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Paramedic > SMOs- Cardiac Protocols > Flashcards

SMOs- Cardiac Protocols Flashcards

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1
Q

Adult Cardiac Arrest (6)

A

*Confirm any criteria for death

  1. CABs/confirm no pulse
  2. Begin CPR
    - 2 inches -100-120/min -100% O2 -ventilations
  3. Cardiac monitor
    - Shockable vs non= go to correct protocol (PEA/Asystole or Adult VF/Pulseless VTach)
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2
Q

Adult Post Resuscitation (8)

A

BLEACHO
BP >90
-Fluids 200ml increments if below, up to 1L
Labs- BGL
Ekg/12-lead
Advanced airway
Capnography
-RR 6-12; ETCO2 35-45
Hypothermia-32-36
Oxygen
-90-99%

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3
Q

Adult Post Resuscitation (8) after BLEACHO

A

Look for and follow appropriate protocol if any of the following are found:
STEMI/suspicion of MI= Adult suspected cardiac patient protocol (16)
Symptomatic Bradycardia= Adult Bradycardia protocol (15)
ROSC with antiarrhythmic given= Arrythmias are common and usually self limiting after ROSC and may not need further meds or drips. If arrhythmia persists follow appropriate rhythm protocol

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4
Q

Termination of Resuscitation (9)

A

Look at protocol

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5
Q

Adult Cardiogenic Shock/ Pulmonary edema (10)
-SBP <90

A

*Initial medical care
12 D.F(E)
1. 12-lead
2. Duoneb if wheezing
3. Fluids or push dose epi to raise BP over 90 (2mL q 3-5 min)

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6
Q

Adult Cardiogenic Shock/ Pulmonary edema (10)
-SBP 100 or 120

A

*Initial medical care
12 CD N
1. 12 lead
2. CPAP
3. Duoneb if wheezing
4. NITRO: BP 100 ( have IV in place
->120mmHG Nitro okay to give without IV

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7
Q

Adult VF/Pulseless VTach (11)

A

*Confirm

  1. CPR
  2. VF/Pulseless VTach on monitor
  3. 1st shock at 120J
  4. CPR for 2 minutes
  • advanced airway w/ ETCO2
  • over 10mmHg is goal
  • 1 breath every 6 seconds
  • establish IV/IO
    5. No pulse and shockable= 2nd shock @200J
    6. CPR 2 minutes
  • EPI 1mg of 1:10,000 IVP q 3-5min
  1. No pulse and shockable= 3rd shock @200J
  2. CPR 2 minutes
    - Amiodarone 300mg IV/IO bolus
    - Tx reversible causes
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8
Q 
Adult Tachycardias (with Pulse) (12) 
Stable
A

*Initial medical care
Stable w/: Rate >150, pt is alert, w/o any signs of hypoperfusion
Wide:
-continue IMC and transport

Narrow:

  1. vagal
  2. Adenosine 6mg RAPID IV/IO w/ 20ml NS flush
  3. Adenosine 12mg if rhythm persists
  4. Continue IMC and transport
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9
Q 
Adult Tachycardias (with Pulse) (12)
Unstable
A

*Initial medical care
Unstable: rate >150 with signs of hypoperfusion
1. Versed consideration @ .05 mg/kg, roughly 2.5mg slow IV/IO/IM/IN (IN preferred)
-monitor via pulse ox and capnography
2. Synchronous cardioversion (100-120-150-200J)
3. Contact med control for further orders
4. Accelerated Transport

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10
Q

Vtach with pulse (stable)

A
  1. Apply pads
  2. 150mg Amiodarone over 10 minutes
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11
Q

Adult Syncope/Pre-Syncope (13)

A

*Initial medical care
check the three ‘whys’
1. Cardiac monitor/12-lead
2. BGL check
-<60= adult diabetic emergency protocol
3. SBP >90?
yes= transport
no= IV NS 200ml increments, max 1L until SBP>90 and transport

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12
Q

Adult PEA/Asystole (14)

A

*Adult cardiac arrest protocol(6) brought you here

  1. CPR
  2. Pads/confirm not shockable/known PEA or Asystole
  3. EPI 1:10,000 1mg IV/IO q 3-5min
  4. 2 min of CPR
    - NOT Shockable= continue CPR
    - consider advanced airway
    - Tx reversible causes
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13
Q 
Adult Bradycardia (15)
Stable
A

Stable: Pt is alert, without any signs of hypoperfusion

  1. Monitor continuously enroute and reassess
  2. Transport
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14
Q 
Adult Bradycardia (15)
Unstable
A

Unstable: Signs of hypoperfusion or ALOC

  1. Atropine 1mg IV/IO q 3-5min
    - max 3 mg
  2. Transcutaneous pacemaker
    - rate 70
  3. While pacing, consider sedation with Versed 2.5mg slow IV/IO/IM/IN
  4. Transport
    - If pacing unavailable or not effective, call med control to order push dose epi (2mL q 3-5min)
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15
Q

How to make push dose epi

A

Take a 10ml syringe with 9ml of normal saline. Into this syringe, draw up 1 ml of EPINEPHRINE (1mg/10ml) from the cardiac amp.
-Administer 0.5ml IV/IO every 2 minutes to maintain SBP > 90 and HR > 60

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16
Q

Adult Suspected Cardiac Patient (16)
SBP <90

A

12 AF

*Initial Medical care

  1. 12-lead and transmit
  2. Aspirin chewable tablet 81mg x 4 (324mg)
  3. Cont. to appropriate protocol
    - most likely NS fluid bolus
17
Q

Adult Suspected Cardiac Patient (16)
SBP 90-110

A

12 AT

*Initial Medical care

  1. 12-lead and transmit
  2. Aspirin chewable tablet 81mg x 4 (324mg)
  3. Transport
18
Q

Adult Suspected Cardiac Patient (16)
SBP >110

A

12 AN PT

*Initial Medical care

  1. 12-lead and transmit
  2. Aspirin chewable tablet 81mg x 4 (324mg)
  3. Nitro .4mg tab q 5 min up to 3 times
    - Have an IV in place
  4. Consider fentanyl or morphine
    - Fentanyl: 50mcg IV/IO/IM/IN
    - -May repeat q5, max 200mcg
    - Morphine 2mg IV/IO/IM
    - -May repeat q5, max 10mg
  5. Transport
19
Q

Consider a 12-lead for:

A
  1. Chest pain/Discomfort/Pressure
  2. Arm Pain (non-traumatic)
  3. Jaw Pain (non-traumatic)
  4. Upper back pain (non-traumatic)
  5. Unexplained diaphoresis
  6. Vomiting without fever or diarrhea
  7. Shortness of breath
  8. Dizziness/syncope
  9. Epigastric pain
  10. Fall in the elderly (unexplained)
  11. Weakness/Fatigue
  12. Bradycardia or Tachycardia
20
Q

Ventricular Assist Device (VAD/LVAD) (18)

A

Look at protocol

21
Q

List H’s and T’s (8,5)

A

H’s
1. Hypovolemia (200ml N.S)
2. Hypokalemia (200ml NS)
3. Hyperkalemia (dialysis pt- 200ml NS and consider 1g Calcium)
4. Hypoxia (Vent w/ O2)
5. H+ ion (Vent w/ O2)
6. Hypothermia (warm)
7. Hyperthermia (cool)
8. Hypoglycemic (D50)

T’s
1. Toxins (200ml NS and Narcan
2. Tamponade (200ml NS)
3. Thrombosis (P.E) 100% O2
4. Tension pneumothorax (Needle decompression)
5. Trauma (Tx associated trauma)

Paramedic (34 decks)

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