Cardiac Emergencies

Question 1

Rapid Afib or Aflutter is defined as?

Answer 1

Ventricular rates greater than 150

Question 2

Rapid Afib or Aflutter treatment stable?

Answer 2

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

Question 3

Contraindication for Caridizem?

Answer 3

Heart blocks, Hypotension, Wide complex QRS, Sick Sinus syndrome, WPW

Question 4

Rapid Afib or Aflutter unstable?

Answer 4

> 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

Question 5

Bradycardia defined?

Answer 5

Heart rate less than 50 beats per min.

Question 6

Brady unstable?

Answer 6

Atropine 0.5 mg to 1 mg IV/IO and 3 min intervals. Max dose 3mg

Question 7

Pt deteriorates unstable brrady?

Answer 7

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.

Question 8

LVF with pulmonary edema and hypotension?

Answer 8

Epi push dose pressor. 1:100,000 0.1 mg in 10 mL.

Question 9

RVF positive V4R, clear lung sounds, hypotensive?

Answer 9

1 liter bag IV. Max 2 L assess lung sounds frequently.

*push dose epi if remains hypotensive.

Question 10

Chest pain protocol?

Answer 10

12 Lead ECG
Aspirin 324 mg
Fentanyl 100 mcg slow IV/OI/IM. Max dose 200 mcg. Repeat dose every 5-10 min.

Question 11

Cardiac alert defined?

Answer 11

ST segment elevation in two or more related leads.

Question 12

ECG Cardiac Alert criteria?

Answer 12

ST segment elevation of 1mm of greater in two or more leads.
**Absent of LBBB, Wide QRS, LVH, Pericarditis, Early repolarization.

Question 13

Inferior MI criteria?

Answer 13

ST segment elevation in two or more inferior leads 2/3/AVF. Complete V4R.

Question 14

STEMI with bradycardia DO NOT!!

Answer 14

Do not correct with atropine. If hypotensive use pacing.

Question 15

CHF

Answer 15

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

Question 16

Contraindications of CPAP?

Answer 16

SBP > 90 mmHg
Airway obstruction, Acute MI, Pneumo, AMS

Question 17

SVT defined?

Answer 17

QRS less .12 or 3 small boxes
HR greater than 150 bpm
SVT will generally not have discernable P waves.

Question 18

SVT Stable Tx?

Answer 18

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.

Question 19

Warning when using Cardizem?

Answer 19

Becareful with patients taking beta blockers. May cause hypotension. Blocking beta and Calcium channels.

Question 20

SVT unstable protocol??

Answer 20

Sedate before Sync Cardioversion
Synch 100- 200-300-360
***DO NOT delay Cardioversion for IV access.

Question 21

Stable Vtach Wide Complex protocol?

Answer 21

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.

Question 22

Regular Really Wide Complex Tachy protocol?

Answer 22

Calcium chloride 1gm in 50 ml NS over 2 min.
Sodium Bicarb 100 meq IV in 2 min.

Unstable Cardiovert

Question 23

You may terminate resuscitation if?

Answer 23

• 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

Question 24

Initial pacing rate of BPM for pediatrics?

Answer 24

80 bpm

Question 25

Pediatric Adenosine dosage?

Answer 25

0.1 mg/kg max dose 6mg
May repeat 0.2 mg/kg Max dose 12 mg
Pediatric

Question 26

Ped synch cardioversion dosages?

Answer 26

0.5 j/kg, 1 j/kg, 2 j/kg

Question 27

Pediatric dosage for Amio?

Answer 27

5mg/kg in 50 ML bag. Max single dose 150 mg

Question 28

Pediatric dosage for Calcium chloride?

Answer 28

20 mg/kg IV/IO in 50 ml bag over 2 min

Question 29

Ped dosage for Bicarb?

Answer 29

1 meq/kg slow push over 2 min. Max 50 meq

Question 30

Vfib/Vtach algorithm

Answer 30

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

Question 31

Pediatric cardiac arrest joule escalation

Answer 31

2 j.kg, 4 j/kg up to 10 j/kg