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PFD Protocols Nov. 2023 > Cardiac Emergencies > Flashcards

Cardiac Emergencies Flashcards

1
Q

Rapid A-Fib/A-flutter heart rate

A

> 150 bpm

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2
Q

Adult Stable A-Fib/A-Flutter Tx

A

~Cardizem 10 mg IV/IO over 2 min
~If HR > 120 after 5 min –> Cardizem 15 mg IV/IO over 2 min

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3
Q

Cardizem contraindications

A

hypotension
wide complex tachycardia (VT)
history of WPW
2nd/3rd degree AV blocks
sick sinus syndrome

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4
Q

adult AFib/AFlutter:
If hypotension develops after giving cardizem….

A

1L NS
1 g CaCl

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5
Q

unstable adult A-Fib/A-Flutter (hypotension)

A

1L NS
Push dose Epi

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6
Q

ADULT A-FIB/A-FLUTTER:
once BP stabilizes after giving fluids & push dose Epi…

A

1) Cardizem 10 mg
2) Cardizem 15 mg after 5 min if no change

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7
Q

Pedi A-Fib/A-Flutter

A

call for orders

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8
Q

HR to treat bradycardia adult

A

< 50

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9
Q

adult stable bradycardia tx

A

transport

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10
Q

adult unstable bradycardia w/ hypotension

A

~1L NS
~Atropine 0.5 mg, repeat prn, max dose 3 mg
~Push Dose Epi
~Pacing at initial HR of 60

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11
Q

pacing sedation

A

1) Ketamine 1 mg/kg IV/IO diluted (mix 9 mL NS with 100 mg Ketamine –> 10 mg/mL)
OR
2) Ketamine 3 mg/kg IM

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12
Q

Adult bradycardia in presence of MI with hypotension

A

pacing (skip Atropine)

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13
Q

Adult high degree AV blocks with hypotension

A

immediate pacing if IV access not immediately accessible

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14
Q

Pedi stable bradycardia

A

monitor & transport

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15
Q

Pedi unstable bradycardia (with AMS & poor perfusion)

A

1) oxygenation & ventilation
30 sec for neonates
1 min for infants/children
…if HR < 60 with signs poor perfusion & AMS, start compressions

2) Push dose Epi
3) Pace at HR set to 80

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16
Q

Pedi pacing sedation

A

1) Ketamine 1 mg/kg IV/IO DILUTED (mix 9 mL NS with 100 mg Ketamine –> 10 mg/mL)

OR
2) Ketamine 3 mg/kg IM

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17
Q

Adult chest pain

A

1) Aspirin 324 mg total
2) Nitroglycerin 0.4 mg, may repeat 3x prn, max 3 doses
3) Dilaudid
1 mg IVP if > 70 kg
0.5 mg IVP if < 70 kg
0.5 mg IVP if age > 65

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18
Q

If patient took 324 mg aspirin within past 24 hours…

A

withhold giving aspirin

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19
Q

if patient took < 324 mg aspirin within past 24 hours…

A

give full 324 mg dose aspirin

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20
Q

contraindications for Aspirin

A

allergy
active GI bleed

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21
Q

contraindications for Nitroglycerin

A

~SBP < 100
~EDD med usage within 24-48 hours
~Right Ventricular infarct (positive V4R)

22
Q

if hypotension occurs with dilaudid use…

A

1L NS

23
Q

Pedi chest pain

A

call for orders

24
Q

STEMI alert criteria

A

ST segment elevation in 2+ continguous leads:
a) CONVEX (frowny face) or “straight morphology”
2 mm or greater in V2 & V3
OR
1 mm or greater in all other
leads

b) CONCAVE (smiley face)
2 mm or greater in any lead

25
Q

STEMI mimics

A

~QRS complexes > 0.12 (LBBB, pacemaker, etc)
~left ventricular hypertrophy (LVH)
~pericarditis
~early repolarization
~ < 2 mm elevation with concave ST segment (smiley face) morphology

26
Q

determining LVH

A

1) take largest negative deflection from isoelectric line of V1 & V2 (“S” wave), whichever is larger, & count small boxes

2) take largest positive deflection of V5 or V6 (“R” wave), whichever is larger, & add it to total from V1 or V2

3) if result > 35, suspicion for LVH should be high

27
Q

S/S CHF (pulmonary edema)

