Algorithms Flashcards
What is the algorithm for VF/VT? (6)
- Shock
- CPR and establish IV access
- Shock if able
- CPR x 2 minutes + epi every 3-5 minutes
- Shock if able
- CPR + amiodarone
If develops into PEA or asystole, then CPR + Epi
What is the algorithm for Asystole/PEA?
- CPR x2 minutes + epi q 3-5 mins
- Shock if able + epi
- If no shock, CPR x 2 mins
What is the algorithm for Post cardiac arrest care?
- Optimize ventilation and oxygenation
- Treat hypotension
- If follow commands, and STEMI, then coronary reperfusion
- If no following of commands, then consider induced hypothermia
What should be done in post cardiac arrest patients who follow commands, but have are suspected of having a STEMI?
Admit to advanced critical care
What should be done if a patient has bradycardia, but has no s/sx?
Monitor and observe
What should be done if a patient has persistent bradycardia, but is having s/sx shock, AMS, HF, or CP?
Atropine or Dopamine or Epi
What is the first dose of atropine in persistent bradycardias? Subsequent doses? Max amount?
First dose = 0.5 mg
Subsequent - 0.5 mg q3-5 mins
Max dose = 3 mg
What is the IV infusion rate of epinephrine in persistent bradycardias?
2-10 mcg per min. no max
What is the IV infusion rate of dopamine in persistent bradycardias?
2- 10 mcg/kg per minutes
What should be done if a patient is having persistent tachyarrhythmia that is causing s/sx of shock, chest pain, HF, or altered mental status?
Synchronized cardioversion
What is the Joule amount for the following tachyarrhythmias if cardioversion is indicated:
- Narrow, regular rhythm
- Narrow irregular
- Wide regular
- Wide irregular
- Narrow, regular rhythm = 50-100 J
- Narrow irregular = 120-200
- Wide regular = 100
- Wide irregular = Defibrillation dose (not synchronized)
What should be done if a patient is having persistent tachyarrhythmia that is NOT causing s/sx of shock, chest pain, HF, or altered mental status, and has a wide QRS complex?
Antiarrhythmic and adenosine iff regular and monomorphic
What should be done if a patient is having persistent tachyarrhythmia that is NOT causing s/sx of shock, chest pain, HF, or altered mental status, and has a narrow QRS complex?
- Vagal maneuvers
- Adenosine
- Beta blocker
What is the first dose of adenosine in persistent tachyarrhythmias? Subsequent dose?
6 mg followed by 12 mg
What is the dose of amiodarone given for persistent, wide-QRS tachy arrhythmias? How often should this be given? What is the maintenance dose?
- 150 mg over 10 minutes PRN.
- 1 mg/min for 6 hours for infusion
What is the dose of sotalol given for persistent, wide-QRS tachy arrhythmias? Over how long should this be given?
100 mg over 5 minutes
When should sotalol be avoided with wide complex QRS-tachyarrhythmias?
If prolonged QT
What is the goal oxygen saturation post cardiac arrest?
more than 94%
What is the goal SBP post cardiac arrest? What should be done to meet this goal if hypotensive?
90 mmHg
- IV bolus
- Vasopressors
- Assess with EKG
When is coronary reperfusion indicated after cardiac arrest?
If there is either a STEMI or high suspicion of AMI
What should be done if a patient does not return to consciousness after ROSC post cardiac arrest?
Consider induced hypothermia, and evaluate for a STEMI
What should be done with a patient following ROSC post cardiac arrest if there is no suspicion of a STEMI or AMI?
Admit to critical care
What is the target PETCO2 with ROSC?
35-40