Author:
amerelman
ID:
71854
Filename:
Static Cardiology
Updated:
2011-03-11 11:10:42
Tags:
Static Cardiology
Folders:

Description:
Static Cardiology
Show Answers:

  1. SVT Stable
    • BSI, Scene safe
    • ABCs
    • O2, IV, EKG

    Vagal maneuvers

    Adenosine 6 mg, 12 mg, 12 mg q 1-2 mins each followed by 20 mL flush

    • Consider:
    • Diltiazem- 0.25 mg/kg repeat in 15 mins at 0.35 mg/kg then infusion 5-15 mg/hr

    Metoprolol- 5 mg over 2-5 mins q 5 mins max 15 mg

    Amiodarone- 150 mg infusion over 10 mins repeat once after 10 mins then infusion 1 mg/min over 6 hours

    Transport and monitor
  2. SVT Unstable
    • BSI, scene safe
    • ABCs
    • O2, IV, EKG

    • Syncronized cardioversion
    • 100, 200, 300, 360j repeat prn

    Consider sedation/pain management

    Transport and monitor
  3. Atrial Fibrillation/Flutter Stable
    • BSI, scene safe
    • ABCs
    • O2, IV, EKG

    Diltiazem- 0.25 mg/kg repeat in 15 mins at 0.35 mg/kg then infusion 5-15 mg/hr

    Metoprolol- 5 mg over 2-5 mins q 5 mins max 15 mg

    Transport and monitor
  4. WPW Stable with pulse
    • BSI, scene safe
    • ABCs
    • O2, IV, EKG

    Vagal maneuvers

    Adenosine- 6 mg, 12 mg, 12 mg q 1-2 mins each followed by 20 mL flush

    Amiodarone- 150 mg infusion over 10 mins repeat once after 10 mins then infusion 1 mg/min over 6 hours

    OR

    Procainamide- 20-50 mg/min to max of 17 mg/kg or until rhythm abolished, QRS widens by 50%, hypotension. Infusion 1-4 mg/min

    Transport and monitor
  5. Monomorphic VT Stable with pulse
    • BSI, scene safe
    • ABCs
    • O2, IV, EKG

    Amiodarone- 150 mg infusion over 10 mins repeat once after 10 mins then infusion 1 mg/min over 6 hours

    OR

    Lidocaine- 1-1.5 mg/kg IV q 3-5 mins at 1/2 dose max total 3 mg/kg, infusion 1-4 mg/min

    OR

    Procainamide- 20-50 mg/min to max of 17 mg/kg or until rhythm abolished, QRS widens by 50%, hypotension. Infusion 1-4 mg/min

    Transport and monitor
  6. Monomorphic VT Unstable with pulse
    BSI, scene safe

    • ABC
    • O2, IV, EKG

    • Syncronized cardioversion
    • 100, 200, 300, 360j
    • Consider sedation/pain managmement

    Lidocaine- 1-1.5 mg/kg IV q 3-5 mins at 1/2 dose max total 3 mg/kg, infusion 1-4 mg/min

    • Amiodarone- 150 mg infusion over 10 mins repeat once after 10 mins then infusion 1 mg/min over 6
    • hours

    Mag sulfate- 1-2 grams in 50-100 mL over 5-60 mins

    Repeat cardioversion 360j prn

    Transport monitor
  7. Polymorphic VT Unstable with pulse
    • BSI
    • ABCs
    • O2, IV, EKG

    Mag sulfate- 1-2 grams in 50-100 mL over 5-60 mins


    Amiodarone- 150 mg infusion over 10 mins repeat once after 10 mins then infusion 1 mg/min over 6 hours

    Lidocaine- 1-1.5 mg/kg IV q 3-5 mins at 1/2 dose max total 3 mg/kg, infusion 1-4 mg/min

    Transport and monitor
  8. VF/Pulseless VT
    • BSI
    • ABCs

    CPR for 2 mins

    Confirm VF/pulseless VT

    Defibrilate 360j and continue CPR

    Intubate

    IV

    Evaluate rhythm after 2 mins

    • Epinephrine- 1 mg 1:10,000 q 3-5 mins
    • (consider vasopressin)

    • Lidocaine- 1-1.5 mg/kg IV q 3-5 mins at 1/2 dose max total 3 mg/kg
    • Infusion if conversion 1-4 mg/min

    Drug, shock, drug, shock pattern at 360j

    • Amiodarone- 300 mg IV repeat in 5 mins at 150 mg
    • Infusion 1 mg/min over 6 hours

    Procainamide- 20-50 mg/min to max of 17 mg/kg or conversion

    Consider H's and T's

    Transport and monitor
  9. Asystole/Bradycardic PEA
    • BSI
    • ABCs

    • CPR
    • Intubate
    • O2, IV, EKG
    • Confirm in 2 leads

    • Epinephrine- 1 mg 1:10,000 IV q 3-5 mins
    • (consider vasopressin)

