Cardiac Protocols

Question 1

True or false: you should interrupt compressions to place an advanced airway.

Answer 1

False

Question 2

If airway is initially maintainable w/ a BVM then you should delay rescue airway attempt until after

Answer 2

initial defib

Question 3

When should you defibrillate a patient with an auto pulse and why?

Answer 3

when the band is compressed to minimize impedance

Question 4

What are the consequences of hyperventilation?

Answer 4

decreased preload, cardiac output, coronary perfusion, and cerebral perfusion

Question 5

In chest pain patients aspirin should only be withheld in what three circumstances?

Answer 5

1) allergy 2) GI bleed 3) Dispatch advised aspirin administration immediately prior to EMS arrival

Question 6

When should you perform a right sided 12 lead?

Answer 6

If elevation is noted in leads II, III, avF, and V1, right sided involvement will be noted in lead V4R.

Question 7

When there is a right sided MI what should your immediate action be?

Answer 7

Establish IV of normal saline at KVO. If time permits establish a second line with NS lock.

Question 8

In patient with ST elevation and right sided involvement what should your NS actions be?

Answer 8

250ml Bolus as needed to maintain systolic BP greater than 90 mmHg. Max should be 20ml/kg and use caution in patients with CHF.

Question 9

What can you consider if hypotension in the right sided STEMI patient persists?

Answer 9

Consider initiation of Levophed (Norepinephrine)

Question 10

What can you give for pain in STEMI patients?

Answer 10

Fentanyl 1 to 3 mcg per kg for pain if systolic BP is over 90 mmHg.

Question 11

What should your actions be after aspirin for the non rightsided STEMI patient?

Answer 11

Make sure patient has not taken any ED drugs (Viagra, Cialis, Levitra in the past 24 hours. If systolic BP is over 90mmHg, administer Nitro 0.4 mg SL every 5 minutes for a max of 3 doses.

Question 12

What are the generic names for Cialis, Viagra, and Levitra?

Answer 12

Cialis is Tadalafil, Viagra is Sildenafil, Levitra is Vardenafil

Question 13

What can you give the chest pain patient for nausea/vomiting and what dose?

Answer 13

Zofran 0.1mg/kg slow over 2-5 minutes max of 4.0mg per dose.

Question 14

Which hospitals are recognized PCI centers in the Richmond area?

Answer 14

Chippenham, Henrico Doctors Hospital, Memorial Regional Medical Center, Southside Regional Medical Center, St. Francis, St. Mary’s, McGuire’s, and VCU

Question 15

In rightsided MIs the fluid bolus helps with

Answer 15

Preload

Question 16

If 12 lead does not indicate AMI and you have reason to believe chest pain is due to cocaine use what can you do?

Answer 16

Administer Versed 2.5 to 5 mg slow IVP

Question 17

Which leads will have elevation and reciprocal depression in a septal MI?

Answer 17

Leads V1 and V2. No reciprocal depression.

Question 18

Which leads will have elevation and reciprocal depression in an anterior MI?

Answer 18

Lead V3 and V4. No reciprocal depression

Question 19

Which leads will have elevation and reciprocal depression in an antero-septal MI?

Answer 19

Leads V1, V2, V3, V4. No reciprocal depression.

Question 20

Which leads will have elevation and reciprocal depression in a lateral MI?

Answer 20

Leads I, avL, V5, V6. Reciprocal in II, III, avF

Question 21

Which leads will have elevation and reciprocal depression in an anterolateral MI?

Answer 21

Leads I, avL, V3, V4, V5, V6. Reciprocal in II, III, avF

Question 22

Which leads will have elevation and reciprocal depression in a inferior MI?

Answer 22

Leads II, III, avF. Reciprocal in I, avF

Question 23

Which leads will have elevation and reciprocal depression in an infero-lateral MI?

Answer 23

Leads II, III, avF, V5, V6. Reciprocal in I, avL, V1, V2

Question 24

Which leads will have elevation and reciprocal depression in a posterior MI?

Answer 24

No elevation. Reciprocal in V1, V2, V3, V4

Question 25

When VFIB or Pulseless VTach is witnessed in the care of EMS, you should…

Answer 25

defibrillate immediately

Question 26

What is the shock sequence of VFIB and Pulseless VTACH?

Answer 26

120 Joules, 150 Joules, 200 Joules

Question 27

What is your drug sequence of VFIB and Pulseless VTACH?

Answer 27

1:10000 Epi at 1mg followed immediately by 300mg of Amiodarone, the Epi again followed by 150 mg of Amiodarone.

Question 28

In asystole if the blood glucose is less than 60 what do you do?

Answer 28

Administer 25g of D50