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14 Cards in this Set

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Initial Rx for all Dysrhythmias
Monitor EKG
O2 Sat
IV 250ml bolus with clear lungs - SO
MR to maintain BP = or > 90 systolic - SO
Definition of "Unstable" patient
BP < 90 AND chest pain OR dyspnea OR ALOC
Unstable Bradycardia WITH Pulse
Bradycardia severe (<30) AND patient unconscious:
- Begin chest compressions

Atropine 0.5mg IVP for pulse < 60 - SO; MR q3-5" to max of 3mg - SO
OR
Atropine 1mg ET for pulse < 60 - SO; MR q3-5" to max of 6mg - SO

If rhythm refractory to Atropine:
ECP - BHPO
If capture occurs:
Sedate with Versed 1-5mg Slow IVP - BHPO

After max Atropine and initiation of ECP:
Dopamine (400mg/250ml) at 5-40mcg/kg/min IV Drip
Titrate to BP = or > 90 - BHO
Unstable A-Fib/Flutter (CONSCIOUS)
HR > 180:

- Versed 1-5mg slow IVP prn precardioversion - BHPO
(If = or > 60 consider lower dose with attention to age and hydration status)
- Sync cardiovert at 100J (or equivilent biphasic) - BHPO
MR at 200, 300, 360J (or equivilent biphasic) - BHPO
ECP Documentation
Capture of the pacing on rhythm strip

Milli-amperage employed

Pulse rate before and after capture

BP before and after capture

Changes in symptoms (LOC, CP, SOB)
Stable SVT
VSM - SO; MR - SO

*Patient with Bronchospasm or COPD Hx: ADENOSINE IS BHO*

Adenosine 6mg IVP followed by 20ml NS IVP - SO
Adenosine 12mg IVP followed by 20ml NS IVP - SO
If NO sinus pause:
MR x1 in 1-2" - SO
Unstable SVT (with severe symptoms OR rhythm refractory to Rx) (CONSCIOUS)
- Versed 1-5mg slow IVP prn precardioversion - BHO
(if = or > 60 y/o consider lower dose with attention to age and hydration status)
- Sync Cardiovert at 100J (or equivalent biphasic) - BHO
MR at 200, 300, 360J - BHO
Unstable A-Fib/Flutter (UNCONSCIOUS)
HR > 180:

- Sync cardiovert at 100J (or equivalent biphasic) - SO
MR 200, 300, 360J (or equivalent biphasic) - SO
MR - BHO
Stable V-Tach
Witnessed Onset:
Precordial Thump - SO

Lidocaine 1.5mg/kg slow IVP - SO
MR 0.5mg/kg slow IVP q8-10" to max of 3mg/kg including initial bolus - SO
OR
Lidocaine 3mg/kg ET - SO
MR 1mg/kg slow IVP q8-10" to max of 6mg/kg including initial bolus - SO
Unstable V-Tach (CONSCIOUS)
- Versed 1-5mg slow IVP prn precardioversion - SO
(if = or > 60 y/o consider lower dose with attention to age and hydration status)
- Sync Cardiovert at 100J (or equivalent biphasic) - SO
MR at 200, 300, 360J - SO
MR - BHO
Unstable V-Tach (UNCONSCIOUS)
- Sync Cardiovert at 100J (or equivalent biphasic) - SO
MR at 200, 300, 360J - SO
MR - BHO
Unstable SVT (with severe symptoms OR rhythm refractory to Rx) (UNCONSCIOUS)
- Sync Cardiovert at 100J (or equivalent biphasic) - SO
MR at 200, 300, 360J - SO
MR - BHO
V-Fib / Pulseless V-Tach / Arrest
Witnessed or Cardiac Arrest with no monitor:
- Precordial thump - SO

- CPR until ready to defibrillate
- Defibrillate at max setting x1 - SO
- CPR x 2"
- 10 sec rhythm & pulse check
- Repeat cycle as indicated by rhythm

Once IV established and NO pulse:
- Epi 1:10000 1mg IVP; MR q3-5"

If still in V-Fib / V-Tach
- Lidocaine 1.5mg/kg IVP; MR x1 in 3-5" - SO
- Intubate (avoiding interruption of CPR- SO
NG prn - SO

If no IV established
- Epi 1:1000 2mg ET (dilute to 10ml); MR q3-5" - SO
OR
- Epi 1:1000 10mg ETAD (dilute to 20ml, esophageal placement via blue port 1); MR q5"- SO
- Lidocaine 3mg/kg ET; MR x1 in 3-5" - SO
Postconversion V-Fib / V-Tach with Pulse = or > 60 (including witnessed spontaneous conversion, precordial thump, AED, AICD)
*IF INITIAL DOSE ALREADY GIVEN , CONTINUE WITH REPEAT DOSES*

Lidocaine 1.5mg/kg slow IVP - SO; MR 0.5mg/kg slow IVP q8-10" - SO to max of 3mg/kg including initial bolus
OR
Lidocaine 3mg/kg ET - SO; MR 1mg/kg ET q8-10" - SO to max of 6mg/kg including initial bolus