AHA Algorithms Practice Flashcards by David Blackthorne

Pt has regular HR 42, complains weakness and dizziness. What Rx?

MOVAB.

Unstable bradycardia = atropine (0.5mg bolus every 3-5 min & repeat until max 3mg)

Pace if atropine doesnt work. Consider dopamine or epi infusion

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Pt has HR 48, but feels fine & A&Ox4. What Rx?

MOVAB

Monitor them. Rx only when they have CHAAPS

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Pt feels like heart is “beating out of her chest”. HR 162bpm. What initial Rx?

MOVAB (monitor, O2, airway/ IV or IO access, breathing support)

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Pt has HR 170. How to determine if they are hemodynamically stable?

CHAAPS = chest pain, hypotension, AMS, Acute heart failure, Pulmonary edema, Shock SS

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Pt has HR 180. Monitor shows wide QRS complex that appear polymorphic. What Rx?

MOVAB.

Polymorphic (irregular) wide complex SVT = possible torsades or V-fib.

Torsades = mag sulfate

Vfib = defibrillate

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Pt has HR 168 w/ regular narrow complex SVT. She appears fine. What Rx

MOVAB.

Attempt to vagal. Then adenosine.

Consider B-blocker or Ca channel blocker (w/ MCP)

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Pt has HR 177 w/ regular narrow complexes. She feels dizzy w/ palpitations. What Rx?

MOVAB

Consider adenosine. Cardiovert (50-100 J)

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Pt has HR 150 w/ irregular narrow QRS complexes. He appears pale and is hypotensive. What Rx?

MOVAB

Synchronized cardioversion @ 120-200 J w/ biphasic pads or 200 J w/ monophasic pads

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Pt w/ HR 156 w/ wide but regular complexes. BP is hypotensive. What Rx?

MOVAB

Consider adenosine if regular and monomorphic

Cardiovert @ 100 J.

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Pt w/ HR 210 w/ wide regular complexes. What Rx?

MOVAB

Adenosine if its regular and monomorphic.

consider antiarrhythmic infusions (ex. Amiodarone)

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You’ve initiated CPR on cardiac arrest pt & attach monitor w/ pads. What next?

Determine rhythm: shockable or not

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Cardiac arrest pt presents w/ shockable rhythm. What Rx?

Defibrillate & continue 2 min CPR (alternate Epi w/ amiodarone)

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You’ve started doing CPR on a pt and finally get the pads and monitor on them. Rhythm is asystole, what do you do next?

Do 2 min CPR, get IV/IO, start Epi, prep or get an adv airway/ETCO2.

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Normally you alternate between epi and amiodarone during CPR. When wouldn’t you do the amiodarone?

During asystole. It’s just repeating epi, until you get a shockable rhythm, then you start the amiodarone alternations

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How often do you check for a shockable rhythm during a cardiac arrest?

Between every 2 min cycle of CPR

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What’s the first thing you do after you get ROSC?

Get a BP and a pulse. Then a 12 lead

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You’ve gotten ROSC on a pt and their BP is 88/62. What do you do?

Listen to lung sounds. If they’re dry, fluids and then vasopressors. If they’re wet, only vasopressor infusion (epi, norepi, dopamine)

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You’ve got a ROSC on a pt with good BP. What’s next?

Get a 12 lead to rule out a STEMI or AMI, if they have it, CATH lab for coronary reperfusion.

Set up IV infusion with whatever medication converted them to ROSC

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You’ve got a pt complaining of chest pain what are the general steps you must take?

MOVAB = monitor/12-lead, O2 if needed, Airway, breathing
MONA= aspirin, O2 if needed, Nitro, and morphine if needed
Use 12 lead to rule out STEMI
If STEMI, notify ER in advance: tell them time of onset
Check if they qualify for clot busting treatment

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Your pt is in unstable condition DT SVT (narrow & regular). The rate is too fast to determine the rhythm. What can you do to better assess the rhythm?

Give adenosine while printing another ECG; the medication will slow the rhythm down long enough to determine indications for cardioversion.

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Pt complains of dizziness & syncope. Monitor shows 3rd degree Heart block w/ rate 42. What Rx?

MOVAB.

Atropine ineffective. Choose one of the following: dopamine infusion, epi infusion, Transcutaneous pacing.

