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Protocols > Cardiac 12/13/15 > Flashcards

Cardiac 12/13/15 Flashcards

1
Q

Unless there are signs of airway compromise what position should a patient be put in during an acute stroke?

A

Left lateral (recovery) position

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2
Q

During an acute stroke you should administer O2 to achieve what minimum SPO2?

A

92%

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3
Q

What does FAST stand for in a FAST exam?

A

Face
Arms
Speech
Time

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4
Q

During an acute stroke what three pieces of information should be obtained?

A
  • Family contact number
  • Medical history
  • Medications

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5
Q

During an acute stroke what medication should be specifically asked if the patient is prescribed?

A

Coumadin

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6
Q

A stroke activation can be called if onset of symptoms has occurred within the last how many hours?

A

7

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7
Q

What are the 5 H’s?

A
  • Hypovolemia
  • Hypoxia
  • Hydrogen ion (acidosis)
  • Hypo/hyperkalemia
  • Hypothermia

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8
Q

What are the 5 T’s?

A
  • Tension pneumothorax
  • Tamponade, cardiac
  • Toxins
  • Thrombosis, pulmonary
  • Thrombosis, coronary

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9
Q

What are the five steps in the asystole/PEA protocol?

A

1) Perform CPR
2) Establish advanced airway
3) Establish IV
4) Administer Epi
5) Investigate H’s and T’s

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10
Q

What is the dose for Epi in asystole or PEA?

A

1mg q 3-5min until ROSC or termination

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11
Q

What is the first treatment for a patient that is bradycardic with serious signs and symptoms?

A

0.5mg Atropine q 3-5min

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12
Q

What is the max dose of atropine for a bradycardic patient?

A

0.04mg/kg or 3mg

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13
Q

What is the next step if atropine is ineffective for a bradycardic patient?

A

Transcutaneous pacing

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14
Q

What should be done for a bradycardic patient when atropine and TCP is not effective?

A

Dopamine at 5-20mg/kg/min titrated to BP

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15
Q

What are the first six steps in the Chest Discomfort Suspected Angina/AMI protocol?

A

1) IV/IO
2) Monitor/12 lead
3) O2
4) 160-324mg ASA
5) 0.4mg nitro if BP>100
6) Repeat step 5 q5min X2 if BP>100 and discomfort persists

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16
Q

In the Chest Discomfort Suspected Angina/AMI protocol, what is the next step if a Pt has received 3 doses of nitro?

A

Give fentanyl at 0.5-1mcg/kg q 10min to a total of 3mcg/kg as long as BP>100.

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17
Q

In the Chest Discomfort Suspected Angina/AMI protocol if BP

A

Trial infusion of NS

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18
Q

In the Chest Discomfort Suspected Angina/AMI protocol if BP

A

Consider dopamine infusion

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19
Q

What 10 things need to be reported to ER if 12 lead shows an AMI?

A

1) Cardiac level 1 transport
2) Pt name if on secure cell or ground line
3) Age
4) Gender
5) 12 lead interpretation both mine & computer
6) Mimickers
7) Name of cardiologist or physician
8) Brief clinical presentation
9) Vital signs
10) Prehospital treatment

126-127

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20
Q

What are the 5 AMI mimickers?

A 
LVH
BBB
Pacemaker
Pericarditis
Early repolarization

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21
Q

What 3 terms should be used to describe an ACS Pt?

A

Cardiac - STEMI
Cardiac - High risk
Cardiac - Post Arrest

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22
Q

What are the five qualities of effective CPR?

A

1) Push hard (2”) and fast (> 100/minute)
2) Minimize interuptions in compressions
3) Avoid exceesive ventilation
4) Rotate compressors every 2 minutes
5) If capnography is

23
Q

Name reversible causes of cardiac arrest or arhythmia (6 Hs and 5Ts)

A
  • Hypovolemia
  • Hypoxia
  • Hydrogen ion
  • Hypothermia
  • Hypo/hyperthermia
  • Hypoglycemia
  • Tension pneumothorax
  • Thrombosis, cardiac
  • Tamponade, cardiac
  • Toxins
  • Thrombosis, pulmonary

128

24
Q

List 5 indications of patient instability

A
  • Hypotension
  • Acutly altered mental status
  • Signs of shock
  • Ischemic chest discomfort
  • Acute heart failure (CHF)

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25
Q

List the 7 steps in post arrest care

A

1) Establish IV/IO access
2) Optimize ventilation and oxygen
3) Assess BP and correct if less than 90
4) Concider NaHCO3
5) Search for and treat reversible causes
6) Report to receiving hospital
7) Update hospital pending arrival

133-134

26
Q

Post cardiac arrest O2 should be titrated to achieve an ETCO2 of what?

