ], "adultRulesExcludedForScope": [ "normal-saline" ], "directDrugChartReference": true }, { "slug": "pediatric-seizures", "population": "Pediatric", "matchedContraindications": [], "reviewFindings": [ "pediatric-preparation" ], "adultRulesExcludedForScope": [ "midazolam" ], "directDrugChartReference": false }, { "slug": "pediatric-shock", "population": "Pediatric", "matchedContraindications": [], "reviewFindings": [ "pediatric-routes", "pediatric-txa", "pediatric-preparation", "pediatric-vitals" ], "adultRulesExcludedForScope": [ "push-dose-epinephrine", "oral-glucose", "normal-saline" ], "directDrugChartReference": false }, { "slug": "pediatric-temperature-emergencies", "population": "Pediatric", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "pediatric-trauma", "population": "Pediatric", "matchedContraindications": [], "reviewFindings": [ "pediatric-routes", "pediatric-ondansetron", "pediatric-morphine-volume", "pediatric-txa", 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"transcutaneous-pacing", "population": "Adult & pediatric", "matchedContraindications": [ "midazolam" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "supraglottic-airway", "population": "Adult & adolescent", "matchedContraindications": [ "midazolam" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "endotracheal-intubation", "population": "Over 36 kg", "matchedContraindications": [ "midazolam" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "twelve-lead-ecg", "population": "All patients", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "twelve-lead-ecg-interpretation", "population": "Adult & adolescent", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "imminent-childbirth", "population": "Maternal & newborn", "matchedContraindications": [ "magnesium-obstetric", "tranexamic-acid" ], "reviewFindings": [ "adult-new-entries" ], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "acetaminophen", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "adenosine", "population": "Adult & pediatric guidance", "matchedContraindications": [ "adenosine" ], "reviewFindings": [ "adult-shortened-instructions" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "albuterol", "population": "Adult & pediatric guidance", "matchedContraindications": [], "reviewFindings": [ "pediatric-albuterol" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "alteplase", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "amiodarone", "population": "Adult & pediatric guidance", "matchedContraindications": [], "reviewFindings": [ "pediatric-routes" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "antacids", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "antifungal-products", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "aspirin", "population": "Adult & pediatric guidance", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "atropine", "population": "Adult & pediatric guidance", "matchedContraindications": [], "reviewFindings": [ "adult-atropine-interval" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "bacitracin", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "body-foot-powders", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "caladryl", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "claritin", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "cough-products", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "covid-19-vaccine", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "dextrose", "population": "Adult & pediatric guidance", "matchedContraindications": [], "reviewFindings": [ "pediatric-preparation" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "diphenhydramine", "population": "Adult & pediatric guidance", "matchedContraindications": [], "reviewFindings": [ "pediatric-routes" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "duodote", "population": "Adult & pediatric guidance", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "epinephrine", "population": "Adult & pediatric guidance", "matchedContraindications": [ "push-dose-epinephrine", "normal-saline" ], "reviewFindings": [ "adult-epinephrine-pathways", "pediatric-routes", "pediatric-preparation" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "eye-drops", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "fentanyl", "population": "Adult & pediatric guidance", "matchedContraindications": [ "fentanyl", "nitroglycerin" ], "reviewFindings": [ "pediatric-routes", "pediatric-age-authority" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "glucagon", "population": "Adult & pediatric guidance", "matchedContraindications": [ "oral-glucose" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "heparin", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "hydroxocobalamin", "population": "Adult & pediatric guidance", "matchedContraindications": [ "normal-saline" ], "reviewFindings": [ "pediatric-hydroxocobalamin" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "ibuprofen", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "influenza-vaccine", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "ketamine", "population": "Adult & pediatric guidance", "matchedContraindications": [ "fentanyl", "ketamine" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "ketorolac", "population": "Adult & pediatric guidance", "matchedContraindications": [ "fentanyl", "ketorolac" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "lidocaine", "population": "Adult & pediatric guidance", "matchedContraindications": [], "reviewFindings": [ "adult-io-lidocaine", "adult-shortened-instructions", "pediatric-lidocaine-rounding" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "loperamide", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "midazolam", "population": "Adult & pediatric guidance", "matchedContraindications": [ "midazolam" ], "reviewFindings": [ "adult-shortened-instructions", "pediatric-routes" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "morphine", "population": "Adult & pediatric guidance", "matchedContraindications": [ "morphine", "nitroglycerin" ], "reviewFindings": [ "pediatric-morphine-volume", "pediatric-age-authority" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "mouthwash", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "naloxone", "population": "Adult & pediatric guidance", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "neosporin", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "nitroglycerin", "population": "Adult & pediatric guidance", "matchedContraindications": [ "nitroglycerin" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "normal-saline", "population": "Adult & pediatric guidance", "matchedContraindications": [ "push-dose-epinephrine", "normal-saline" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "ondansetron", "population": "Adult & pediatric guidance", "matchedContraindications": [ "ondansetron" ], "reviewFindings": [ "pediatric-ondansetron" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "oral-glucose", "population": "Adult & pediatric guidance", "matchedContraindications": [ "oral-glucose" ], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "oxygen", "population": "Adult & pediatric guidance", "matchedContraindications": [], "reviewFindings": [ "adult-oxygen-wording" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "poison-oak-products", "population": "Adult & pediatric scope", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "sodium-bicarbonate", "population": "Adult & pediatric guidance", "matchedContraindications": [], "reviewFindings": [ "adult-bicarbonate", "pediatric-preparation" ], "adultRulesExcludedForScope": [], "directDrugChartReference": true }, { "slug": "orange-county-ambulance-driver-attendant-license", "population": "Applicants / practicing clinicians", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "california-emt-skills-verification", "population": "Applicants / practicing clinicians", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "orange-county-emt-paramedic-schools", "population": "Applicants / practicing clinicians", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "orange-county-emt-paramedic-employment", "population": "EMTs / paramedics / applicants", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "mass-casualty-incident", "population": "Adult & pediatric", "matchedContraindications": [], "reviewFindings": [], "adultRulesExcludedForScope": [], "directDrugChartReference": false }, { "slug": "hazmat", "population": "Adult & pediatric", "matchedContraindications": [], "reviewFindings": [ "adult-atropine-interval", "pediatric-hydroxocobalamin" ], "adultRulesExcludedForScope": [], "directDrugChartReference": false } ], "publicationCoverage": { "guidesReviewed": 99, "guidesWithReleaseChecks": 64, "referencePages": 72, "versionedLearningMaps": 122, "contraindicationRuleGroups": 14, "explicitChecks": 37 }, "clinicalSourceReview": { "compared": "2026-11-14", "counts": { "source-resolved": 9, "partially-resolved": 