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115 Cards in this Set
- Front
- Back
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Epinephrine
What is the IV/IO push dose in Pulseless VF/VT (cardiac arrest)? |
1 mg Q3-5 min
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Indications for Adenosine
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first drug for most forms of stable narrow complex SVT (*pulse), consider for unstable narrow complex while preparing for cardioversion, regular monomorphic wide tachycardia (*pulse)
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you find a patient who is not breathing. You activate the EMS and you determine there is no pulse. What is your next action?
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Start chest compressions
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Indications for Amiodarone
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fatal arrhythmias (VF/ pulseless VT) unresponsive to shock, CPR, epi, recurrent unstable VT
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You are evaluating a 58 year old man with chest pain. The BP is 92/50 and HR is 92/mi, nonlabored respiratory rate is 14 breaths/min and the pulse ox reading is 97%. What is the assessment step is most important now?
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Obtaining a 12 lead ECG
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For any rhythm.
Epinephrine What is the maximum total dose? |
No Maximum
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Indications for Atropine
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symptomatic bradycardia (not responsive for mobitz type 2 block)
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Epinephrine
What is the IV/IO push dose in Asystole/PEA? |
1 mg Q3-5 min
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Indications for Dopamine
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second line drug for bradycardia after atropine, use for hypotension with s/s shock
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Epinephrine
What is the infusion dose in Symptomatic Bradycardia? |
2-10 ug/min
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Indications for Epi
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Cardiac arrest: VF/ pulseless VT, asystole, PEA…symptomatic bradycardia if atropine/pacing ineffective
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completed 2 minutes CPR. the ECG monitor displays PEA and the patient has no pulse. Member of the team resumes chest compressions, IV placed. What is the management step is the next priority?
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Admin 1mg Epi
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What are the nonshockable rhythms
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asystole and any pulseless electrical activity/arrhythmia
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Dosage for Adenosine
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6 mg fast! Second dose 12 mg
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during pause in cpr your monitor shows Normal sinus rhythm with no pulse. What is the next action
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Resume chest compressions.
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How often should you rotate compressors during CPR
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every 2 minutes or 5 cycles
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Dosage for Amiodarone
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First dose 300 mg, second dose 150 mg in cardiac arrest
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Atropine
What is the IV/IO dose in Symptomatic Bradycardia? |
0.5 mg Q 3-5 min
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Dosage for Atropine
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0.5 mg every 3-5 min
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Atropine
What is the maximum total dose for any rhythm? |
0.04 mg/kg (3mg)
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Dosage for Dopamine
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2-20 mcg/kg/min (infusion)
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whisch action increases the chance for successful conversion of V FIB?
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providing quality compressions immediately before defib attempts
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Dosage for Epi
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1 mg every 3-5 min….for brady, 2-10 mcg/min infusion
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Amiodarone
What is the first IV/IO dose in Cardiac Arrest? (Pulseless VF/VT) |
300 mg
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Amiodarone
What is the second IV/IO dose in Cardiac Arrest? (Pulseless VF/VT) |
150 mg
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Amiodarone
What maximum total dose for 24 hours? |
2.2 gm per 24 hours
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Amiodarone
What is the Rapid Infusion dose for Recurrent Life-Threatening Ventricular Arrhythmias? |
150 mg over 10 min. May repeat Q 10 min as necessary.
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Amiodarone
What is the Slow Infusion dose for Recurrent Life-Threatening Ventricular Arrhythmias? |
360 mg over 6 hours
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what are the 2 shockable rhythms?
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pulsless VT
VF (this deteriorates to asystole if not treated) |
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10 reversible causes of cardiac arrest
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Hypovolemia, Hypoxia, Hydrogen ions (acidosis), Hypo/Hyperkalemia, Hypothermia
Tension pneumothorax, Tamponade, Toxins, Thrombosis (pulmonary and cardiac) |
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With ROSC, what should the oxygen saturation be maintained at
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>94%
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drugs for VF/VT
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epinephrine
vasopressin lidocaine amiodarone magnesium (if torsades present) |
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Once you have ROSC and have optimized ventilation, what steps do you do next
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1. give 1-2L saline or Ringer's lactate (at 4 degrees)
2. Give a vasopressor (Epi, Dopamine, or NER) 3. Obtain a 12-lead ECG 4. Consider the 10 treatable causes |
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What's the normal dosage of dopamine when given after ROSC
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5-10mcg/kg per minute
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asystole/ pulseless arrest algorithm- not shockable rhythm
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CPR- 5 cycles
Give epi 1mg every 3-5 min or vasopressin 40U CPR- 5 cycles Check rhythm rinse and repeat if rhythm remains unshockable no antiarrhythmics needed since PEA is not an arrhythmia |
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which drug and dose is recommended for the management of refractory v fib.
