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92 Cards in this Set
- Front
- Back
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Pulseless Arrest
Initial steps |
BLS Algorithm: Call for help, give CPR
Give oxygen when available Attach monitor/defibrillator when available |
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Pulseless Arrest
What is a shockable rhythm? |
VF/VT
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Pulseless Arrest
What is not a shockable rhythm? |
Asytole/PEA
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Pulseless Arrest
What is the joules setting for a biphasic device? |
120-200 J
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Pulseless Arrest
What is the joules setting for a monophasic device? |
360 J
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Pulseless Arrest
How long should a pulse check be performed after a shock? |
A rhythm or pulse check is not performed. CPR is immediate resumed.
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Pulseless Arrest
When resuming CPR which is done first? |
Chest compressions.
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Pulseless Arrest
How many cycles of CPR are given before the next rhythm check? |
5 cycles or 2 minutes
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Pulseless Arrest
Shockable rhythm, what is the first medication given? |
Epinephrine 1 mg IV/IO
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Pulseless Arrest
How often can Epinephrine be given? |
Repeat every 3 to 5 minutes
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Pulseless Arrest
Shockable What may be given to replace first or second dose of epinephrine? |
vasopressin 40 U IV/IO
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Pulseless Arrest
Shockable What may else may be given after the second shock? |
antiarrhythmics
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Pulseless Arrest
Shockable What antiarrhythmics may be given? |
amiodarone or lidocaine or magnesium for torsades de pointes
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Pulseless Arrest
Shockable How is amiodarone given? |
300 mg IV/IO once, then consider additional 150 mg IV/IO once
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Pulseless Arrest
Shockable How is lidocaine given? |
1 to 1.5 mg/kg first dose, then 0.5 to 0.75 mg/kg IV/IO
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Pulseless Arrest
Shockable What is the maximum dose for lidocaine? |
3 doses or 3 mg/kg
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Pulseless Arrest
Shockable What is the magnesium loading dose? |
1 to 2 G IV/IO
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Pulseless Arrest
Not shockable What medications are given? |
Epinephrine
Vasopressin Atropine |
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Pulseless Arrest
Not shockable Epinephrine dose |
1 mg IV/IO may repeat every 3 to 5 minutes
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Pulseless Arrest
Not shockable What may be given in place of epinephrine |
vasopressin
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Pulseless Arrest
Not shockable How much and when is vasopressin given? |
May give 1 dose 40 U IV/IO to replace first or second dose of epinephrine
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Pulseless Arrest
Not shockable When may atropine be considered? |
For asystole or slow PEA rate
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Pulseless Arrest
Not shockable How much atropine is given? |
1 mg IV/IO.
Repeat every 3 to 5 minutes up to 3 doses) |
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What are the Hs & Ts?
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Hypovolemia
Hypoxia Hydrogen ion (acidosis) Hypo-/hyperkalemia Hypoglycemia Hypothermia Toxins Tamponade, cardiac Tension pneumothorax Thrombosis (coronary or pulmonary) Trauma |
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How many breaths are given per minute once an advanced airway is placed?