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Your partner wants to push atropine on a 48 YOF but forgot the dose. What is it?

First dose = 0.5mg bolus & repeat every 3-5min until max dose 3mg

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You have an unstable bradycardic pt and MCP orders a dopamine IV infusion. What is the dosage?

2-20mcg/kg per min. Titrate to effect.

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You have an unstable bradycardic pt and MCP orders Epi IV infusion. What is the dosage/rate?

2-10 mcg/min. Titrate to effect.

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Pt has HR 224 and appears cool pale diaphoretic w/ lethargy. What Rx?

Unstable SVT = cardiovert. Consider adenosine if narrow regular complex

Pt appears stable with HR 195 with wide QRS complexes. What Rx?

If complexes are regular and monomorphic, consider adenosine. - consider antiarrhythmic infusion

Pt has HR 179 w/ narrow complex SVT. What Rx?

Vagal - adenosine if regular - MCP consider beta blocker or calcium channel blocker

You print a 12 lead ECG on a pt w/ HR 160. How do you know if its wide or narrow complex SVT?

If the QRS complex is 3 or more little boxes = wide

You have a stable pt w/ wide complex SVT and decide to give amiodarone. What dosage?

First dose 150mg over 10 min. Repeat PRN if VT recurs. Follow w/ maintenance infusion of 1mg/min for first 6 hours.

MCP orders you to give Sotalol to your SVT pt. What is the dosage?

100mg (1.5mg/kg) over 5 min. Don’t give if prolonged QT

You have a pt in stable condition w/ wide complex SVT. Your drug bag is missing amiodarone and Sotalol. What other drug could you use? What dosage?

Procainamide IV @ 20-50 mg/min until… - arhythmia is fixed - Hypotension - QRS duration increases >50% - max dose 17mg/kg given Maintenance infusion @ 1-4mg/min. Contraindication = prolonged QT or CHF

Your pt has HR 188 and is altered & lethargic. Monitor displays narrow regular rhythms. You decide to synchronized cardiovert at what joules?

50-100 J (narrow regular)

Your pt has HR 222 and is hypotensive. Monitor displays narrow irregular rhythms. You decide to synchronized cardiovert at what joules?

Biphasic pads = 120-200 J Monophasic pads = 200J

Your pt has HR 168 and is complaining of chest pain. Monitor displays wide regular rhythms. You decide to synchronized cardiovert at what joules?

100 J = wide regular

Your pt has HR 196 and is altered. Monitor displays wide irregular rhythms. You decide to synchronized cardiovert at what joules?

No cardioversion. Use defib

60 YOM found unconscious on ground apneic & pulses. What initial Rx?

Check pulse & breathing <10s, begin compressions 2w/ BVM immediately. Attach defib pads asap.

You begin Compressions on a 35 YOF cardiac arrest. After attaching monitor you identify Vtach. What Rx?

Defibrillate immediately @ 120-200J (for biphasic pads) or 360J (monophasic pads)

Your partner has been doing compressions > 2 min. What VS on monitor would indicate his quality of compressions?

ETCO2 (<10mm HG = bad quality)

On a Cardiac arrest, you identify the initial rhythm being PEA. What Rx next?

Continue compressions 2min + Epi 1mg IVP. Consider Hs & Ts

You’ve done 8 min of CPR on pt that has been in asystole. Suddenly you note a change in rhythm to vfib. What Rx next?

Defibrillate (120-200 J biphasic or 360 J monophasic) and resume immediate compressions w/ amiodarone (300mg initial dose).

Your paramedic partner is directing the code. After 2 min CPR, he pushes Epi, checks for a pulse, and checks the monitor (vfib) before charging and defibrillating. Is this sequence effective or not.

Ineffective. compressions interrupted >10s. 1. Charge the pads 15s & confirm pulse placement prior to stopping Compressions 2. Then stop CPR & simultaneously check pulse & rhythm before defibrillating immediately 3. Resume compressions & push epi or amiodarone after. * this way interrupts compressions <2s

You & EMT are performing CPR on adult pt. You are bagging w/ basic OPA in place. EMT says its fine to compress & bag simultaneously. Is this correct?

No. Simultaneous compression only when adv airway in place. 30:2 ratio for adults critical w/ basic adjuncts.

