Arrhythmia and pacing SOP

Question 1

Outline the contents of the arrhythmia and pacing SOP

Answer 1

Applies to all clinical staff
Covers:
- Pacing
- Cardioversion
- Refractory VF/VT
- MgSO4

Question 2

Which patients may benefit from a dose of Calcium Chloride in the context of bradycardia?

Answer 2

Calcium channel blocker use/overdose
Hyperkalaemia

Question 3

How many minijets of calcium chloride are in the standard kit?

Answer 3

4 - 2 in the blood consumables pouch (red bag internal compartment), 2 in the meds pouch (blue bag lower front pouch)

Question 4

What position should the pads be in for pacing/cardioversion?

Answer 4

AP

Question 5

How would you administer amiodarone in for a patient with pulsed VT?

Answer 5

Amiodarone 300mg in 100ml 5% Glucose administered over 20mins

Question 6

What is the cardioversion energy for paeds?

Answer 6

1 then 2 J/kg, given amio after 2 shocks

Question 7

How would you administer amiodarone to a paediatric patient?

Answer 7

Dose: 5mg/kg in 5% glucose

Add 250mg amio to 100ml 5% Glucose
Clearly label
Calculate 2ml/kg and remove excess dose from bag
Infuse over 20mins

Question 8

When would you consider lidocaine in refractory arrhythmia? What dose?

Answer 8

After the 7th shock
1.5mg/kg

In the medicine pouch in the blue bag, we carry 4 x 5ml vials

Question 9

If suspected cause of arrest is hyperkalaemia, what drugs would you consider?

Answer 9

Calcium chloride
50ml 8.4% Sodium bicarb

Question 10

Outline the role of magnesium in arrhythmia

Answer 10

VF/VT or TdP - 2g in 250ml 0.9% over 10 mins
AF (fast) - 4.5g in 250ml 0.9% over 30 mins