A

HTN
tachycardia
orthopnea
rales
pedal edema

28
Q

Adult CHF

A

Aspirin 324 mg PO
Nitroglycerin 0.4 mg SL (max 3 doses)
CPAP 10 cm H2O

29
Q

Contraindications to CPAP use

A

SPB > 100 mmHg
AMS (lethargic)
apnea

30
Q

pedi CHF

A

call for orders

31
Q

Adult cardiogenic shock
(heart failure/pulmonary edema, hypotension)

A

Push Dose Epi
follow CHF protocol

32
Q

Pedi cardiogenic shock

A

call for orders

33
Q

Adult SVT (HR>150) tx

A

1) vagal maneuver
2) Adenosine 12 mg IVP + rapid 10 mL NS flush

34
Q

contraindication for Adenosine use

A

A-Fib/A-Flutter

35
Q

If adult SVT fails to convert with use of Adenosine ….

A

1) Cardizem 10 mg IVP over 2 min
2) if HR > 120 after 5 min –> Cardizem 15 mg IVP over 2 min

36
Q

what pt medication class should the paramedic be cautious of when using cardizem?

A

beta-blockers

37
Q

adult SVT:
If hypotension develops after giving cardizem….

A

1L NS
1 g CaCl over 2 min

38
Q

Unstable Adult SVT (hypotension) but pt is alert

A

Adenosine 12 mg IVP + rapid 10 mL NS flush

39
Q

Unstable Adult SVT (hypotension) where pt is alert but adenosine has no effect

A

Monitor & transport

40
Q

Unstable Adult SVT (hypotension) where pt has AMS

A

synchronized cardioversion with sedation:

Ketamine 1 mg/kg IV/IO diluted OR Ketamine 3 mg/kg IM

SYNC 100-200-300-360 joules

41
Q

HR for SVT in children

A

> 190 bpm

42
Q

HR for SVT in infants

A

> 220 bpm

43
Q

stable pedi SVT

A

1) vagal maneuvers
2) Adenosine 0.1 mg/kg rapid IV/IO + rapid 10 mL NS flush
max dose 6 mg
3) after 1 min with no change: Adenosine 0.2 mg/kg rapid IV/IO + rapid 10 mL NS flush
max dose 12 mg

44
Q

unstable pedi SVT (age-appropriate hypotension) & pt is alert

A

1) Adenosine 0.1 mg/kg rapid IV/IO + rapid 10 mL NS flush
max dose 6 mg
2) after 1 min with no change: Adenosine 0.2 mg/kg rapid IV/IO + rapid 10 mL NS flush
max dose 12 mg

45
Q

Unstable Pedi SVT (hypotension) where pt has AMS

A

synchronized cardioversion with sedation:

Ketamine 1 mg/kg IV/IO diluted OR
Ketamine 3 mg/kg IM

SYNC 1 J/kg, 2 J/kg

46
Q

definition of really wide complex tachycardia (think hyperkalemia)

A

1) QRS complex > 0.200 ms
2) HR = ~100-120 bpm with no discernible P waves
3) QTc > 500

47
Q

really wide complex tachycardia tx

A

1) CaCl 1 g IV/IO over 2 min
2) NaHCO3 50 mEq slow over 2 min
3) Albuterol 10 mg (4x2.5 mg) continuous treatments

48
Q

definition wide complex tachycardia

A

1) QRS > 0.12 ms (adult) OR
QRS > 0.09 ms (pedi)
2) HR > 120 bpm with no discernible P waves
3) regular (think VT)

49
Q

stable adult wide complex tachycardia

A

Lidocaine bolus
1) 0.5-0.75 mg/kg up to 1-1.5 mg/kg
2) repeat 0.5-0.75 mg/kg q 5-10 min
max total dose 3 mg/kg

50
Q

unstable adult wide complex tachycardia

A

synchronized cardioversion with sedation:

Ketamine 1 mg/kg IV/IO diluted OR Ketamine 3 mg/kg IM

SYNC 100-200-300-360 joules

51
Q

unstable adult WCT where 4 times cardioversion fails….

A

1) Lidocaine bolus
0.5-0.75 mg/kg up to 1-1.5 mg/kg
2) repeat 0.5-0.75 mg/kg q 5-10 min
max total dose 3 mg/kg

3) cardioversion 360 J q 2 min prn

52
Q
A

PFD Protocols Nov. 2023 (5 decks)

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