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Section 2 (Adult Protocols) > Cardiac Emergencies > Flashcards

Cardiac Emergencies Flashcards

1
Q

What are the Hs

A 
Hypovolemia
Hypoxia
Hydrogen ion-acidosis
Hyperkalemia
Hypoglycemia
Hypocalcemia
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2
Q

What are the Ts

A 
Tablets
Tamponade, cardiac
Tension pneumothorax
Thrombosis, coronary/pulmonary
Trauma
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3
Q

ALS level 1 for Asystole/PEA

A

Epi (1:10,000) - 1 mg IV/IO every 3-5 mins
Vasopressin - 40 U IV/IO (1st or 2nd dose of EPI)
Calcium Chloride - 1 g IV/IO (for calcium-channel blockers/renal failure)

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4
Q

CPR depth for an adult

A

Equal or greater than 2 inches

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5
Q

How often should personnel be rotated when performing CPR

A

Every 2 mins

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6
Q

What patients are considered unstable in Bradycardia

A 
AMS
Ischemic CP/discomfort
Acute heart failure
Hypotension (BP less than 90)
Dyspnea
HB or ischemia/infarction on 12Lead
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7
Q

ALS level 1 for Bradycardia

A

Atropine - 0.5 mg IV/IO every 3-5 mins (max. 3 mg)

Dopamine - 2-10 mcg/kg/min (if bradycardia is unresponsive to atropine)

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8
Q

Bradycardia w/ hypotension and inferior MI w/ +V4R

A

Withhold NTG, give fluids 500 mL NS & Pacing

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9
Q

Medications for sedation prior to pacing

A

Valium - 5 mg IV/IO/IN (max. 10 mg)

Versed - 2 mg increments IV/IO (IN: 10mg/2mL dose) (max. 10 mg)

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10
Q

What should be considered prior to max dose of Atropine

A

Pacing

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11
Q

If suspected digitalis toxicity, what med improves AV nodal conduction

A

Atropine

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12
Q

If persist hypotension/cardiogenic shock with bradycardia what should be admins.

A

Dopamine - 5-10 mcg/kg/min (max. 20 mcg/kg/min) (1600 mcg/mL infusion = 15-60 gtts/mins) (titrate to BP: 90-120)

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13
Q

Sinus Tachycardia range

A

100-160 bpm

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14
Q

Junctional Tachycardia range

A

100-180 bpm

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15
Q

Atrial Tachycardia range

A

150-250 bpm

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16
Q

Atrial Flutter range

A

250-350 bpm

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17
Q

Atrial Fibrillation range

A

350-above bpm

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18
Q

What patients are treated with medication

A

borderline symptomatic

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19
Q

What is considered borderline symptomatic

A

Alert & oriented
BP above 90
Mild chest discomfort
SOB

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20
Q

What is considered unstable

A 
Decreased LOC
BP less than 90
CP
SOB
Diaphoresis
CHF/PE
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21
Q

At what rate is tachycardia treated

A

150 and above

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22
Q

ALS level 1 for borderline SVT

A

Vagal maneuvers
Adenosine - 6 mg IVP w/ 20 mL flush
Adenosine - 12 mg IVP w/ 20 mL flush

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23
Q

ALS level 2 for borderline SVT

A

Cardizem - 0.25 mg/kg IV over 2 mins (avg. 20 mg)

24
Q

ALS level 1 for borderline A. Flutter & A. Fib

A

Cardizem - 0.25 mg/kg IV/IO over 2 mins (avg. 20 mg)

If not resolved after 15 mins - 0.35 mg/kg IV/IO over 2 mins (avg. 25 mg)