    Atropine- 1 mg IV q 3-5 mins max total 0.04 mg/kg

    Consider H's and T's

    Transport or consider termination of efforts
  10. 3rd Degree AV Block Stable
    • BSI
    • ABCs
    • O2, IV, EKG

    • Attach TCP pads
    • Consider:
    • Dopamine- 2-10 mcg/kg/min
    • Epinephrine- 2-10 mcg/min

    Transport and monitor
  11. Bradycardia or 1st, 2nd, 3rd degree AV Blocks Unstable
    • BSI
    • ABCs
    • O2, IV, EKG

    • TCP starting at lowest setting increasing until electrical and mechanical capture at 70-80 bpm
    • (consider sedation/pain management)

    • Consider:
    • Dopamine- 2-10 mcg/kg/min
    • Epinephrine- 2-10 mcg/min
    • Glucagon- 2-5 mg IV/IM/SC for BB or CCB OD
    • Calcium chloride- 8-16 mg/kg IV for CCB OD

    Transport and monitor
  12. Bradycardia or 1st, 2nd degree AV blocks Stable
    • BSI
    • ABCs
    • O2, IV, EKG

    Atropine- 0.5 mg q 3-5 mins max 0.04 mg/kg

    • Consider:
    • Dopamine- 2-10 mcg/kg/min
    • Epinephrine- 2-10 mcg/min
    • Glucagon for BB OD
    • Calcium chloride for CCB OD

    Transport and monitor
  13. Chest Pain
    • BSI
    • ABCs
    • O2, IV, EKG

    Allergies?

    Aspirin 324 mg PO

    • With systolic > 90mmhg:
    • Nitroglycerin- 0.4 mg SL q 5 mins PRN
    • Morphine- 1-5 mg IV q 5 mins up to 15 mg

    • 12-lead
    • Blood draw

    • Consider:
    • Nitroglycerin drip- 10-20 mcg/min increasing by 5-10 mcg/min q 5 mins
    • Nitroglycerin paste- 1-2 inches
    • Metoprolol- 5 mg over 2-5 mins q 5 max 15 mg

    Transport and monitor
  14. CHF
    • BSI
    • ABCs
    • O2, IV, EKG

    Nitroglycerin- 0.4 mg SL q 5 x 3 (systolic >90 mmhg)

    Furosemide- 0.5-1 mg/kg IV

    • Consider:
    • CPAP
    • Morphine- 1-5 mg IV q 5 max 15 mg
    • Nitroglycerin drip- 10-20 mcg/min increasing 5-10 mcg/min q 5
    • Nitroglycerin paste- 1-2 inches
    • Dobutamine- 2-20 mcg/kg/min

    Reassess, transport and monitor
  15. Asthma
    • BSI
    • ABCs
    • O2, IV, EKG

    Albuterol- 2.5 mg via nebulizer with 8 lpm O2 prn

    Ipratropium bromide- 0.5 mg via nebulizer q 6 hours

    • Consider:
    • Methylprednisolone- 125-250 mg IV
    • Epinephrine- 0.3-0.5 mg 1:1,000 IM/SC q 15-20 mins or 0.1 mg 1:10,000 IV
    • CPAP

    Transport and monitor
  16. Anaphylaxis
    • BSI
    • ABCs
    • O2, IV, EKG

    Epinephrine- 0.3-0.5 mg 1:1,000 IM/SC q 15-20 mins if ineffective 0.1-0.5 mg 1:10,000 IV

    Albuterol- 2.5 mg via nebulizer with 8 lpm O2 prn

    Ipratropium- 0.5 mg via nebulizer q 6 hours

    Benadryl- 25-50 mg PO/IV/IM

    • Consider:
    • Methylprednisolone- 125-250 mg IV
    • Epinephrine drip- 1-4 mcg/min

    Transport and monitor
  17. Seizure (pediatric)
    • BSI
    • ABCs
    • O2, IV, EKG

    BGL check

    • If febrile:
    • Cool patient
    • Acetaminophen- 15 mg/kg PO/PR q 4-6 hours

    And/Or

    Ibruprofen- 10 mg/kg PO q 6-8 hours

    • If refractory:
    • Diazepam- 0.2 mg/kg IV (max 5 mg) or 0.5 mg/kg PR q 5 mins x 1
    • Lorazepam- 0.1 mg/kg IV/IM (max 2 mg) q 5 mins x 1
    • Midazolam- 0.1 mg/kg IV/IM (max 6 mg) q 5 mins x 1

    Transport and monitor
  18. Seizure (adult)
    • BSI
    • O2, IV, EKG

    BGL check

    • If hypoglycemic:
    • Dextrose 50%- 25 g IV
    • Glucagon- 1 mg IM/SC

    • If refractory:
    • Diazepam- 5 mg IV q 5 at 2.5 mg max total 10 mg
    • Lorazepam- 1-2 mg IV/IM q 5 max 8 mg
    • Midazolam- 1-2.5 mg IV/IM q 5 mins

    Transport and monitor