Cardiac/Circulation Directives Flashcards
(162 cards)
1
Q
Medical Cardiac Arrest Indications
A
non-traumatic cardiac arrest
2
Q
Epinephrine MCA Conditions
A
Age >/= 30
LOA altered
If Anaphylaxis suspected as causative event consider IM
3
Q
Amiodarone MCA conditions
A
> /= 30 days
Altered
VF or pulseless VT
4
Q
Lidocaine MCA Conditions
A
Age >/= 30 days
Altered
VF or Pulseless VT where amiodarone not available
5
Q
Fluid Bolus MCA
A
> /= 30 days
Altered
PEA
Rhythm where hypovolemia suspected
6
Q
Epinephrine Contraindications MCA
A
Allergy
7
Q
Amiodarone MCA Contraindications
A
Allergy
8
Q
Lidocaine MCA contraindications
A
Allergy
Use/availability of amiodarone
9
Q
Fluid Bolus MCA contraindications
A
Fluid overload
10
Q
Manual Defibrillation adult cut off
A
8 years
11
Q
Manual defibrillation initial dose peds
A
2J/kg
12
Q
Manual defib subsequent doses peds
A
4J/kg
13
Q
Epinephrine Non anaphylaxis MCA >/=12 yo Dose IV/IO/CVAD
A
1mg
14
Q
Epinephrine MCA Dosing interval
A
4 min
15
Q
Max # doses Epinephrine MCA
A
N/A
16
Q
Epinephrine >/= 12 MCA ETT Dose
A
2 mg
17
Q
Epinephrine >30 <12 dose IV
A
0.01mg/kg
18
Q
Epinephrine >30 <12 dose ETT
A
0.1mg/kg to max 2mg
19
Q
Epinephrine concentration ETT >30 <12
A
1:1,000
20
Q
Epinephrine Min Single Dose >30 <12 MCA IV
A
0.1mg
21
Q
Epinephrine min single dose ETT MCA
A
1 mg
22
Q
Amiodarone >30 <12 Initial dose MCA
A
5mg/kg
23
Q
Amiodarone >12 initial dose MCA
A
300mg
24
Q
Amiodarone >30 <12 max initial dose MCA
A
300mg
25
Amiodarone >30 <12 subsequent dose MCA
5mg/kg to max of 150 mg
26
Amiodarone >12 max repeat dose MCA
150mg
27
Dosing interval Amiodarone MCA
4 min
28
Max # doses Amiodarone MCA
2
29
Lidocaine MCA >30 <12 IV dose
1mg/kg
30
Lidocaine ETT >30 <12 dose MCA
2mg/kg
31
Lidocaine >/= 12 IV dose MCA
1.5mg/kg
32
Lidocaine >/= 12 ETT dose MCA
3 mg/kg
33
Lidocaine dosing interval MCA
4 min
34
Max # doses lidocaine MCA
2
35
Fluid Bolus MCA
20mL/kg
36
Fluid Bolus MCA >30 <12 reassess
100mL
37
Max Volume Fluid Bolus MCA
2000mL
38
Reassess >/=12 Bolus MCA
250mL
39
Patch Point MCA
Following 3rd round of epinephrine
After 3rd analysis if no access
40
BHP Patch failure
Transport after 4th epi or interpretation if no access
41
Transport after 1st analysis
Pregnancy >/= 20 weeks
Hypothermia
Airway obstruction
Suspected PE
Medication overdose/toxicology
Other known reversible cause
42
Trauma TOR Conditions
Age >/= 16
Altered
No palpable pulse, no defibrillation, monitored HR = 0 or HR >0 and closes ED >/= 30 min away
43
FBAO VSA post removal of object
Treat as medical cardiac arrest
44
ROSC Fluid Bolus Conditions
Hypotension
Chest auscultation clear
45
Dopamine ROSC conditions
>/= 8 yo
Hypotension
46
Fluid Bolus ROSC contraindications
Fluid overload
47
Dopamine ROSC contraindications
Allergy
Tachydysrhythmias excluding sinus tachycardia
Mechanical shock
Hypovolemia
Pheochromocytoma
48
Oxygen + ETCO2 ROSc
94-98% spO2
30-40mmHg ETCO2
49
Fluid Bolus ROSC infusion
10mL/kg
50
ROSC <12 Reassess Bolus
100mL
51
ROSC >12 Reassess
250mL
52
Max volume Bolus ROSC
1000mL
53
Dopamine Initial infusion rate
5mcg/kg/min
54
Titration increment dopamine
5mcg/kg/min
55
Titration interval dopamine
