Aha Acls Med Review

Front 1

Adenosine

-Indications

Back 1

I:
- 1st drug for most forms of stable narrow complex SVT
- May consider for unstable narrow-complex reentry tachycardia while preparing for cardioversion.
-Regular & monomorphic wide-complex tachycardia

Front 2

Adenosine

-Dosage

Back 2

D:
IV Rapid Push:
1st bolus: 6mg over 1-3 secs followed by 20 mL NS bolus

2nd bolus: 12mg rapid IVP
Use port closest to cannulation.

Front 3

Adenosine

-Precautions

Back 3

Side effects: flushing, chest pain, or tightness, brief preiods of asystole or bradycardia.

Precautions:
-Cut dose in 1/2 if administering through Central Line, presence of dipyridamole or carbamazepine.
-Large doses may be needed for caffeine or theophylline use.

Front 4

Amiodarone
(Antiarrhythmic)

-Indications

Back 4

I:
-VF/Pulseless VT unresponsive to shock delivery, CPR & a vasopressor.
-Stable irregular narrow complex tachycardia (atrial fib).
-Stable regular narrow complex tachycardia.
-To control rapid ventricular rate due to accessory pathway conduction in pre-excited atrial arrhythmias

Front 5

Amiodarone
(Antiarrhythmic)

-Dosage

Back 5

Cardiac Arrest:
1st dose: 300mg IV/IO push.
2nd dose: 150mg IV/IO push.

Life Threatening Arrhythmias:
-Rapid IV: 150mg over 10 mins (15mg/min). May repeat q 10 mins PRN
-Slow IV: 360mg over 6 hrs (1 mg/min).
-Maintenance IV: 540mg over 18 hrs (0.5mg/min)

Max Dose: 2.2g over 24 hrs

Front 6

Amiodarone
(Antiarrhythmic)

-Precautions

Back 6

Side effects: Bradycardia, hypotension, phlebitis.

Precautions:
-Do not use w/ other drugs that prolong QT interval.
-Terminal elimination is extremely long (half-life lasts up to 40 days).

Front 7

Aspirin
(NSAID)

-Indications

Back 7

I:
-Administer to all pt's w/ ACS, unless hypersensitive to aspirin
-Any person w/ symptoms ("pressure," "heavy wt.," "squeezing," "crushing") suggestive of ischemic pain.

Front 8

Aspirin
(NSAID)

-Dosage

Back 8

PO: 160mg - 325mg non-enteric coated tablet (chewing preferable).

Suppository: 300mg.

Front 9

Aspirin
(NSAID)

-Precautions

Back 9

Relatively contraindicated in pt's w/ active ulcer disease or asthma, or w/ known hypersensitivity to aspirin.

Front 10

Atropine
(Parasympathetic blocker)
*Can be given via endotracheal tube

-Indications

Back 10

I:
-1st drug for symptomatic sinus bradycardia
-May be beneficial in presence of AV nodal block or ventricular asystole.
**Will not be effective for infranodal (Mobitz type II) block.**

Front 11

Atropine
(Parasympathetic blocker)
*Can be given via endotracheal tube

- Dosage

Back 11

Bradycardia:
-0.5mg IV q 3-5 mins, PRN, not to exceed total dose of 0.04mg/kg (3mg).

-Use shorter dosing interval (3 mins) & higher doses in several clinical conditions.

Front 12

Atropine
(Parasympathetic blocker)
*Can be given via endotracheal tube

-Precautions

Back 12

-Avoid in hypothermic bradycardia

-Doses <0.5 may result in paradoxical slowing of the heart.

Front 13

Beta-blockers:

Metoprolol Tartrate -
Indications

Back 13

-Administer to all pt's w/ suspected MI & unstable angina in the absence of contraindication.
-Useful as adjunctive agent w/ fibrinolytic therapy
-To convert to normal sinus rhythm or to slow ventricular response (or both) in SVT, AFib, or AFlutter.

