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Directives > Cardiac/Circulation Directives > Flashcards

Cardiac/Circulation Directives Flashcards

1
Q

Medical Cardiac Arrest Indications

A

non-traumatic cardiac arrest

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2
Q

Epinephrine MCA Conditions

A

Age >/= 30
LOA altered
If Anaphylaxis suspected as causative event consider IM

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3
Q

Amiodarone MCA conditions

A

> /= 30 days
Altered
VF or pulseless VT

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4
Q

Lidocaine MCA Conditions

A

Age >/= 30 days
Altered
VF or Pulseless VT where amiodarone not available

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5
Q

Fluid Bolus MCA

A

> /= 30 days
Altered
PEA
Rhythm where hypovolemia suspected

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6
Q

Epinephrine Contraindications MCA

A

Allergy

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7
Q

Amiodarone MCA Contraindications

A

Allergy

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8
Q

Lidocaine MCA contraindications

A

Allergy
Use/availability of amiodarone

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9
Q

Fluid Bolus MCA contraindications

A

Fluid overload

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10
Q

Manual Defibrillation adult cut off

A

8 years

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11
Q

Manual defibrillation initial dose peds

A

2J/kg

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12
Q

Manual defib subsequent doses peds

A

4J/kg

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13
Q

Epinephrine Non anaphylaxis MCA >/=12 yo Dose IV/IO/CVAD

A

1mg

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14
Q

Epinephrine MCA Dosing interval

A

4 min

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15
Q

Max # doses Epinephrine MCA

A

N/A

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16
Q

Epinephrine >/= 12 MCA ETT Dose

A

2 mg

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17
Q

Epinephrine >30 <12 dose IV

A

0.01mg/kg

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18
Q

Epinephrine >30 <12 dose ETT

A

0.1mg/kg to max 2mg

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19
Q

Epinephrine concentration ETT >30 <12

A

1:1,000

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20
Q

Epinephrine Min Single Dose >30 <12 MCA IV

A

0.1mg

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21
Q

Epinephrine min single dose ETT MCA

A

1 mg

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22
Q

Amiodarone >30 <12 Initial dose MCA

A

5mg/kg

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23
Q

Amiodarone >12 initial dose MCA

A

300mg

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24
Q

Amiodarone >30 <12 max initial dose MCA

A

300mg

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25
Q

Amiodarone >30 <12 subsequent dose MCA

A

5mg/kg to max of 150 mg

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26
Q

Amiodarone >12 max repeat dose MCA

A

150mg

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27
Q

Dosing interval Amiodarone MCA

A

4 min

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28
Q

Max # doses Amiodarone MCA

A

2

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29
Q

Lidocaine MCA >30 <12 IV dose

A

1mg/kg

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30
Q

Lidocaine ETT >30 <12 dose MCA

A

2mg/kg

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31
Q

Lidocaine >/= 12 IV dose MCA

A

1.5mg/kg

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32
Q

Lidocaine >/= 12 ETT dose MCA

A

3 mg/kg

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33
Q

Lidocaine dosing interval MCA

A

4 min

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34
Q

Max # doses lidocaine MCA

A

2

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35
Q

Fluid Bolus MCA

A

20mL/kg

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36
Q

Fluid Bolus MCA >30 <12 reassess

A

100mL

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37
Q

Max Volume Fluid Bolus MCA

A

2000mL

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38
Q

Reassess >/=12 Bolus MCA

A

250mL

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39
Q

Patch Point MCA

A

Following 3rd round of epinephrine
After 3rd analysis if no access

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40
Q

BHP Patch failure

A

Transport after 4th epi or interpretation if no access

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41
Q

Transport after 1st analysis

A

Pregnancy >/= 20 weeks
Hypothermia
Airway obstruction
Suspected PE
Medication overdose/toxicology
Other known reversible cause

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42
Q

Trauma TOR Conditions

A

Age >/= 16
Altered
No palpable pulse, no defibrillation, monitored HR = 0 or HR >0 and closes ED >/= 30 min away

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43
Q

FBAO VSA post removal of object

A

Treat as medical cardiac arrest

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44
Q

ROSC Fluid Bolus Conditions

A

Hypotension
Chest auscultation clear

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45
Q

Dopamine ROSC conditions

A

> /= 8 yo
Hypotension

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46
Q

Fluid Bolus ROSC contraindications

A

Fluid overload

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47
Q

Dopamine ROSC contraindications

A

Allergy
Tachydysrhythmias excluding sinus tachycardia
Mechanical shock
Hypovolemia
Pheochromocytoma

