Cardiac Emergencies Flashcards
1
Q
Acute Coronary Syndrome
A
- ASA: 162-325 mg, Check allergy status. Contraindicated for anaphylaxis reactions, and active GI bleed.
- IV prior to NTG
- NTG: 0.4 mg SL q 3-5 min. Maintain >100 mg. If pt has self administered with no inprovement, consider other treatment.
- Fentanyl: 1 mcg/kg slow IV/IO/IM/IN. Max 150 mcg.
2
Q
Atrial Fib/Flutter
A
- Consider vagal manuvers.
-Unstable BP A-Fib: 120-200 BIphasic
> A-Flutter: 50 Biphasic
> Consider Pain/sedation, and check pulse btw conversion
- HR >150 stable but symptomatic:
> Diltiazem: 0.25 mg/kg slow IV/IO (2 min) repeat in 15 min 0.35 mg/kg (2 min). - HR 2.5-5 mg IV/IO (2 min), q 5 min, max of 15 mg.
3
Q
Bradycardia Adult
A
- Symptomatic:
> TCP
> Atropine: 0.5 mg IV/IO q 3-5 min, max of 3 doses. Considering during TCP set up.
> Consider pain/sedation - MEDCONTROL:
> Dop: 2-20 mcg/kg/min IV/IO
> Epi Inf: 1-10 mcg/min (1 mg 1:1,000/250 mL)
> Glucagon: 1-5 mg IV/IO/IM/SC for BB/CCB
> Ca++Chl-: 10% 2-4 mg/kg max of 1G IV/IO (over 5 min) for CCB.
4
Q
Bradycardia Pedi
A
- Epi: 1:10,000, 0.01 mg/kg IV/IO (max dose 0.5 mg)
> Atropine: 0.02 mg/kg IV/IO (min/max single 0.1 /1 mg), if increased vagal tone or AV block.
MEDCONTROL:
- Additional meds
- Additional fluid boluses (10-20 mL/kg)
- TCP
- Epi: 1:10,000 0.01-0.03 mg/kg IV/IO (max single 0.5 mg)
- Epi Inf: 0.1-1 mcg/kg/min IV/IO (1 mg 1:1000/250 mL)
5
Q
CA: Asystole/PEA Adult
A
- Verify in 2 leads
- Epi: 1 mg of 1:10,000 IV/IO q 3-5 min OR
- Vasopressin: 40 Units IV/IO for 1st/2nd dose of Epi
- H&T’s
MEDCONTROL
- Additional doses
- Na+HCO3-: 1 mEq/kg IV/IO
- Atropine: 1 mg IV/IO max of 3 mg
6
Q
CA: Asystole/PEA Pedi
A
- Epi Brady/CA: 0.01 mg/kg (1:10,000) IV/IO q 3-5 min
- Epi Inf: 0.1 (titrate to ) 1 mcg/kg/min (1 mg 1:1000/250 mL)
- H&Ts
MEDCONTROL:
- Additional doses
- Na+HCO3-: 1 mEq/kg IV/IO
- Atropine: 0.02 mg/kg IV/IO (min/max single 0.1/1 mg)
7
Q
CA: V-fib/V-tach Adult
A
- Epi: 1 mg (1;10,000) IV/IO q 3-5 min OR
- Vasopressin: 40 units IV/IO for 1st/2nd of epi
- Amio: 300 mg slow IV/IO
MEDCONTROL:
- Additional Doses
- Na+HCO3-: 1 mEq/kg IV/IO
- Mag: 1-2 G over 5 min (For torsades/hypomag/refactory V-fib/V-tach)
- Amio: 150 mg to follow the 300 mg puch
- Lido: 1.5 mg/kg IV/IO, repeat at 0.5-0.75 mg/kg q 3-5 min. Max dose of 3 mg/kg.
