Exam Review Flashcards
A fib tx
Rate control/cardioversion
Atrial Flutter tx
Rate control or cardioversion
SVT tx
Rate control or cardioversion
Adenosine
Monomorphic V tach tx
Antiarrhythmias or cardioversion
Amiodarone if they have a pulse
Polymorphic V tach tx
Antiarrhythmics or cardioversion (unsynchronized)
Torsades tx
Antiarrhythmics or cardioversion (unsynchronized)
plus magnesium
First Degree Heart Block tx
12 lead and consult
Second Degree Heart Block tx
Treat all symptomatic bradycardia with atropine 0.5 mg
Third Degree Heart Block
Treat all symptomatic bradycardia with atropine 0.5 mg
V fib tx
Defibrillator, CPR
PEA
Any unorganized electrical activity that is not v fib, v tach or asystole
unsynchronized cardioversion
a fib
v tach
If pt is in cardiac arrest w/ shockable rhythm (VF or pVT)
start CPR, give O2 and attach defib
if rhythm shockable→ shock then CPR 2 min, IV/IO access→
shock → CPR 2 min → epi q3-5 min →
shock → CPR 2 min → amiodarone
If pt is in cardiac arrest w/ NO shockable rhythm (asystole or PEA)
start CPR, give O2 and attach defib
if rhythm NOT shockable→ CPR 2 min, IV/IO access →
epi q3-5 min →
consider adv airway →
CPR 2 min and repeat
What indicates ROSC?
pulse and BP
abrupt sustained inc in PETCO2
spontaneous arterial pressure waves with intra-arterial monitoring
What are reversible causes of cardiac arrest?
hypovolemia
hypoxia
hydrogen ion (acidosis)
hypo/hyperkalemia
hypothermia
tension pmneumo
tamponade, cardiac
toxins
thrombosis, pulmonary or coronary
Pt is in cardiac arrest of VF/VT, what do you do?
start cpr, give O2, attach defib
shockable rhythm → shock → cpr 2 min →
shockable rhythm → shock →
CPR 2 min → epi q3-5 min→
shockable rhythm → shock → CPR 2 min → amiodarone and repeat
Epi IV/IO dose for cardiac arrest
1mg q3-5 min
Amiodarone IV/IO dose for cardiac arrest
first dose: 300 mg bolus
second dose: 150 mg
Pt is in cardiac arrest of asystole/PEA, what do you do?
start cpr, give O2, attach defib
non-shockable rhythm → CPR 2 min, IV/IO access →
epi q3-5 min→
consider adv airway→
non-shockable → CPR 2 min and repeat
Pt ROSC what do you do?
maintain O2 dat, consider adv airway
treat hypotension <90 via IV/IO bolus, or vasopressor infusion→
12 lead ekg (if STEMI then reperfuse) → if can follow commands → adv critical care
if NOT → initiate targeted temp mgmt
IV bolus for post cardiac care hypotension
1-2 L NS or LR
epi IV dose for ROSC
0.1-0.5 mcg/kg/min
70-35 mcg in 70 kg adult
dopamine IV dose for ROSC
5-10 mcg/kg/min
norepinephrine IV dose for ROSC
0.1-0.5 mcg/kg/min
70-35 mcg in 70 kg adult
If stable brady arrhythmia <50 bpm w/ pulse what is tx
monitor and observe
What makes pt unstable?
hypotension
acutely altered mental status
signs of shock
ischemic chest discomfort
acute heart failure
If unstable brady arrhythmia <50 bpm w/ pulse what is tx
Atropine
If uneffective → transcutaneous pacing or
dopamine infusion
or epi infusion
Consider: expert consult or transvenous pacing
atropine IV dose for brady arrhythmia
first dose: 0.5 mg bolus q3-5 min
MAX 3 mg
Dopamine IV dose for brady arrhythmia
2-20 mcg/kg/min
titrate pt response taper slowly
Epinephrine IV dose for brady arrhythmia
2-10 mcg/min
titrate pt response taper slowly
Unstable tachy arrhythmia w/ pulse
synchronized cardioversion
consider sedation
if narrow complex consider adenosine
Synchronized cardioversion doses
narrow and reg: 50-100
Wide and reg: 100
Narrow and irreg biphasic: 120-200
Narrow and irreg monophasic: 200
Wide and irreg: defibrillation
Stable tachy arrhythmia w/ pulse and wide QRS
IV access, 12 lead EKG
Consider adenosine if regular and monophasic
consider antiarrhythmic
consider expert consult
Stable tachy arrhythmia w/ pulse and narrow QRS
IV access, 12 lead
vagal maneuvers
adenosine (IF REGULAR)
beta blocker or calcium channel blocker
consider expert consult
Adenosine IV dose for tachy arrhythmia
first dose 6 mg rapid IV push
follow w/ NS flush
second dose 12 mg
Amiodarone IV dose for tachy arrhythmia stable w/ wide QRS
first does 150 mg over 10 min
repeat as needed if VT recurs
follow by maintenance of 1 mg/min for first 6 hrs
Narrow and reg rhythms
SVT and A flutter
Narrow and irregular
A fib
Wide and regular
SVT and V tach
Wide and irregular
Wide a fib
polymorphic v tach and monomorphic v tach
Tachy Narrow and reg rhythms (SVT or A flutter) tx
vagal
adenosine 6 mg then 12 mg
Tachy Narrow and irregular (a fib) tx
vagal
calcium channel blockers or beta blockers
Tachy Wide and regular
if SVT adeonsine
If Vtach amiodarone
Tachy Wide and irregular
Amiodarone 150 mg over 10 min
If polymorphic torsades add magnesium