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48
Q

Oxygen + ETCO2 ROSc

A

94-98% spO2
30-40mmHg ETCO2

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49
Q

Fluid Bolus ROSC infusion

A

10mL/kg

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50
Q

ROSC <12 Reassess Bolus

A

100mL

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51
Q

ROSC >12 Reassess

A

250mL

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52
Q

Max volume Bolus ROSC

A

1000mL

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53
Q

Dopamine Initial infusion rate

A

5mcg/kg/min

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54
Q

Titration increment dopamine

A

5mcg/kg/min

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55
Q

Titration interval dopamine

A

5 min

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56
Q

Max infusion rate dopamine

A

20mcg/kg/min

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57
Q

Goal SBP of dopamine titration

A

> /= 90 to <110mmHg

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58
Q

Discontinuing dopamine

A

Do over 5-10 min

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59
Q

ASA Conditions

A

> /= 18
Unaltered
Able to chew and swallow

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60
Q

Nitro Conditions Ischemia

A

> /= 18
Unaltered
HR 60-159bpm
Normotensive
Prior history or IV access

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61
Q

Morphine Conditions

A

> /= 18
Unaltered
Normotensive
Severe pain

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62
Q

Contraindications ASA

A

Allergy to NSAIDs
Asthmatic without prior use
Current bleeding
CVA or TBI in previous 24hrs

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63
Q

Nitroglycerin Contraindication Ischemia

A

Allergy
Phosphodiesterase inhibitor use within previous 48 hours
SBP drops 1/3 or more after administration
RVMI

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64
Q

Morphine contraindications

A

Allergy
SBP drops by more than 1/3

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65
Q

ASA Dose

A

160-162mg x 1

66
Q

Nitro Dose Ischemia

A

0.3 or 0.4 mg

67
Q

Dosing interval Nitro

A

5 min

68
Q

Max # doses Nitro No STEMI

A

6

69
Q

Max # doses Nitro STEMI

A

3

70
Q

Morphine when to administer with ischemia

A

after 3rd dose of nitro or if nitro contraindicated

71
Q

Dose morphine

A

2mg

72
Q

Dosing interval morphine

A

5 min

73
Q

Max # doses morphine

A

5

74
Q

ACPE Indications

A

Moderate to severe respiratory distress
Suspected ACPE

75
Q

Nitroglycerin ACPE Conditions

A

> /= 18
HR 60-159
Normotensive

76
Q

Nitro ACPE Contraindications

A

Allergy
Phosphodiesterase use in last 48 hours
SBP drops 1/3 or more

77
Q

SBP >100 <140 nitro ACPE dose

A

0.4mg

78
Q

SBP >140 no IV or HX Dose Nitro ACPE

A

0.4

79
Q

SBP >140 IV/Hx Nitro Dose ACPE

A

0.8

80
Q

Max # doses nitro ACPE

A

6

81
Q

Cardiogenic Shock Indications

A

STEMI
Cardiogenic shock

82
Q

Fluid Bolus Cardiogenic Shock Indications

A

> /= 18
Hypotension
Chest auscultation clear

83
Q

Dopamine cariogenic shock indications

A

> /= 18
Hypotension

84
Q

Fluid Bolus Cardiogenic Shock Contraindications

A

Fluid overload
SBP >/= 90

85
Q

Dopamine Contraindications Cardiogenic Shock

A

Allergy
Tachydysrhythmia excluding sinus tachycardia
Mechanical shock
Hypovolemia
Pheochromocytoma

86
Q

Fluid Bolus Cardiogenic shock infusion

A

10mL/kg

87
Q

Fluid bolus Cardiogenic shock reassess

A

250mL

88
Q

Fluid bolus max volume cardiogenic shock

A

1000mL

89
Q

Dopamine Cardiogenic Shock initial

A

5mcg/kg/min

90
Q

Dopamine Cardiogenic shock titration increment

A

5mcg/kg/min

91
Q

Dopamine Cardiogenic shock titration interval

A

5 min

92
Q

Dopamine cardiogenic shock max infusion rate

A

20mcg/kg/min

93
Q

Cardiogenic Shock BHP

A

If pt bradycardic

94
Q

Symptomatic Bradycardia Indications

A

Bradycardia
Hemodynamic instability

95
Q

Atropine Conditions

A

> /=18
HR <50
Hypotension

96
Q

Transcutaneous Pacing Conditions

A

> /=18
HR <50
Hypotension

97
Q

Dopamine Bradycardia Conditions

A

> /= 18
HR <50
Hypotensive

98
Q

Atropine Contraindications

A

Allergy
Hypothermia
History of heart transplant

99
Q

Transcutaneous pacing Contraindications

A

Hypothermia

100
Q

Dopamine Bradycardia directives

A

Allergy
Mechanical shock
Pheochromocytoma

101
Q

Atropine Dose

A

1mg

102
Q

Atropine Dosing interval

A

5min

103
Q

Atropine # doses

A

2

104
Q

Dopamine Brady Treatment

A

5mcg/kg/min, increased 5 mcg/kg/min q 5 min to max of 20mcg/kg/min

105
Q

Valsalva Maneuver Conditions

A

> /= 18
Unaltered
HR >/= 150
Normotensive
Narrow complex and regular

106
Q

Adenosine Conditions

A

> /=18
Unaltered
HR >/= 150
Normotensive
Narrow complex and regular

107
Q

Amiodarone Tachy Conditions

A

> /= 18
Unaltered
HR >/= 120
Normotensive
Wide complex and regular

108
Q

Lidocaine Tachy Conditions

A

> /= 18
Unaltered
HR >/= 120
Normotensive
Wide and regular

109
Q

Cardioversion Conditions

A

> /= 18
HR >/= 120 (wide) or >/= 150 (narrow)
Hypotensive
Altered mental status, chest pain, signs of shock

