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32 Cards in this Set
- Front
- Back
CPR quality
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-push hard (>=2 inches) and fast (>=100/min)
-Minimize interruptions to compressions -Avoid excessive vent -Rotate compressor q 2minutes -If no advanced airway, 30:2 c-v ratio -Quant. waveform capnography -PETCO2<10, improve CPR quality -Intra-arterial pressure -If relaxation phase (diastolic) pressure <20mmHg, improve CPR quality |
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Return of Spontaneous Circulation (ROSC)
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-Pulse and Pressure
-Abrupt sustained incr in PETCO@ (typically >=40mmHg) -Spont arterial waves with intra-art. monitoring |
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Shock Energy
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Biphasic: (initial 120-200J)
consider higher doses Monophasic: 360J |
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Drug Therapy: Epinephrine
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IV/IO Dose:
-1mg q 3-5 minutes |
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Drug Therapy: Vasopressin
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IV/IO Dose:
-40 Units can replace first or second dose of epinephrine |
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Drug Therapy: Amiodarone
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IV/IO Dose:
-First Dose: 300mg bolus -Second Dose: 150mg |
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Advanced airway
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-Supraglottic airway or endotracheal intubation
-Waveform capnography to confirm and monitor for ET tube placement -8-10 breaths per minute with continuous chest compressions |
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Reversible Causes of Cardiac Arrest
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-Hypovolemia
-Hypoxia -Hydrogen Ion (acidosis) -Hypothermia -Hypo/hyperkalemia -Trauma -Toxin -Thrombosis, pulmonary -Thrombosis, coronary -Tension pneumo -Tamponade |
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Cardiac Arrest Algorithm
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1) shout for help/ER
2) Rhythm shockable -Yes-->VF/VT -Shock CPR 2 min IV/IO access Shockable Rhythm? No -->If no signs of ROSC, continue CPR and give Epinephrine every (1mg) every 3-5 minutes and consider advanced airway -Consider treating reversible causes If Rhythm is not shockable, continue 2 minutes CPR and give 300mg dose of amiodarone |
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Immediate Post-Cardiac Arrest Algorithm
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ROSC-->Optimize ventilation and ox (>94%)
- COnsider advaced airway and waveform capnography -Treat hypotension -IV/IO bolus 1-2L NS -Vasopressor infusion (epinephrine: 0.1- 0.5 mcg/kg/min) (dopamine: 5-10 mcg/kg/min) (norepinephrine: 0.1-0.5 mcg/kg/min) Following commands? -If no consider induced hypothermia If STEMI or high suspicion AMI-->coronary reperfusion |
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Bradycardia with pulse algorithm
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Assess appropriateness for clinical condition (HR<50 if bradyarrhythmia)
-Identify and tx underlying causes -Maintain airway -Oxygen (if hypoxemic) -Monitor, BP, Pulse Ox -IV access -12-lead ECG If persistent bradyarrhythmia-->hypotension, AMS, shock, chest pain, CHF -->give Atropine -->if atropine ineffective: -transcut pacing, Dopamine infusion, or epi infusion--> comnsider transvenous pacing |
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Doses of drugs for Bradyarrhythmia
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Atropine IV Dose:
-First dose: 0.5mg bolus -Repeat every 3-5minutes for maximum of 3mg Dopamine infusion: 2-10 mcg/kg/min Epi infusion: 2-10 mcg/kg/min |
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Tachycardia with Pulse algorithm
with hypotension, AMS, shock, CP, HF |
Assess appropriateness for clinical condition.
(HR > = 150/min if tachyarrhythmia) Identify and tx underlying cause (Maintain patent airway; assist breathing -->Oxygen if hypoxemic -->Monitor, BP, pulse ox) Persistent tachyarrhythmia causing: -hypotension -AMS -Shock -Ischemic CP -HF -->Synchronized cardioversion Recc Initial: -narrow reg: 50-100J -narrow irreg: 120 -220J biphasic, 200J monopha -Wide reg: 100J -Wide irreg: defribrillation dose (Not synchronized) Consider Adenosine: -first dose (6mg rapod IV push; follow with NS flush) -Second dose: 12mg if required |
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Stable Wide-COmplex tach
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IV access and 12-ECG
-Consider adenosine if regular and monomorphoic -consider antiarrhythmic infusion Procainamide IV: 20-50mg/min until arrhythmia suppressed (max dose 17mg/kg) -avoid if prolonged QT or CHF -Amiodarone IV Dose: -First dose: 150mg over 10 minutes -Rpt if VT recures -maintainance infusion of 1mg/min for first 6 hrs -Sotalol IV: 100mg over 5 minutes |
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Stable Narrow complex Tachychardia
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IV
ECG Vagal maneuvers Adenosine (if regular) Beta-blocker/Ca channel blocker |
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Tachycardia with Pulse algorithm
with hypotension, AMS, shock, CP, HF |
Assess appropriateness for clinical condition.