Front 14

Beta-blockers:

Metoprolol Tartrate -
Dosage

Back 14

Metoprolol Tartrate:
- Initial IV Dose: 5mg slow at 5 min intervals to a total of 15mg.
-Begin oral regimen to follow IV dose w/ 50mg PO; titrate to effect.

Front 15

Beta-blockers:

Metoprolol Tartrate -
Precautions

Back 15

-Do not give to pt's w/ STEMI if signs of heart failure, low cardiac output, risk of cardiogenic shock.
-Contraindicated if PR interval >0.24sec., 2nd or 3rd degree heart block, active asthma, SBP <100mmHg.
-Contraindicated if cocaine-induced ACS.

Front 16

Beta-blockers:

Atenolol -
Indications

Back 16

I:
-Administer to all pt's w/ suspected MI & unstable angina in the absence of contraindication.
-Useful as adjunctive agent w/ fibrinolytic therapy
-To convert to normal sinus rhythm or to slow ventricular response (or both) in SVT, AFib, or AFlutter.

Front 17

Beta-blockers:

Atenolol -
Dosage

Back 17

D:
-5mg iV over 5 mins.
-Wait 10 mins, then give 2nd dose or 5mg IV over 5 mins.
-In 10 mins, if tolerated, begin 50mg PO; titrate to effect.

Front 18

Beta-blockers:

Atenolol -
Precautions

Back 18

D:
-Do not give to pt's w/ STEMI if signs of heart failure, low cardiac output, risk of cardiogenic shock.
-Contraindicated if PR interval >0.24sec., 2nd or 3rd degree heart block, active asthma, SBP <100mmHg.
-Contraindicated if cocaine-induced ACS.

Front 19

Beta-blockers:

Propranolol -
Indications

Back 19

I:
-Administer to all pt's w/ suspected MI & unstable angina in the absence of contraindication.
-Useful as adjunctive agent w/ fibrinolytic therapy
-To convert to normal sinus rhythm or to slow ventricular response (or both) in SVT, AFib, or AFlutter.

Front 20

Beta-blockers:

Propranolol -
Dosage

Back 20

D:
0.5-1mg over 1 min, repeated PRN up to a total dose of 0.1mg/kg.

Front 21

Beta-blockers:

Propranolol -
Precautions

Back 21

P:
-Do not give to pt's w/ STEMI if signs of heart failure, low cardiac output, risk of cardiogenic shock.
-Contraindicated if PR interval >0.24sec., 2nd or 3rd degree heart block, active asthma, SBP <100mmHg.
-Contraindicated if cocaine-induced ACS.

Front 22

Beta-blockers:

Esmolol -
Indications

Back 22

I:
-Administer to all pt's w/ suspected MI & unstable angina in the absence of contraindication.
-Useful as adjunctive agent w/ fibrinolytic therapy
-To convert to normal sinus rhythm or to slow ventricular response (or both) in SVT, AFib, or AFlutter

Front 23

Beta-blockers:

Esmolol -
Dosage

Back 23

D:
-0.5mg/kg (500mcg/kg) over 1 min, followed by 0.05 mg/kg (50mcg/kg) per min IV.
-Max: 0.3mg/kg (300mcg/kg) per min. Wait 10 mins, then give 2nd dose or 5mg IV over 5 mins.

Front 24

Beta-blockers:
Esmolol -
Precautions

Back 24

P:
-Do not give to pt's w/ STEMI if signs of heart failure, low cardiac output, risk of cardiogenic shock.
-Contraindicated if PR interval >0.24sec., 2nd or 3rd degree heart block, active asthma, SBP <100mmHg.
-Contraindicated if cocaine-induced ACS.

