CFD Paramedic Course > AHA Algorhythms > Flashcards

AHA Algorhythms Flashcards

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1
Q

What AHA HR = bradycardia?

A

“Typically <50bpm”

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2
Q

What are the general steps of the Bradycardia algorithm?

A
  1. Identify/treat the cause (MOVAB = monitor/12-lead, O2, VS, Airway/access (IV/IO), breathing (assist if needed)
  2. Determine CHAAPS (Chest pn, hypotension, AMS/acute heart failure, pulm edema, shock)
  3. No CHAAPS = monitor them
  4. YES CHAAPS = atropine then transcutaneous pace or Dopamine/Epi infusion
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3
Q

What is CHAAPS

A

CHAAPS = mnemonic to determine if pt stable or not

Chest pn, hypotension, AMS/acute heart failure, Pulm edema, shock SS

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4
Q

Dosage for Atropine (max dose?)

A

First dose = 0.5mg then repeat every 3-5min

Max dose = 3mg

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5
Q

What is dosage/infusion rate for dopamine IV

A

Dose = dale’s rule (in lbs, drop last number & minus 2)

Infusion = 2-20mcg/kg per min. Titrate to effect

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6
Q

Dosage/infusion rate for IV epi (bradycardia)

A

2-10 mcg per min. Titrate to effect

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7
Q

What AHA HR = tachyARRHYTHMIA (SVT)

A

150bpm or more (SVT)

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8
Q

General steps of Tachy (SVT) algorithm

A
  1. Identify/treat underlying cause (MOVAB = monitor/12lead, O2, VS, airway/access (IV/IO), breathing)
  2. Rule out CHAAPS
  3. if no CHAAPS, differentiate wide vs narrow QRS complex SVT (<0.12s) then treat accordingly
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9
Q

Rx for tachyarrhythma (SVT) w/ CHAAPS

A

Synchronized cardioversion.

Consider: sedation or adenosine (if narrow complex SVT)

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10
Q

Rx for stable, wide complex QRS SVT

A
  1. MOVAB.
  2. Regular & monomorphic = adenosine
  3. If not working, consider MCP & antiarrhythmic infusion
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11
Q

Rx for narrow complex QRS SVT (no CHAAPS)

A
  1. MOVAB
  2. Vagal
  3. Adenosine (if regular)
  4. Consider Med control w/ Beta or Calcium channel blocker
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12
Q

You want to cardiovert your SVT pt. what initial joules for wide regular SVT vs wide irregular SVT?

A

Wide regular = 100 J

Wide irregular = no cardiovert. Defibrillation

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13
Q

You want to cardiovert your SVT pt. What initial Joules for the following:

  • Narrow regular SVT
  • Narrow Irregular SVT
A

Narrow regular SVT = 50-100J

Narrow irregular SVT = 120-200 J (biphasic), or 200 J (monophasic)

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14
Q

Biphasic vs monophasic shock pads?

A

Biphasic = current goes from one pad to the other then back

Monophasic = current goes from one pad to the other

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15
Q

For tacharrhythmias (SVT), what dose for adenosine?

A

1st = 6mg rapid IVP, follow w/ flush

2nd = 12mg if needed

3rd = 12mg ( for hospital, call MCP)

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16
Q

What Rx for stable, wide QRS complex SVT?

A

Rx = Procainamide, amiodarone, Sotalol

If unsure if SVT vs VTach. Assume Vtach and defib

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17
Q

What is Procainamide? indications & contraindications?

A

Procainamide = antiarrhythmic infusion med

Indication = stable wide QRS complex tachycardia (SVT)

Contraindication = prolonged QT or Hx CHF

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18
Q

Procainamide:

Infusion dose/rate?
Maintenance rate?
Max dose?

A

Dose/rate = 20-50mg/min

Maintenance = 1-4 mg/min

Max dose/stop = arrhythmia suppressed, pt hypotensive, QRS duration >50%, or max dose 17mg/kg given

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19
Q

What is amiodarone? When to use it?

A

Amiodarone = antiarrhythmic infusion med For stable, wide QRS tachyarrhythmia (SVT)

Also used for cardiac arrest w/ vfib or pulseless vtach

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20
Q

Amiodarone initial infusion rate? Maintenance infusion rate?

A

Initial = 150mg over 10 min. Repeat PRN if Vtach recurs. Follow w/ maintenance infusion

Maintenance infusion = 1mg/min for first 6 hours

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21
Q

What is Sotalol? What contraindications?

A

Sotalol = Antiarrhythmic infusion med for stable, wide QRS tachycardia

Contraindications = prolonged QT

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22
Q

What is the dosage for Sotalol?