5 min
56
Max infusion rate dopamine
20mcg/kg/min
57
Goal SBP of dopamine titration
>/= 90 to <110mmHg
58
Discontinuing dopamine
Do over 5-10 min
59
ASA Conditions
>/= 18
Unaltered
Able to chew and swallow
60
Nitro Conditions Ischemia
>/= 18
Unaltered
HR 60-159bpm
Normotensive
Prior history or IV access
61
Morphine Conditions
>/= 18
Unaltered
Normotensive
Severe pain
62
Contraindications ASA
Allergy to NSAIDs
Asthmatic without prior use
Current bleeding
CVA or TBI in previous 24hrs
63
Nitroglycerin Contraindication Ischemia
Allergy
Phosphodiesterase inhibitor use within previous 48 hours
SBP drops 1/3 or more after administration
RVMI
64
Morphine contraindications
Allergy
SBP drops by more than 1/3
65
ASA Dose
160-162mg x 1
66
Nitro Dose Ischemia
0.3 or 0.4 mg
67
Dosing interval Nitro
5 min
68
Max # doses Nitro No STEMI
6
69
Max # doses Nitro STEMI
3
70
Morphine when to administer with ischemia
after 3rd dose of nitro or if nitro contraindicated
71
Dose morphine
2mg
72
Dosing interval morphine
5 min
73
Max # doses morphine
5
74
ACPE Indications
Moderate to severe respiratory distress
Suspected ACPE
75
Nitroglycerin ACPE Conditions
>/= 18
HR 60-159
Normotensive
76
Nitro ACPE Contraindications
Allergy
Phosphodiesterase use in last 48 hours
SBP drops 1/3 or more
77
SBP >100 <140 nitro ACPE dose
0.4mg
78
SBP >140 no IV or HX Dose Nitro ACPE
0.4
79
SBP >140 IV/Hx Nitro Dose ACPE
0.8
80
Max # doses nitro ACPE
6
81
Cardiogenic Shock Indications
STEMI
Cardiogenic shock
82
Fluid Bolus Cardiogenic Shock Indications
>/= 18
Hypotension
Chest auscultation clear
83
Dopamine cariogenic shock indications
>/= 18
Hypotension
84
Fluid Bolus Cardiogenic Shock Contraindications
Fluid overload
SBP >/= 90
85
Dopamine Contraindications Cardiogenic Shock
Allergy
Tachydysrhythmia excluding sinus tachycardia
Mechanical shock
Hypovolemia
Pheochromocytoma
86
Fluid Bolus Cardiogenic shock infusion
10mL/kg
87
Fluid bolus Cardiogenic shock reassess
250mL
88
Fluid bolus max volume cardiogenic shock
1000mL
89
Dopamine Cardiogenic Shock initial
5mcg/kg/min
90
Dopamine Cardiogenic shock titration increment
5mcg/kg/min
91
Dopamine Cardiogenic shock titration interval
5 min
92
Dopamine cardiogenic shock max infusion rate
20mcg/kg/min
93
Cardiogenic Shock BHP
If pt bradycardic
94
Symptomatic Bradycardia Indications
Bradycardia
Hemodynamic instability
95
Atropine Conditions
>/=18
HR <50
Hypotension
96
Transcutaneous Pacing Conditions
>/=18
HR <50
Hypotension
97
Dopamine Bradycardia Conditions
>/= 18
HR <50
Hypotensive
98
Atropine Contraindications
Allergy
Hypothermia
History of heart transplant
99
Transcutaneous pacing Contraindications
Hypothermia
100
Dopamine Bradycardia directives
Allergy
Mechanical shock
Pheochromocytoma
101
Atropine Dose
1mg
102
Atropine Dosing interval
5min
103
Atropine # doses
2
104
Dopamine Brady Treatment
5mcg/kg/min, increased 5 mcg/kg/min q 5 min to max of 20mcg/kg/min
105
Valsalva Maneuver Conditions
>/= 18
Unaltered
HR >/= 150
Normotensive
Narrow complex and regular
106
Adenosine Conditions
>/=18
Unaltered
HR >/= 150
Normotensive
Narrow complex and regular
107
Amiodarone Tachy Conditions
>/= 18
Unaltered
HR >/= 120
