Algorithms Flashcards

1
Q

What is the algorithm for VF/VT? (6)

A
  1. Shock
  2. CPR and establish IV access
  3. Shock if able
  4. CPR x 2 minutes + epi every 3-5 minutes
  5. Shock if able
  6. CPR + amiodarone

If develops into PEA or asystole, then CPR + Epi

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2
Q

What is the algorithm for Asystole/PEA?

A
  1. CPR x2 minutes + epi q 3-5 mins
  2. Shock if able + epi
  3. If no shock, CPR x 2 mins
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3
Q

What is the algorithm for Post cardiac arrest care?

A
  1. Optimize ventilation and oxygenation
  2. Treat hypotension
  3. If follow commands, and STEMI, then coronary reperfusion
  4. If no following of commands, then consider induced hypothermia
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4
Q

What should be done in post cardiac arrest patients who follow commands, but have are suspected of having a STEMI?

A

Admit to advanced critical care

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5
Q

What should be done if a patient has bradycardia, but has no s/sx?

A

Monitor and observe

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6
Q

What should be done if a patient has persistent bradycardia, but is having s/sx shock, AMS, HF, or CP?

A
Atropine
or
Dopamine
or
Epi
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7
Q

What is the first dose of atropine in persistent bradycardias? Subsequent doses? Max amount?

A

First dose = 0.5 mg
Subsequent - 0.5 mg q3-5 mins
Max dose = 3 mg

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8
Q

What is the IV infusion rate of epinephrine in persistent bradycardias?

A

2-10 mcg per min. no max

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9
Q

What is the IV infusion rate of dopamine in persistent bradycardias?

A

2- 10 mcg/kg per minutes

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10
Q

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?

A

Synchronized cardioversion

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11
Q

What is the Joule amount for the following tachyarrhythmias if cardioversion is indicated:

  • Narrow, regular rhythm
  • Narrow irregular
  • Wide regular
  • Wide irregular
A
  • Narrow, regular rhythm = 50-100 J
  • Narrow irregular = 120-200
  • Wide regular = 100
  • Wide irregular = Defibrillation dose (not synchronized)
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12
Q

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?

A

Antiarrhythmic and adenosine iff regular and monomorphic

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13
Q

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?

A
  • Vagal maneuvers
  • Adenosine
  • Beta blocker
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14
Q

What is the first dose of adenosine in persistent tachyarrhythmias? Subsequent dose?

A

6 mg followed by 12 mg

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15
Q

What is the dose of amiodarone given for persistent, wide-QRS tachy arrhythmias? How often should this be given? What is the maintenance dose?

A
  • 150 mg over 10 minutes PRN.

- 1 mg/min for 6 hours for infusion

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16
Q

What is the dose of sotalol given for persistent, wide-QRS tachy arrhythmias? Over how long should this be given?

A

100 mg over 5 minutes

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17
Q

When should sotalol be avoided with wide complex QRS-tachyarrhythmias?

A

If prolonged QT

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18
Q

What is the goal oxygen saturation post cardiac arrest?

A

more than 94%

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19
Q

What is the goal SBP post cardiac arrest? What should be done to meet this goal if hypotensive?

A

90 mmHg

  • IV bolus
  • Vasopressors
  • Assess with EKG
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20
Q

When is coronary reperfusion indicated after cardiac arrest?

A

If there is either a STEMI or high suspicion of AMI

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21
Q

What should be done if a patient does not return to consciousness after ROSC post cardiac arrest?

A

Consider induced hypothermia, and evaluate for a STEMI

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22
Q

What should be done with a patient following ROSC post cardiac arrest if there is no suspicion of a STEMI or AMI?

A

Admit to critical care

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23
Q

What is the target PETCO2 with ROSC?

A

35-40

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24
Q

What is the timeframe for the ED assessment of a suspected MI?

A

Less than 10 minutes

25
Q

How fast should a CXR be obtained with a suspected MI?

A

10 minutes from ED arrival

26
Q

What should be done in a STEMI patient if the time of onset is less than 12 hours?

