in cardiac arrest when do you first introduce medical intervention? which drug? - answer
after 2 rounds of CPR/shock
after 2nd shock give 1 mg epinephrine every 3-5 minutes
when do you introduce amiodarone during cardiac arrest? - answer after the 3rd shock
give 300 mg bolus of amiodarone
if second dose is needed give 150mg as second dose
what rhythms are shockable in cardiac arrest – answer VF
VT
what rhythms are not shockable in cardiac arrest – answer asystole
PEA
if you are in an unshockable rhythm arrest when do you give epi - answer1mg epi every
3-5 minutes after 1st round of CPR
what do you do after return of spontaneous circulation - answer maintain O2 sat at 94%
treat hypotension (fluids vasopressor)
12 lead EKG
if in coma consider hypothermia
if not in coma and ekg shows STEMI or AMI consider re-perfusion
what are the 5 h's and 5 t's - answerhypovolemia
hypoxia
hydrogen ion (acidosis)
hypo/hyperkalemia
hypothermia
how do you treat non-symptomatic bradycardia - answermonitor and observe
what constitutes symptomatic bradycardia - answerhypotension
altered mental status
signs of shock
chest pain
, acute heart failure
how do you treat symptomatic bradycardia - answer1. give 0.5mg atropine every 3-5
mins to max of 3mg
if that doesn't work try one of the following:
transcutaneous pacing
2-10mcg/kg / minute dopamine infusion
2-10mcg/minute epinephrine infusion
what is considered a tachycardia requiring treatment - answerover 150 per minute
when do you consider cardioversion - answerif persistent tachycardia is causing:
hypotension
altered mental status
signs of shock
chest pain
acute heart failure
if persistent tachycardia does not present with symptoms what do you need to consider
- answerwide QRS?
greater than 0.12 seconds
If persistent tachycardia without symptoms DOES have a wide QRS what to do you do?
- answerIV access and 12 lead if available
6mg adenosine followed by NS flush only IF regular and monomorphic
consider anti-arrhythmic infusion:
- 20-50mg/min procainamide (max 17mg/kg)
- 150mg amiodarone over 10 minutes
- 100mg sotalol over 5 minutes
which anti-arrhythmic drugs can be used if prolonged QT - answeronly amiodarone
150mg over 10 minutes, repeat if VT occurs
follow by maintenance infusion 1mg/min for first 6 hours
if persistent tachycardia without symptoms and without wide QRS what do you do -
answerIV access and 12 lead EKG if available
vagal maneuvers
6mg adenosine followed by NS flush only IF regular
Beta blocker or calcium channel blocker
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