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amioderone 300 mg.
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Vasopressin
What is the dose in cardiac arrest? (VF, VT, asystole, PEA) |
40u IV/IO
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After ROSC, if the person still remains unconscious and can't follow commands, what's the next step
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induce hypothermia
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Normal heart rate associated with a bradyarrythmia
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<50/min
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when and how do you give magnesium?
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Magnesium is for torsades de pointes
loading dose 1-2g IV/IO diluted in 10ml D5W |
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1st drug used in someone with a symptomatic bradyarrythmia
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atropine- 0.5mg bolus every 3-5 minutes (max dose 3mg)
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how does the VF/VT algorithm differ in a patient with hypothermia?
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a single defibrillation attempt is appropriate
- hypothermic heart may be unresponsive to drug therapy so defer admin of drugs until core temperature rises above 86 |
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3 alternate treatments for a symptomatic bradyarrythmia if atropine proves ineffective
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1. dopamine
2. epinephrine 3. transcutaneous pacing |
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pt presents with new onset of dizzines and fatigue. on exam pt HR 35 b/p 70/50 breaths p/min 22 O2 sats 95%. what is appropriate first med.?
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atropine .5 mg
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Procainamide
What is the maximum dose |
17 mg/kg
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Putting someone on a transcutaneous pacer requires what other drug therapy
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a sedative and analgesic
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what is the appropriate dose of dopamine for a pt with bradycardia when the initial dose of atropine was ineffective?
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2-10 mcg/kg p/min
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What's the normal dose of dopamine when given to someone with a bradyarrythmia
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2-10mcg/kg per minute
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sudden on set dizziness with HR 180 b/p 110/70, R 18, O2 98% room air, lead II ecg sinus tachy. what is the next appropriate intervention?
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vagal maneuvers
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an ICU pt developed sudden onset of narrow-complex tachycardia at a rate of 220/min. b/p 128/58, PETCO2 38, O2 98%. IV in left IJ and pt has not been given any vassoactive drugs. a 12 lead ECG confirms a supraventricular tachycardia w/ no evidence of ischemia or infarction. HR not responded to vagal maneuvers. what is the next recommended intervention ?
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adenosine 6 mg IV
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In what bradyarrythmias would atropine be contraindicated
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2nd and 3rd degree heart blocks
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Dopamine
What is the infusion dose in Symptomatic Bradycardia? |
2-10 ug/kg/min
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Adenosine
What is the first dose and how is it given? |
6 mg given rapidly over 1-3 secs followed by a 20cc NS bolus
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What's the accepted voltage for cardioversion of a narrow regular tachyarrythmia
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50-100J
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49 y/o women ER w/ persistent epigastric pain, she had been taking oral antacids for past 6hrs for self diagnosed heart burn. incial b/p 118/72, P 92 reg. non-labored R 14, Os 96%. what is the most appropriate intervention to perform next?
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12 lead ECG
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Adenosine
What is the second dose and how is it given? |
12mg given rapidly over 1-3 secs followed by a 20cc NS bolus
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pt in respiratory failure becomes apnic but continues have strong pulse Hr dropping rapidly now showing sinus brady at rate of 30 /min. what intervention has highest priority?
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simple airway maneuvers and assisted ventilation
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Adenosine
When can a second dose be given? |
1-2 minutes after the first dose
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What's the accepted voltage for cardioversion of a wide regular tachyarrythmia
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100J
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Sodium Bicarbonate
When is sodium bicarbonate administration appropriate? |
Known preexisting hyperkalemia
Know preexisting bicarbonate-responsive acidosis. |
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treating a pt with dizziness, b/p 68/30 with cool clammy skin. lead II shows second degree AV block type II (looks like a shark)? what is the most appropriate first intervention?