A

PCI

27
Q

What is the goal PCI time for a STEMI?

A

90 minutes from door

28
Q

What is the goal fibrinolysis time for a STEMI?

A

30 minutes from door

29
Q

If a pt has a STEMI, but it has been longer than 12 hours, what should be done?

A
  • Obtain troponin
  • Start adjuvant therapy with platelet blockers
  • Admit with continued ASA, heparin, and other therapies PRN
30
Q

What should be done with a pt with ST depression, T wave inversion, or o/w suspicious for NSTEMI or unstable angina?

A
  • Start adjuvant therapy with platelet blockers

- Admit with continued ASA, heparin, and other therapies PRN

31
Q

What should be done for patients who have no ST/T wave changes, and/or who are o/w low risk for ACS?

A

Admit with serial troponins and EKGs

32
Q

What should be done for patients who were admitted as low risk risk for ACS, but develop elevated trop, EKG changes or other concerning findings?

A
  • Start adjuvant therapy with platelet blockers

- Admit with continued ASA, heparin, and other therapies PRN

33
Q

What should be done for patients who were admitted as low risk risk for ACS, but show an abnormal stress test?

A

-Admit with continued ASA, heparin, and other therapies PRN

34
Q

How often should NTG be given for chest pain patients? How many doses is max?

A

1 dose q3-5 minutes, max 3 doses

35
Q

What are the BP and HR contraindications for NTG use?

A

Less than 90 SBP or 30 below baseline

-∉[50-100 bpm]

36
Q

What is the amount of fluid given post cardiac arrest if there is hypotension?

A

1-2 L

37
Q

What is the epi infusion rate for post ROSC?

A

0.1-.05 mcg/kg

38
Q

What is the norepi infusion rate for post ROSC?

A

0.1-.05 mcg/kg

39
Q

What is the dopamine infusion rate for post ROSC?

A

5-10 mcg/kg

40
Q

What is the shock dose for monophasic shock?

A

360 J

41
Q

What should be done if a patient has an ischemic stroke, but is not a candidate for fibrinolytics?

A

ASA and admit to ICU

42
Q

What should be aggressively monitored when administering tPA?

A

BP and neuro

43
Q

How long should anticoagulants / antiplatelets be avoided in pts who receive tPA?

A

24 hours

44
Q

In a stroke, what is the timeframe for: general assessment

A

10 minutes

45
Q

In a stroke, what is the timeframe for: neurological assessment

A

25 minutes

46
Q

In a stroke, what is the timeframe for: Acquisition of a head CT?

A

25 minutes

47
Q

In a stroke, what is the timeframe for: interpretation of a head CT?

A

45 minutes

48
Q

In a stroke, what is the timeframe for: administration of fibrinolytic therapy, (timed from ED arrival)?

A

60 minutes

49
Q

In a stroke, what is the timeframe for: administration of fibrinolytic therapy (timed from symptom onset)

A

3-4.5 hours

50
Q

What are the three components of the cincinnati stroke scale?

A

Facial droop
Arm drift
Abnormal speech

51
Q

True or false: any previous h/o intracranial hemorrhage is a contraindication for fibrinolytics

A

true

52
Q

Arterial puncture within how many days is a contraindication to fibrinolytics?

A

7 days

53
Q

What is the BP that is a contraindication for fibrinolytics?

A

More than 185/110

54
Q

Platelet count below what value is a contraindication to tPA?

A

100000

55
Q

Heparin received within what timeframe is a contraindication to tPA

A

48 hours

56
Q

true or false: current use of an anticoagulant is a contraindication to tPA

A

True

57
Q

BG under what value is a contraindication for fibrinolytics?

A

50 mg/dL

58
Q

True or false: CT demonstrating a multilobar infarction is an absolute contraindication for tPA

A

True

59
Q

What is the only indication for adenosine in patients who are asymptomatic and have tachyarrhythmia with a wide QRS?

A

If regular and monomorphic