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Flashcards in Algorithms Deck (59):
1

What is the algorithm for VF/VT? (6)

1. Shock
2. CPR and establish IV access
3. Shock if able
4. CPR x 2 minutes + epi every 3-5 minutes
5. Shock if able
6. CPR + amiodarone

If develops into PEA or asystole, then CPR + Epi

2

What is the algorithm for Asystole/PEA?

1. CPR x2 minutes + epi q 3-5 mins
2. Shock if able + epi

2. If no shock, CPR x 2 mins

3

What is the algorithm for Post cardiac arrest care?

1. Optimize ventilation and oxygenation
2. Treat hypotension
3. If follow commands, and STEMI, then coronary reperfusion

3. If no following of commands, then consider induced hypothermia

4

What should be done in post cardiac arrest patients who follow commands, but have are suspected of having a STEMI?

Admit to advanced critical care

5

What should be done if a patient has bradycardia, but has no s/sx?

Monitor and observe

6

What should be done if a patient has persistent bradycardia, but is having s/sx shock, AMS, HF, or CP?

Atropine
or
Dopamine
or
Epi

7

What is the first dose of atropine in persistent bradycardias? Subsequent doses? Max amount?

First dose = 0.5 mg
Subsequent - 0.5 mg q3-5 mins
Max dose = 3 mg

8

What is the IV infusion rate of epinephrine in persistent bradycardias?

2-10 mcg per min. no max

9

What is the IV infusion rate of dopamine in persistent bradycardias?

2- 10 mcg/kg per minutes

10

What should be done if a patient is having persistent tachyarrhythmia that is causing s/sx of shock, chest pain, HF, or altered mental status?

Synchronized cardioversion

11

What is the Joule amount for the following tachyarrhythmias if cardioversion is indicated:
-Narrow, regular rhythm
-Narrow irregular
-Wide regular
-Wide irregular

-Narrow, regular rhythm = 50-100 J
-Narrow irregular = 120-200
-Wide regular = 100
-Wide irregular = Defibrillation dose (not synchronized)

12

What should be done if a patient is having persistent tachyarrhythmia that is NOT causing s/sx of shock, chest pain, HF, or altered mental status, and has a *wide* QRS complex?

Antiarrhythmic and adenosine iff regular and monomorphic

13

What should be done if a patient is having persistent tachyarrhythmia that is NOT causing s/sx of shock, chest pain, HF, or altered mental status, and has a *narrow* QRS complex?

-Vagal maneuvers
-Adenosine
-Beta blocker

14

What is the first dose of adenosine in persistent tachyarrhythmias? Subsequent dose?

6 mg followed by 12 mg

15

What is the dose of amiodarone given for persistent, wide-QRS tachy arrhythmias? How often should this be given? What is the maintenance dose?

-150 mg over 10 minutes PRN.
-1 mg/min for 6 hours for infusion

16

What is the dose of sotalol given for persistent, wide-QRS tachy arrhythmias? Over how long should this be given?

100 mg over 5 minutes

17

When should sotalol be avoided with wide complex QRS-tachyarrhythmias?

If prolonged QT

18

What is the goal oxygen saturation post cardiac arrest?

more than 94%

19

What is the goal SBP post cardiac arrest? What should be done to meet this goal if hypotensive?

90 mmHg
-IV bolus
-Vasopressors
-Assess with EKG

20

When is coronary reperfusion indicated after cardiac arrest?

If there is either a STEMI or high suspicion of AMI

21

What should be done if a patient does not return to consciousness after ROSC post cardiac arrest?

Consider induced hypothermia, and evaluate for a STEMI

22

What should be done with a patient following ROSC post cardiac arrest if there is no suspicion of a STEMI or AMI?

Admit to critical care

23

What is the target PETCO2 with ROSC?

35-40

24

What is the timeframe for the ED assessment of a suspected MI?

Less than 10 minutes

25

How fast should a CXR be obtained with a suspected MI?

10 minutes from ED arrival

26

What should be done in a STEMI patient if the time of onset is less than 12 hours?

PCI

27

What is the goal PCI time for a STEMI?

90 minutes from door

28

What is the goal fibrinolysis time for a STEMI?

30 minutes from door

29

If a pt has a STEMI, but it has been longer than 12 hours, what should be done?

-Obtain troponin
-Start adjuvant therapy with platelet blockers
-Admit with continued ASA, heparin, and other therapies PRN

30

What should be done with a pt with ST depression, T wave inversion, or o/w suspicious for NSTEMI or unstable angina?

-Start adjuvant therapy with platelet blockers
-Admit with continued ASA, heparin, and other therapies PRN

31

What should be done for patients who have no ST/T wave changes, and/or who are o/w low risk for ACS?

Admit with serial troponins and EKGs

32

What should be done for patients who were admitted as low risk risk for ACS, but develop elevated trop, EKG changes or other concerning findings?

-Start adjuvant therapy with platelet blockers
-Admit with continued ASA, heparin, and other therapies PRN

33

What should be done for patients who were admitted as low risk risk for ACS, but show an abnormal stress test?

-Admit with continued ASA, heparin, and other therapies PRN

34

How often should NTG be given for chest pain patients? How many doses is max?

1 dose q3-5 minutes, max 3 doses

35

What are the BP and HR contraindications for NTG use?

Less than 90 SBP or 30 below baseline

-∉[50-100 bpm]

36

What is the amount of fluid given post cardiac arrest if there is hypotension?

1-2 L

37

What is the epi infusion rate for post ROSC?

0.1-.05 mcg/kg

38

What is the norepi infusion rate for post ROSC?

0.1-.05 mcg/kg

39

What is the dopamine infusion rate for post ROSC?

5-10 mcg/kg

40

What is the shock dose for monophasic shock?

360 J

41

What should be done if a patient has an ischemic stroke, but is not a candidate for fibrinolytics?

ASA and admit to ICU

42

What should be aggressively monitored when administering tPA?

BP and neuro

43

How long should anticoagulants / antiplatelets be avoided in pts who receive tPA?

24 hours

44

In a stroke, what is the timeframe for: general assessment

10 minutes

45

In a stroke, what is the timeframe for: neurological assessment

25 minutes

46

In a stroke, what is the timeframe for: Acquisition of a head CT?

25 minutes

47

In a stroke, what is the timeframe for: interpretation of a head CT?

45 minutes

48

In a stroke, what is the timeframe for: administration of fibrinolytic therapy, (timed from ED arrival)?

60 minutes

49

In a stroke, what is the timeframe for: administration of fibrinolytic therapy (timed from symptom onset)

3-4.5 hours

50

What are the three components of the cincinnati stroke scale?

Facial droop
Arm drift
Abnormal speech

51

True or false: any previous h/o intracranial hemorrhage is a contraindication for fibrinolytics

true

52

Arterial puncture within how many days is a contraindication to fibrinolytics?

7 days

53

What is the BP that is a contraindication for fibrinolytics?

More than 185/110

54

Platelet count below what value is a contraindication to tPA?

100000

55

Heparin received within what timeframe is a contraindication to tPA

48 hours

56

true or false: current use of an anticoagulant is a contraindication to tPA

True

57

BG under what value is a contraindication for fibrinolytics?

50 mg/dL

58

True or false: CT demonstrating a multilobar infarction is an absolute contraindication for tPA

True

59

What is the only indication for adenosine in patients who are asymptomatic and have tachyarrhythmia with a wide QRS?

If regular and monomorphic