Protocols (Cardiac Arrest) Flashcards
Metoprolol dose recurring Vfib/Vtach
5mg IV/IO over 1 min
May repeat to max 15mg
After 3rd shock and fib/Vtach hasn’t broken, next shock should be…
Double sequential, two sets pads/two monitors 720 joules
Persistent V-fib/V-tach meds
Lidocaine 100 mg IV/IO
-or-
Procainamide 1.5 g IV/IO over 15 mins
Max procainamide dose reached then,
Metoprolol 5 mg over 1 min, repeat q 5 mins x3 (up to 15 mg total)
Epi drip cardiac arrest
To give 1mg q 4 mins: Mix 12 mL (12mg) epi 1:1 in 250 mL bag of NS with 10gtt/min (macro) drip set.
Run @ 60 http/min (~1 gtt q second)
Rx for Torsades
Defib
2g mag sulfate over 2 mins
Max cold fluid dose
2 L
Epi infusion set-up
Mix 12mg of 1:1000 (12 mL) in a 250 mL bag of NS with a 10 gtt/cc drip set.
Run at 60 gtt/min (one drop q second) to deliver approx 1mg q 4 min.
Drugs to consider after 3rd shock for refractory Vfib/Vtach when Vfib/Vtach has not broken at all
Procainamide 1.5g IV/IO over 15 min or lidocaine 100mg
Rx for tricyclic antidepressant OD
Sodium bicarbonate 50 mEq IV/IO
Procainamide dose for recurrent Vfib/Vtach
1.5g IV/IO over 15 mins
Lidocaine dose recurring fib/Vtach
100mg IV/IO
induced hypothermia target temp
33 C / 91.4 F (range 32-34 C)
Calcium Chloride dose for PEA with suspected hyperkalemia (renal failure) or hypocalcemia
1g IV/IO
Consider what drug for extended down time, hyperkalemia, renal failure or tricyclic antidepressant OD?
Sodium bicarbonate 50 mEq
Peds cardiac arrest defibrillation energy setting
4 joules/kg
Adult Norepi (levaphed) dose for BP after ROSC
1-10 mcg/min IV/IO
Dopamine dose for post ROSC hypotension or bradycardia
5-20 mcg/kg/min IV/IO
Maternal arrest
Treat mother per appropriate protocol for rhythm. Rapid transport. Place her supine and manually displace uterus to left. Place IV/IO above diaphragm if possible. Defib appropriately.
ROSC fluid bolus dose for adult
500 mL repeated to 2 L max
After ROSC, don’t move pt for ___ mins
10 mins
Ventilatory rate during cardiac arrest with BVM
8-10 breaths/min
Organophosphate poisoning OD
Nerve agent antidote kit
Atropine and 2pam
ROSC RR
6-12 breaths/min to an ETCO2 of 35-45 mmHg
If refractory fib/Vtach after two shocks…
Replace pads and move to new location
For shockable rhythm defib every ___ mins
2 mins
criteria for induced hypothermia
cardiac arrest or ROSC not related to trauma or hemorrhage or intracranial hemorrhage. temp must be greater than 34 F / 93 F. Advanced airway or BIAD in place.
Drugs to consider for recurring Vfib/Vtach after 3 shocks
Procainamide, lidocaine, metoprolol
post ROSC hyperventilation must be avoided due to potentially causing…
severe hypotension or recurring arrest
Amiodarone Vfib/Vtach arrest dose
300mg IV/IO
Repeat once at 150mg
Atropine indication in PEA arrest
organized PEA with rate
Optimum ROSC ETCO2
35-45 mmHg
glucagon dose for PEA with suspected beta or calcium channel blocker OD
4mg IV/IO/IM
Epi cardiac arrest dose
1mg of 1:10 IV/IO q 3-5 mins
Rx for calcium channel or beta blocker OD
Glucagon 4 mg IV/IO (repeat x1 in 15 mins)
Calcium chloride 1g IV/IO
dopamine 5-20 mcg/kg/min
Rx for cardiac arrest with renal failure
Calcium chloride 1g IV/IO
Sodium bicarbonate 50 mEq IV/IO
Titrate post ROSC pressors (dopamine) to
SBP
survival from asystole/PEA is based on…
identifying and correcting the cause
Consider early for PEA…
- repeated NS boluses for hypovolemia
- check/treat BGL
- Narcan
- Glucagon beta blocker or Ca2+ channel blocker OD
- CaCl for hyperkalemia or hypocalcemia
- Sodium Bicarb for OD or renal failure
- Epi drip
- Dopamine
- Atropine 1mg IV ONLY for PEA with rate
consider definitive airway placement early in ___ arrest
PEA
site for needle chest decompression
second intercostal space, midclavicular on the side of the tension pneumo. Insert 14g catheter just above the third rib.
ETCO2 with BIAD or advanced airway should be
ETCO2
Adult CPR compression rate
120/min (utilize metronome)
in cardiac arrest, consider sodium bicarb for suspected ___ overdose
tricyclic antidepressant OD
Pulseless V-tach/V-fib drugs
Epi 1:10,000 1mg q 3-5 mins Amiodarone 300 mg IV/IO Amiodarone 150 mg IV/IO Consider Mag 2g IV/IO (torsades) Consider Bicarb 50 mEq (renal, extended downtime)
