Cardiac Flashcards
Acute Coronary Syndrome
Aspirin 325mg. 12 lead (15 lead if inferior suspected). Notify receiving facility. Transport Immediately.
Fentanyl 50mcg (repeat every 10 minutes).
Nitro 0.4mg SL (if BP >100 and no decrease in pain after fentanyl). Repeat every 5 minutes if BP>100.
If BP<90: 500ml bolus may repeat to titrate BP>90
Acute Coronary Syndrome- Pedi
Contact OLMCP
Acute Coronary Syndrome Pearls
- Early Recognition 2. Early notification of hospitals 3. Early initiation of transport
No additional ASA if pt taken within the past 12 hours.
Nitro administered if BP above 120 (OLMCP consult if BP between 90-100).
No nitrates if erectile dysfunction meds in the last 48 hours.
Nitro contraindicated in Right Ventricular Infarct
Right Sided (V4R) and Posterior ECG Reference
Indications:
Inferior wall MI. ST elevation in V1. ST depression in V1-V3. Significant chest pain, but normal 12 lead. Medic suspicion.
Atrial Fibrillation/Flutter- Adult
Sustained rate >150/ stable
Amiodarone 150mg over 10 minutes
Sustained rate>150/unstable
Sync Cardioversion- 100,200,300,360 (maximum 4 attempts)
Versed 5-10mg slow for sedation (repeat once)
Atrial Fibrillation/Flutter-Pedi
Child: >180 Infant: >220 stable- 12 lead and transport.
Unstable- 1j/kg, 2j/kg, 2 j/kg, 2 j/kg (4 attempts maximum) Versed- 0.1mg/kg (up to 5mg) IV OR Versed- 0.2mg/kg IN
Atrial Fibrillation/Flutter- Pearls
NTG is contraindicated prior to rate control. Amiodarone- draw up 3ml with 7ml of NS in a syringe. Give 1ml/min.
Bradycardia-Adult
12 lead. Warm up if secondary to cold.
Atropine 1.0mg & repeat ~ 3-5 minutes up to 3mg.
TCP- RATE OF 80/MIN.
Ketamine 25mg IV/IO/IM/IN (repeat once) for TCP sedation
Bradycardia-Pedi
Basic Airway maneuvers w/O2.
After 30 seconds, HR < 60 then compressions.
Epi: 0.1mg/ml (1:10) 0.01mg/kg IV (every 3-5 minutes)
If increased vagal tone/AV block: Atropine 0.02mg/kg (minimum dose 0.1mg) may repeat once.
No response then TCP at 100/min.
Ketamine for sedation- 10mg if pt weight above 10kg IV,IO,IM,IN (may repeat once)
Bradycardia Pearls
Treat w/ fluid bolus, medications, pacing while monitoring need for CPR.
Continuous 12 lead.
Symptomatic Unstable: HR <60, altered mental status, chest pain, hypotension, poor perfusion, signs of shock.
Nitro administration with HR less than 50 can further reduce heart rate.
Transcutaneous Pacing. Indications and Procedure
HR<60 and unstable.
4 lead and pads placed (Anterior/Posterior). Negative- left anterior chest just below nipple. Positive- left upper back below scapula and lateral to spine.
Begin pacing at 20mA until capture.
Narrow Complex Tachycardia- Adult
Stable: Rate >150. 12 lead. Valsalva. Adenosine 12mg (10ml flush) repeat if no response.
Unstable: Rate >150. Sync Cardioversion 100, 200, 300, 360 (maximum 4 attempts). Versed 5-10mg (may repeat once)
Narrow Complex Tachycardia-Pedi
Child:HR>180; Infant: HR>220
Stable: 12 lead, valsalva, Adenosine 0.1mg/kg rapid (10ml flush). Repeat if no response with Adenosine 0.2mg/kg rapid and 10ml flush
Unstable: Sync Cardioversion 1j/kg, 2j/kg, 2j/kg, 2j/kg (4 attempts maximum).