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8 to 10
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Hypovolemia
Clues from ECG and Monitor |
Narrow complex rapid rate
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Hypovolemia
Clues from History and Physical Exam |
History, flat neck veins
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Hypovolemia
Recommended Treatment |
Volume infusion
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Hypoxia
Clues from ECG and Monitor |
Slow rate (hypoxia)
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Hypoxia
Clues from History and Physical Exam |
Cyanosis, blood gases, airway problems
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Hypoxia
Recommended Treatment |
Oxygenation, ventilation
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Hydrogen ion
What is the other name? |
Acidosis
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Hydrogen ion (acidosis)
Clues from ECG and Monitor |
Smaller-amplitude QRS complexes
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Hydrogen ion (acidosis)
Clues from History and Physical Exam |
History of diabetes, bicarbonate-responsive preexisting acidosis, renal failure
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Hydrogen ion (acidosis)
Recommended Treatment |
Sodium bicarbonate, hyperventilation
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Hyperkalemia
Clues from ECG and Monitor |
Both hyper and hypokalemia cause wide-complex QRS
T waves taller and peaked P waves get smaller QRS widens Sine-wave PEA |
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Hyperkalemia
Clues from History and Physical Exam |
History of renal failure, diabetes, recent dialysis, dialysis fistulas, medications
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Hyperkalemia
Recommended Treatment |
Sodium bicarbonate
Glucose plus insulin Calcium chloride Kayexalate/sorbitol Dialysis (long term) Possibly albuterol |
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Hypokalemia
Clues form ECG and Monitor |
Both hypo and hyperkalemia cause wide-complex QRS
T waves flatten Prominent U waves QRS widens QT prolongs Wide-complex tachycardia |
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Hypokalemia
Clues form History and Physical Exam |
Abnormal loss of potassium, diuretic use
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Hypokalemia
Recommended Treatment |
Rapid but controlled infusion of potassium
Add magnesium if cardiac arrest |
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Hypothermia
Clues from ECG and Monitor |
J or Osborne waves
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Hypothermia
Clues from Hyistory and Physical exam |
History of exposure to cold, central body temperature
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Tamponade, cardiac
Clues from ECG and Monitor |
narrow complex raid rate
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Tambonade, cardiac
Clues from History and Physical exam |
History, no pulse felt with CPR, vein distension
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Tamponade, cardiac
Recommended Treatment |
pericardiocentesis
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Tension pneumothorax
Clues from ECG and Monitor |
Narrow complex slow rate (hypoxia)
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Tension pneumothorax
Clues from History and Physical exam |
History, no pulse felt with CPR, neck vein distension, tracheal deviation, unequal breath sounds, difficult to ventilate patient
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Tension pneumothorax
Recommended Treatment |
Needle decompression
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Thrombosis, heart: acute, massive MI
Clues from ECG and Monitor |
Abnormal 12-lead ECG
Q-waves ST-segment changes T waves, inversions |
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Thrombosis, heart: acute, massive MI
Clues from History and Physical exam |
History, cardiac markers
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Thrombosis, heart: acute, massive MI
Recommended Treatment |
Fibrinolytic agents; see the STEMI case
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Thrombosis, lungs; massive pulmonary embolish
Clues from ECG and Monitor |
Narrow complex rapid rate
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Thrombosis, lungs; massive pulmonary embolish
Clues from History and Physical exam |
History, no pulse felt with CPR, distended neck veins, prior positive dest for DVT or PE
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Thrombosis, lungs; massive pulmonary embolish
Recommended Treatment |
Surgical embolectomy, fibrinolytics
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Bradycardia
Symptoms |
Chest discomfort or pain
SOB Decreased LOC Weakness Fatigue Lightheadedness dizziness presyncope or syncope |
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Bradycardia
Signs |
Hypotension
Orthostatic hypotension Diaphoresis Pulmonary congestion of physical exam or chest x-ray Frank CHF or pulmonary edema Bradycardia-related (escape) - prequent premature ventricular complexes (PVCs) or VT. |
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Bradycardia
When should transcutaneous pacing be started without delay? |
Type II second-degree HB or third-degree AV block
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Bradycardia
What medications can be given while awaiting pacer? |
Atropine
Epinephrine Dopamine |
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Bradycardia
Atropine dose |
0.5 mg IV. May repeat to a total dose of 3 mg. If ineffective begin pacing
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Bradycardia
Epinephrine dose |
2 to 10 ug/min infusion while awating pacer or if pacing ineffective
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Bradycardia
Dopamine |
2 to 10 ug/kg per minute infusion while awaiting pacer or if pacing ineffective
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Tachycardia with pulses
Unstable signs |
AMS
Ongoing chest pain Hypotension or other signs of shock |
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Tachycardia with pulses
Rate-related symptoms uncommon at what rate? |
<150/min
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Tachycardia with pulses
First action if unstable |
PERFORM IMMEDIATE SYNCHRONIZED CARDIOVERSION
Establish IV access and give sedation if patient is conscious; do not delay cardioversion Consider expert consultation If pulseless arrest develops, see Pulseless Arrest Algorithm |
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Tachycardia if patient is pulseless
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Treat as VF and follow ACLS Pulseless Arrest Algorithm
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If wide-complex tachycardia and patient unstable assume what rhythm?
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Assume is is VT until proven otherwise
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Regular uniform wide-complex VT is called
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monomorphic VT
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Monomophic VT, unstable but has pulse
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Treat w synchronized cardioversion initial shock of 100 J (monophasic)
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Monomorphic VT, unstable but has pulse but first shock unsuccessful
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Increase synchronized cardioversion stepwise 200 J, 300 J, 360 J (monophasic)
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If patient has polymorphic VT and unstable, treat as
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Treat as VF with high-energy unsynchronized shocks (eg, defibrillation doses.