110
Q

Valsalva Contraindications

A

Sinus tach or atrial fibrillation or atrial flutter

111
Q

Adenosine Contraindications

A

Allergy
Sinus tachycardia or atrial fibrillation or atrial flutter
Pt taking dipyridamole or carbamazepine
Bronchoconstriction on exam

112
Q

Amiodarone tachy contraindications

A

Allergy

113
Q

Lidocaine tachy contraindications

A

Allergy

114
Q

Cardioversion contraindications

A

N/A

115
Q

Valsalva Treatment

A

2 attempts lasting 10-20s

116
Q

BHP Patch tachydysrhythmia

A

For amiodarone or lidocaine or if monomorphic wide complex regular rhythm for adenosine

For cardio version

117
Q

Adenosine initial dose

A

6 mg

118
Q

Adenosine 2nd dose

A

12 mg

119
Q

Adenosine dosing interval

A

2 min

120
Q

Adenosine max # doses

A

2

121
Q

Amiodarone tachy initial dose

A

150mg

122
Q

Amiodarone tachy subsequent dose

A

150mg

123
Q

Amiodarone dosing interval tachy

A

10 min through IV infusion

124
Q

Amiodarone # doses tachy

A

2

125
Q

Lidocaine tachy initial dose

A

1.5mg/kg

126
Q

Lidocaine tachy subsequent dose

A

0.75mg/kg

127
Q

Lidocaine tachy max single dose

A

150mg

128
Q

Lidocaine tachy dosing interval

A

10 min

129
Q

Lidocaine max # doses tachy

A

3

130
Q

of cardioversion

A

3

131
Q

Joule settings cardioversion

A

100, 200, maximum

132
Q

Indications Hyperkalemia

A

Suspected hyperkalemia in patients at high risk and Cardiac arrest or prearrest + 12 lead suggesting hyperk

133
Q

Patients at high risk of hyperkalemia

A

Currently on dialysis
History of end-stage renal disease
Relevant incident history (prolonged crush)

134
Q

Calcium Gluconate Conditions

A

> /=18

135
Q

Salbutamol Conditions

A

> /= 18

136
Q

Contraindications calcium gluconate

A

N/A

137
Q

Salbutamol Contraindications

A

Allergy

138
Q

Calcium Gluconate Dose

A

1g (10mL) over 2-3 minutes

139
Q

Max single dose calcium gluconate

A

1g (10mL)

140
Q

Dosing interval calcium gluconate

A

5 minutes

141
Q

Max # doses calcium gluconate

A
  1. Additional 3rd dose after 30min if symptoms recur
142
Q

Salbutamol MDI Dose

A

1600mcg

143
Q

Salbutamol # doses

A

2

144
Q

Salbutamol NEB dose

A

10mg

145
Q

Pre-arrest pt for hyperk

A

Hypotension
Altered
Symptomatic bradycardia

146
Q

12 lead changes of hyperk

A

wide and bizarre QRS (>/= 120)
Peaked T waves
Loss of P waves
QRS sine wave

147
Q

IV Indications

A

Acute or potential need for IV medication or fluid therapy

148
Q

IV cannulation conditions

A

N/A

149
Q

Fluid Bolus IV conditions

A

Hypotension

150
Q

IV cannulation contraindications

A

Fracture proximal to access site

151
Q

Fluid bolus IV contraindications

A

Fluid overload

152
Q

TKVO <12

A

15mL/hr

153
Q

TKVO >/=12

A

30-60mL/kg

154
Q

Bolus IV infusion

A

20mL/kg

155
Q

Reassess <12 bolus IV

A

100mL

156
Q

Reassess bolus >/=12 IV

A

250mL

157
Q

Max volume Bolus IV

A

2000mL

158
Q

IO Indications

A

Acute or potential need for IV med or fluid therapy
IV unobtainable
Cardiac arrest or pre-arrest

159
Q

IO Conditions

A

> /=12

160
Q

IO Contraindications

A

Fracture or crush injury proximal to access site
Suspected/known replacement/prostheses immediately proximal to the access site

161
Q

Paediatric IO Condtions

A

Age <12

162
Q

Ped IO site

A

Proximal Tibia

Directives (4 decks)

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