Front 25

Beta-blockers:

Labetalol -
Indications

Back 25

I:
-Administer to all pt's w/ suspected MI & unstable angina in the absence of contraindication.
-Useful as adjunctive agent w/ fibrinolytic therapy
-To convert to normal sinus rhythm or to slow ventricular response (or both) in SVT, AFib, or AFlutter

-Labetalol recommended for emergency antihypertensive therapy for hemorrhagic & acute ischemic stroke

Front 26

Beta-blockers:

Labetalol -
Dosage

Back 26

D:
-10mg IV push over 1-2 mins.
-May repeat or double q 10 mins.
-Max: 150mg, or give initial dose as a bolus, then start IV @ 2-8mg/min.

Front 27

Beta-blockers:

Labetalol -
Precautions

Back 27

P:
-Do not give to pt's w/ STEMI if signs of heart failure, low cardiac output, risk of cardiogenic shock.
-Contraindicated if PR interval >0.24sec., 2nd or 3rd degree heart block, active asthma, SBP <100mmHg.
-Contraindicated if cocaine-induced ACS.

Front 28

Calcium Chloride 10%
(Electrolyte)

-Indications

Back 28

- Known or suspected hyperkalemia (eg, renal failure)
- Ionized hypocalcemia (eg, after multiple blood transfusions).
- As an antidote for toxic effects (hypotension & arrhythmias) from calcium channel blocker or beta-blocker OD.

Front 29

Calcium Chloride 10%
(Electrolyte)

-Dosage

Back 29

D:
- 500mg-1000mg (5-10mL of a 10% soln) IV for hyperkalemia & calcium channel blocker OD. May be repeated PRN.
-Note: comparable dose of 10% calcium gluconate is 15-30mL.

Front 30

Calcium Chloride 10%
(Electrolyte)

-Precautions

Back 30

Do not mix w/ sodium bicarbonate

Front 31

Dextrose 50%/Glucose
(Carbohydrate)

-Indications

Back 31

I: Hypoglycemia

Front 32

Dextrose 50%/Glucose
(Carbohydrate)

-Dosage

Back 32

D:
- 10-25gm slow IV push.
- May be repeated once.

Front 33

Dextrose 50%/Glucose
(Carbohydrate)

-Precautions

Back 33

P:
- Do not use routinely during cardiac arrest.

Front 34

Diltiazem
(Calcium channel blocker)

-Indications

Back 34

I:
-A-fib/A-Flutter
-Use after adenosine to treat narrow QRS complex & adequate BP.

Front 35

Diltiazem
(Calcium channel blocker)

-Dosage

Back 35

D:
-15-20mg (0.25mg/kg) IV over 2 mins
-May give another IV dose in 15 mins @ 20-25mg (0.35mg/kg) over 2 mins.
-Maintenance IV: 5-15mg/hr, titrated to physiologically appropriate HR (can dilute in D5W or NS).

Front 36

Diltiazem
(Calcium channel blocker)

-Precautions

Back 36

P:
-May cause hypotension
-Do not use in wide QRS tachycardias of uncertain origin or for poison/drug-induced tachycardia.
-Avoid in WPW, rapid AFib or Flutter, or pt's w/ AV block w/o a pacemaker.

Front 37

Dobutamine

-Indications

Back 37

I:
-Pump problems (congested heart failure, pulmonary congestion) w/ ABP of 70-100 Hg & signs of shock.

Front 38

Dobutamine

-Dosage

Back 38

D:
-2-20mcg/kg per min.
-Titrate so heart dose not increase by > 10% of baseline

Front 39

Dobutamine

-Precautions

Back 39

P:
- Contraindicated in suspected or known poison/drug-induced shock.
-Avoid w/ SBP < 100mmHg & signs of shock.
-May cause tachyarrhythmias, fluctuations in BP, headache & nausea.
-Do not mix w/ sodium bicarbonate.

Front 40

Dopamine
(Catecholamine)

-Indications

Back 40

I:
-2nd line drug for symptomatic bradycardia (after atropine).
-Hypotension (systolic <70-100mmHg) w/ signs & symptoms of shock.