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atropine
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What's the normal dose of adenosine when given for a tachyarrhythmia
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1st dose: 6mg rapid IV push followed by a flush
2nd dose: 12mg |
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What is the most important therapy to perform immediately after defibrillation?
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CPR
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What's the accepted therapy for someone with a tachyarrhythmia that has a QRS < 0.12 seconds
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vagal maneuvers
6mg Adenosine either a B-blocker or CCB (dialtezam) expert consultation |
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When a rhythm check by a manual defibrillator reveals VF/VT, one provider charges the defibrillator. What function does the other provider perform?
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Continues CPR
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3 acceptable antiarrhythmics to give to someone with a tachyarrhythmia with a QRS > 0.12 seconds
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Procainamide, Amiodarone, and Sotalol
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After two minutes of CPR which action is immediately performed?
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Rhythm check
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What's the normal dose of procainamide when given for a tachyarrhythmia
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20-50mg/min with optional maintenance infusions of 1-4mg/min
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62 y.o male in ER states hear "beating fast" denies angina or SOB, b/p 142/98, P 200, R 14, O2% 95? what intervention perform next?
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12 ECG
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What's the normal dose of amiodarone when given for a tachyarrhythmia
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150mg over 10 minutes with maintenance infusions of 1mg/min (after the initial 10 minutes) for the next 6 hours
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you evaluate a 48 man with crushing chest pains. is a semi-truck driver pale, diaphoretic, cool to touch, slow to respond to questions, b/p 58/32, H 190, R 18, O2% unable to obtain due to no pulse, lead II ECG displays regular wide complex tachycardia. what intervention should you perform next?
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synchronized cardio-version
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When a shockable rhythm is discovered after a rhythm check, how many times should the victim be defibrillated before resuming CPR?
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1 time
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What is the most important issue in predicting Return Of Spontaneous Circulation (ROSC) after defibrillation?
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Short time interval between compressions and defibrillation
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what is the recommended second dose of adenosine for patients in refractory but stable narrow complex tachycardia ?
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12 mg
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Which is true about ventricular tachycardia?
a. VT therapy should always be guided by the Pulseless Arrest Algorithm b. Victims in VT are unresponsive c. VT victims are treated with the Pulseless Arrest Algorithm if they are pulseless. d. VT victims are treated with the Tachycardia Algorithm if they have a pulse. e. Answers c and d. |
e.
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In the Pulseless Arrest Algorithm, what is the first type of medication administered for Pulseless VF-VT?
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Vasopressor
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First thing you always do once you stabilize a patient who presented with a heart condition
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obtain a 12-lead ECG
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What is a theoretical benefit of a vasopressor drug in cardiac arrest?
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To increase myocardial coronary blood flow
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If given as a bolus during CPR, when is the peak effect of an IV/IO vasopressor?
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1-2 minutes after administration
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Which vasopressors are suggested to be given in VF/VT Pulseless Arrest?
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Epinephrine and Vasopressin
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What drug is the first-line Antiarrhythmic used in VF-VT Pulseless Arrest
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Amiodarone
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what is the minimum systolic BP one should attempt to achieve with fliud, intropic , or vasopressor administration i n a hypotensive post cardiac arrest patient who achieves ROSC.
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90
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If Amiodarone is unavailable, which drug may be considered for VF-VT Pulseless Arrest?
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Lidocaine
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what is the 1st treatment priority in a patient who achieves ROSC ?
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Optimizing oxygenation and ventilation
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What are the H'S
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Hypovolemia
Hypoxia hydrogen Ion (acidosis) hypo/hyperkalimia Hypothermia |
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physical symptoms of bradycardia
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SOB, decreased consciousness, fatigue, light-headedness, dizziness, syncope
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What are the T'S
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tension Pneumo
tamponade (cardiac) toxins thrombosis, pulmonary/coronary |
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What should be considered as a potential etiology in the case of refractory VF/Pulseless VT?
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Coronary ischemia
Myocardial infarction |
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What should be done after a monitor-defibrillator reveals an organized rhythm?
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A pulse check is performed
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Which should be done after a monitor-defibrillator reveals an organized rhythm and a pulse is detected?
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Post-cardiac care should be initiated immediately
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Which of the following drug classes is given first for Asystole/PEA?
