Protocols - Cardiac Flashcards
Adult Bradycardia Indications:
Slow heart rate < 60 with:
1) chest pain/shortness of breath
2) Altered/decreased level of consciousness
3) hypotension/hypoperfusion
4) CHF/pulmonary congestion
5) Acute myocardial infarction
Adult Bradycardia Treatment (serious signs and symptoms):
1) Transcutaneous Pacemaker
2) Atropine 0.5-1mg IVP (repeated q 3-5mins; total 0.04mg/kg)
3) Epi Infusion 1ml/min (2-10mcg/min on IV Infusion Pump)
Pediatric Bradycardia Treatment (serious signs and symptoms):
HR < 60 with poor perfusion - START CPR
1) Epi IV/IO 0.01 mg/kg q 3-5 mins
2) Atropine IV/IO 0.02 mg/kg MAX 0.5mg
repeat once
Define Hemodynamically Unstable:
Systolic blood pressure less than 60 in neonates (<28 days old) 70 in infants (<1yr old) and < [70 + (2 x age)] for patients > 1 yr old
Adult SVT Treatment (Regular narrow complex tachycardia above 150bpm):
1) Valsalva
2) Adenosine 6 mg rapid IVP
3) Adenosine 12 mg rapid IVP (repeat in 1-2 mins)
4) If life threatening (Synchronized Cardioversion)
Adult V Tach w Pulse (Monomorphic wide QRS Tachycardia) Treatment:
1) Amiodarone 150mg IV/IO over 10 minutes (mixed in 50-100 ml approved diluent) Repeat if necessary
2) If life threatening signs and symptoms develop - Synchronized Cardioversion)
Adult Tachycardia with history of Wolff-Parkinson White syndrome, Lown-Ganong-Levine syndrome or Mahaim type Treatment:
1) Monitor
2) Unstable and life-threatening (Synchronized cardioversion)
Pediatric Narrow Complex Tachycardia (less than or equal to 0.09 seconds) Treatment
Sinus Tach - Identify underlying cause
SVT-
1) Vagal Maeuvers
2) Adenosine 0.01 mg/kg Max 6mg Rapid IV/IO Push
3) Adenosine 0.02mg/kg Max 12 mg Rapid IV/IO Push (x2)
4) synchronized Cardioversion 0.5 j/kg, 1 j/kg, 2 j/kg
Pediatric V-Tach w pulse (Wide Regular) Hemodynamically Unstable Treatment:
1) Cardiovert 0.5 j/kg, 1 j/kg, 2 j/kg
2) Consult - Amiodarone 5mg/kg IV/IO (over 20 minutes mixed in 50-100 ml approved diluent) Obtain 12 lead prior to administration
Pediatric V-Tach w pulse (Wide Regular) Hemodynamically Stable Treatment:
1) Consider Adenosine 0.01 mg/kg Max 6mg Rapid IV/IO Push
2) Adenosine 0.02mg/kg Max 12 mg Rapid IV/IO Push (x2)
3) onsult - Amiodarone 5mg/kg IV/IO (over 20 minutes mixed in 50-100 ml approved diluent) Obtain 12 lead prior to administration
Adult Cardiac Arrest Indications:
Medical Arrest: 13 yoa and older
Trauma Arrest: 15 yoa and older
Patient’s are unconscious, apenic and pulseless
Adult PEA (Narrow QRS Complex) Treatment:
CONSIDER SEVERE HYPOTENSION OR OBSTRUCTIVE CAUSES
High Performance CPR
Adequate Oxygenation and Ventilation
IV/IO - Wide Open
1) Epinephrine 1mg q 4 mins (Max 4 doses)
2) If Tension Pneumo - Decompress
Adult PEA (Wide QRS Complex) Treatment:
CONSIDER TOXICOLOGICAL OR METABOLIC CAUSES
High Performance CPR
Adequate Oxygenation and Ventilation
IV/IO - Wide Open
1) Epinephrine 1mg q 4 mins (Max 4 doses)
IF HYPERKALEMIA:
