what is the shock energy for biphasic cardiac arrest?
120-200 J
what is the shock energy for monophasic cardiac arrest?
360 J
what is the drug therapy for cardiac arrest?
- EPI IV/IO 1 mg every 3-5 min
- vasopressin IV/IO 40 units can replace 1st or 2nd dose of EPI
- amiodarone IV/IO first dose 300 mg bolus, second dose 150 mg
how is ET tube placement confirmed?
waveform capnopgraphy
what is the RR in cardiac arrest respirations?
8-10 per minute (with continuous chest compressions)
what are the reversible causes of cardiac arrest?
- hypovolemia
- hypoxia
- hydrogen ion (acidosis)
- hypo/hyperkalemia
- hypothermia
- tension pneumothorax
- tamponade
- toxins
- thrombosis, pulmonary
- thrombosis, coronary
for ROSC oxygen saturation should be maintained at at least _____%
94%
how is hypovtension (SBP under 90) treated in ROSC?
- IV/IO bolus (1-2 L NS or LR)
- vasopressor infusion
- consider treatable causes
- 12-lead ECG
when do you consider induced hypothermia (4 degree NS) in ROSC?
if patient is not able to follow commands following treatment of oxygen saturation and hypotension
what is the dosage of vasopressor (EPI) infusion in ROSC? what about dopamine? what about NE?
- EPI: 0.1-0.5 mcg/kg per minute
- DA: 5-10 mcg/kg per minute
- NE: 0.1-0.5 mcg/kg per minute
what HR is considered bradyarrhythmia?
50 / minute or less
what are the symptoms of symptomatic bradycardia?
- hypotension
- acutely altered mental status
- signs of shock
- ischemic chest discomfort
- acute HF
what is the drug therapy (and dosages) for symptomatic bradycardia?
- atropine IV (first line): 0.5 mg bolus first dose, repeated every 3-5 minutes [max 3mg]
- transcutaneous pacing
- dopamine IV: 2-10 mcg/kg per minute
- EPI IV: 2-10 mcg per minute
what are the symptoms of symptomatic tachycardia with a pulse?
- hypotension
- acutely altered mental status
- signs of shock
- ischemic chest discomfort
- acute HF
if signs and symptoms of tachycardia with a pulse are PRESENT, what do you do?
synchronized cardioversion
- consider sedation
- if regular narrow complex, consider adenosine
if signs and symptoms of tachycardia with a pulse are ABSENT, what is the next step?
determine if there is a wide QRS (0.12 seconds or longer)
if there is a wide QRS (0.12 seconds or longer) in NON-sympomatic tachycardia with a pulse, what do you do?
- IV access and 12-lead ECG
- consider adenosine only if regular and monomorphic
- consider antiarrhythmic infusion
- consider expert consultation
if there is NOT a wide QRS (0.12 seconds or longer) in NON-sympomatic tachycardia with a pulse, what do you do?
- IV access and 12-lead ECG
- vagal maneuvers
- adenosine (if regular)
- BB or CCB
- consider expert consultation
what are the doses / details of synchronized cardioversion in symptomatic tachycardia with a pulse?
- narrow regular: 50-100 J
- narrow irregular: 120-200 J biphasic or 200 J monophasic
- wide regular: 100 J
- wide irregular: defibrillation (NOT synchronized)
what is the drug therapy / dosage for asymptomatic tachycardia with a pulse (only wide complex QRS)?
adenosine IV: first dose 6 mg rapid push followed by NS, second dose 12 mg if required
what is the antiarrhythmic drug therapy for tachycardia with a pulse (with or without wide QRS)?
- procainamide IV: 20-50 mg/min until arrhythmia suppressed, hypotension ensues, QRS duration increases 50% or more, or max dose 17mg/kg; maintenance infusion 1-4mg/kg
- amiodarone IV: first dose 150 mg over 10 min repeat PRN if VT returns; follow with maintenance infusion 1 mg/min for first 6 hrs
- sotalol IV: 100 mg (1.5mg/kg) over 5 min; avoid if prolonged QT