Front 41

Dopamine
(Catecholamine)

-Dosage

Back 41

D:
-2-20mcg/kg per min
-Titrate to pt response; taper slowly

Front 42

Dopamine
(Catecholamine)

-Precautions

Back 42

P:
-Correct hypovolemia w/ volume replacement before dopamine.
-May cause tachyarrhythmias, excessive vasoconstriction.
-Do not mix w/ sodium bicarbonate.

Front 43

Epinephrine 1:10,000
(Vasopressor)
*Can be given via endotracheal tube.*

-Indications

Back 43

I:
-VF/Pulseless VT, Asystole, PEA.
-Symptomatic bradycardia: Can be considered after atropine as an alternative to dopamine.
-Severe hypotension: Can be used w/ pacing & atropine fail.

Front 44

Epinephrine 1:10,000
(Vasopressor)
*Can be given via endotracheal tube.*

-Dosage

Back 44

D:
-IV/IO: 1mg (10ml) q 3-5 mins.
-Infusion: 0.1-0.5mcg/kg per min (for 70-kg pt: 7-35mcg/min); titrate to response.
-Profound bradycardia or hypotension: 2-10mcg/min infusion to pt response

Front 45

Epinephrine 1:10,000
(Vasopressor)
*Can be given via endotracheal tube.*

-Precautions

Back 45

P:
Raising BP & increasing HR may cause myocardial ischemia, angina, & increased myocardial oxygen demand.

Front 46

FIBRINOLYTIC AGENTS

Alteplase, Recombinant (Activase): Tissue Plasminogen Activator (rtPA)

50 & 100 mg vials reconstituted w/ sterile water to 1mg/mL

*For all 4 agents, insert 2 peripheral IV lines; use 1 line exclusively for fibrinolytic administration*

-Indications

Back 46

I:
AMI in adults:
-ST elevation (>1mmin >= 2 continguous leads) or new or presumably new LBBB.
-In context of signs & symptoms <= 12 hrs.

Acute ischemic stroke:
-Ateplase is the only fibrinolytic agent approved for ischemic stroke.

Front 47

FIBRINOLYTIC AGENTS

Alteplase, Recombinant (Activase): Tissue Plasminogen Activator (rtPA)

50 & 100 mg vials reconstituted w/ sterile water to 1mg/mL

*For all 4 agents, insert 2 peripheral IV lines; use 1 line exclusively for fibrinolytic administration*

-Dosage

Back 47

D:
-Ateplase, Recombinant (rtPA): Recommended total dose is based on pt's wt.
STEMI:
-Accelerated infusion (1.5 hrs)
*Give 15mg IV bolus.
*Then 0.75mg/kg over next 30 mins (not to exceed 50mg).
*Then 0.5mg/kg over 60 mins (not to exceed 35mg).
*Max total: 100mg

Front 48

FIBRINOLYTIC AGENTS

Alteplase, Recombinant (Activase): Tissue Plasminogen Activator (rtPA)

50 & 100 mg vials reconstituted w/ sterile water to 1mg/mL

*For all 4 agents, insert 2 peripheral IV lines; use 1 line exclusively for fibrinolytic administration*

-Precautions

Back 48

P:
Follow ACS & Stroke Protocol Checklists for indications, precautions, and contraindications.

Front 49

FIBRINOLYTIC AGENTS

Reteplase, Recombinant (Retavase): 10 unit vials reconstituted w/ sterile water to 1unit/mL.

-Indications

Back 49

I:
AMI in adults:
-ST elevation (>1mmin >= 2 continguous leads) or new or presumably new LBBB.
-In context of signs & symptoms <= 12 hrs.

Acute ischemic stroke:
-Ateplase is the only fibrinolytic agent approved for ischemic stroke.

Front 50

FIBRINOLYTIC AGENTS

Reteplase, Recombinant (Retavase): 10 unit vials reconstituted w/ sterile water to 1unit/mL

-Dosage

Back 50

D:
-Give 1st 10 unit IV bolus over 2 mins
-30 mins later give 2nd 10 unit IV bolus over 2 mins (Give NS flush before & after each bolus).