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Vasopressor
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Brady with pulse Atropine?
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atropine .5 mg bolus repeat every 3-5 minutes
MAX 3 MG |
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Brady with pulse Dopamine
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2-10 mcg/kg per minute
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Brady with pulse Epi?
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2-10 mcg/min
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Tachy with Pulse Adenosine ?
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Adenosine 6 mg rapid IV follow with NS flush
2nd dose 12 mg if required |
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tachy with pulse Amioderone
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1st dose 150mg over 10 minutes repeat PRN if VT recurs
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Which of the following is/are true for PEA?
a. A slow rhythm with a weak pulse b. Any rhythm with a weak pulse c. Any organized rhythm without a pulse d. Answers a and c |
c. Any organized rhythm without a pulse
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2 ROSC questions
Return Of Spontaneous Circulation What do you do when Pt ROSC After ROSC what do you give |
When pt ROSC OPTIMIZE VENTILATION AND OXYGENATION
GIVE 1-2 L NS if lungs are CTA |
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For Acute Coronary Syndrome: If systolic is greater than 90 you can use _______
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greater than 90 use Nitro
Immediate general treatment of ACS is MONA Morphine 2-5 mg IV O2 @ 4l/min Nitro Aspirin 325mg chewed |
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VF/VT algorithm
(after BLS primary survey and initial ABCs and O2) |
Give 1 shock
- 120J Resume CPR- 5 cycles (2 min) Check rhythm give another shock 200J (if needed) Resume CPR immediately give epinephrine 1mg IV/IO - repeat every 3-5 min - can use vasopressin 40U to replace 1st or second dose of epi Resume CPR- 5 cycles Check rhythm give 1 shock 360J Resume CPR cosider antiarrythmics - amiodarone 300mg once (then 150mg additional) OR - lidocaine 1-1.5 mg 1st dose then 0.5-0.75; max 3 doses |
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Which of these rhythms should be defibrillated?
a. Sinus rhythm with a pulse b. Sinus rhythm without a pulse c. Asystole d. Ventricular tachycardia without a pulse |
d. Ventricular tachycardia without a pulse
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when should you conduct a rhythm check?
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after every1 cycle = 5 sets of CPR
1 cycle = 30 compressions, 2 ventilations or ET tube = 1 ventilation every 5-6 sec between compressions |
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What's accepted voltage for a wide irregular tachyarrythmia
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You do NOT cardiovert this rhythm but rather use a defibrillator 120J
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Procainamide
What is the dose for recurrent VF/VT WITH a pulse? |
20 mg/min IV/IO
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When Asystole is displayed on the monitor, what are important considerations?
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a. Fine ventricular fibrillation may appear as asystole in some leads
b. The monitor is operating properly c. All ECG leads are connected d. Monitor signal gain is adjusted properly |
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Which of the following is the initial treatment for bradycardia with signs and symptoms of instabiltiy?
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Atropine 0.5 mg IV
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Which of the statements below are true for bradycardia?
a. All patients with a heart rate <50 will be symptomatic b. Patients should be treated based on their clinical condition c. Patients should be treated based on their heart rate d. Answers a. and b. |
b. Patients should be treated based on their clinical condition
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What statements are true for athletic patients regarding bradycardia?
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a. Many athletic patients do well with bradycardic rates
b. Athletic patients at rest often have heart rates <50 |
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Why should atropine be used cautiously in the presence of acute coronary ischemia?
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Increased heart rate may worsen ischemia
Increased heart rate may increase infarction site |
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What rhythm(s) is/are commonly responsive to atropine?
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Sinus bradycardia
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What is/are true concerning Dopamine infusion at lower doses?
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Increased strength of heart contractions
Increased heart rate |
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What is a relatively common cause of tachycardia?
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Hypoxia
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What is/are appropriate treatment(s) for a tachycardic patient with shock symptoms?
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Immediate synchronized cardioversion
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Synchronized cardioversion is recommended for which of these unstable rhythms
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Atrial Fibrillation
Atrial Flutter Monomorphic VT (with pulse) |
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Which of the following best describe Paroxysmal Supraventricular Tachycardia (PSVT).
a. PSVT has a slow beginning and end b. PSVT has a suddent beginning and end. |
b. PSVT has a sudden beginning and end
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