A

100mg (1.5mg/kg) over 5 min

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23
Q

General steps of AHA cardiac arrest algorithm

A
  1. Start CPR (MOVAB: monitor, O2, VS, airway/access, breathing)
  2. Determine shockable rhythm
  3. NO = asystole/PEA algorhythm
  4. YES = Vfib/ pulseless Vtach algorithm
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24
Q

General steps for AHA asystole/PEA

A
  1. CPR 2min (MOVAB = monitor, O2, VS, Airway/access IV or IO, breathing) then check if rhythm shockable. Epi every 3-5min (2 cycles)
  2. YES = defib & Vfib/pVT algorithm
  3. NO = CPR & H’s and T’s. Keep checking for shockable rhythm & repeat
  4. If ROSC = do ROSC algorithm
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25
General steps for VF/pVT algorithm
1. Shock 2. CPR 2min & check if rhythm shockable (MOVAB = monitor, VS, Airway/access IV or IO, breathing) 3. No shock = Asystole or ROSC (follow appropriate algorithm) 4. YES shock = shock and repeat CPR. H’s & Ts. Epi (3-5min), amiodarone (300mg then 150mg every other cycle) * re-evaluate every 2 min
26
What are pneumonic for H’s and T’s
HERMis the homosexual, DROve to KALi to play VOLleyball = hypothermia, hydrogen (acidosis), Hyperkalemia, hypovolemia THROMBO the lesbian raises TENSION, when she TOX about her TAMPONs = thrombosis (PE or MI), tensionpneumo, toxicity (OD), tamponade (cardiac)
27
What are the Hs and Ts used for?
Reversible causes of cardiac arrest
28
What is ROSC? How do you know its happened?
ROSC = return of spontaneous circulation SS = sudden spike in ETCO2, presence of pulse & BP, spontaneous pressure waves w/ intra-arterial monitoring
29
What qualifies as an advanced airway?
ET intubation or supraglottic airway
30
Which supraglottic airway has the biggest aspiration risk?
LMAs
31
Which Adv airway is best for pulseless, apneic kids?
Supraglottics
32
How to confirm placement of adv airway?
Waveform capnography, condensation in tube, lung/epigastric sounds, EQUAL chest rise, bagging compliance
33
What are the ventilation rates for advanced airways?
1 breath every 6-8s (10 per min) w/ continuous compressions
34
Epi dose for adult vs ped cardiac arrest?
Adult = 1mg every 3-5 min Ped = 0.01mg/kg
35
Amiodarone dosage for cardiac arrest?
1st = 300mg bolus 2nd = 150mg bolus
36
What adult defibrillation energy for biphasic shock pads?
120-200 J & repeat. Call med control if you want to raise the dose
37
What shock energy setting to use when you don’t know the inital adult defib shock dose?
Give the max dose (in joules)
38
For adult defibrillation, what shock energy for monophasic shocks?
360J
39
How to assess bad chest compressions
1. Hard & fast 2. Chest recoil 3. Short interruptions between compressions (<10s) 4. Don’t Over bag pt 5. Rotate compressors every 2 min 6. Good ratio if no adv airway (30:2) 7. DBP 20mmHG or more during relaxation phase (arterial monitoring)
40
ROSC algorithm
1. VS (BP, HR, SPO2 & 12-lead) 2. fix hypotension & start infusion with whatever meds you last pushed before ROSC 3. Consider Hypothermia therapy
41
How to fix hypotension in a ROSC pt?
1. Auscultate lung sounds 2. Clear = fluid bolus then vasopressor infusion 3. Consider & fix Hs and Ts
42
You get a 12-lead following ROSC. 12-lead indicates STEMI. What do you do?
Immediate transport to Cath lab
43
What’s hypothermia therapy and how do you evaluate it?
Hypothermia therapy = keep pt CBT lower to prevent tissue infarction Evaluation: can they follow commands? Yes = ICU, no = Hypothermia therapy then ICU
44
How to ventilate a ROSC pt?
Start @ 10 breaths/min (1 every 6s) Titrate bagging rate until ETCO2 35-40mm HG Titrate FIO2 until SPO2 94% or more
45
What IV fluid bolus dose for ROSC pt w/ hypotension
1-2L normal saline or Lactated Ringers
46
What different vasopressors can you use on a ROSC pt?
Epi, NORepi, dopamine, (all of them are IV infusions)
47
Infusion rate for Epi on ROSC pt?
0.1 - 0.5mcg /kg per min (ex. 70kg or 154lb adult = 7-35mcg per min) Same dosage as NORepi
48
Norepi infusion rate for ROSC pt?
