Cardiac Emergencies Flashcards
What are three classifications of dysrhythmias
a. Slow rhythm
b. Fast rhythm
c. No rhythm
What is the most common dysrhythmia for pediatrics
Bradycardia
AEDs may be used for what age of range
1-8 y/o
What is the dose for a fluid challenge for Asystole/PEA
20 mL/kg or 10 mL/kg for neonates
What is the first line drug for Asystole/PEA
Epi 1:10,000 - 0.01 mg/kg IV (max. 1 mg) ever 3-5 mins
If the patient is taking calcium-channel blockers or there is high suspicion of hyperkalemia what is given:
Calcium Chloride - 20 mg/kg IV/IO slowly
How many cycles of CPR should be performed before reevaluating the heart rhythm
10 cycles
What is the dose for Narcan (Asystole/PEA)
0.1 mg/kg IVP (repeat once)
What is the compression to ventilation ratio (Asystole/PEA)
15:2
After advanced airway is in place provide 1 breath ever?
6 seconds
EtCO2 less than 10 mmHg
Improve CPR
Goal EtCO2 during resuscitation
12-25 mmHg
EtCO2 of 35-45 mmHg
Check for ROSC
Causes of symptomatic bradycardia
a. Hypoxemia
b. Hypothermia
c. Head injury
d. Heart block
e. Heart transplant
f. Overdose
At what heart rate should CPR be started with an infant or child with poor systemic perfusion: (Bradycardia)
less than 60/min
What is the first line drug for bradycardia
EPI 1:10,000 - 0.01 mg/kg (max. dose 1 mg)
What is the second line drug for bradycardia
Atropine 0.02 mg/kg IV/IO (min. single dose 0.1 mg) Repeat once, (max. single dose for a child 0.5 mg, max. for adolescent is 1 mg)
When should Atropine be administered prior to EPI
Suspected increased vagal tone or primary AV block
Paradoxical bradycardia may be produced with small dose of Atropine less than
0.1 mg
What is the primary drug to sedate the patient prior to pacing
Versed - 0.1 mg/kg max. single dose 4 mg IV/IO/IM (IN - administer 0.2 mg/kg/dose use 10mg/2mL concentration; max single dose 5 mg) Max. total dose 10 mg
What is the secondary drug to sedate the patient prior to pacing
Valium - 0.2 mg/kg IV/IO/IN (max. single dose 5 mg) Repeat once
Narrow complex tachycardia is classified as a QRS of:
less than or equal to 0.08 seconds
Sinus tachycardia for a child
Greater than 180/min
Sinus tachycardia for an infant
Greater than 220/min
SVT for an infant
Above 220 min
SVT for pt. greater than 2 y/o
180-220/min
ALS level 1 for a stable SVT patient
a. 12Lead
b. Fluid challenge
ALS level 2 for stable SVT
a. Vagal maneuvers w/ ice water
b. Adenosine 0.1 mg/kg w/ 6 mL flush (max. 6 mg)
c. Adenosine 0.2 mg/kg w/ 6 mL flush (max. 12 mg)
ALS level 1 for unstable SVT
a. Adenosine 0.1 mg/kg w/ 6 mL flush (max. 6 mg)
b. Adenosine 0.2 mg/kg w/ 6 mL flush (max. 12 mg)
c. Cardio version
Joule dosage for cardio version
a. 0.5 joule/kg
b. 1 joule/kg
c. 2 joule/kg
Wide complex tachycardia is classified as a QRS of
greater than 0.12 seconds
ALS level 1 for stable VT w/pulse
Administer Amiodarone 5 mg/kg IV over 20-60 mins
ALS level 1 for unstable VT w/pulse
Sedate and Cardiovert
ALS level 2 for unstable VT w/pulse
Amiodarone - 5 mg/kg over 20-60 mins (If pt. converts to sinus rhythm after cardioversion and pt. is normotensive)
What is the initial defibrillation dose of VF/VT
2 J/kg
For refractory VF, what is the shock dose increased to:
4 J/kg
Subsequent energy level should be:
at least 4 J/kg, not to exceed 10 J/kg or adult max dose
VF/VT: If the patient has torsades de pointes what drug is given
Magnesium Sulfate - 25-50 mg/kg IV/IO max. 2 g over 2 mins.
What age is considered a newborn/neonate
Infants less than 1 month
When and how should a newborn be suctioned with a meconium aspirator
If not vigorous and crying after suctioning w/ bulb syringe:
a. Thru ETT
b. Suction set at low pressure (less than 100 mmHg)
c. Max. 5 seconds (max. 3 times)
How do you stimulate a newborn
Rub the newborn’s back
How far apart do you place and cut umbilical clamps
2 inches apart & 8 inches from the navel
When should blow-by oxygen be given to a newborn:
a. When breathing but have central cyanosis
b. No improvement in respiratory, circulatory or neuro status w/in 90 seconds of initial assessment
Ventilate at 40-60 bpm @ 100% oxygen under what conditions (Newborn)
a. Apena
b. HR less that 100/min
c. Persistant central cyanosis after high-flow O2
When should an advanced airway be placed: (Newborn)
a. BVM is ineffective after 2 mins
b. Suctioning w/ meconium aspirator
c. Prolonged positive pressure vent. is needed
When should CPR be started on a newborn and how:
a. If HR is less than 100/min and not rapidly increasing despite ventilations for approx. 30 secs.
b. Performed by 2 rescuers @ 120/min with both thumbs on sternum below nipple line
EPI should be given when and what dose (Newborn)
EPI - (1:10,000) 0.01 mg/kg IV/IO ever 3-5 mins
a. Asystole
b. HR less than 60/min after vent. and 30 secs of CPR
When should a fluid challenge be given and what dose (Newborn)
10 mL/kg
a. Pallor that persist after oxygenation
b. Faint pulse with good HR
c. Poor response to resuscitation w/ vent.
What should be done if newborn’s glucose is below 40 mg/dL
D10: 5mL/kg IV/IO (dilute D50 1:4 w/ saline)
ALS level 2 for newborn resuscitation
Narcan 0.1 mg/kg IV/IO/IN/IM (1 mg/mL concentration) if unresponsive w/ depressed respirations
Each year how many infants die suddenly of no immediately, obvious cause
about 4,000
What are the three most reported causes of infant death
a. SIDS
b. Cause unknown
c. Accidental suffocation/strangulation in bed
What should the paramedic document for SIDS
location and appearance of infant
