Rhythms and treatments Flashcards
Atrial flutter
VOMIT
treatment with medication or electricity only in pts with RVR
Cardizem 0.25 mg/kg - 0.35 mg/kg
Synchronized cardioversion
PAC
treat underlying cause
PVC asymptomatic
usually no treatment
V fib or pulseless V tach
if witnessed defibrillate 200 J biphasic if not witnessed do 2 minutes of CPR then defibrillate Epi 1 mg 1:10,000 2 minutes of CPR Defibrillate 200 J 1st dose antidysrhythmic (amiodarone 300mg/150mg or lidocaine 1.5 mg/kg / .75/ .75 max of 3 mg/kg) 2 minutes CPR Defibrillate 200 J Epi 1 mg 1:10,000 2 minutes CPR Defibrillate 200 J 2nd dose antidysrhythmic 2 minutes CPR Defibrillate 200 J Epi 1 mg 1:10,000 Mag sulfate 1-2 G in 100cc bag over 5-10 minutes 2 minutes CPR Defibrillate 200 J consider sodium bicarb 1 meq/kg If ROSC initiate FIFTH protocol
Amiodarone dose and action for cardiac
300mg second dose 150mg
antidysrhythmic, give to SVT, VT with normal QT interval, VF or VT without a pulse
Atropine dose and action for cardiac
0.5 mg every 3-5 minutes with max dose of 3 mg
increases HR in symptomatic bradycardia
Junctional tachycardia rhythm
seldom treated prehospital
Midazolam dose and action for cardiac
0.5-2.5mg
benzodiazepine, RSI
sedative drug
Adenosine dose and action for cardiac
6mg may repeat once at 12mg
antidysrythmic, slows conduction of the AV node, converts narrow complex tach to NSR
Accelerated junctional rhythm
seldom treated prehospital
Mag sulfate dose and action for cardiac
1-2 g in 100 bag over 5-20 minutes or 25-50 mg/kg with max dose or 2G IV/IO bolus
electrolyte, give for torsades or pulseless vf/vt that is refractory to amiodarone
Polymorphic VT or torsades des pointes
mag sulfate 25-50 mg/kg with max dose or 2G IV/IO bolus
if unsuccessful start TCP
if still unsuccessful give lidocaine 1.5 mg/kg may be repeated every 3-5 minutes at 0.75 mg/kg with a max of 3 mg/kg
if still unsuccessful synchronize cardiovert at 50, 100, 150, 200, 300, 360
Lidocaine dose and action for cardiac
1.5 mg/kg repeat every 3-5 at 0.75 mg/kg to a max of 3 mg
Antidysrhythmic
SVT
VOMIT
vagal maneuvers
syncronized cardioversion 50-100 Joules if unstable
If stable SVT give adenosine 6 mg (1st dose)
12 mg (2nd dose)
*consider beta blocker or calcium channel blocker
Epinephrine dose and action for cardiac
1 mg every 3-5 minutes
infusion 2-10 mcg/min
cardiac arrest, brady as alternate to dopamine.
sympathomimetic
Bradycardia, 2nd degree type 2 and 3rd degree
VOMIT
fluid challenge for symptomatic hypotension
TCP
if TCP and pt is conscious administer midazolam 0.5-2.5 mg
continuous refractory hypotension/bradycardia give dopamine infusion 5-20 mcg/kg/min or epi infusion 2-10 mcg/min
Stable or wide complex V tach with pulse
*remember QRS is less than .11 (or .12/3 boxes)
lidocaine 1.5 mg/kg may be repeated every 3-5 minutes at 0.75 mg/kg with a max of 3 mg/kg
if pt becomes unstable at any time synchronize cardiovert at 50, 100, 150, 200, 300, 360
if conscious when cardioversion is done give midazolam 0.5-2.5 mg
Atrial fibrillation (non symptomatic)
not usually treated
Sodium bi carb dose and action for cardiac
1 meq/kg
used during cardiac arrest for acidosis
PVC symptomatic or greater than 5/min
lidocaine 1.5 mg/kg, may be repeated every 3-5 minutes at 0.75 mg/kg with a max of 3 mg/kg
if lidocaine is successful, start lidocaine infusion
*avoid treating bigeminy and trigeminy in stable pts because it can make them bradycardic
Symptomatic sinus brady
VOMIT
atropine 0.5 mg every 3-5 minutes with max dose of 3 mg