A

35-40mmHg

133

27
Q

What is the treatment in post arrest if BP is

A

Dopamine at 5-10ug/kg

133

28
Q

In post arrest SPO2 should be maintained in what range?

A

94-96%

133

29
Q

In post arrest when should NaHCO3 be considered?

What is the dose?

A

Prolonged resuscitation with effective ventilation or ROSC with a long arrest interval.

1meq/kg

133

30
Q

In post arrest what 10 things need to be reported to the reviving hospital?

A

1) Cardiac arrest - ROSC
2) Pt name if on secure cell or ground line
3) Age
4) Gender
5) 12 lead interpretation both mine & computer
6) Mimickers
7) Name of cardiologist or physician
8) Brief clinical presentation
9) Vital signs
10) Prehospital treatment

133-134

31
Q

What are the 8 steps in the pulmonary edema protocol?

A

1) Sit patient up if possible
2) cardiac monitor
3) IV/IO
4) High flow O2
5) consider CPAP if respiratory distress is present
6) Consider ETT and PEEP if respiratory distress increases or LOC decreases.
7) If BP > 100 give nitro 0.4mg SL X 2
8) If BP

32
Q

What are the first three steps in the Stable Narrow-Complex Tachycardia protocol?

A

1) IV/IO
2) O2
3) Attempt to establish a specific diagnosis through a 12 lead EKG and patient history

136

33
Q

What is the first treatmentin the Stable Narrow-Complex Tachycardia protocol?

A

Perform Vagel Manuvers

136

34
Q

What is the next three step treatment in the in the Stable Narrow-Complex Tachycardia protocol if vagal maneuvers are unsuccessful?

A

1) Place the patient in mild reverse Trendelenburg position
2) Administer 6 mg of adenosine (Adenocard®) via rapid IV bolus,
followed by 20 ml NS. Elevate the extremity
3) A second dose of 12 mg may be given after 1-2 minutes if
dysrhythmia persists

136

35
Q

What are the two indications for diltiazem in the Stable Narrow-Complex Tachycardia protocol?

A

1) Rhythm appears irregular and atrial fibrillation with a rapid ventricular response is suspected
2) Atrial flutter (which may be regular) with a rapid ventricular response is suspected

136

36
Q

What are the initial and second doses of diltiazem in the Stable Narrow-Complex Tachycardia protocol?

A
  • 15-20 mg (0.25 mg/kg) over 2 minutes
  • 20-25 mg (0.35 mg/kg) over 2 minutes

136

37
Q

What are the first four steps in the Stable Wide-Complex Tachycardia protocol?

A

1) IV/IO
2) O2
3) Apply cardiac monitor
4) Attempt to establish a specific diagnosis through a 12 lead EKG and clinical information

137

38
Q

In the Stable Wide-Complex Tachycardia protocol when should vagal maneuvers be attempted?

A

If the rhythm appears to be a regular and monomorphic wide-complex tachycardia

137

39
Q

What should be considered if vagal maneuvers in the Stable Wide-Complex Tachycardia protocol are unsuccessful?

A

Adenosine

137

40
Q

What are the doses for adenosine in the in the Stable Wide-Complex Tachycardia protocol?

A

1) 6mg rapid IV bolus followed by a 20 ml NS flush
2) 12 mg rapid IV bolus followed by a 20 ml NS flush

137

41
Q

What is the next step in the Stable Wide-Complex Tachycardia protocol if both vagal maneuvers and adenosine do not slow the heart rate?