(HR > = 150/min if tachyarrhythmia) Identify and tx underlying cause (Maintain patent airway; assist breathing -->Oxygen if hypoxemic -->Monitor, BP, pulse ox) Persistent tachyarrhythmia causing: -hypotension -AMS -Shock -Ischemic CP -HF -->Synchronized cardioversion Recc Initial: -narrow reg: 50-100J -narrow irreg: 120 -220J biphasic, 200J monopha -Wide reg: 100J -Wide irreg: defribrillation dose (Not synchronized) Consider Adenosine: -first dose (6mg rapod IV push; follow with NS flush) -Second dose: 12mg if required |
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Stable Wide-COmplex tach
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IV access and 12-ECG
-Consider adenosine if regular and monomorphoic -consider antiarrhythmic infusion Procainamide IV: 20-50mg/min until arrhythmia suppressed (max dose 17mg/kg) -avoid if prolonged QT or CHF -Amiodarone IV Dose: -First dose: 150mg over 10 minutes -Rpt if VT recures -maintainance infusion of 1mg/min for first 6 hrs -Sotalol IV: 100mg over 5 minutes |
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Stable Narrow complex Tachychardia
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IV
ECG Vagal maneuvers Adenosine (if regular) Beta-blocker/Ca channel blocker |
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If in Torsades de pointes, what do you give
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MgSO4 1-2g diluted in 10ml D5W given over 5 to 20 mintues
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BLS Survey
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1) Check Responsiveness
-Are you all right -Absent abnormal breathing (scan chest for movement (5-10 seconds) 2) Activate ERS/ AED 3) Circulation -Carotid Pulse fo 5-10 seconds -No pulse-->CPR (30:2) If pulse resumes-->start rescue breaths at 1 breath q 5-6seconds (10-12 breaths minute) check pulse q 2 minutes 4) Defibrillation -No pulse-->check for shockable rhythmn with AED as sson as arrives |
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Rate of ventilation with patient in respiratory arrest
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q 5-6seconds
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Coronary perfusion pressure
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Diastolic pressure - R atrial diastolic pressure
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What do you do after shocking?
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Immediatley resume CPR, beginning with chest comrpessions. GIve 2 minutes (5 cycles) of CPR
Establish IV/IO access After 5 minutes, rhythm check If the rhythm in organized (regular narrow) palpate pulse ANy doubt about presence of pulse, resume CPR IF there is a pulse-->post-cardiac arrest care IF the rhythm is non-shockable-->asystole/PEA |
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Dose of epi and Vasopressin during VF/pulseless VT
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Epi: 1mg IV/IO q 3- 5 minutes
improves coronary/cerebral perfusion presure Vasopressin: 40 Units IV/IO - may substitute for 1st or second dose of epi nonadren peripheral vasoconstrictor |
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What do you do after shock?
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Give meds
continue CPR for 2 minutes then analyze rhythm, if nonshockable ryth present and it is organized (regular and narrow) check pulse -->any doubt about pulse-->resume CPR Palpable pulse-->post-cardiac arrest care nonshockable-->no pulse-->asystole/PEA If shockable, resume CPR while defib charging |
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Do you give antiarrhythmics during cardiac arrest
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No evidence that it increases survival to d/c
-can give amiodarone 1st dose: 300mg bolus 2nd dose: 150mg If amiodarone is unavaiable -Lidocaine 1 - 1.5mg/kg IV/IO 1st dose 2nd dose - 0.5 - 0.75mg/kg IV/IO at 5 - 10 minute intervals -->max, 3 mg/kg Torsades de Pointes: 1 - 2 g IV/IO diluted in 10ml D5W given as bolus over 5 - 20 minutes |
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Goals of Post-Cardiac Arrest Care
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-Optimize hemodynamic/vent status
-therapeutic hypotherm -coronary reperfusion with PCI -glycemic control |
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hypotension
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IV bolus 1-2L NS, (may use 4 degree C if hypotherm)
-Epi: 0.1-0.5mcg/kg/min (7-35mcg/min in adult) -Dopa: 5-10mcg/kg/min for SBP>90, MAP>65 -Norepi: 0.1-0.5 mcg/kg/min (7-35mcg/min in 70kg adult) |
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Post-cardiac care-->patient is not following commands
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initiate therapeutic hypothermia
target temp: 32-34 deg C for 12 - 24 hrs get 12 lead ECG-->if AMI or STEMI-->cath lab for PCI |
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How do you deliver synchronized cardioversion in Unstable tachycardia
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Narrow Regular: 50-100J
Narrow Irregular: 120-200J biphas, or 200J monophas Wide Regular: 100J Wide Irreg: defib dose |
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Stable Wide-complex tachy drugs
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Adenosine 6mg-->12mg if monomorphioc and regular
Procainamide 20-50mg/min (1-4mg/min maintenance dose) Amiodarone (150mg/10min) Maintenance 1mg/min Sotalol 100mg/5min |
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When to use synchronized shocks
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-unstable SVT
-Unstable regular monomorphic tachy with pulses -Unstable A fib -Unstable A flutter |