Static Cardiology

Question 1

Static Cardiology for Stable SVT Treat it

Answer 1

Scene Safety
BSI
Manage ABC’s
Monitor, O2, IV
Attempt Vagal Maneuvers
(bearing down, cold compress) If no Result
Administer Adenosine
6mg RAPID IVP with 20 ML Flush If no result after 2min
12mg RAPID IVP with 20 ML Flush If no result after 2min
12mg RAPID IVP with 20 ML Flush

[Consider Rate control if Adenosine Unsuccessful:
Consider Calcium Channel Blockers: Administer 0.25mg/kg Cardizem repeat at 0.35mg/kg after 15minutes (IV infusion 5-15mg/hour titrating to HR)
Consider Beta Blockers
Metoprolol 5mg over 5min wait 5min]

Expert Consult

Transport and monitor.

Question 2

Static Cardiology for unstable SVT

Answer 2

-Scene Safety
-BSI
-Manage ABC’s
-Monitor, O2, IV
IF SYNC CARDIOVERSION IS NOT IMMEDIATELY AVAILABLE
-Administer Adenosine
6mg Rapid IVP with 20mL Flush if no result in 2min
12mg Rapid IVP with 20mL Flush if no result in 2min
12mg Rapid IVP with 20mL Flush
AS SOON AS it is available sync Cardioversion:
-Initial Energy: 200J Monophasic
-Initial Energy: 50J Biphasic or manufacturer’s recommendations
-Increase electricity in a step-wise fashion if no change in cardiac monitor
-Consider Pain management/sedation.
-Repeat sync cardioversion 360J PRN q1-2minutes
Transport and monitor

Question 3

Static Cardiology for STABLE Atrial Fibrillation or Atrial Flutter

Answer 3

-Scene Safety
-BSI
-Manage ABC’s
-Monitor, O2, IV
-if rate is 100 it is considered uncontrolled
Consider medical rate control with:
Calcium Channel Blocker
-administer Cardizem 0.25mg/kg repeat at 0.35mg/kg after 15 minutes. [IV infusion of 5-15mg/hour titrated to heart rate]
OR
Beta Blocker
-Administer metoprolol: 5mg over 5 minutes q5 x3 doses
Transport and monitor

Question 4

Static Cardiology for Atrial Fibrillation (tachy) Unstable

Answer 4

-Scene Safety
-BSI
-Manage ABC’s
-Monitor, O2, IV
Synchronized Cardioversion
-initial energy monophasic: 200J
-initial energy biphasic: 120-200J
Immediately increase energy in step fashion if no change on cardiac monitor
- Consdier sedation and pain management if patient is hemodynamically stable enough
Repeat Sync cardioversion 360J PRN q1-2 min
Transport and monitor

Question 5

Static Cardiology for Atrial Flutter Tachy and Unstable

Answer 5

-Scene Safety
-BSI
-Manage ABC’s
-Monitor, O2, IV
Synchronized Cardioversion
-initial energy monophasic: 200J
-initial energy biphasic: 50J

Immediately increase energy in a step-wise fashion if no change on cardiac monitor

• Consider sedation and pain management
• Repeat sync cardioversion 350J PRN q1-2minutes

Transport and monitor

Question 6

Static Cardiology for Monomorphic VT (with a pulse and Stable)

Answer 6

-Scene Safety
-BSI
-Manage ABC’s
-Monitor, O2, IV
[CONSIDER ADENOSINE in case this is SVT with a ventricular reentry
6mg Rapid IVP with 20mL Flush if no result in 2min
12mg Rapid IVP with 20mL Flush if no result in 2min
12mg Rapid IVP with 20mL Flush]

Administer Amiodarone: 150 mg in 100mL of NS over 10 minutes. Maintenance infusion of 1mg/min over next 6 hours
[if no amiodarone available: Administer Lidocaine
1-1.5mg/kg IV q3-5minutes with subsequent doses at half initial dose. Max dose 3mg/kg. Maintenance infusion 1-4mg/minute]
OR
Procainamide: 20-50mg/min
STOP if any of the following occur:
-rhythm is converted
-hypotension
-QRS duration increases by 50%
-reach dose max of 17mg/kg

Consider expert consultation

Transport and monitor