A

Consult with medical control for possible administration of 150 mg of amiodarone over 10 minutes

137

42
Q

In the Stable Wide-Complex Tachycardia protocol, what is done if the patient becomes unstable with a wide, regular complex tachycardia?

A

Consider sedation and synchronized cardioversion beginning at 100j

137

43
Q

In the Stable Wide-Complex Tachycardia protocol, what is done if the patient becomes unstable with a wide, irregular complex tachycardia?

A

Consider sedation and defibrillate patient at defibrillation dose.

137

44
Q

What is the dose for etomidate in the Stable Wide-Complex Tachycardia protocol?

A

0.1mg/kg IV/IO

137

45
Q

What are the seven steps in the Unstable Narrow-Complex Tachycardia protocol?

A

1) IV/IO
2) O2
3) Confirm rapid heart rate as cause of signs and symptoms
4) Prepare for immediate cardioversion
5) Consider sedation by administration of etomidate at 0.1 mg/kg IV/IO
6) Perform synchronized cardioversion at 100 j, 200 j, 300 j, 360 j, monophasic dose (or manufacturer recommended biphasic dose)
7) Transport

140

46
Q

In the Unstable Narrow-Complex Tachycardia protocol, what is used for sedation and what is the dose?

A
  • etomidate
  • 0.1 mg/kg IV/IO

140

47
Q

In the Unstable Narrow-Complex Tachycardia protocol, what are the doses for synchronized cardioversion?

A
  • 100 j monophonic dose
  • 200 j monophonic dose
  • 300 j monophonic dose
  • 360 j monophasic dose -or manufacturer recommended biphasic dose

140

48
Q

What are the four criteria differentiating unstable and stable Wide-Complex Tachycardia?

A
  • Hypotension
  • Acutely altered mental status
  • Signs of shock, ischemic chest discomfort
  • Acute heart failure (CHF)

141

49
Q

What are the seven steps in the Unstable Wide-Complex Tachycardia protocol?

A

1) IV/IO
2) O2
3) Consider sedation by administration of etomidate at 0.1 mg/kg IV/IO
4) Perform synchronized cardioversion at 100 j, 200 j, 300 j, 360 j, monophasic dose (or manufacturer recommended biphasic dose)
5) Consider administering 150 mg of amiodarone IV/IO over 10 minutes, as needed.
6) Perform synchronized cardioversion at 360 j, monophasic dose (or manufacturer recommended biphasic dose).
7. Transport

141

50
Q

What is the dose for amiodarone in the Unstable Wide-Complex Tachycardia protocol?

A

150 mg of amiodarone IV/IO over 10 minutes, as needed

141

51
Q

What alternative can be used in the Unstable Wide-Complex Tachycardia protocol if the patient is hypersensitive to amiodarone?

A

Lidocaine

141

52
Q

When should a precordial thump be considered?

A

If V-Fib or pulseless V-Tach is witnessed while being monitored

144

53
Q

List the first 21 steps in the V-Fib/pulseless V-Tach protocol

A

1) Consider precordial thump
2) Initiate High Performance CPR while the defibrillator is being attached
3) Immediately shock all shockable rhythms
4) CPR for 2 minutes
5) IV/IO access, NS at TKO
6) One shock
7) CPR for 2 minutes
8) Establish advanced airway (ETT or advanced supraglottic airway) without interruption of chest compressions
9) 1.0mg Epi
10) CPR for 2 minutes
11) One shock
12) CPR for 2 minutes
13) Consider amiodarone at 300 mg IVP/IO
14) One shock
15) CPR for 2 minutes
16) Consider amiodarone at 150 mg IVP/IO
17) One shock
18) CPR for 2 minutes
19) Consider administering 1-2 gm of magnesium sulfate IV/IO for Torsades de Pointes and refractory VF/Pulseless VT
20) One shock
21) Continue cycles of CPR and defibrillation with appropriate interval administration of epinephrine until ROSC or termination

144-145

54
Q

When should Mag Sulfate be considered in the V-Fib/pulseless V-Tach protocol and what is the dose?

A
  • Torsades de Pointes and refractory VF/Pulseless VT

- 1-2 gm

Protocols (2 decks)

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