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CFD Paramedic Course > AHA Algorhythms > Flashcards

AHA Algorhythms Flashcards

1
Q

What AHA HR = bradycardia?

A

“Typically <50bpm”

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2
Q

What are the general steps of the Bradycardia algorithm?

A
  1. Identify/treat the cause (MOVAB = monitor/12-lead, O2, VS, Airway/access (IV/IO), breathing (assist if needed)
  2. Determine CHAAPS (Chest pn, hypotension, AMS/acute heart failure, pulm edema, shock)
  3. No CHAAPS = monitor them
  4. YES CHAAPS = atropine then transcutaneous pace or Dopamine/Epi infusion
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3
Q

What is CHAAPS

A

CHAAPS = mnemonic to determine if pt stable or not

Chest pn, hypotension, AMS/acute heart failure, Pulm edema, shock SS

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4
Q

Dosage for Atropine (max dose?)

A

First dose = 0.5mg then repeat every 3-5min

Max dose = 3mg

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5
Q

What is dosage/infusion rate for dopamine IV

A

Dose = dale’s rule (in lbs, drop last number & minus 2)

Infusion = 2-20mcg/kg per min. Titrate to effect

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6
Q

Dosage/infusion rate for IV epi (bradycardia)

A

2-10 mcg per min. Titrate to effect

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7
Q

What AHA HR = tachyARRHYTHMIA (SVT)

A

150bpm or more (SVT)

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8
Q

General steps of Tachy (SVT) algorithm

A
  1. Identify/treat underlying cause (MOVAB = monitor/12lead, O2, VS, airway/access (IV/IO), breathing)
  2. Rule out CHAAPS
  3. if no CHAAPS, differentiate wide vs narrow QRS complex SVT (<0.12s) then treat accordingly
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9
Q

Rx for tachyarrhythma (SVT) w/ CHAAPS

A

Synchronized cardioversion.

Consider: sedation or adenosine (if narrow complex SVT)

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10
Q

Rx for stable, wide complex QRS SVT

A
  1. MOVAB.
  2. Regular & monomorphic = adenosine
  3. If not working, consider MCP & antiarrhythmic infusion
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11
Q

Rx for narrow complex QRS SVT (no CHAAPS)

A
  1. MOVAB
  2. Vagal
  3. Adenosine (if regular)
  4. Consider Med control w/ Beta or Calcium channel blocker
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12
Q

You want to cardiovert your SVT pt. what initial joules for wide regular SVT vs wide irregular SVT?

A

Wide regular = 100 J

Wide irregular = no cardiovert. Defibrillation

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13
Q

You want to cardiovert your SVT pt. What initial Joules for the following:

  • Narrow regular SVT
  • Narrow Irregular SVT
A

Narrow regular SVT = 50-100J

Narrow irregular SVT = 120-200 J (biphasic), or 200 J (monophasic)

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14
Q

Biphasic vs monophasic shock pads?

A

Biphasic = current goes from one pad to the other then back

Monophasic = current goes from one pad to the other

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15
Q

For tacharrhythmias (SVT), what dose for adenosine?

A

1st = 6mg rapid IVP, follow w/ flush

2nd = 12mg if needed

3rd = 12mg ( for hospital, call MCP)

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16
Q

What Rx for stable, wide QRS complex SVT?

A

Rx = Procainamide, amiodarone, Sotalol

If unsure if SVT vs VTach. Assume Vtach and defib

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17
Q

What is Procainamide? indications & contraindications?

A

Procainamide = antiarrhythmic infusion med

Indication = stable wide QRS complex tachycardia (SVT)

Contraindication = prolonged QT or Hx CHF

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18
Q

Procainamide:

Infusion dose/rate?
Maintenance rate?
Max dose?

A

Dose/rate = 20-50mg/min

Maintenance = 1-4 mg/min

Max dose/stop = arrhythmia suppressed, pt hypotensive, QRS duration >50%, or max dose 17mg/kg given

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19
Q

What is amiodarone? When to use it?

A

Amiodarone = antiarrhythmic infusion med For stable, wide QRS tachyarrhythmia (SVT)

Also used for cardiac arrest w/ vfib or pulseless vtach

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20
Q

Amiodarone initial infusion rate? Maintenance infusion rate?

A

Initial = 150mg over 10 min. Repeat PRN if Vtach recurs. Follow w/ maintenance infusion

Maintenance infusion = 1mg/min for first 6 hours

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21
Q

What is Sotalol? What contraindications?

A

Sotalol = Antiarrhythmic infusion med for stable, wide QRS tachycardia

Contraindications = prolonged QT

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22
Q

What is the dosage for Sotalol?

