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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 |
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Bradycardia with pulse
despite giving OXYGEN and attaching monitor/defibrillator |
If HR < 60/min and poor perfusion start CPR
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Symptomatic Bradycardia with pulse, patient on OXYGEN and CPR has begun.
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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) |
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Symptomatic Bradycardia with pulse, CPR in progress, Epinephrine given but now patient has increased vagal tone or primary AV block
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Atropine 0.02mg/kg may repeat dose until max 1 mg
consider cardiac pacing |
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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 |
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Tachycardia with pulse and Poor perfusion
*Rapid Heart Rate with pulse |
Assess and support ABC
give OXYGEN Attach Monitor/ defibrillator |
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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
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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 |
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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 |
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Pulseless Arrest
BLS algorithm, Continue CPR, Give OXYGEN, attach monitor /defibrillator |
Check Rhythm
Shockable or not |
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What are the shockable rhythms for pulseless arrest?
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VFib and Vtach
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Which pulseless arrest rhythms are not shockable?
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Asystole and pulseless electrical activity
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Treatment for Pulseless VFib / Vtach
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Shock manually 2 J/kg x 1
AED > 1yo resume CPR immediately for 5 cycles |
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VFIB/Vtach after 1st shock and 5 cycles of CPR
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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 |
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Vfib/Vtach after 2nd shock and second 5 cycles of CPR and epinephrine
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Give 1 shock
continue CPR Consider Amiodarone or lidocaine and repeat 5 cycles of CPR |
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Asystole and pulseless electrical activity
*not shockable |
Resume CPR
Give epinephrine q 3-5 min complete 5 cycles of CPR and check rhythm |
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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 |
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Septic shock
Not responsive to fluids Normotensive |
Normotensive
start dopamine |
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Septic Shock
Not responsive to fluids Warm Hypotension (vasodilated) shock |
Hypotensive (warm vasodilated)
Begin Norepinephrine |
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Septic Shock
not responding to fluids Hypotensive vasoconstricted (cold) shock |
Hypotensive cold vasoconstricted shock
Begin epinephrine |
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Septic shock started on pressor support
Evaluate Scvo2 not at Goal Scvo2 > 70% |
Hypotensive Warm vasodilated on Norepi
Start Vasopressin and more fluids |
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Septic shock started on pressor support
Evaluate Scvo2 at Goal Scvo2 > 70% but low BP WARM SHOCK |
Hypotensive Cold vasoconstricted
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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 |
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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 |
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Define Adrenal insufficiency in terms of shock
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When its fluid refractory and dopamine-or norepinephrine-dependent
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Postarrest Shock
step 1 |
Give Fluid bolus 5-10 ml/kg
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Postarrest Shock
Step 2 |
Measure blood pressure
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Post arrest Shock
Hypotensive shock |
Fluid bolus and
epinephrine and or dopamine and or norepinephrine |
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Post arrest Shock
Normotensive |
Fluid bolus and
dobutamine and or dopamine and or low-dose epinephrine and or inamrinone or milrinone |