Cardiac Protocols

Question 1

ACS/Chest Pain/STEMI

Answer 1

12 lead
324 ASA if non in past 24
IV access (if unsuccessful 1 dose of nitro if sys > 100)

0.4mg Nitro if sys 100+ (3x q5)

If sys < 100 than 250ml fluid bolus up to 500mL

If chest pain not resolved call medcontrol for Morphine or more nitro

Question 2

Asystole/PEA

Answer 2

CPR
IV 20ml/kg up to 1L
1mg EPI fast ever 3-5 min

Question 3

Bradycardia (adult)

Answer 3

IV 20ml/kg up to 1L
1 mg Atropine (3x q5)
TCP @70
Versed 2.5mg IV after capture
Dopamine 5-20 mcg/kg/min

Question 4

Bradycardia (peds)

Answer 4

IV 20ml/kg up to 1L
0.01 mg/kg of 1:10,000 EPI q5
0.02 mg/kg Atropine (max 0.5mg, min 0.1mg) 2x
TCP @100 consult med control for pain control

Question 5

CHF

Answer 5

if RR > 24 or SpO2 < 90 - 10cm CPAP (med control for Versed)
12-lead
0.4 mg Nitro of Sys > 100 3x q5
If no improvement
40mg Furosemide (Lasix) if sys > 140 and no infection
If no improvement
2mg IV morphine over 2 min 2x q5
If no improvement
40mg Furosemide (Lasix)

Question 6

Hypertension

Answer 6

Goal 10-15% reduction
If sys >220 or dia > 120
10mg Labetalol over 2 min
2nd dose
20mg Labetalol over 2 min
Furosemide (Lasix) 40mg

If no IV
0.4 mg nitro 2x q5

Question 7

Hypotension

Answer 7

Non-cardiac 20ml/kg 1L
Cardiac 10ml/kg .5L

Dope 5-20 mcg/kg/min titrate to 90sys

Question 8

SVT (unstable)

Answer 8

IV
12 Lead

6mg Adenosine 20ml flush
V2.5 mg IV Versed (MED CONTROL)
Sync Cardiovert 100 - 200 - 300 - 360 (MED CONTROL)

Question 9

SVT (stable)

Answer 9

IV
12 lead
Vagal
6mg Adenosine 20 ml flush q1
12 mg Adenosine 20 ml flush q1
12 mg Adenosine 20 ml flush

Question 10

Afib/Aflutter (adults only)

Answer 10

5 mg Metoprolol (Lopressor) over 2 min (Goal HR < 100, Sys > 100)

Question 11

VFib/ Pulseless VTach

Answer 11

CPR
Shock 200
CPR
IV 20ml/kg up to 1L NS
Shock 300
EPI 1mg
Shock 360
Amio 300
Shock 360
EPI 1mg
Shock 360
Amio 150

If torsades 1 mg Mag

Question 12

VTach w pulse (stable)

Answer 12

12 lead
IV
150mg Amio over 10 min 2x

Question 13

Vtach w pulse (unstable)

Answer 13

12 lead
IV
2.5 mg Versed IV if pt is conscious BUT DO NO DELAY CARDIOVERSION
Sync Cardiovert 100-200-300-360

If torsades - 2g of Mag over 10 min