Cardiac Emergencies Flashcards
Rapid A-Fib/A-flutter heart rate
> 150 bpm
Adult Stable A-Fib/A-Flutter Tx
~Cardizem 10 mg IV/IO over 2 min
~If HR > 120 after 5 min –> Cardizem 15 mg IV/IO over 2 min
Cardizem contraindications
hypotension
wide complex tachycardia (VT)
history of WPW
2nd/3rd degree AV blocks
sick sinus syndrome
adult AFib/AFlutter:
If hypotension develops after giving cardizem….
1L NS
1 g CaCl
unstable adult A-Fib/A-Flutter (hypotension)
1L NS
Push dose Epi
ADULT A-FIB/A-FLUTTER:
once BP stabilizes after giving fluids & push dose Epi…
1) Cardizem 10 mg
2) Cardizem 15 mg after 5 min if no change
Pedi A-Fib/A-Flutter
call for orders
HR to treat bradycardia adult
< 50
adult stable bradycardia tx
transport
adult unstable bradycardia w/ hypotension
~1L NS
~Atropine 0.5 mg, repeat prn, max dose 3 mg
~Push Dose Epi
~Pacing at initial HR of 60
pacing sedation
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
Adult bradycardia in presence of MI with hypotension
pacing (skip Atropine)
Adult high degree AV blocks with hypotension
immediate pacing if IV access not immediately accessible
Pedi stable bradycardia
monitor & transport
Pedi unstable bradycardia (with AMS & poor perfusion)
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
Pedi pacing sedation
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
Adult chest pain
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
If patient took 324 mg aspirin within past 24 hours…
withhold giving aspirin
if patient took < 324 mg aspirin within past 24 hours…
give full 324 mg dose aspirin
contraindications for Aspirin
allergy
active GI bleed
contraindications for Nitroglycerin
~SBP < 100
~EDD med usage within 24-48 hours
~Right Ventricular infarct (positive V4R)
if hypotension occurs with dilaudid use…
1L NS
Pedi chest pain
call for orders
STEMI alert criteria
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
STEMI mimics
~QRS complexes > 0.12 (LBBB, pacemaker, etc)
~left ventricular hypertrophy (LVH)
~pericarditis
~early repolarization
~ < 2 mm elevation with concave ST segment (smiley face) morphology
determining LVH
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
S/S CHF (pulmonary edema)
HTN
tachycardia
orthopnea
rales
pedal edema
Adult CHF
Aspirin 324 mg PO
Nitroglycerin 0.4 mg SL (max 3 doses)
CPAP 10 cm H2O
Contraindications to CPAP use
SPB > 100 mmHg
AMS (lethargic)
apnea
pedi CHF
call for orders
Adult cardiogenic shock
(heart failure/pulmonary edema, hypotension)
Push Dose Epi
follow CHF protocol
Pedi cardiogenic shock
call for orders
Adult SVT (HR>150) tx
1) vagal maneuver
2) Adenosine 12 mg IVP + rapid 10 mL NS flush
contraindication for Adenosine use
A-Fib/A-Flutter
If adult SVT fails to convert with use of Adenosine ….
1) Cardizem 10 mg IVP over 2 min
2) if HR > 120 after 5 min –> Cardizem 15 mg IVP over 2 min
what pt medication class should the paramedic be cautious of when using cardizem?
beta-blockers
adult SVT:
If hypotension develops after giving cardizem….
1L NS
1 g CaCl over 2 min
Unstable Adult SVT (hypotension) but pt is alert
Adenosine 12 mg IVP + rapid 10 mL NS flush
Unstable Adult SVT (hypotension) where pt is alert but adenosine has no effect
Monitor & transport
Unstable Adult SVT (hypotension) where pt has AMS
synchronized cardioversion with sedation:
Ketamine 1 mg/kg IV/IO diluted OR Ketamine 3 mg/kg IM
SYNC 100-200-300-360 joules
HR for SVT in children
> 190 bpm
HR for SVT in infants
> 220 bpm
stable pedi SVT
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
unstable pedi SVT (age-appropriate hypotension) & pt is alert
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
Unstable Pedi SVT (hypotension) where pt has AMS
synchronized cardioversion with sedation:
Ketamine 1 mg/kg IV/IO diluted OR
Ketamine 3 mg/kg IM
SYNC 1 J/kg, 2 J/kg
definition of really wide complex tachycardia (think hyperkalemia)
1) QRS complex > 0.200 ms
2) HR = ~100-120 bpm with no discernible P waves
3) QTc > 500
really wide complex tachycardia tx
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
definition wide complex tachycardia
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)
stable adult wide complex tachycardia
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
unstable adult wide complex tachycardia
synchronized cardioversion with sedation:
Ketamine 1 mg/kg IV/IO diluted OR Ketamine 3 mg/kg IM
SYNC 100-200-300-360 joules
unstable adult WCT where 4 times cardioversion fails….
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