TCP
dopamine 5-20 mcg/kg/min titrate to effect
Epi infusion 2-10 mcg/min titrate to effect
Junctional rhythm
treated same as sinus brady
VOMIT
fluid challenge for symptomatic hypotension
apply pacer pads
atropine 0.5-1mg repeat as needed to a max of 3mg
if atropine doesnt work initiate TCP
if TCP and pt is conscious administer midazolam 0.5-2.5mg
continuous refractory hypotension/bradycardia give dopamine infusion 5-20 mcg/kg/min or epi infusion 2-10 mcg/min
Asystole/PEA
VOMIT
Hs&Ts
Epi 1:10,000 after every pulse check as needed
Sodium bicarb 1 meq/kg
Sinus arrest
pacemaker
Sinus tach
treat underlying cause
Atrial fibrillation (symptomatic/RVR)
Treat same as a flutter
VOMIT
cardizem 0.25 mg/kg - 0.35 mg/kg
synchronized cardioversion
Sinus brady, 1st degree, 2nd degree type 1 (wenkebach)
VOMIT
fluid challenge for symptomatic hypotension
apply pacer pads
atropine 0.5-1mg repeat as needed to a max of 3mg
if atropine doesnt work initiate TCP
if TCP and pt is conscious administer midazolam 0.5-2.5mg
continuous refractory hypotension/bradycardia give dopamine infusion 5-20 mcg/kg/min or epi infusion 2-10 mcg/min
PSVT or junctional tachycardia
VOMIT
vagal maneuvers
adenosine 6 mg (1st dose)
adenosine 12 mg (2nd dose)
if sinus rhythm not restored give diltiazem 0.25 mg/kg
if pt becomes unstable at any time synchronize cardiovert at 50, 100, 150, then 200
if conscious when cardioversion is done give midazolam 0.5-2.5 mg
Dopamine dose and action for cardiac
5-20 mcg/kg/min
2nd line drug for brady
inotropic agent increases strength of contraction
Diltiazem/Cardizem dose and action for cardiac
0.25 mg/kg repeat in 15 at 0.35mg/kg
antidysrythmic, stable narrow complex tach, a fib, a flutter
relaxes blood vessels-lowers blood pressure
H’s & T’s
Hypoxia Hypovolemia H+ acidosis Hyper/hypokalmeia Hypothermia Hypoglycemia
Thrombosis (cardiac & pulmonary thrombus)
Tamponade
Tension pneumothorax
Toxins (drug overdose)
rhythms you give cartizem for
a flutter/ a fib rvr
psvt/junctional tach after adenosine
rhythms you give dopamine for
Junctional rhythm, Sinus brady, 1st degree, 2nd degree type 1 (wenkebach) after atropine and pacing
2nd degree type 2 and 3rd degree after pacing
rhythms you give lidocaine for
PVC symptomatic or greater than 5/min
Stable or wide complex V tach with pulse
Polymorphic VT or torsades des pointes after mag
rhythms you give epi for
v fib/ pulseless vt
Junctional, Sinus brady, 1st degree, 2nd degree type 1 (wenkebach) alternative to dopamine after atropine and pacing
asystole/PEA
Bradycardia, 2nd degree type 2 and 3rd degree after pacing
rhythms you give atropine for
Junctional, Sinus brady, 1st degree, 2nd degree type 1 (wenkebach)
rhythms you give adenosine for
PSVT or junctional tachycardia
stable SVT
rhythms you give amiodarone for
vf/pulseless vt
rhythms you give mag sulfate for
Polymorphic VT or torsades des pointes
vf/pulseless vt after about 10 minutes
rhythms you give sodium bicarb for
vf/pulseless vt consider for acidosis
give midazolam for?
TCP or cardioversion
Cardiovert for?
PSVT or junctional tachycardia
Atrial fibrillation/flutter (symptomatic/RVR)
unstable Stable or wide complex V tach with pulse
unstable SVT
Polymorphic VT or torsades des pointes after pacing
TCP for?
Sinus brady, 1st degree, 2nd degree type 1 (wenkebach)
Junctional
Bradycardia, 2nd degree type 2 and 3rd degree
Polymorphic VT or torsades des pointes
Cardiovert at?
50, 100, 150, 200, 300, 360 for most
50 - 100 for SVT
50, 100, 150, 200 for PSVT