5, "unresolved": 4 }, "scope": "Focused reconciliation of 18 I-15/I-20 findings against complete applicable protocols; not full migration of every document or clinical sign-off.", "clinicalReview": "pending", "clinicalReviewer": null, "agencyAdoption": "not-confirmed", "publicationCoverage": { "guidesWithFindingOrProcedureUpdates": 46, "guideSlugs": [ "adult-cardiac-arrest", "anaphylaxis", "base-contact", "bradycardia", "burns", "narrow-complex-tachycardia", "nausea-vomiting", "pediatric-altered-mental-status", "pediatric-anaphylaxis", "pediatric-assessment", "pediatric-bradycardia", "pediatric-burns", "pediatric-cardiac-arrest", "pediatric-nausea-vomiting", "pediatric-poisoning", "pediatric-respiratory-distress", "pediatric-seizures", "pediatric-shock", "pediatric-trauma", "poisoning", "seizures", "sepsis", "shock", "trauma", "wide-complex-tachycardia", "intraosseous-infusion", "synchronized-cardioversion", "imminent-childbirth", "adenosine", "albuterol", "amiodarone", "atropine", "dextrose", "diphenhydramine", "epinephrine", "fentanyl", "hydroxocobalamin", "ketorolac", "lidocaine", "midazolam", "morphine", "naloxone", "ondansetron", "oxygen", "sodium-bicarbonate", "hazmat" ], "originalFindings": 18, "remainingOriginalFindings": 9, "additionalFindings": 1, "procedureRuleGroups": 3, "procedureChecks": 10 } }, "procedureSafetyChecks": [ { "id": "pediatric-pde-hemorrhagic-shock", "medication": "Push-dose epinephrine", "population": "Pediatric", "context": "PR-205 push-dose pathway", "code": "PR-205", "pages": [ 1 ], "checks": [ "Hemorrhagic shock is contraindicated." ], "notes": "Base Hospital contact AND an order are required before administration. In cardiogenic shock with pulmonary edema, the procedure directs contact without the fluid bolus.", "guideSlugs": [ "epinephrine", "pediatric-shock", "pediatric-cardiac-arrest", "base-contact" ], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-205%20Ped%20PDE%20%2810-2026%29.pdf#page=1", "clinicalReview": "pending", "agencyAdoption": "not-confirmed" }, { "id": "pediatric-txa-exclusions", "medication": "Tranexamic acid", "population": "Pediatric", "context": "PR-081 traumatic hemorrhagic shock", "code": "PR-081", "pages": [ 1 ], "checks": [ "Traumatic injury more than 3 hours earlier.", "Isolated neurogenic shock.", "Isolated extremity injury when bleeding has been controlled.", "Active thromboembolic event within the last 24 hours (stroke, myocardial infarction, pulmonary embolism or DVT).", "History of hypersensitivity or anaphylactic reaction to TXA.", "Traumatic arrest without ROSC.", "Drowning or hanging." ], "notes": "Base Hospital order only. These pediatric exclusions come from PR-081; do not import the adult obstetric timing criterion. Exact age-boundary eligibility still needs clarification.", "guideSlugs": [ "pediatric-trauma", "pediatric-shock", "base-contact" ], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-081%20Ped%20TXA%20%2810-2026%29.pdf#page=1", "clinicalReview": "pending", "agencyAdoption": "not-confirmed" }, { "id": "pediatric-trauma-ketorolac-exclusions", "medication": "Ketorolac", "population": "Pediatric", "context": "P-015 trauma analgesia", "code": "P-015", "pages": [ 3 ], "checks": [ "Age younger than 2 years.", "Designated trauma patients." ], "notes": "P-015 explicitly lists these exclusions in its ketorolac row. Trauma analgesia eligibility is not established by a drug-chart dose alone.", "guideSlugs": [ "ketorolac", "pediatric-trauma" ], "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-015%20Ped%20General%20Injury%20%2810-2026%29.pdf#page=3", "clinicalReview": "pending", "agencyAdoption": "not-confirmed" } ], "additionalFindings": [ { "id": "adult-arrest-naloxone-repeat", "title": "Additional source question: adult arrest naloxone repeat", "sourceStatus": "unresolved", "clinicalReview": "pending", "guideSlugs": [ "naloxone", "adult-cardiac-arrest" ], "detail": "C-010 page 3 prints 2 mg IV/IO or 4 mg IN, permits one repeat and gives a 6 mg maximum. Repeating the full 4 mg IN dose would exceed that maximum. The permitted repeat amount/route after an initial IN dose is not explicit.", "remainingDecision": "Clarify the allowed naloxone repeat amount and route within the printed 6 mg maximum. Keep CPR priority and do not publish an inferred repeat schedule.", "sourceUrl": "https://www.ochealthinfo.com/sites/healthcare/files/2026-10/C-010%20Cardiac%20Arrest%20%2810-2026%29.pdf#page=3", "code": "C-010", "pages": [ 3 ] } ] }