code cards

Question 1

1. Adult cardiac arrest Vfib/Vtach
2. What drugs can we give here that we can’t in Asystole or PEA?
3. What are the dosages of the meds?
4. What are the breaths w/ advanced airway and without?
5. How many joules for defib?

Answer 1

1. Start CPR, check rhythm, shock, shock, epi 1mg q3-5 min. Treat H’s&T’s
2. Amiodarone or Lidocaine
3. epi = 1mg, amiodarone = 1st dose 300mg, 2nd dose 150mg (after 3-5min).
4. with advanced airway = 1 ventilation q6sec. (keep doing compressions).
   without advanced airway = 2 ventilations: 30 compressions
5. 120-200 joules

Question 2

1. Adult cardiac arrest Asystole/PEA:
2. Do we give amiodarone or lidocaine?

Answer 2

1. Start CPR, check rhythm, give epi asap and q3-5min thereafter, continue CPR and check pulse q2min. Treat H’s&T’s
2. no

Question 3

1. Generally, what do we do for all tachyarrythmias?
2. Tachy, CASH, and wide? If no CASH?
3. Tachy, CASH, narrow?
4. What additional meds can be given to tachyarrhythmias (if they are refractory)?
5. How many Joules do we cardiovert with? What do we sedate with, and dosage?

Answer 3

1. Maintain airway, pulse ox, Give O2 if needed, EKG, cardiac monitoring and BP, get IV access asap.
2. Consider adenosine first, but most likely synchro cardiovert. If not symptomatic, adenosine first.
3. Adenosine 6mg, 12mg, 12mg
4. Amiodarone 150mg/10min, Procainamide 20-50mg/min, or Sotalol 100mg/5min
5. 50-100 J. Morphine or versed 2-4mg

Question 4

1. What do we do generally with bradycardia <50bpm?
2. If CASH?
3. how many rounds of atropine?
4. What to do if atropine is ineffective?

Answer 4

1. ABC’s, pulse ox, O2 if needed, cardiac monitor, BP, IV access, EKG.
2. Atropine 1mg q3-5min. May jump straight to pacing if 2nd degree type 2 or 3rd degree heart block or if IV is difficult to acheive.
3. 3
4. Transcutaneous pacing, epi 2-10mcg/min titration, dopamine 5-20mcg/kg/min titrated

Question 5

1. Cardiac arrest in pregnancy. Is thing to do:
2. If fundal height is above umbilicus or we know fetus is >20 weeks:
3. If fundal height is below umbilicus or we know fetus is <20 weeks:
4. what are the reasons for Resuscitative cesarean delivery?

Answer 5

1. start cpr and check fundal height.
2. Proceed with adult cardiac arrest code card, but IVor IO needs to be above diaphragm and need emergency c-section within 5 min if no ROSC.
3. Follow normal adult cardiac arrest code card
4. No ROSC or intermittent ROSC after 2 cycles of CPR, non shockable rhythm,

Question 6

1. what to do after ROSC (9)?
2. what to do after ROSC if addt’l cardiac support is needed (3)?
3. What to do after ROSC if can’t follow commands (3)?

Answer 6

1. intubate, keep O2 94-99% and PaCO2 35-45, keep SBP >90, MAP >65, fluids, pressors, EKG, H’s and T’s
2. angio, mechanical circulatory support, cardiology consult
3. cooling, brain imaging, EEG monitoring

Question 7

1. Opioid overdose (no breaths, pulse present) and dosage of narcan:
2. Opioid overdose (no breaths, no pulse):
3. Opioid overdose (breathing & pulse present):
4. How long do we monitor after last dose of naloxone?

Answer 7

1. ensure airway, supposrt oxygenation (BVM), naloxone 0.4-2mg IV/IM/IN/SC (prioritize respiratory status over naloxone admin).
2. Initiate adult cardiac arrest code card. Admin naloxone asap
3. give naloxone
4. 4-6 hours or more if needed.

Question 8

1. What to do with stroke within 10min (9)?
2. Within 20 min?
3. Ischemic?
4. Hemorrhagic?

Answer 8

1. ABC’s, order CT, neuro screening, last known norm? IV access and labs, Blood glucose, EKG, NPO status.
2. Focused HX, complete CT, NIHSS
3. Are they eligible for Fibrinolytic (TNK) or endovascular therapy?
   TNK within 1hr of arrival.
4. stop anticoags, tx of hypertensive crisis, manage ICP, treat and prevent seizures,