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29 Cards in this Set

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Algorithm for symptomatic bradycardia
C-A-B/Determine stability
administer O2 & initiate IV
*Atropine 0.5mg IVP Q3-5min or until max 0.04mg/kg (total 3mg)
*Transcutaneous Pacing -OR-
*Dopamine 10-20mcg/kg/min (mix 400mg/250mL D5W) -OR-
*Epi drip 2-10mcg/kg/min (mix 1mg/250 D5W)
Algorithm for SVT
C-A-B & Determine stability
O2 & start IV
*Vagal maneuvers
*Adenosine 6mg (rapid) IVP, followed by 10mL NS
*Adenosine 12mg(rapid) IVP, followed by 10mL NS
*Adenosine 12mg(rapid) IVP, followed by 10mL NS
*(BB) Lopressor 5mg IVP
*(CCB) Cardizem 0.25mg/kg IV over 2 min
*If pt does not convert or becomes unstable at any time, you must ssynchronized cardiovert
***SVT as easy as ABC
Algorithm for V-tach (with pulse)
C-A-B/Determine stability
O2 & proximal IV
*Amiodarone 150mg over 10min (15mg/min)
*If needed, repeat Amidarone 150mg over 10min
*If Torsades De Points, consider magnesium sulfate 1-2 grams IVPB over 5-60min
*If pt does not convert or becomes unstable, must synchronized cardiovert
Algorithm for PEA
*Initiate CPR
*O2 (if needed)
Establish IV
*Epi 1mg IVP
*CPR (2min)
*Epi 1mg IVP
*CPR (2 min)
*Epi 1mg IVP
*Consider Sodium Bicarb 1mEq/kg
Algorithm for asystole
*Initiate CPR
*O2 (if needed)
Establish IV
*Epi 1mg IVP
*CPR (2min)
*Epi 1mg IVP
*CPR (2 min)
*Epi 1mg IVP
*Consider Sodium Bicarb 1mEq/kg
Algorithm for pulseless v-tach/v-fib
*CPR until defibrillator arrives
*Defib @360j monophasic or 200j biphasic
*CPR 2 min
*Defib @360j monophasic or 300j biphasic
<establish IV & intubate>
*Epi 1mg IVP -OR-
40units Vasopressin (1 time)
*CPR 2 min
*Defib @360j mono/bi phasic
*Amiodarone 300mg -OR-
Lidocaine 1-1.5mg/kg
*CPR 2min
*Defib @360j mono/bi phasic
*Epi 1mg IVP
*CPR 2min
*Defib @360j mono/bi phasic
*Amiodarone 150mg IVP -OR
Lidocaine (1/2 original dose)
*CPR 2min
*Defib @360j mono/bi phasic
*Epi 1mg IVP
*CPR 2 min
*Defib @360j mono/bi phasic
*consider Lidocaine 0.5-0.75mg/kg
*CPR 2 min
*Defib @360j mono/bi phasic
*Epi 1mg IVP
*CPR 2 min
*Defib @360j mono/bi phasic
***consider sodium bicarb 1mEq/kg
Algorithm for uncontrolled a-fib/a-flutter
C-A-B/Determine stability
O2 & proximal IV
**Control rate:
Lopressor 5mg IVP (beta blocker)
(use with caution if CHF or pulm disease) -OR-
Cardizem 0.25mg/kg (Ca+ channel blocker)
**If pt becomes unstable, must synchronized cardiovert
Epinepherine
1 mg IVP q3-5min

IV drip: 1mg/250mL D5W @ 2-10mcg/min

ET: 2-2 1/2 times the dose diluted in 10mL NS
Vasopressin
40 units IVP (single dose)

Lasts 10-20 min
Lidocaine
1-1.5 mg/kg IVP q 3-5 min
**Repeat at half the initial dose, so 0.5-0.75 mg/kg
++Max dose 3mg/kg

IV drip: 2 grams/250mL D5W @ 2-4 mg/min

1mg/min = 7mL/hr on the pump

ET: 2-2 1/2 the IV dose diluted with 10mL NS
Amiodarone for cardiac arrest r/t v-tach or v-fib
300mg diluted in 30 mL D5W IV bolus
Repeat 150mg in 3-5 min

Max cumulative dose of 2-2 grams IV over 24 hours
Amiodarone for (stable) wide complex tachy
Rapid infusion: 150mg/100mL D5W IV over 10min (15mg/min)
*may repeat every 10 min as needed

Slow infusion:
360mg IV over 6hrs (1mg/min)

Maintenance infusion:
540mg IV over 18 hrs (0.5mg/min)

IV drip: 900 mg/500 mL D5W
33.3 mL/hr x 6hrs (1mg/min)
17mL/hr x 18hrs (0.5mg/min)
Magnesium
Stable: 1-2 grams/100mL D5W IVPB over 5-60min

Unstable: 1-2 grams IVP
Procainamide (Pronestyl)
**antiarrythmic**

20-30 mg/min, up to 50mg/min if urgent

IV drip: 2 grams/250 mL D5W @ 2-4mg/min

max dose: 17mg/kg
Adenosine (Adenocard)
6mg over 1-3 sec IVP
Repeat 12mg x 2 every 1-2 minutes

flush with 10mL NS

Elevate the extremity
Verapamil
++calcium channel blocker++

2.5 - 5mg IVP
repeat 5-10mg in 15-30min

max 20mg

****antidote is calcium chloride
Cardizem
IV Bolus 0.25mg/kg over 2 min
Repeat bolus 0.35 mg/kg over 2min
Maintenance infusion 250mg/250mL D5W @ 5-15mg/hr
*titrate to heart rate
Tenormin
5mg IV over 5min
wait 10min, give 2nd dose
5mg IV over 5 min
Labetolol
10mg IVP over 1-2 min

may repeat or double dose every 10min to max dose of 150mg
Lopressor
initial dose:
5 mg slow IVP @ 5 min intervals to total 15mg
Nitoglycerin
0.3-0.4 mg sublingual q5min
(max 3 doses)

IV drip: 50mg/250mL D5W
titrate to effect (300mcgs)
Morphine
1-3 mg IVP, slowly, to desired effect
ASA
160-325mg PO ASAP!
Atropine
Brady: 0.5mg IVP q5 min

Max 0.04mg/kg

ET: 2- 2 1/2 the IV dose diluted in 10mL NS
Dopamine
Dopa: 1-5 mg/kg/min
Beta: 5-10 mg/kg/min
Alpha: 10-20 mg/kg/min

IV drip: 400mg/250 mL D5W
Dobutamine
IV drip: 500 - 1000 mg/ 250mL D5W @ 2-20mg/kg/min
Isuprel
IV drip: 1mg/250mL D5W @ 2-10mcg/min
Sodium Bicarb
1 mEq/kg IVP

IV drip: 200 mEq/1000mL LR
Meds that can go down an ET
Narcan
Atropine
Valium
Epi
Lidocaine

2 - 2 1/2 times the IV dose diluted in mL NS