Protocols 2021 Flashcards
What do we report on a 12-lead?
LBBB, RBBB or poor quality EKG
Where do we send the 12-lead?
receiving hospital
Chest Pain
Systolic BP is 100 or greater
NTG, 0.4mg SL, SO, MR q3-5 min
Treat per pain management protocol
Discomfort/pain of suspected cardiac origin with associated shock
250 mL fluid bolus IV/IO with no rales SO,
MR to maintain SBP >90 mmHg SO
Discomfort/pain of suspected cardiac origin with associated shock:
If BP refractory to second fluid bolus?
Push-dose epinephrine 1:100,000 (0.01 mg/mL) 1 mL IV/IO BHO, MR q3 min, titrate to SBP mmHg BHO
Push-dose epinephrine mixing instructions:
- Remove 1 mL normal saline (NS) from the 10 mL NS syringe
- Add 1 mL of epinephrine 1:10,000 (0.1 mg/mL) to 9 mL NS syringe
The mixture now has 10 mL of epinephrine at 0.01 mg/mL (10 mcg/mL) concentration.
NTG is contraindicated in patients who have taken
erectile dysfunction medications such as sildenafil (Viagra®), tadalafil (Cialis®), and vardenafil
(Levitra®) within 48 hours; and
pulmonary hypertension medications such as sildenafil (Revatio®) and epoprostenol sodium
(Flolan® and Veletri®)
Use supplemental O2 to maintain saturation at?
94-98%
Are we applying the pads and shocking V-fib or V-tach Pulseless now?
Yes; we are no longer waiting for two minutes to check and shock
Team leader priorities? CPR
Monitor CPR quality, rate, depth, full chest recoil, and capnography value and waveform
Minimize interruption of compressions (<5 sec) during EKG rhythm checks
Charge monitor prior to rhythm checks. Do not interrupt CPR while charging.
For EtCO2 ____ mmHg, may place ET/PAA without interrupting compressions
> 0
If EtCO2 rises rapidly during CPR? Do what?
Pause CPR and check for pulse
Unstable Bradycardia:
Obtain 12-lead EKG
Atropine 1 mg IV/IO SO, MR q3-5 min to max 3 mg SO
250 mL fluid bolus IV/IO SO, MR SO
Unstable Bradycardia:
Rhythm unresponsive to atropine
Midazolam 1-5 mg IV/IO PRN pre-pacing SO
External cardiac pacing* SO
If capture occurs and Systolic BP is 100 or greater mmHg, treat per Pain Management Protocol (S-141)
Unstable Bradycardia
Rhythm unresponsive to atropine
If SBP <90 mmHg after atropine or initiation of pacing
250 mL fluid bolus IV/IO SO, MR x1 SO
Push-dose epinephrine 1:100,000 (0.01 mg/mL) 1 mL IV/IO BHO. MR q3 min, titrate to SBP
mmHg BHO.
What determines unstable for cardiac rhythms?
There is no more narrow vs wide for bradycardia.
SBP <90 HHmg and exhibiting signs or symptoms of inadequate perfusion, e.g.,
Altered mental status (decreased LOC, confusion, agitation)
Pallor
Diaphoresis
Significant chest pain of suspected cardiac origin
Severe dyspnea
External cardiac pacing:
What rate do you begin at?
Dial up until capture occurs?
Increase by a small amount?
Begin at rate 60/min
Dial up until capture occurs, usually between 50 and 100 mA
Increase by a small amount, usually about 10%, for ongoing pacing
SVT - Stable (symptomatic)
Obtain 12-lead EKG
If SBP <90 mmHg and rales not present, 250 mL fluid bolus IV/IO SO, MR SO, VSM SO
Adenosine 6 mg rapid IV/IO followed by 20 mL NS rapid IV/IO SO
Adenosine 12 mg rapid IV/IO followed by 20 mL NS rapid IV/IO SO, MR x1 SO
SVT (Unstable)
Unstable‡ (or refractory to treatment)
Consider midazolam 1-5 mg IV/IO pre-cardioversion SO
Synchronized cardioversion at manufacturer’s recommended energy dose SO, MR x2 SO, MR BHO
After successful cardioversion
Check BP. If SBP <90mmHG and rales not present, 250 mL fluid bolus IV/IO SO, MR SO.
Obtain 12-lead EKG
What does waveform look like in hyperventilation?
Becomes closer together and the level begins to decrease.
What does waveform look like in hypoventilation?
Waveform looks normal in shape, but it increases.
What does “shark fin” pattern normally indicate on ETCO2?
Some type of bronchoconstriction (asthma, COPD, or an airway obstruction)
- typically elevated ETCO2
What does loss of waveform indicate in an intubated patient?
The tube might be dislodged
What does ETCO2 measure?
Cardiac output
What is necessary to generate a waveform in cardiac arrest patients?
CPR
What tool can be used to determine good CPR?
ETCO2 waveform
Someone that has been in cardiac arrest for a period of time may not have high ETCO2 or a good waveform. What might they have to prevent pulling a tube?
If they have a small but distinct square wave form
What can be the first sign of ROSC?
ETCO2 (rapid increase of ETCO2)
—Stop CPR and check for a pulse
“KING” Airway
Size use
Size 3 (yellow) is for patients 4-5 feet tall
Size 4 (red) is for patients 5-6 feet tall
Size 5 (purple) for patients >6 feet tall
How far do you advance the KING airway?
Until the base of the ventilation port is at the teeth or gums
KING Airway
Inflate a size 3 with how much air?
50ml
KING Airway
Inflate a size 4 with how much air?
70ml
KING Airway
Inflate a size 5 with how much air?
80ml
If ventilation becomes hard with a KING airway, what can you do to make it easier?
Gently withdraw the tube until ventilation becomes easy
LEAD-SD
Lung sounds
ETCO2
Abdominal sounds
Depth
Size
Document presence of EtCO2 waveform and EtCO2 numeric value at Transfer of Care
When do we reconfirm SD-LEAD?
After we move the patient and after turn over.
What’s the max gastric tube size we can place?
18 max French gastric tube
