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paramedic > Rhythms and treatments > Flashcards

Rhythms and treatments Flashcards

1
Q

Atrial flutter

A

VOMIT
treatment with medication or electricity only in pts with RVR
Cardizem 0.25 mg/kg - 0.35 mg/kg
Synchronized cardioversion

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2
Q

PAC

A

treat underlying cause

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3
Q

PVC asymptomatic

A

usually no treatment

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4
Q

V fib or pulseless V tach

A 
if witnessed defibrillate 200 J biphasic
if not witnessed do 2 minutes of CPR then defibrillate 
Epi 1 mg 1:10,000
2 minutes of CPR
Defibrillate 200 J 
1st dose antidysrhythmic (amiodarone 300mg/150mg or lidocaine 1.5 mg/kg / .75/ .75 max of 3 mg/kg)
2 minutes CPR
Defibrillate 200 J 
Epi 1 mg 1:10,000
2 minutes CPR
Defibrillate 200 J 
2nd dose antidysrhythmic 
2 minutes CPR
Defibrillate 200 J 
Epi 1 mg 1:10,000
Mag sulfate 1-2 G in 100cc bag over 5-10 minutes 
2 minutes CPR
Defibrillate 200 J 
consider sodium bicarb 1 meq/kg 
If ROSC initiate FIFTH protocol
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5
Q

Amiodarone dose and action for cardiac

A

300mg second dose 150mg

antidysrhythmic, give to SVT, VT with normal QT interval, VF or VT without a pulse

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6
Q

Atropine dose and action for cardiac

A

0.5 mg every 3-5 minutes with max dose of 3 mg

increases HR in symptomatic bradycardia

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7
Q

Junctional tachycardia rhythm

A

seldom treated prehospital

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8
Q

Midazolam dose and action for cardiac

A

0.5-2.5mg

benzodiazepine, RSI

sedative drug

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9
Q

Adenosine dose and action for cardiac

A

6mg may repeat once at 12mg

antidysrythmic, slows conduction of the AV node, converts narrow complex tach to NSR

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10
Q

Accelerated junctional rhythm

A

seldom treated prehospital

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11
Q

Mag sulfate dose and action for cardiac

A

1-2 g in 100 bag over 5-20 minutes or 25-50 mg/kg with max dose or 2G IV/IO bolus

electrolyte, give for torsades or pulseless vf/vt that is refractory to amiodarone

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12
Q

Polymorphic VT or torsades des pointes

A

mag sulfate 25-50 mg/kg with max dose or 2G IV/IO bolus
if unsuccessful start TCP
if still unsuccessful give lidocaine 1.5 mg/kg may be repeated every 3-5 minutes at 0.75 mg/kg with a max of 3 mg/kg
if still unsuccessful synchronize cardiovert at 50, 100, 150, 200, 300, 360

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13
Q

Lidocaine dose and action for cardiac

A

1.5 mg/kg repeat every 3-5 at 0.75 mg/kg to a max of 3 mg

Antidysrhythmic

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14
Q

SVT

A

VOMIT
vagal maneuvers
syncronized cardioversion 50-100 Joules if unstable
If stable SVT give adenosine 6 mg (1st dose)
12 mg (2nd dose)

*consider beta blocker or calcium channel blocker

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15
Q

Epinephrine dose and action for cardiac

A

1 mg every 3-5 minutes

infusion 2-10 mcg/min

cardiac arrest, brady as alternate to dopamine.
sympathomimetic

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16
Q

Bradycardia, 2nd degree type 2 and 3rd degree

A

VOMIT
fluid challenge for symptomatic hypotension
TCP
if TCP and pt is conscious administer midazolam 0.5-2.5 mg
continuous refractory hypotension/bradycardia give dopamine infusion 5-20 mcg/kg/min or epi infusion 2-10 mcg/min

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17
Q

Stable or wide complex V tach with pulse

*remember QRS is less than .11 (or .12/3 boxes)

A

lidocaine 1.5 mg/kg may be repeated every 3-5 minutes at 0.75 mg/kg with a max of 3 mg/kg
if pt becomes unstable at any time synchronize cardiovert at 50, 100, 150, 200, 300, 360
if conscious when cardioversion is done give midazolam 0.5-2.5 mg

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18
Q

Atrial fibrillation (non symptomatic)

A

not usually treated

19
Q

Sodium bi carb dose and action for cardiac

A

1 meq/kg

used during cardiac arrest for acidosis

20
Q

PVC symptomatic or greater than 5/min

A

lidocaine 1.5 mg/kg, may be repeated every 3-5 minutes at 0.75 mg/kg with a max of 3 mg/kg
if lidocaine is successful, start lidocaine infusion

*avoid treating bigeminy and trigeminy in stable pts because it can make them bradycardic