Front 51

FIBRINOLYTIC AGENTS

Streptokinase (Streptase): Reconstitute to 1mg/mL

-Indications

Back 51

I:
AMI in adults:
-ST elevation (>1mmin >= 2 continguous leads) or new or presumably new LBBB.
-In context of signs & symptoms <= 12 hrs.

Acute ischemic stroke:
-Ateplase is the only fibrinolytic agent approved for ischemic stroke.

Front 52

FIBRINOLYTIC AGENTS

Streptokinase (Streptase): Reconstitute to 1mg/mL

-Dosage

Back 52

D:
1.5 million units in a 1-hr infusion

Front 53

FIBRINOLYTIC AGENTS:

Tenectaplase (TNKase):
50mg vial reconstituted w/ sterile water.

-Dosage

Back 53

D:
-Bolus, wt adjusted
* <60kg: Give 30 mg
*60-69kg: Give 35 mg
*70-79kg: Give 40mg
*80-89kg: GIve 45mg
*>=90kg: Give 50mg
-Administer single IV bolus over 5 secs.
-Incompatible w/ dextrose solns.

Front 54

FLUID ADMINISTRATION:

Normal Saline/NaCl
Fluid volume

-Indications

Back 54

I:
Hypovolemia

Front 55

FLUID ADMINISTRATION:
Normal Saline/NaCl
Fluid volume

-Dosage

Back 55

D:
- 250-500ml bolus.
-Repeat PRN

Front 56

FLUID ADMINISTRATION:
Normal Saline/NaCl
Fluid volume

-Precautions

Back 56

P: Routine aminstration of fluids during resuscitation is not indicated, as it can reduce coronary perfusion pressure.

Front 57

FLUMAZENIL

-Indications

Back 57

I:
Reverse respiratory depression & sedative effects form benzodiazepine OD.

Front 58

FLUMAZENIL

-Dosage

Back 58

D:
-1st dose: 0.2mg IV over 15 secs
-2nd dose: 0.3mg IV over 30 secs.
-3rd dose: 0.5mg IV over 30 secs.
-If no adequate response, repeat once q minute until adequate response or a total of 3 mg is given.

Front 59

FLUMAZENIL

-Precautions

Back 59

P:
-Effects may not outlast effect of benzodiazepines.
-Monitor for recurrent respiratory depression.
-Do not use in suspected tricyclic OD.
-Do not use in seizure-prone pt's, chronic benzodiazepine users, or alcoholics.
-Do not use in unknown drug OD if mixed drug OD w/ drugs know to cause seizures (tricyclic antidepressants, cocaine, amphetamine).

Front 60

FUROSEMIDE:

-Indications

Back 60

I:
-Adjuvant therapy of acute pulmonary edema in pt's w/ SBP>90-100mmHG (w/o s/s of shock).
-Hypertensive emergencies.

Front 61

FUROSEMIDE:

-Dosage

Back 61

D:
-0.5-1mg/kg over 1-2 mins.
-If no response, double dose to 2mg/kg, given slowly over 1-2 mins.
-For new-onset pulmonary edema w/ hypovolemia: <0.5mg/kg.

Front 62

FUROSEMIDE:

-Precautions

Back 62

P: Dehydration, hypovolemia, hypotension, hypokalemia, or other electrolyte imbalance may occur.

Front 63

GLUCAGON:
Powdered in 1 mg vials
Reconstitute w/ provided soln.

-Indications

Back 63

I: Adjuvant tx of toxic effects of calcium channel blocker or beta-blocker.

Front 64

GLUCAGON:
Powdered in 1 mg vials
Reconstitute w/ provided soln.