During CPR, you successfully visualize passage of ETT past vocal cords. What next?

Note teeth measurement & attach ETCO2 for confirmation. Never let go of tube until it is fully secured.

Your team has been working a cardiac arrest for 10 min now. The team leader verbalizes the need to consider Hs and Ts. What are the Ts?

*think: thrombo the lesbian raises Tension when she tox about her tampons* Thrombosis (cardiac or pulmonary), tension pneumo, toxicity, tamponade (pericardial)

Your team has been working a cardiac arrest for 10 min now. The team leader verbalizes the need to consider Hs and Ts. What are the Hs?

*think: HERMIs the homosexual DROve to KALI to play VOLIball* Hypothermia, hydrogen (acidosis), hyper/hypokalemia, hypovolemia

What increase in ETCO2 indicates ROSC?

Sudden spike > or equal to 40mm Hg

Your team has been working a cardiac arrest for 10 min now and notice a spike in pt’s ETCO2 to 55mm HG. What to do next?

Complete the 2 min of CPR!! (Heart needs help after ROSC) Then check pulse & BP & initial ROSC protocol

Your pt has achieved ROSC following administration of Epi. You know that you must maintain SPO2 & BP as part of ROSC protocol. What levels for each?

SPO2 94%, BP systolic >90mm HG

Your ROSC pt has BP 72/45. What to do next?

Check for lung sounds & give IV/IO bolus (1-2L NS) if they are clear

You want to give your hypotensive ROSC pt IV fluids to increase their BP, but note diffuse crackles in lungs. What do you do?

Vasopressor infusion (epi, norepi, or dopamine) & consider Hs & Ts.

MCP orders Dopamine infusion for your ROSC pt. What rate & dose?

5-10mcg/kg/min

MCP orders Epi infusion for your ROSC pt following ROSC. What dose/rate?

0.1-0.5mcg/kg/min

After achieving ROSC, you successful maintain your pt’s BP & SPO2. What next?

1. Get a 12-lead to rule out STEMI. | 2. Assess if pt can follow commands. (Targeted temperature mgmt)

You have found that your ROSC pt is unable to follow commands. What temperature range is required for target temperature MGMT?

32-36C

You remember the acronym “MONA” during a Chest Pn call. What is it and what is the correct order.

MONA = morphine, o2, nitro, ASA. Correct order = O2, ASA, Nitro & morphine (if nitro doesn’t help pain)

What happens to a ROSC pt that shows a 12-lead w/ STEMI or high AMI suspicion?

They go immediately to the CATH lab

Your pt in stable, wide complex SVT weighs 100kg. What’s the IV dosage of Sotalol for him?

Sotalol = 1.5mg/kg over 5 min = (1.5 x 100kg) = 150mg over 5min

You’ve given an initial dose of 150 mg amiodarone over 10 min to a pt in stable, wide complex SVT. What is the maintenance infusion rate for her?

Continue with 1mg/min for first 6 hours

Your symptomatic bradycardic pt was given the max dose of atropine. You’ve decided to try a dopamine infusion. What rate if pt weights 50kg?

Start at 6mcgs/kg/min at 1600/1 concentration = (400mcgs/min x 60 drops/mL) 1600mcg/mL = 15 drops/min

You want to start a dopamine drop for a ROSC pt and know that your medic unit only carries 500ml bags. How do you mix it?

Take 800 mg and mix w/ 500mL NS to get concentration 1600mcg/1mL

Your pt is in torsades on the monitor. What medication & what dosage?

Mag sulfate 1-2g (2-4mL of 50% solution) diluted in 10 mL D5W IVP.

You’ve converted a pt into ROSC following an amiodarone administration. What infusion setup afterwards?

2 options: 360mg IV over 6 hr (1mg/min) Or 540mg IV over 18 hours (0.5mg/min)

You’ve converted a 100kg pt from VF to ROSC following epi administration. What’s the Epi drip rate for her during ROSC?

Rate = 0.1-0.5mcg/kg/min 10-50mcg/min

You’ve achieved ROSC on a pt and want to set up a norepi drip. What’s the rate if she weighs 70kg?

0.1-0.5mcg/kg/min = 7-35mcg/min Rate = (7mcg/min x 60 drops/mL) / 0.1mg/mL = 4200 drops / min?