Cardiac Emergencies Flashcards
Rapid Afib or Aflutter is defined as?
Ventricular rates greater than 150
Rapid Afib or Aflutter treatment stable?
Cardizem 10 mg IV/IO over 2 min. Dilute in 10 ml syringe. No response repeat in 5 in with 15 mg in 10 mL syringe over 2 min
Contraindication for Caridizem?
Heart blocks, Hypotension, Wide complex QRS, Sick Sinus syndrome, WPW
Rapid Afib or Aflutter unstable?
> 90 systolic NS 1,000 ml
repeat x 1 if needed.
Remains >90 systolic give push dose Epi 1:100,000 0.1 mg in 10 ml.
Cardizem induced hypotension Calcium chloride 500 mg IV over 2 min
Bradycardia defined?
Heart rate less than 50 beats per min.
Brady unstable?
Atropine 0.5 mg to 1 mg IV/IO and 3 min intervals. Max dose 3mg
Pt deteriorates unstable brrady?
Pacing. Set rate of 60 bpm. Increase miliamps until capture.
**Max rate of 80 bpm
*Sedation- Ketamine 1mg/kg/ IV/IO. Mix 50 ml in 50 ml NS. FOr 1:1. Max dose 200mg
Push dose pressor Epi if Pacing doesnt work.
LVF with pulmonary edema and hypotension?
Epi push dose pressor. 1:100,000 0.1 mg in 10 mL.
RVF positive V4R, clear lung sounds, hypotensive?
1 liter bag IV. Max 2 L assess lung sounds frequently.
*push dose epi if remains hypotensive.
Chest pain protocol?
12 Lead ECG
Aspirin 324 mg
Fentanyl 100 mcg slow IV/OI/IM. Max dose 200 mcg. Repeat dose every 5-10 min.
Cardiac alert defined?
ST segment elevation in two or more related leads.
ECG Cardiac Alert criteria?
ST segment elevation of 1mm of greater in two or more leads.
**Absent of LBBB, Wide QRS, LVH, Pericarditis, Early repolarization.
Inferior MI criteria?
ST segment elevation in two or more inferior leads 2/3/AVF. Complete V4R.
STEMI with bradycardia DO NOT!!
Do not correct with atropine. If hypotensive use pacing.
CHF
12 lead ECG
CPAP 10 cm H2o
Spo2 greater than 95%
EtCO2 level between 35-45 mmhg
Nitro 0.4 mg SL. Repeat x2 Max 3 doses
Contraindications of CPAP?
SBP > 90 mmHg
Airway obstruction, Acute MI, Pneumo, AMS
SVT defined?
QRS less .12 or 3 small boxes
HR greater than 150 bpm
SVT will generally not have discernable P waves.
SVT Stable Tx?
Vagal maneuvers
Adenosine 12 mg IVP with 10 ml flush. One min no change repeat x1
*Rhythm fails to convert.
Cardizem 10 mg in 10 ml. NS. No response in 5 min repeat with 15mg in 10 ml NS.
Warning when using Cardizem?
Becareful with patients taking beta blockers. May cause hypotension. Blocking beta and Calcium channels.
SVT unstable protocol??
Sedate before Sync Cardioversion
Synch 100- 200-300-360
***DO NOT delay Cardioversion for IV access.
Stable Vtach Wide Complex protocol?
Amio if BP systolic is greater than 90 mmhg.
150 mg in 50 ml NS over 10 min. Max dose 300 mg. Repeat x1
Unstable Cardiovert.
If pt converts after cardioversion. Amio drip.
DO NOT administer if pt already got Amio.
Regular Really Wide Complex Tachy protocol?
Calcium chloride 1gm in 50 ml NS over 2 min.
Sodium Bicarb 100 meq IV in 2 min.
Unstable Cardiovert
You may terminate resuscitation if?
- Asystolic for 15 min
- Normothermic
- Airway ET
- CPR
- ETCo2 less than 10
- 3 rounds performed of meds
- Fluid replacement of 500 ml
- Trial defib of 200 j
Initial pacing rate of BPM for pediatrics?
80 bpm
Pediatric Adenosine dosage?
0.1 mg/kg max dose 6mg
May repeat 0.2 mg/kg Max dose 12 mg
Pediatric
Ped synch cardioversion dosages?
0.5 j/kg, 1 j/kg, 2 j/kg
Pediatric dosage for Amio?
5mg/kg in 50 ML bag. Max single dose 150 mg
Pediatric dosage for Calcium chloride?
20 mg/kg IV/IO in 50 ml bag over 2 min
Ped dosage for Bicarb?
1 meq/kg slow push over 2 min. Max 50 meq
Vfib/Vtach algorithm
CPR, Defibrillate, Amio 300 mg IV, If refractory 150mg Amio, after max dose Esmolol 40 mg IV if refractory 60 mg in 50 ml bag over 10 min.
After 5th defib dual sequential shock at 360j
Pediatric cardiac arrest joule escalation
2 j.kg, 4 j/kg up to 10 j/kg