-Dosage

Back 64

D:
-3-10mg IV slowly over 3-5 mins, followed by infusion of 3-5mg/hr

Front 65

GLUCAGON:
Powdered in 1 mg vials
Reconstitute w/ provided soln.

-Precautions

Back 65

P: May cause vomiting, hyperglycemia.

Front 66

HEPARIN, unfractionated (UFH):
Anticoagulant
Concentrations range from 1000-40,000 units/mL.

-Indications

Back 66

I:
-STEMI (AMI).
-Begin heparin w/ fibrin-specific lyrics (eg, alteplase, reteplase, tenecteplase).

Front 67

HEPARIN, unfractionated (UFH):
Anticoagulant
Concentrations range from 1000-40,000 units/mL.

-Dosage

Back 67

D:
-STEMI Infusion:
*Initial bolus 60units/kg (max bolus: 4000units).
*Continue 12 units/kg per hr, round to the nearest 50units (maximum initial rate: 1000units/hr).
*Adjust to maintain a PTT 1.5-2 times the control values (50-70 secs) for 48 hrs or until angiography.
*Check initial aPTT at 3 hours, then q 6 hrs until stable, then daily.

UA/NSTEMI:
*initial bolus 6t0 units/kg. Max: 4000 units.
*12 units/kg/hr. Max initial rate: 1000units/hr

Front 68

HEPARIN, unfractionated (UFH):
(Anticoagulant)
Concentrations range from 1000-40,000 units/mL.

-Precautions

Back 68

P:
-Do not use in pt's w/ active bleeding or bleeding disorders, severe HTN, or recent surgery
-Do not use if platelet count is or falls below <100,000 or w/ hx of heparin-induced thrombocytopenia.

Front 69

LIDOCAINE:
(Antiarrhythmic)
*Can be given via endotrach tube

-Indications

Back 69

I:
-Alternative to Amiodarone in cardiac arrest VF/VT.
-Stable monomorphic VT w/ preserved ventricular function
-Stable polymorphic VT w/ normal baseline QT interval & preserved LV function when ischemia is treated & electrolyte balance is corrected.

Front 70

LIDOCAINE:
(Antiarrhythmic)
*Can be given via endotrach tube

-Dosage

Back 70

D:
-1-1.5mg/kg IV/IO
-For refractory VF may give additional 0.5-0.75mg/kg IV push, repeat in 5-10 mins.
-Max 3 doses or total of 3mg/kg.
-Maintenance infusion or 1-4mg/min (30-50mcg/kg per min).

Front 71

LIDOCAINE:
(Antiarrhythmic)
*Can be given via endotrach tube

-Precautions

Back 71

P:
-Prophylactic use in AMI is contraindicated
-Reduce maintenance dose (not loading dose) in presence of impaired liver function or LV dysfunction.
-D/c infusion immediately if signs of toxicity develop.

Front 72

MAGNESIUM SULFATE:
(Electrolyte)

-Indications

Back 72

I:
-Torsades de Pointes or suspected hypomagnesemia.
-Life threatening ventricular arrhythmias due to digitalis toxicity.
-Routine administration in hospitalized pt's w/ AMI is not recommended.

Front 73

MAGNESIUM SULFATE:
(Electrolyte)

-Dosage

Back 73

D: 1-2 (2-4mL of a 50% soln) diluted in 10mL or D5W IV/IO.

Front 74

MAGNESIUM SULFATE:
(Electrolyte)

-Precautions

Back 74

P: A fall in BP may be noted w/ rapid administration. Use w/ caution in renal failure.

Front 75

MORPHINE SULFATE
(Opiate/Analgesic)

-Indications

Back 75

I:
-Chest pain w/ ACS unresponsive to nitrates.
-Acute cardiogenic pulmonary edema (if BP is adequate)

Front 76

MORPHINE SULFATE
(Opiate/Analgesic)

-Dosage

Back 76

D:
-2-4 mg IV
-May give additional doses of 2-8mg IV at 5-15 min intervals

Front 77

MORPHINE SULFATE
(Opiate/Analgesic)

-Precautions

Back 77

P:
-Administer slowly & titrate to effect; may cause hypotension.
-May cause respiratory depression - be prepared to support ventilations. Naloxone (0.04-2mg IV).