Sedation- Versed 0.1mg/kg (up to 5mg) slow OR 0.2mg/kg (up to 5mg) IN. Repeat once as needed
Narrow Complex Tachycardia-Pearls
Adenosine needs to be given AC. NTG contraindicated to rate control in patients with rapid HR. Adenosine contraindicated in WPW & Lown-Ganong-Levine Syndrome. Contraindicated in Afib/Flutter. No Cardioversion in short lived tachydysrhythmias. Postural modification preferred over standard valsalva maneuver
Wide Complex Tachycardia- Adult w/pulse
Stable: Rate >150. 12 lead. Amiodarone 150mg over 10mins (repeat once as needed).
Unstable: Sync Cardioversion 100,200,300,360 (maximum 4 attempts).
Versed: 5-10mg for sedation
If no response to Cardioversion or VT recurs: Amiodarone 150/10mins (repeat once). Continue sync Cardioversion @ 360
Torsades: Mag 2 grams IV (mix in NS up to 500ml and infuse over 5 minutes)
Wide Complex Tachycardia- Pedi w/Pulse
Stable: Rate>150. 12 lead. Amiodarone 5mg/kg (up to 150) over 20 minutes. (May repeat once)
Unstable: Rate>150. Sync Cardioversion 1j/kg, 2j/kg, 2j/kg,2 j/kg (maximum 4 attempts)
Versed for sedation: 0.1mg/kg(up to 5) IV OR 0.2mg/kg(up to 5) IN may repeat once.
No response to 4 Cardioversions or VT recurs: Amiodarone 5mg/kg (up to 150) over 20 minutes. Repeat once.
Wide Complex Tachycardia w/Pulse- Pearls
Nonsustained VT is <30seconds.
Pedi- give 1ml every other minute.
Amiodarone is contraindicated in VT from tricyclic antidepressants or fast sodium channel blockers.
Arrhythmia Reference Guidelines
- 12 lead 2. Clinical Instability is combination of vital signs, patient symptoms, and clinical impression. Unstable if hypotensive AND altered, dyspnea, Chest pain, or syncope.
- TRANSPLANT HEARTS ARE NOT RESPONSIVE TO ATROPINE (TCP preferred). 4. Bradycardia (40-60) may be seen in pt’s with head injury or CVA. 5. Bradycardia in MI is treated with 500ml first. 10. Valsalva Maneuver- Postural Modification: bear down, tighten abs, lay down and hold legs in air. NO CAROTID MASSAGE.
Cardiac Arrest- AED/No monitor. Adult
Unwitnessed: two minutes of CPR @100-120bpm
Cardiac Arrest-AED/No Monitor-Pedi
Start CPR if the pt is: < 1 month to 1 year: if no spontaneous pulse or HR<60 after 30 seconds of ventilation with O2
OR
1-12yrs: if no spontaneous pulse
Cardiac Arrest-AED/No Monitor- Pearls
CPR performed around 2 minute cycles. Pause for no more than 10 seconds to assess for ROSC or insert airway.
Pediatrics: Compression rate of 100-120 utilizing a ratio of 15 compressions to 2 ventilations
Cardiac Arrest- Asystole/PEA- Adult
2 minutes of manual compressions.
Oral airway & NRB.
Continuous compressions.
Epi 0.1mg/ml (1:10), 1mg IV (repeat every 3-5 minutes up to 3mg)
Cardiac Arrest- Asystole/PEA-Pedi
Begin CPR if pt is birth to 1 yr after 30 seconds of ventilation and HR <60. OR 1-12 yes with no spontaneous pulse.
Oral airway & BVM.
Epi 0.1mg/ml (1:10), 0.01mg/kg (0.1ml/kg) IV (repeat every 3 to 5 minutes)
Cardiac Arrest-Asystole/PEA- Pearls
If using Lucas, pause after two minutes to check rhythm.
Advanced Airway Placement: Adult-completed by third 2 minute cycle of compressions. Pt should be ventilated with a BVM after three 2-minute cycles of compressions whether an advanced airway is in place or not.
Pedi-consider advanced airway as soon as possible. Prior to advanced airway 15:2 compression/ventilation. After advanced airway: 100-120 compressions with 8-10 ventilations per minute