A

100mg (1.5mg/kg) over 5 min

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23
Q

General steps of AHA cardiac arrest algorithm

A
  1. Start CPR (MOVAB: monitor, O2, VS, airway/access, breathing)
  2. Determine shockable rhythm
  3. NO = asystole/PEA algorhythm
  4. YES = Vfib/ pulseless Vtach algorithm
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24
Q

General steps for AHA asystole/PEA

A
  1. CPR 2min (MOVAB = monitor, O2, VS, Airway/access IV or IO, breathing) then check if rhythm shockable. Epi every 3-5min (2 cycles)
  2. YES = defib & Vfib/pVT algorithm
  3. NO = CPR & H’s and T’s. Keep checking for shockable rhythm & repeat
  4. If ROSC = do ROSC algorithm
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25
Q

General steps for VF/pVT algorithm

A
  1. Shock
  2. CPR 2min & check if rhythm shockable (MOVAB = monitor, VS, Airway/access IV or IO, breathing)
  3. No shock = Asystole or ROSC (follow appropriate algorithm)
  4. YES shock = shock and repeat CPR. H’s & Ts. Epi (3-5min), amiodarone (300mg then 150mg every other cycle)
    * re-evaluate every 2 min
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26
Q

What are pneumonic for H’s and T’s

A

HERMis the homosexual, DROve to KALi to play VOLleyball = hypothermia, hydrogen (acidosis), Hyperkalemia, hypovolemia

THROMBO the lesbian raises TENSION, when she TOX about her TAMPONs = thrombosis (PE or MI), tensionpneumo, toxicity (OD), tamponade (cardiac)

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27
Q

What are the Hs and Ts used for?

A

Reversible causes of cardiac arrest

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28
Q

What is ROSC? How do you know its happened?

A

ROSC = return of spontaneous circulation

SS = sudden spike in ETCO2, presence of pulse & BP, spontaneous pressure waves w/ intra-arterial monitoring

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29
Q

What qualifies as an advanced airway?

A

ET intubation or supraglottic airway

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30
Q

Which supraglottic airway has the biggest aspiration risk?

A

LMAs

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31
Q

Which Adv airway is best for pulseless, apneic kids?

A

Supraglottics

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32
Q

How to confirm placement of adv airway?

A

Waveform capnography, condensation in tube, lung/epigastric sounds, EQUAL chest rise, bagging compliance

33
Q

What are the ventilation rates for advanced airways?

A

1 breath every 6-8s (10 per min) w/ continuous compressions

34
Q

Epi dose for adult vs ped cardiac arrest?

A

Adult = 1mg every 3-5 min

Ped = 0.01mg/kg

35
Q

Amiodarone dosage for cardiac arrest?

A

1st = 300mg bolus

2nd = 150mg bolus

36
Q

What adult defibrillation energy for biphasic shock pads?

A

120-200 J & repeat. Call med control if you want to raise the dose

37
Q

What shock energy setting to use when you don’t know the inital adult defib shock dose?

A

Give the max dose (in joules)

38
Q

For adult defibrillation, what shock energy for monophasic shocks?

39
Q

How to assess bad chest compressions

A
  1. Hard & fast
  2. Chest recoil
  3. Short interruptions between compressions (<10s)
  4. Don’t Over bag pt
  5. Rotate compressors every 2 min
  6. Good ratio if no adv airway (30:2)
  7. DBP 20mmHG or more during relaxation phase (arterial monitoring)
40
Q

ROSC algorithm

A
  1. VS (BP, HR, SPO2 & 12-lead)
  2. fix hypotension & start infusion with whatever meds you last pushed before ROSC
  3. Consider Hypothermia therapy
41
Q

How to fix hypotension in a ROSC pt?

A
  1. Auscultate lung sounds
  2. Clear = fluid bolus then vasopressor infusion
  3. Consider & fix Hs and Ts
42
Q

You get a 12-lead following ROSC. 12-lead indicates STEMI. What do you do?

A

Immediate transport to Cath lab

43
Q

What’s hypothermia therapy and how do you evaluate it?

A

Hypothermia therapy = keep pt CBT lower to prevent tissue infarction

Evaluation: can they follow commands? Yes = ICU, no = Hypothermia therapy then ICU

44
Q

How to ventilate a ROSC pt?

A

Start @ 10 breaths/min (1 every 6s)

Titrate bagging rate until ETCO2 35-40mm HG

Titrate FIO2 until SPO2 94% or more

45
Q

What IV fluid bolus dose for ROSC pt w/ hypotension

A

1-2L normal saline or Lactated Ringers

46
Q

What different vasopressors can you use on a ROSC pt?

A

Epi, NORepi, dopamine, (all of them are IV infusions)

47
Q

Infusion rate for Epi on ROSC pt?

A

0.1 - 0.5mcg /kg per min (ex. 70kg or 154lb adult = 7-35mcg per min)

Same dosage as NORepi

48
Q

Norepi infusion rate for ROSC pt?

A

0.1-0.5 mcg/kg per min (ex. 70kg or 154lb adult = 7-35mcg per min)

Same dosage as Epi

49
Q

Dopamine infusion rate for ROSC pt

A

5-10mcg/kg per min

50
Q

ACS (acute coronary syndrome) / CP algorithm

A
  1. Monitor & ABCs
  2. MONA (morphine, O2, nitro, ASA) correct order = OANM
  3. 12-lead notify hospital if STEMI
  4. Assess pt for clot buster criteria (fibrinolytic checklist)
51
Q

Cut off time for CATH lab. What happens after that?