Front 78

NALOXONE HYDROCHLORINE (NARCAN)
(Opiate Antagonist)
*Can be given via endotrach tube

-Indications

Back 78

I: Respiratory & neurologic depressiond ue to opiate intoxication unresponsive to oxygen & ventilation support.

Front 79

NALOXONE HYDROCHLORINE (NARCAN)
(Opiate Antagonist)
*Can be given via endotrach tube

-Dosage

Back 79

D:
-0.04-0.4mg, titrate until ventilation adequate.
-Use higher doses for complete narcotic reversal.
-Can administer up to 6-10mg over short period (<10 mins).
-If total reversal is not required, smaller doses of 0.04mg repeated q 2-3 mins may be used.
-IM/Subcutaneously give 0.4-0.8mg.

Front 80

NALOXONE HYDROCHLORINE (NARCAN)
(Opiate Antagonist)
*Can be given via endotrach tube

-Precautions

Back 80

P:
-Monitor pt! May cause narcotic w/drawal
-Repeat dosing may be needed.
-Assist ventilation before Naloxone administration, avoid sympathetic stimulation

Front 81

NITROGLYCERIN
(Vasodilator)

-Indications

Back 81

I:
-Initial antianginal for suspected ischemic pain.
-For initial 24-48 hrs in pt's w/ AMI & CHF, large anterior wall infarction, persistent or recurrent ischemia, or HTN.

Front 82

NITROGLYCERIN
(Vasodilator)

-Dosage

Back 82

D:
-IV bolus: 12.5-25mcg (if no SL or spray given).
-Infusion: Begin at 10 mcg/min.
-Titrate to effect, increase by 10mcg/min q 3-5 mins until desired effect.
-Ceiling dose of 200mcg/min commonly used.
-SL: 1 Tab (0.3-0.4 mg) repeated for total of 3 doses @ 5 min intervals.
-1-2 sprays for 0.5-1 sec @ 5 min intervals (provides 0.4mg/dose). Max 3 sprays w/n 15 mins

Front 83

NITROGLYCERIN
(Vasodilator)

-Precautions

Back 83

P:
-Hypotension may occur
-Do not use w/ Viagra or other phosphodiasterase inhibitors.
-Contraindicated in pt's w/ hypotension severe bradycardia or tachycardia
-Do not mix w/ other drugs.
-Pt. should sit or lie down when receiving medication.
-Do not shake aerosol spray

Front 84

OXYGEN (Atmospheric Gas)

-Indication

Back 84

I:
- Any cardiopulmonary emergency.
-Complaints of SOB & suspected ischemic pain.
-For ACS: administer to all pt's until stable. Continue if pulmonary congestion, ongoing ischemia, or oxygen saturation <94%
-For pt's w/ suspected Stroke & hypoxemia.
-After ROSC following resuscitation: use the minimum inspired oxygen concentration to achieve oxyhemoglobin saturation >= 94%. If equipment available, to avoid hyperoxia, wean inspired oxygen w/ oxyhemoglobin sat. is 100% but maintain >=94%.

Front 85

OXYGEN (Atmospheric Gas)

-Dosage

Back 85

D:
-NC: 1-6L per min (21-44% O2).
-Venturi mask: 4-12L per min (24-50% O2)
-Partial rebreathing mask: 6-10L per min (35-60% O2).
-Nonbreathing oxygen mask w/ reservoir: 6-15L per min (60-100% O2).
-Bag-mask w/ nonrebreathing "tail": 15L per min (95-100% O2).