21
Q

Symptomatic sinus brady

A

VOMIT
atropine 0.5 mg every 3-5 minutes with max dose of 3 mg
TCP
dopamine 5-20 mcg/kg/min titrate to effect
Epi infusion 2-10 mcg/min titrate to effect

22
Q

Junctional rhythm

A

treated same as sinus brady
VOMIT
fluid challenge for symptomatic hypotension
apply pacer pads
atropine 0.5-1mg repeat as needed to a max of 3mg
if atropine doesnt work initiate TCP
if TCP and pt is conscious administer midazolam 0.5-2.5mg
continuous refractory hypotension/bradycardia give dopamine infusion 5-20 mcg/kg/min or epi infusion 2-10 mcg/min

23
Q

Asystole/PEA

A

VOMIT
Hs&Ts
Epi 1:10,000 after every pulse check as needed
Sodium bicarb 1 meq/kg

24
Q

Sinus arrest

A

pacemaker

25
Q

Sinus tach

A

treat underlying cause

26
Q

Atrial fibrillation (symptomatic/RVR)

A

Treat same as a flutter
VOMIT
cardizem 0.25 mg/kg - 0.35 mg/kg
synchronized cardioversion

27
Q

Sinus brady, 1st degree, 2nd degree type 1 (wenkebach)

A

VOMIT
fluid challenge for symptomatic hypotension
apply pacer pads
atropine 0.5-1mg repeat as needed to a max of 3mg
if atropine doesnt work initiate TCP
if TCP and pt is conscious administer midazolam 0.5-2.5mg
continuous refractory hypotension/bradycardia give dopamine infusion 5-20 mcg/kg/min or epi infusion 2-10 mcg/min

28
Q

PSVT or junctional tachycardia

A

VOMIT
vagal maneuvers
adenosine 6 mg (1st dose)
adenosine 12 mg (2nd dose)
if sinus rhythm not restored give diltiazem 0.25 mg/kg
if pt becomes unstable at any time synchronize cardiovert at 50, 100, 150, then 200
if conscious when cardioversion is done give midazolam 0.5-2.5 mg

29
Q

Dopamine dose and action for cardiac

A

5-20 mcg/kg/min

2nd line drug for brady

inotropic agent increases strength of contraction

30
Q

Diltiazem/Cardizem dose and action for cardiac

A

0.25 mg/kg repeat in 15 at 0.35mg/kg

antidysrythmic, stable narrow complex tach, a fib, a flutter
relaxes blood vessels-lowers blood pressure

31
Q

H’s & T’s

A 
Hypoxia 
Hypovolemia
H+ acidosis 
Hyper/hypokalmeia
Hypothermia
Hypoglycemia

Thrombosis (cardiac & pulmonary thrombus)
Tamponade
Tension pneumothorax
Toxins (drug overdose)

32
Q

rhythms you give cartizem for

A

a flutter/ a fib rvr

psvt/junctional tach after adenosine

33
Q

rhythms you give dopamine for

A

Junctional rhythm, Sinus brady, 1st degree, 2nd degree type 1 (wenkebach) after atropine and pacing

2nd degree type 2 and 3rd degree after pacing

34
Q

rhythms you give lidocaine for

A

PVC symptomatic or greater than 5/min

Stable or wide complex V tach with pulse

Polymorphic VT or torsades des pointes after mag

35
Q

rhythms you give epi for

A

v fib/ pulseless vt

Junctional, Sinus brady, 1st degree, 2nd degree type 1 (wenkebach) alternative to dopamine after atropine and pacing

asystole/PEA

Bradycardia, 2nd degree type 2 and 3rd degree after pacing

36
Q

rhythms you give atropine for

A

Junctional, Sinus brady, 1st degree, 2nd degree type 1 (wenkebach)

37
Q

rhythms you give adenosine for

A

PSVT or junctional tachycardia

stable SVT

38
Q

rhythms you give amiodarone for

A

vf/pulseless vt

39
Q

rhythms you give mag sulfate for

A

Polymorphic VT or torsades des pointes

vf/pulseless vt after about 10 minutes

40
Q

rhythms you give sodium bicarb for

A

vf/pulseless vt consider for acidosis

41
Q

give midazolam for?

A

TCP or cardioversion

42
Q

Cardiovert for?

A

PSVT or junctional tachycardia

Atrial fibrillation/flutter (symptomatic/RVR)

unstable Stable or wide complex V tach with pulse

unstable SVT

Polymorphic VT or torsades des pointes after pacing

43
Q

TCP for?

A

Sinus brady, 1st degree, 2nd degree type 1 (wenkebach)

Junctional

Bradycardia, 2nd degree type 2 and 3rd degree

Polymorphic VT or torsades des pointes

44
Q

Cardiovert at?

A

50, 100, 150, 200, 300, 360 for most

50 - 100 for SVT

50, 100, 150, 200 for PSVT

paramedic (7 decks)

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