1) Calcium Chloride 1gm IVP/IO
2) Sodium Bicarbonate 1meq/kg IV/IO
IF NA CHANNEL BLOCKER (Including tricyclic and phenobarbital overdose) or SEVERE METABOLIC ACIDOSIS
1) Sodium Bicarbonate 1meq/kg IV/IO
Adult Asystole Treatment
CONSIDER HYPOXIC CAUSES
High Performance CPR
Adequate Oxygenation and Ventilation
IV/IO - Wide Open
1) Epinephrine 1mg q 4 mins (Max 4 doses)
2) If Tension Pneumo - Decompress
Adult V-FIB/V-TACH (without pulse) Treatment:
High Performance CPR
Ensure Adequate Oxygenation/Ventilation
1) Defibrilate 120J
2) Defibrilate 150J
3) Amiodarone 300mg and Epinephrine 1mg
4) Defibrilate 200J
5) Epinephrine 1mg
6) Alternative Defibrillation Techniques (One defibrilator - Vector Change; Two defibrillators - Dual sequential)
If Torsades develops- Mag Sulfate 2 g IV/IO over 2 mins
**If Hyperkalemia suspected - Calcium 1 g and Sodium Bicarbonate 1 meq/kg
**If Sodium channel blocker OD suspected - Sodium Bicarbonate 1 met/kg
Vector Change Defibrillation
Dual Sequential Defibrillation
Pediatric V-Fib/V-Tach Treatment:
1) CPR
2) Assure Adequate Oxygenation/Ventilation
3) Defibrillate 2 J/kg
4) IV/IO Access
5) Defibrillate 4 J/kg
6) Epi 1 dose q 4 minutes Max 4 doses (See Chart)
7) Defibrillate 6 J/kg
8) Amiodarone 5 mg/kg (Max 300mg) (Repeat x2 Max 15 mg/kg
9) Defibrillate 8 J/kg, 10 J/kg and Epi administration
Pediatric Asystole/PEA Treatment:
1) CPR
2) Assure Adequate Oxygenation/Ventilation
3) Epi 1 dose q 4 minutes Max 4 doses (See Chart)
Chest Pain Indications:
1) Angina or anginal equivalents
2) Chest pain, pressure or discomfort
3) Pain or discomfort in the upper abdomen, arm or jaw
4) Shortness of breath
5) Unexplained diaphoresis
Chest Pain Treatment:
1) Perform 12 Lead EKG
2) Establish IV
3) Nitroglycerin 0.4 mg SL
4) Repeat Nitro if BP >90 mmHg and pulse is between 60-150 bpm (Max 1.2 mg)
*If no prescription or previous Nitro use, IV must be established. CONSULT for additional doses, No IV access or patient BP drops > 20 mmHg
**Nitro contraindicated in patient taking pulmonary artery hypertension drugs (Adcirca, Revatio) or ED drugs (Viagra, Levitra or Cialis) within previous 48 hrs
STEMI Indications:
Patient with ACS symptoms and meets one of the following:
1) New ST elevation of 1mm (or greater) in two or more anatomically contiguous leads (Inferior, Lateral, Septal, Anterior)
2) Posterior MI - ST depression > 1mm in V1-3
STEMI Treatment:
1) Aspirin 324mg
2) Nitro 0.4 mg SL (Max 1.2mg)
3) Pain Management
4) Hypotensive with clear lung sounds - 250ml LR
- If Inferior MI - Obtain V4R (If ST elevation noted withhold Nitro)
**If Posterior MI - Obtain V7-V9
LBB/Paced Rhythm with any of the following requires consult:
1) Cardiogenic Shock
2) ST Elevation > 5mm
3) ST segment deviation (elevation or depression) in the same direction as the QRS complex
****Consult for Wellness Wave (Biphasic T waves or deeply inverted T waves in V2-V4)
**Consult for ST elevation in AVR
****Consult for Hyperacute T Waves