25
ALS level 1 for all unstable SVTs
Fluid challenge - 500cc IV/IO | Cardio version
26
Cardio version dose for regular SVT & A. Flutter
50-100 joules
27
Cardio version dose for A. Fib
120-200 joules
28
When should Adenosine not be given (tachycardia)
Patients w/ A.Fib or A. Flutter
29
What patients should not be given Cardizem
Pts. w/ WPW syndrome
30
What drug should be considered for WPW
Amiodarone
31
ALS level 1 for PVCs
O2 via non-rebreather 10-15 L/min
32
ALS level 1 for borderline VT w/ pulse
Amiodarone - 150 mg in 50 mL D5W over 10 mins (10 gtts set) at 1 gtt/sec.
33
If the patient has torsades de pointes (stable), what drug is admins.
Mag. Sulfate - 2g in 50mL D5W over 1-2 mins
34
ALS level 1 for unstable VT w/pulse
Sedate & cardiovert - 100, 200, 300, 360 Joules
35
If wide irregular/unstable or polymorphic and/or torsades what is done
Defibrillate (not synchronized)
36
What is admins if not given prior to cardioversion (VT w/pulse)
Amiodarone - 150 mg in 50 mL D5W over 10 mins (if BP is above 100) repeat x1 after 10 mins as needed
37
What is the initial dose for cardioversion for suspected digitalis toxicity in unstable VT w/pulse
5-20 joules
38
ALS level 1 for VF/VT
Epi (1:10,000) - 1 mg IV/IO every 3-5 mins Vasopressin - 40 U IV/IO (1st/2nd dose of Epi) Amiodarone - 300 mg IVP. After 3-5 mins: 150 mg IVP Torsades - Mag. Sulfate: 2g in 50 mL D5W over 1-2 mins
39
If Mag sulfate converts out of VF/VT what is admins
Mag Sulfate maintenance - 2g in 500 mL NS @ 30-60 gtts/min
40
ALS level 1 for ROSC
BP below 90: IV NS 500 mL (repeat x1 to main BP above 90) | Dopamine - 5-10 mcg/kg/min (titrate to BP: 90)
41
In ROSC, if Amiodarone was admins during resuscitation can you admins more Amiodarone
No
42
In ROSC, if frequent PVCs or runs of VT, or transport longer than 30 mins what is admins
Amiodarone drip - 150 mg in 50 mL D5W = 3:1 concentration (flow at 1 gtt every 3 sec.) (60 gtt set)
43
Amiodarone exclusion in ROSC:
HR less than 60 2nd*/type 2 HB 3rd* HB Hypotension
44
Unconscious adult patients w/ROSC should be cooled to
89.6*F - 93.2*F for 12-24 hrs if in VF/VT
45
Inclusion criteria for Therapeutic Hypothermia
a. All patients with ROSC b. Advanced airway w/ETCO2 greater than 20 & pt. remains comatose c. BP above 90 or maintained above 90 w/drugs d. 16 y/o and older
46
Exclusion criteria for Therapeutic Hypothermia
a. Pregnant b. Traumatic arrest c. Head trauma d. Hemorrhage e. Initial temp below 93.2*F f. BP below 90
47
ALS level 1 for Therapeutic Hypothermia
Apply cold pack to head, axillae and groin Prevent shivering w/ Valium or Versed Persistent shivering - Morphine: 5 mg (max. 10 mg) Cold IV bolus @ 30 mL/kg (max. 2 L) Dopamine - 10 mcg/kg/min (if BP drops below 90) (Maintain BP above 110)
48
What is written on the cold IV bag
Hypothermia
49
What is documented prior to initiation of cold therapy
Pupils (size, reactivity, equality) | Motor response to pain
50
ALS level 1 for Cardiogenic Shock
12Lead Fluid challenge - 500 mL NS (repeat x1) Dopamine - 5-20 mcg/kg/min (titrate BP: 90-120)(60gtt set)
51
Fluids should be avoided if 12lead shows what
Anterior wall MI
52
Elevation in what leads is an Anterior wall MI
I, AVL, V1-V6
53
ALS level 1 for Angina/AMI
Aspirin - 162-324 mg PO NTG - 0.4 mg SL every 3-5 mins (max. 1.2 mg or 3 doses) Morphine - 5 mg IV/IM repeat after 5-10 mins (max. 10 mg)(titrate to BP above 90)
54
AMI is probable when
a. Min. 1mm ST elevation in 2 or more leads | b. New onset of LBBB
55
On scene time for cardiac alerts should be minimized to
10 mins or less
56
Hypertensive emergencies is defined as
Systolic BP above 180 & diastolic BP above 110 | w/ S&S of end organ failure
57
ALS level 1 - (Stable VT w/pulse): If Mag. Sulfate converts torsades what is given?
Mag. Sulfate - 1g in 250 mL D5W @ 30-60 gtts/min (60 gtts set)

Section 2 (Adult Protocols) (8 decks)

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