AHA Algorhythms Flashcards
What AHA HR = bradycardia?
“Typically <50bpm”
What are the general steps of the Bradycardia algorithm?
- Identify/treat the cause (MOVAB = monitor/12-lead, O2, VS, Airway/access (IV/IO), breathing (assist if needed)
- Determine CHAAPS (Chest pn, hypotension, AMS/acute heart failure, pulm edema, shock)
- No CHAAPS = monitor them
- YES CHAAPS = atropine then transcutaneous pace or Dopamine/Epi infusion
What is CHAAPS
CHAAPS = mnemonic to determine if pt stable or not
Chest pn, hypotension, AMS/acute heart failure, Pulm edema, shock SS
Dosage for Atropine (max dose?)
First dose = 0.5mg then repeat every 3-5min
Max dose = 3mg
What is dosage/infusion rate for dopamine IV
Dose = dale’s rule (in lbs, drop last number & minus 2)
Infusion = 2-20mcg/kg per min. Titrate to effect
Dosage/infusion rate for IV epi (bradycardia)
2-10 mcg per min. Titrate to effect
What AHA HR = tachyARRHYTHMIA (SVT)
150bpm or more (SVT)
General steps of Tachy (SVT) algorithm
- Identify/treat underlying cause (MOVAB = monitor/12lead, O2, VS, airway/access (IV/IO), breathing)
- Rule out CHAAPS
- if no CHAAPS, differentiate wide vs narrow QRS complex SVT (<0.12s) then treat accordingly
Rx for tachyarrhythma (SVT) w/ CHAAPS
Synchronized cardioversion.
Consider: sedation or adenosine (if narrow complex SVT)
Rx for stable, wide complex QRS SVT
- MOVAB.
- Regular & monomorphic = adenosine
- If not working, consider MCP & antiarrhythmic infusion
Rx for narrow complex QRS SVT (no CHAAPS)
- MOVAB
- Vagal
- Adenosine (if regular)
- Consider Med control w/ Beta or Calcium channel blocker
You want to cardiovert your SVT pt. what initial joules for wide regular SVT vs wide irregular SVT?
Wide regular = 100 J
Wide irregular = no cardiovert. Defibrillation
You want to cardiovert your SVT pt. What initial Joules for the following:
- Narrow regular SVT
- Narrow Irregular SVT
Narrow regular SVT = 50-100J
Narrow irregular SVT = 120-200 J (biphasic), or 200 J (monophasic)
Biphasic vs monophasic shock pads?
Biphasic = current goes from one pad to the other then back
Monophasic = current goes from one pad to the other
For tacharrhythmias (SVT), what dose for adenosine?
1st = 6mg rapid IVP, follow w/ flush
2nd = 12mg if needed
3rd = 12mg ( for hospital, call MCP)
What Rx for stable, wide QRS complex SVT?
Rx = Procainamide, amiodarone, Sotalol
If unsure if SVT vs VTach. Assume Vtach and defib
What is Procainamide? indications & contraindications?
Procainamide = antiarrhythmic infusion med
Indication = stable wide QRS complex tachycardia (SVT)
Contraindication = prolonged QT or Hx CHF
Procainamide:
Infusion dose/rate?
Maintenance rate?
Max dose?
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
What is amiodarone? When to use it?
Amiodarone = antiarrhythmic infusion med For stable, wide QRS tachyarrhythmia (SVT)
Also used for cardiac arrest w/ vfib or pulseless vtach
Amiodarone initial infusion rate? Maintenance infusion rate?
Initial = 150mg over 10 min. Repeat PRN if Vtach recurs. Follow w/ maintenance infusion
Maintenance infusion = 1mg/min for first 6 hours
What is Sotalol? What contraindications?
Sotalol = Antiarrhythmic infusion med for stable, wide QRS tachycardia
Contraindications = prolonged QT
What is the dosage for Sotalol?
100mg (1.5mg/kg) over 5 min
General steps of AHA cardiac arrest algorithm
- Start CPR (MOVAB: monitor, O2, VS, airway/access, breathing)
- Determine shockable rhythm
- NO = asystole/PEA algorhythm
- YES = Vfib/ pulseless Vtach algorithm
General steps for AHA asystole/PEA
- CPR 2min (MOVAB = monitor, O2, VS, Airway/access IV or IO, breathing) then check if rhythm shockable. Epi every 3-5min (2 cycles)
- YES = defib & Vfib/pVT algorithm
- NO = CPR & H’s and T’s. Keep checking for shockable rhythm & repeat
- If ROSC = do ROSC algorithm
General steps for VF/pVT algorithm
- Shock
- CPR 2min & check if rhythm shockable (MOVAB = monitor, VS, Airway/access IV or IO, breathing)
- No shock = Asystole or ROSC (follow appropriate algorithm)
- YES shock = shock and repeat CPR. H’s & Ts. Epi (3-5min), amiodarone (300mg then 150mg every other cycle)
* re-evaluate every 2 min
What are pneumonic for H’s and T’s
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)
What are the Hs and Ts used for?
Reversible causes of cardiac arrest
What is ROSC? How do you know its happened?
ROSC = return of spontaneous circulation
SS = sudden spike in ETCO2, presence of pulse & BP, spontaneous pressure waves w/ intra-arterial monitoring
What qualifies as an advanced airway?
ET intubation or supraglottic airway
Which supraglottic airway has the biggest aspiration risk?
LMAs
Which Adv airway is best for pulseless, apneic kids?
Supraglottics