Scenario Algorhythms

Question 1

What is your treatment for Asystole?

Answer 1

BSI
Check in 2 leads
CPR
O2
IV/Monitor 
1 mg EPI every 3-5
Consider h's & t's

Question 2

What is your treatment for PEA?

Answer 2

BSI
CPR
02
IV/monitor 
1 mg EPI every 3-5
Consider h's & t's

Question 3

What is the MONA alogorhythm?

Answer 3

BSI
ABC's
O2
IV/monitor/12 lead
325 mg aspirin 
0.4 mg nitro
2-5 mg morphine

Question 4

What is your treatment for polymorphic vtach with a pulse (torsades)

Answer 4

BSI
ABC's
O2
IV/monitor/12 lead
Mag sulfate 1-2 g over 5-60 min
*if unstable treat as unstable vtach (chap present?)

Question 5

What is your treatment for malignant PVC’s?

Answer 5

BSI
ABC's
O2
IV/monitor/12 lead
1-1.5 mg/kg lidocaine 
20-50 mg/min procainamide until QRS widens by 50% or 17 mg/kg is given or rhythm changes

Question 6

What is your treatment for sinus bradycardia with a pulse or Brady 2nd degree heart block (wenckebach)?

Answer 6

BSI
ABC's
O2
IV/monitor/12 lead
0.5 atropine IVP/ 3mg max
TCP (not for 2nd degree block)
Dopamine 2-10 mcg/kg/min
EPI drip 2-10 mcg/min

Question 7

What do you do for Brady 2nd degree heart block type II or 3rd degree heart block?

Answer 7

BSI
ABC's
O2
IV/monitor/12 lead
Consider 0.5 mg atropine IVP
GO TO TCP

Question 8

What do you do for narrow tachy with a pulse that’s stable?

Answer 8

BSI
ABC's
O2
IV/monitor/12 lead/vagal
6 mg adenosine IVP
12 mg adenosine IVP

Question 9

What do you do for narrow tachy with a pulse that’s unstable?

Answer 9

BSI
ABC's
O2
IV/monitor/12 lead
Sedation (midazolam 2-4 mg up to 10 mg)
Synch cardioversion 100j
Synch cardioversion 200j

Question 10

What do you do for wide tachy with a pulse that’s stable?

Answer 10

BSI
ABC's
O2
IV/monitor/12 lead
Unknown origin? Consider 6 mg adenosine
Lidocaine 0.5-0.75 mg/kg IVP or 150 mg amiodarone over 10 min

Question 11

What do you do for wide tachy with a pulse that’s unstable?

Answer 11

BSI
ABC's
O2
IV/monitor/12 lead
Sedation (midazolam 2-4 mg up to 10 mg)
Synch cardio 100j
Synch cardio 200j

Question 12

What is your treatment for pulse less vtach/vfib?

Answer 12

BSI
CPR
02
IV/monitor
Unwitnessed 2 min CPR/ witnessed 200j/360j
Perform CPR as long as the patient is pulse less
1 mg EPI delivered every other cycle of CPR
200j/360j after 2 min CPR while in this rhythm
1.0-1.5 mg/kg lidocaine or 300 mg amiodarone IVP
2nd dose will be 0.5 mg/kg or 150 mg IVP

*sequence is drug/shock/drug/shock

Question 13

What is the equation for converting with lidocaine?

Answer 13

2g in 500 mL/ 4 mg/mL, 1-4 mg/min

Question 14

What is the equation for an EPI drip?

Answer 14

2mg/500 mL