Front 86

OXYGEN (Atmospheric Gas)

-Precautions

Back 86

P: Pulse ox may be inaccurate in low cardiac output states, w/ vasoconstriction, or w/ exposure to carbon monoxidel

Front 87

PROCAINAMIDE

-Indications

Back 87

I:
-Useful tx of a wide variety of arrhythmias, including stable monomorphic VT w/ normal QT interval & preserved LV function.
-May use for tx of reentry SSVT uncontrolled by adenosine & vagal maneuvers if BP stable.
-Stable wide-complex tachycardia or unknown origin.
-A-Fib w/ rapid rate in WPW syndrome

Front 88

PROCAINAMIDE

-Dosage

Back 88

D:
Recurrent VF/VT:
-20mg/min IV infusion (max total dose: 17mg/kg)
-In urgent situation, up to 50mg/min may be administered to total dose of 17mg/kg.
-Maintenance Infusion: 1-4mg/min (dilute in D5W or NS).

Front 89

PROCAINAMIDE

-Precautions

Back 89

P:
-If cardiac or renal dysfuntion present, reduce max dose to 12mg/kg & maintenance infusion to 1-2mg/min.
-May induce hypotension in pt's w/ impaired LV function.
-Use w/ caution w/ other drugs that prolong QT interval (amiodarone).

Front 90

SODIUM BICARBONATE
(Buffer)

-Indications

Back 90

I:
-Known preexisting hyperkalemia.
-Known preexisiting bicarbonate-responsive acidosis (eg, diabetic ketoacidosis or OD of tricyclic antidepressant, aspirin, cocaine, or diphenhydramine).
-Prolonged resuscitation w/ effective ventilation; on ROSC after long arrest interval.

Front 91

SODIUM BICARBONATE
(Buffer)

-Dosage

Back 91

D:
-1mEq/kg IV bolus.
-If rapidly available, use arterial blood gas analysis to guide bicarbonate therapy.

Front 92

SODIUM BICARBONATE
(Buffer)

-Precautions

Back 92

P:
-Adequate ventilation & CPR are the major "buffer agents" in cardiac arrest, not bicarbonate.
-Not useful or effective in hypercarbic acidosis (eg, cardiac arrest & CPR w/o intubation).

Front 93

VASOPRESSIN
(hormone)
*Can be given via endotrach tube.

-Indications

Back 93

I:
-Used as alternative pressor to epinephrine in tx of Pulseless arrest (VF, Asystole, PEA).

Front 94

VASOPRESSIN
(hormone)
*Can be given via endotrach tube.

-Dosage

Back 94

D:
-One dose of 40 U IV/IO push. May replace either 1st or 2nd epinephrine dose. Epi can be administered every 3-5 mins during cardiac arrest.

Front 95

VASOPRESSIN
(hormone)
*Can be given via endotrach tube.

-Precautions

Back 95

P: Potential peripheral vasoconstrictor. Not recommended for responsive pt's w/ CAD.

Front 96

VERAPAMIL
(Calcium-channel blocker)

-Indications

Back 96

I: Alternative drug after adenosine to terminate reentry SVT w/ narrow QRS complex & adequate BP & Preserved LV function.

Front 97

VERAPAMIL
(Calcium-channel blocker)

-Dosage

Back 97

D:
-1st dose: 2.5-5mg IV bolus over 2 mins (over 3 mins in older pt's).
-2nd dose: 5-10mg, if needed, q 15-30 mins. Max 20mg.
-Alternative: 5mg bolus q 15 mins to total of 30mg

Front 98

VERAPAMIL
(Calcium-channel blocker)

-Precautions

Back 98

P:
-Give only to pt's w/ narrow-complex reentry SVT or known supraentricular arrhythmias.
-Do not use for wise QRS tachycardias of uncertain origin, & avoid use for WPW syndrome & Afib, or 2nd or 3rd degree AV block w/o pacemaker.
-May decrease myocardial contractility & can produce peripheral vasodilation & hypotension. IV calcium may restore BP in toxic cases.
-Use w/ caution in pt's receiving oral B-blockers.