A

<12 hrs after initial SS onset

12 hours plus = blood thinners, unless pt super high risk/unstable

52
Q

How to pace someone (according to dale)

A
  1. Attach pt to pads (w/ limb leads on).
  2. Press sync
  3. Set rate @70 bpm
  4. Slowly increase milliamps until capture
  5. GIVE THEM PAIN MEDS
  6. Check BP after and give vasopressor if necessary
53
Q

How to determine if pt is hemodynamically stable (AHA)

A

CHAAPS = chest pain, hypotension, AMS, acute heart failure, pulmonary edema, shock SS

54
Q

When administering cardiac meds like Epi or adenosine. What is the required IV site?

A

AC or higher. Adenosine biotransforms quickly

55
Q

How to manually draw up push dose epi?

A
  1. Take 10ml flush & waste 1 ml
  2. Use blunt needle on flush & draw 1 ml of Epi 1:1000
  3. Administer every min until BP is appropriate
56
Q

What is the targeted temperature mgmt range for a pt during first 24 hours following ROSC?

57
Q

How do you draw up push dose epi?

A

Draw 1mL epi (0.1mg/mL) from Bristol jet. discard 1mL from a 10mL flush.

Add 1mL epi to the flush.

Result = 0.01mg/mL epi in 10ml

Push 0.5-2mL every 2-5 min

58
Q

Can you make push dose epi from a 1mg/mL vial?

A

No! Concentration will be 10 fold overdose. Always take from the bristojet

59
Q

What constitutes low dose dopamine? What action?

A

Low = 1-5mcg/kg/min = increase in urine output & renal perfusion

60
Q

What constitutes medium dose dopamine. What action?

A

Medium = 5-15 mcg/kg/min IV = increase kidney perfusion & beta 1 actions

61
Q

What is high dose dopamine? What action?

A

High = 20-50mcg/kg/min = vasoconstriction & BP

62
Q

What drip set do you need for a dopamine infusion? How do you mix it for what concentrations?

A

Always 60 Gtts set (60 drops = 1mL)

Mix 800mg in 500 mL NS = 1600 mcg/mL concentration

63
Q

What is the required concentration of dopamine? How do you calculate appropriate drip rate for a pt?

A

Always use 1600 mcg/mL

Formula: (drip rate) = (desired dose x drip set)/concentration

64
Q

What’s the bolus dose of lidocaine?

A

1-1.5mg/kg IVP

Repeat PRN at 1/2 the initial dose over 5-10min until max 3mg

65
Q

What’s the IV infusion dose of lidocaine? What’s the infusion concentration?

A

Dose = 1-4mg using a 60 gtts set

Concentration = 4mg/mL

66
Q

What’s the infusion concentration of lidocaine? How do you mix it to get that concentration?

A

Concentration = 4mg/1mL

Mix 2g in 500mL NS = 4mg per mL

Or

4g in 1000mL NS = 4mg per mL

67
Q

What is lidocaine used for?

A

Antiarrhythmic used as alternative to amiodarone for VF/pulseless VT

68
Q

What is the lidocaine clock formula?

A

1mg = 15 drops/min

2mg = 30 drops/min

3mg = 45 drops/min

4mg = 60 drops/min

*think: 1-2-3-4 = 15-30-45-60

69
Q

In the 3 phase model of CPR what are the phases?

A
  1. Electrical phase = onset of arrest to 4min
  2. Circulatory phase = 4-10min
  3. Metabolic phase = >10min after arrest
70
Q

When is Mag sulfate used in regards to cardiac issues?

A

For torsades de pointes, refractory VF, VF w/ hx alcoholism

71
Q

What dose for mag sulfate?

A

1-2g (2-4ml or a 50% solution) diluted in 10 ml D5W IVP

72
Q

When do we typically use dopamine, besides as a vasopressor during ROSC?

A

It’s a second line drug after atropine in bradycardia w/ CHAP

73
Q

What’s a good starting point for dopamine when administering it for Bradycardia? What concentration?

A

Start at 6 mcg/kg/min

Concentration = 1600/1

74
Q

What’s the Endotracheal dose for lidocaine?

75
Q

What’s the infusion rate of amiodarone following ROSC?

A

360mg IV over 6 hours (1mg/min)

Or

540mg IV over 18 hours (0.5mg/min)

76
Q

How is the AHA dopamine dosage different for ROSC vs bradycardia

A

ROSC = 5-10mcg/kg/min

Bradycardia = 2-20mcg/kg/min

77
Q

How is Epi AHA infusion dose different for ROSC vs Bradycardia

A

Bradycardia = 2-10mcg/min

ROSC = 0.1-0.5 mcg/kg/min

78
Q

How much drip rate lidocaine for a ROSC pt?

A

1mg more than the bolus dose you gave. Set drip rate accordingly.

CFD Paramedic Course (12 decks)

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