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29 Cards in this Set

  • Front
  • Back
Bradycardia with pulse
"slow heart rate but you can feel a pulse"
Step 1
Support ABC's as needed
Give OXYGEN
attach monitor/defibrillator
Bradycardia with pulse
despite giving OXYGEN and attaching monitor/defibrillator
If HR < 60/min and poor perfusion start CPR
Symptomatic Bradycardia with pulse, patient on OXYGEN and CPR has begun.
Give Epinephrine IV/IO
0.01mg/kg (1:10000 0.1mL/kg)
repeat q 3-5 minutes
ET 0.1mg/kg (1:1000 .1mL/kg)
Symptomatic Bradycardia with pulse, CPR in progress, Epinephrine given but now patient has increased vagal tone or primary AV block
Atropine 0.02mg/kg may repeat dose until max 1 mg
consider cardiac pacing
Reminders for CPR
What is the rate of compressions?
6 H's and and 5 T's
rate: 100/min
6 H
Hypovolemia, Hypoxia, Hydrogen ions, Hypo/hyperkalemia
Hypoglycemia, Hypothermia
5T
Toxins, Tamponade, Tension pneumothorax, Thrombosis, Trauma
Tachycardia with pulse and Poor perfusion
*Rapid Heart Rate with pulse
Assess and support ABC
give OXYGEN
Attach Monitor/ defibrillator
Tachycardia with pulse and Poor perfusion despite OXYGEN.
NARROW QRS (<0.8 sec)
Evaluate Rhythm with 12 lead
Probable Sinus Tachycardia
Search for and treat cause
Tachycardia with pulse and Poor perfusion despite OXYGEN.
NARROW QRS (<0.8 sec)
Evaluate Rhythm with 12 lead
Probable Supraventricular Tachycardia *P waves absent
HR >220 infants
HR >180 children
Start
Vagal Maneuvers
Give adenosine may repeat x 1
or SHOCK with 0.5-1 J/kg
if repeat then 2 J/kg
If unsuccessful give amiodarone OR procainamide
Tachycardia with pulse and Poor perfusion despite OXYGEN.
WIDE QRS (>0.8 sec)
Possible Ventricular Tachycardia
Shock 0.5-1 J/kg, increase to 2 J/kg for second shock
May attempt adenosine
May consider amiodarone OR procainamide
Pulseless Arrest
BLS algorithm, Continue CPR, Give OXYGEN, attach monitor /defibrillator
Check Rhythm
Shockable or not
What are the shockable rhythms for pulseless arrest?
VFib and Vtach
Which pulseless arrest rhythms are not shockable?
Asystole and pulseless electrical activity
Treatment for Pulseless VFib / Vtach
Shock manually 2 J/kg x 1
AED > 1yo
resume CPR immediately for 5 cycles
VFIB/Vtach after 1st shock and 5 cycles of CPR
Give 2nd shock of 4 J/kg
AED >1 yo
Resume CPR and give Epinephrine repeat every 3-5 min while completing 5 cycles of CPR
Vfib/Vtach after 2nd shock and second 5 cycles of CPR and epinephrine
Give 1 shock
continue CPR
Consider Amiodarone or lidocaine and repeat 5 cycles of CPR
Asystole and pulseless electrical activity
*not shockable
Resume CPR
Give epinephrine q 3-5 min
complete 5 cycles of CPR and check rhythm
Septic Shock
(first hour)
Give Oxygen and support ventilation, establish vascular access and begin resuscitation, Get VBG /ABG, lactate, glucose, ionized calcium, cultures and CBC. Push repeated 20ml/kg isotonic fluids, correct hypoglycemia/ hypocalcemia
administer antibiotics STAT, consider STAT Vasopressor gtt and stress dose of hydrocortisone
Septic shock
Not responsive to fluids
Normotensive
Normotensive
start dopamine
Septic Shock
Not responsive to fluids
Warm Hypotension (vasodilated) shock
Hypotensive (warm vasodilated)
Begin Norepinephrine
Septic Shock
not responding to fluids
Hypotensive vasoconstricted (cold) shock
Hypotensive cold vasoconstricted shock
Begin epinephrine
Septic shock started on pressor support
Evaluate Scvo2 not at
Goal Scvo2 > 70%
Hypotensive Warm vasodilated on Norepi
Start Vasopressin and more fluids
Septic shock started on pressor support
Evaluate Scvo2 at
Goal Scvo2 > 70% but low BP
WARM SHOCK
Hypotensive Cold vasoconstricted
Septic shock started on pressor support
Evaluate Scvo2 not at
Goal Scvo2 < 70%
Normal BP/poor perfusion
Transfuse blood
Consider milrinone or nitroprusside
consider dobutamine
Septic shock started on pressor support
Evaluate Scvo2 not at
Goal Scvo2 < 70% low BP
COLD SHOCK
Transfuse blood product to HG>10
Consider EPINEPHRINE or dobutamine + norepinephrine
Define Adrenal insufficiency in terms of shock
When its fluid refractory and dopamine-or norepinephrine-dependent
Postarrest Shock
step 1
Give Fluid bolus 5-10 ml/kg
Postarrest Shock
Step 2
Measure blood pressure
Post arrest Shock
Hypotensive shock
Fluid bolus and
epinephrine and or dopamine and or norepinephrine
Post arrest Shock
Normotensive
Fluid bolus and
dobutamine and or dopamine and or low-dose epinephrine
and or inamrinone or milrinone