Emergency Manual

Question 1

H’s for PEA attests

Answer 1

Heart rate (vagal)
Hypovolemia
Hypoxia
H+ (acidosis)
HyperK
HypoK
Hypoglycemia
HypoCa
Hyperthermia
Hypothermia

Question 2

T’s for PEA arrest

Answer 2

Toxins
Tamponade
Tension PTX
Thrombus - coronary
Thrombus - pulmonary

Question 3

LAST management

Answer 3

• stop local anesthetic administration
• CPR if arrest
• Intralipid bolus 100cc over 2-3min
• Intralipid gtt 250cc over 15-20min
• Repeat bolus and double gtt if needed

Note: max Intralipid dose 12cc/kg (840cc for 70kg adult)

Monitor in PACU or ICU for:
- 2 hrs after seizure
- 6 hrs after hemodynamic instability
- 1-2 days after arrest

Question 4

PEA arrest management

Answer 4

• 100-120 compressions/min
• switch compressors and rhythm check q2min
• place defib pads, if rhythm becomes shockable 200J biphasic or 360J monophasic
• mask ventilate 2 breaths every 30 compressions OR manually ventilate 10 breaths/min
• epi 1mg q3-5min
• H’s (10) nd T’s (5)

Question 5

Epinephrine dose for LAST

Answer 5

0.2-1mcg/kg (reasonable to start with 10-15mcg in a normal sized adult)

Question 6

Asystole initial management

Answer 6

• Call code
• CPR 100-120 compressions/min, depth >/=5cm, rotate q2min. Goal: keep EtCO2 >10, DBP >20
• Place defib pads; rhythm check q2min. If shockable, 200J biphasic or 360J monophasic
• Mask ventilate 2 breaths every 30 compressions; if intubated 10 breaths/min
• IV access
• Epi 1mg q3-5min
• Turn off anesthetic/vasodilators
• H’s & T’s

Question 7

Unstable SVT management

Answer 7

-Immediate cardioversion; consider sedation if patient awake
- Narrow + regular: 50-100 J biphasic
- Narrow + irregular: 120-200 J biphasic
- Wide + regular: 100 J biphasic
- Wide + irregular: unsynced 200J biphasic
- If still unstable, repeat cardioversion w/ increased J
- consider amio 150 over 10 min

Question 8

Stable SVT management

Answer 8

• Vagal maneuver
• Narrow + regular: adenosine; if not converted, rate control w/ BB or CCB
• Narrow + irregular: Rate control w/ BB or CCB; consider amio
• Wide + regular: adenosine (if SVT w/ aberrancy); amio (if VT)
• Wide + irregular: consider Mg for TdP, stat cardiology c/s

BB: esmolol 0.5 mg/kg (repeat after 1 min, then gtt 50-300 mc/kg/min) or metoprolol 1-2.5mg (repeat or double after 3-5 min)
CCB: diltiazem 10-20mg over 2 min
Adenosine: 6mg, can follow w/ 12mg
Procainamide: 20-50mg/min until arrhythmia suppressed
Sotalol: 100mg over 5 min

Question 9

Vfib/VT ACLS initial management

Answer 9

• Call code
• CPR 100-120 compressions/min, >/= 5cm, rotate q2min. Goal: keep EtCO2 >10 and DBP >20
• Defibrillation higher priority than intubation. Defibrillate 120-200 J biphasic or 360 J monophasic and immediately resume CPR
• IV access
• Turn of anesthetic/vasodilators
• After 2nd shock: epi 1mg q3-5min
• After 3rd shock: amio 300mg push (can redose 150) OR lidocaine 1-1.5 mg/kg (can redose 0.5-0.75mg/kg)
• Identify and treat underlying causes