Normotensive
Wide complex and regular
108
Lidocaine Tachy Conditions
>/= 18
Unaltered
HR >/= 120
Normotensive
Wide and regular
109
Cardioversion Conditions
>/= 18
HR >/= 120 (wide) or >/= 150 (narrow)
Hypotensive
Altered mental status, chest pain, signs of shock
110
Valsalva Contraindications
Sinus tach or atrial fibrillation or atrial flutter
111
Adenosine Contraindications
Allergy
Sinus tachycardia or atrial fibrillation or atrial flutter
Pt taking dipyridamole or carbamazepine
Bronchoconstriction on exam
112
Amiodarone tachy contraindications
Allergy
113
Lidocaine tachy contraindications
Allergy
114
Cardioversion contraindications
N/A
115
Valsalva Treatment
2 attempts lasting 10-20s
116
BHP Patch tachydysrhythmia
For amiodarone or lidocaine or if monomorphic wide complex regular rhythm for adenosine
For cardio version
117
Adenosine initial dose
6 mg
118
Adenosine 2nd dose
12 mg
119
Adenosine dosing interval
2 min
120
Adenosine max # doses
2
121
Amiodarone tachy initial dose
150mg
122
Amiodarone tachy subsequent dose
150mg
123
Amiodarone dosing interval tachy
10 min through IV infusion
124
Amiodarone # doses tachy
2
125
Lidocaine tachy initial dose
1.5mg/kg
126
Lidocaine tachy subsequent dose
0.75mg/kg
127
Lidocaine tachy max single dose
150mg
128
Lidocaine tachy dosing interval
10 min
129
Lidocaine max # doses tachy
3
130
of cardioversion
3
131
Joule settings cardioversion
100, 200, maximum
132
Indications Hyperkalemia
Suspected hyperkalemia in patients at high risk and Cardiac arrest or prearrest + 12 lead suggesting hyperk
133
Patients at high risk of hyperkalemia
Currently on dialysis
History of end-stage renal disease
Relevant incident history (prolonged crush)
134
Calcium Gluconate Conditions
>/=18
135
Salbutamol Conditions
>/= 18
136
Contraindications calcium gluconate
N/A
137
Salbutamol Contraindications
Allergy
138
Calcium Gluconate Dose
1g (10mL) over 2-3 minutes
139
Max single dose calcium gluconate
1g (10mL)
140
Dosing interval calcium gluconate
5 minutes
141
Max # doses calcium gluconate
2. Additional 3rd dose after 30min if symptoms recur
142
Salbutamol MDI Dose
1600mcg
143
Salbutamol # doses
2
144
Salbutamol NEB dose
10mg
145
Pre-arrest pt for hyperk
Hypotension
Altered
Symptomatic bradycardia
146
12 lead changes of hyperk
wide and bizarre QRS (>/= 120)
Peaked T waves
Loss of P waves
QRS sine wave
147
IV Indications
Acute or potential need for IV medication or fluid therapy
148
IV cannulation conditions
N/A
149
Fluid Bolus IV conditions
Hypotension
150
IV cannulation contraindications
Fracture proximal to access site
151
Fluid bolus IV contraindications
Fluid overload
152
TKVO <12
15mL/hr
153
TKVO >/=12
30-60mL/kg
154
Bolus IV infusion
20mL/kg
155
Reassess <12 bolus IV
100mL
156
Reassess bolus >/=12 IV
250mL
157
Max volume Bolus IV
2000mL
158
IO Indications
Acute or potential need for IV med or fluid therapy
IV unobtainable
Cardiac arrest or pre-arrest
159
IO Conditions
>/=12
160
IO Contraindications
Fracture or crush injury proximal to access site
Suspected/known replacement/prostheses immediately proximal to the access site
161
Paediatric IO Condtions
Age <12
162
Ped IO site
Proximal Tibia
