Protocols Flashcards
(45 cards)
What should be attempted if the rhythm appears to be amenable in narrow complex tachycardia?
Vagal maneuvers
This applies to rhythms like ‘regular narrow SVT’.
What is the systolic blood pressure threshold for unstable patients requiring cardioversion?
Less than 100 mm Hg
Signs of hypoperfusion must also be present.
What is the initial energy setting for synchronized cardioversion in Atrial Fibrillation?
200 J
This is for patients with unstable systolic blood pressure.
What is the starting energy setting for synchronized cardioversion in Atrial Flutter?
50 J
This is the initial setting for Atrial Flutter.
What should be checked between each attempted cardioversion?
Rhythm and pulse
Monitoring is essential to assess response.
What medication is used for stable Atrial Fibrillation with a heart rate greater than 150?
Diltiazem HCL
Administered as a slow IV/IO bolus.
What is the initial bolus dose of Diltiazem for symptomatic patients?
0.25 mg/kg
Administered slowly over two minutes.
What is the re-bolus dose of Diltiazem if there is an inadequate response after 15 minutes?
0.35 mg/kg
Administered slowly over two minutes.
What are the contraindications for using Diltiazem?
- Wolff-Parkinson-White Syndrome
- Second or third degree heart block
- Sick sinus syndrome (without a ventricular pacemaker)
- Severe hypotension
- Cardiogenic shock
It’s important to avoid these conditions when administering Diltiazem.
What alternative medication can be used if the patient is already taking a Beta Blocker?
Metoprolol
This can be given as a bolus for heart rates above 150.
What is the bolus dose range for Metoprolol?
2.5-5 mg
Administered slowly over 2 minutes.
What is the maximum total dose of Metoprolol that can be administered?
15 mg
Dosing can be repeated in 5-minute intervals.
What should be done if the heart rate is less than 150 and the patient is stable but symptomatic?
Contact Medical Control
Further instructions or orders may be provided.
What additional medication may Medical Control order?
Amiodarone 150 mg
Administered slowly IV/IO over 10 minutes.
What is a caution regarding the use of IV Metoprolol?
Do not use with IV Ca Blockers
This combination can lead to adverse effects.
What should be done if a patient with Bradycardia is symptomatic?
Transcutaneous Pacing (TCP) should be initiated.
What medication can be administered while waiting for pacer set-up?
Atropine sulfate 0.5 mg IV/IO every three (3) to five (5) minutes up to a total dose of 3 mg may be considered.
What additional orders may medical control provide for Bradycardia?
Medical control may order additional doses of medications, norepinephrine infusion, dopamine, epinephrine infusion, glucagon, or calcium chloride.
What is the dopamine infusion dosage for Bradycardia?
Dopamine 2-20 mcg/kg/min IV/IO.
What is the glucagon dosage for suspected beta-blocker or calcium-channel blocker toxicity?
Glucagon 1 - 5 mg IV/IO/IM.
What is the calcium chloride dosage for suspected calcium channel blocker toxicity?
Calcium chloride 10% 20 mg/kg IV/IO administered slowly over 5 minutes to a maximum dose of 1 gram.
What is the initial dose of Epinephrine for an adult allergic reaction/anaphylaxis?
Epinephrine auto-injector 0.3mg or IM check and inject (0.3 1:1,000).
How soon can a second dose of Epinephrine be administered?
A 2nd dose may be administered in 5 minutes if necessary.
What is the dosage of Albuterol for an adult allergic reaction?
Albuterol 2.5mg via nebulizer. Repeat every 5 minutes up to 4 doses.