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If doubt whether unstable patient has monomorphic or polymorphic VT...
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Do not delay treatment for further analysis. Provide high-energy, unsynchronized shocks.
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Tachycardia with Pulses
Pt. stable. Next action and question |
Establish IV access
Obtain 12-lead ECG (when available or rhythm strip) Is QRS narrow? |
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Tachycardia with Pulses
QRS Narrow. Next question. |
Regular or Irregular
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Tachycardia with Pulses
QRS Narrow, Regular |
Attempt vagal maneuvers
Give adenosine 6 mg rapid IV push. If no conversion give 12 mg rapid IV push; may repeat 12 mg dose once. |
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Tachycardia with Pulses
QRS Narrow, Regular, after vagal maneuvers and meds converts What was the probable rhythm? |
Probable reentry SVT
Observer for recurrence Treat recurrence with adenosine or longer-acting AV nodal blocking agents (eg, diltiazem, B-blockers) |
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Tachycardia with Pulses
QRS Narrow, Regular, after vagal maneuvers and meds converts What is done next and what meds are given if recurrence? |
Observer for recurrence
Treat recurrence with adenosine or longer-acting AV nodal blocking agents (eg, diltiazem, B-blockers) |
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Tachycardia with Pulses
QRS Narrow, Regular, after vagal maneuvers and meds and does not convert. What is the probable rhythm? |
Possible atrial flutter, ectopic atrial tachycardia or junctional tachycardia
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Tachycardia with Pulses
QRS Narrow, Regular, after vagal maneuvers and meds. what meds may be given if it does not convert? |
- Control rate (eg, diltiazem, B-blockers; use B-blockers with caution in pulmonary disease or CHF)
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Tachycardia with Pulses
QRS Narrow, Regular, after vagal maneuvers and meds. Along with medications what other actions are required if it does not convert? |
Treat underlying cause
Consier expert consultation |
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Tachycardia with Pulses
QRS Narrow, Irregular What are the probable rhythms? |
Atrial fibrillation
Atrial flutter MAT (multifocal atrial tachycardia) |
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Tachycardia with Pulses
QRS Narrow, Irregular. What meds may be given? |
Control rate (eg, diltiazem, B-blockers; use B-blockers with caution in pulmonary disease or CHF.
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Tachycardia with Pulses
QRS Wide and Regular If VT or uncertain rhythm give what med? |
Amiodarone 150 mg IV over 10 min. Repeat as needed to maximum dose of 2.2 g/24 hours.
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Tachycardia with Pulses
QRS Wide and Regular If SVT with aberrancy give what med and next action? |
Adenosine and to go Tachycardia-Narrow QRS-Regular rhythm algorithm
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Tachycardia with Pulses
QRS Wide and Regular. What must patient be also prepared for? |
Elective synchronized cardioversion.
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Tachycardia with Pulses
QRS Wide and Irregular What can the rhythms be? |
Atrial fibrillation with aberrancy
Pre-excited atrial fibrillation (AF + WPW) Recurrent polymorphic VT Torsades de pointes |
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Tachycardia with Pulses
QRS Wide and Irregular. Atrial fibrillation with aberrancy |
Go to Tachycardia-Narrow-Irregular portion of algorithm.
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Tachycardia with Pulses
QRS Wide and Irregular Pre-excited atrail fibrillation (AF + WPW) What meds should be avoided? |
Avoid AV nodal blocking agents (eg, adenosine, digoxin, diltiazem, verapamil)
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Tachycardia with Pulses
QRS Wide and Irregular Pre-excited atrail fibrillation (AF + WPW) Medications to be considered. |
Consider antiarrhythmics (eg, amiodarone 150 mg IV over 10 min)
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Tachycardia with Pulses
QRS Wide and Irregular Pre-excited atrail fibrillation (AF + WPW) What else must be done besides meds. |
Expert consultation advised.
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Tachycardia with Pulses
QRS Wide and Irregular Recurrent polymorhic VT action. |
Seek expert consultation.
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Tachycardia with Pulses
QRS Wide and Irregular Torsades de pointes |
Give magnesium (load with 1-2 g over 5-60 min, then infusion)
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