8
Q
CA: V-fib/V-tach Pedi
A
- Defib once at 2-4 j/kg
- Epi: 0.01 mg/kg IV/IO (1:10,000, 0.1 mL/kg); q 3-5 min
- Defib: 4-10 j/kg (max of 10 j/kg) q 2 min
- Amio: 5 mg/kg IV/IO
- Defib 4 j/kg 30-60 sec after ea med
MEDCONTROL
- Additional doses
- Na+HCO3-: 1 mEq/kg IV/IO
- All other treatment
9
Q
CHF
A
- IV prior to NTG
- NTG: 0.4-0.8 mg (1/150 gr.) tablet/spray SL, q 5 min, maintain BP >100
- NTG Paste: 1 inch if BP >140
- CPAP, may consider in-line neb
MEDCONTROL
- Additional doses
- Furosemide: 20-40 mg IV/IO or 40-80 mg IV/IO if already on diuretics
- Dop: 2-20 mcg/kg/min
- Consider Difficult Airway Protocols
10
Q
Induced Hypothermia Adult
- Indications
A
- Indications: > Pt is 16 yrs or older, < 16 call MC > ROSC: No purposeful movement to sternal rub or response to commands 5 minutes into ROSC > Palpable Carotid pulse > Stable Rhythm > Pt is not already hypothermic ( Advanced airway is placed > Is S/P CA > Post arrest in setting of a STEMI
11
Q
Induced Hypothermia Adult
-Contraindications
A
- Contraindications
> Traumatic Arrest
> Hypothermia is already exists (CBT Identified a pregnant
> Resp Arrest
12
Q
Induced Hypothermia Adult
A
- ITH:
> Ice packs: Neck, Torso, Armpit, and Groin
> Advanced Airway placement, ETCO2 Goal of 40 mmhg
> 1-2 IVs
> Infuse child fluids NS (2-4 deg C) wide open @ 500 mL increments with a max of 2000 mL OR
> 30 mL/kg max of 2 L monitoring for CHF
> Taget temp CBT 32-34 Deg C - 12 Lead: STEMI to Local Cath Center
- Place Esophageal Thermometer (>/= 34 deg C)
- Shivering: one of the following
> Lorazepam: 2-4 mg IV/IM/IO
> Midazolam: 2.5-5 mg IV/IO/IM/IN
> Diazepam: 5-10 mg IV/IO/IM/PR
> Morphine: 2 mg IV/IO/IM/IN q 5 min, max of 10 mg
> Fentanyl: 50 mcg IV/IO/IM/IN q 5 min, max of 200 mcg
13
Q
ROSC Care Adult
A
- 12 Lead
- If was V-fib/V-tach and no anti-arrhythmic was given:
> Amio: 150 mg in 10 cc NS slow (8-10 min), then
> Amio Infusion: 1 mg/min IV - Begin ITH
- Dop: 2-20 mcg/kg/min IV/IO
MEDCONTROL
- Additiona doses
- Epi Infusion: 1-10 mcg/min (1mg 1:1000/250 mL)
- Amio: additional treatment
- Lido: 1-1.5 mg/kg IV/IO followed by 2-4 mg/min infusion
14
Q
SVT Adult
A
- Vagal Maneuvers: Valsalva and/or cough
- Unstable, BP Syncro Cardio: 50 j increase in step like fashion
> Check Pulse inbtw
> Consider pain/sedation - Stable but symptomatic:
> Adenosine: 6 mg, 12mg and 12 mg all with 20 mL flush and elevate extremity
MEDCONTROL - Additional doses - Diltiazem: > 0.25 mg/kg IV/IO over 2 min > then 0.35 mg/kg after 15 min IV/IO over 2 min - Amio: 150 mg IV/IO slow, over 10 min
15
Q
SVT Pedi
A
Syncro Cardio only considered with HR over 220 or demonstrate 1 or more of the following > AMS > Weak and thready pulse > Cap Refill >4 seconds > No palpable BP
- 20 mL/kg NS if hypovolemic is component is suspected
MEDCONTROL
- Additional med
- Consider vagal maneuvers after IV/monitor are est
- Syncho Cardio: 0.5 j/kg increase to max of 1 j/kg
> consider pain/sedation
- Adenosine: 0.1 mg/kg IV/IO, 0.2 mg/kg, max single dose of 12 mg
