EKGs, cardiac codes ACLS

Question 1

how to quickly tell the rate on EKG

Answer 1

big boxes
1 - 300
2- 150
3- 100
4 - 75
5 - 60
6- 50
7-42
8- 37.5
9 -33
10 -10

Question 2

drugs that can be delivered via ETT

Answer 2

ETT drugs, pneumonic
NAVEL

Naloxone - higher?
atropine - peds dose is 0.04 mg
vasopressin 40 units
epi - 10x in peds 0.1 mg/kg?
lidocaine - higher?

Question 3

tachycardia algorithm

Answer 3

If during a sedation on boards CHECK PULSE. if pulse present:
symptoms or no symptoms?
if symptomatic then do synchronized cardioversion

if no symptoms and narrow then adenosine 6mg/12 mg IV push

if no symptoms and wide then antiarrythmic infusion and put the pads on right away
- antiarrythmic infusions: solatol, amiodarone and procainamide
dose of amiodarone 150 mg over 10 minutes can do infusion dose - on acls card
other dosages on ACLS card

Question 4

how to evaluate EKG

Answer 4

1) first look at the rhythm - is it regular?
2) look at the rate - boxes
3) PR interval is one box or less 200 milliseconds (to rule out heart block, esp if bradycardia
4) tight qrs - less than one box?
5) qt interval length - less than 480 ms and that it doesn’t get longer after being put on medications by 60 millisec
6) signs of MI - st elevation, st depression, inverted t waves (history of infarct)
7) peaked t waves (hyperkalemia) - which will deteriorate into sine wave - dead man at that point