0.1-0.5 mcg/kg per min (ex. 70kg or 154lb adult = 7-35mcg per min) Same dosage as Epi
49
Dopamine infusion rate for ROSC pt
5-10mcg/kg per min
50
ACS (acute coronary syndrome) / CP algorithm
1. Monitor & ABCs 2. MONA (morphine, O2, nitro, ASA) correct order = OANM 3. 12-lead notify hospital if STEMI 4. Assess pt for clot buster criteria (fibrinolytic checklist)
51
Cut off time for CATH lab. What happens after that?
<12 hrs after initial SS onset 12 hours plus = blood thinners, unless pt super high risk/unstable
52
How to pace someone (according to dale)
1. Attach pt to pads (w/ limb leads on). 2. Press sync 3. Set rate @70 bpm 4. Slowly increase milliamps until capture 5. GIVE THEM PAIN MEDS 6. Check BP after and give vasopressor if necessary
53
How to determine if pt is hemodynamically stable (AHA)
CHAAPS = chest pain, hypotension, AMS, acute heart failure, pulmonary edema, shock SS
54
When administering cardiac meds like Epi or adenosine. What is the required IV site?
AC or higher. Adenosine biotransforms quickly
55
How to manually draw up push dose epi?
1. Take 10ml flush & waste 1 ml 2. Use blunt needle on flush & draw 1 ml of Epi 1:1000 3. Administer every min until BP is appropriate
56
What is the targeted temperature mgmt range for a pt during first 24 hours following ROSC?
32-36 C
57
How do you draw up push dose epi?
Draw 1mL epi (0.1mg/mL) from Bristol jet. discard 1mL from a 10mL flush. Add 1mL epi to the flush. Result = 0.01mg/mL epi in 10ml Push 0.5-2mL every 2-5 min
58
Can you make push dose epi from a 1mg/mL vial?
No! Concentration will be 10 fold overdose. Always take from the bristojet
59
What constitutes low dose dopamine? What action?
Low = 1-5mcg/kg/min = increase in urine output & renal perfusion
60
What constitutes medium dose dopamine. What action?
Medium = 5-15 mcg/kg/min IV = increase kidney perfusion & beta 1 actions
61
What is high dose dopamine? What action?
High = 20-50mcg/kg/min = vasoconstriction & BP
62
What drip set do you need for a dopamine infusion? How do you mix it for what concentrations?
Always 60 Gtts set (60 drops = 1mL) Mix 800mg in 500 mL NS = 1600 mcg/mL concentration
63
What is the required concentration of dopamine? How do you calculate appropriate drip rate for a pt?
Always use 1600 mcg/mL Formula: (drip rate) = (desired dose x drip set)/concentration
64
What’s the bolus dose of lidocaine?
1-1.5mg/kg IVP Repeat PRN at 1/2 the initial dose over 5-10min until max 3mg
65
What’s the IV infusion dose of lidocaine? What’s the infusion concentration?
Dose = 1-4mg using a 60 gtts set Concentration = 4mg/mL
66
What’s the infusion concentration of lidocaine? How do you mix it to get that concentration?
Concentration = 4mg/1mL Mix 2g in 500mL NS = 4mg per mL Or 4g in 1000mL NS = 4mg per mL
67
What is lidocaine used for?
Antiarrhythmic used as alternative to amiodarone for VF/pulseless VT
68
What is the lidocaine clock formula?
1mg = 15 drops/min 2mg = 30 drops/min 3mg = 45 drops/min 4mg = 60 drops/min *think: 1-2-3-4 = 15-30-45-60
69
In the 3 phase model of CPR what are the phases?
1. Electrical phase = onset of arrest to 4min 2. Circulatory phase = 4-10min 3. Metabolic phase = >10min after arrest
70
When is Mag sulfate used in regards to cardiac issues?
For torsades de pointes, refractory VF, VF w/ hx alcoholism
71
What dose for mag sulfate?
1-2g (2-4ml or a 50% solution) diluted in 10 ml D5W IVP
72
When do we typically use dopamine, besides as a vasopressor during ROSC?
It’s a second line drug after atropine in bradycardia w/ CHAP
73
What’s a good starting point for dopamine when administering it for Bradycardia? What concentration?
Start at 6 mcg/kg/min Concentration = 1600/1
74
What’s the Endotracheal dose for lidocaine?
2-4mg/kg
75
What’s the infusion rate of amiodarone following ROSC?
360mg IV over 6 hours (1mg/min) Or 540mg IV over 18 hours (0.5mg/min)
76
How is the AHA dopamine dosage different for ROSC vs bradycardia
ROSC = 5-10mcg/kg/min Bradycardia = 2-20mcg/kg/min
77
How is Epi AHA infusion dose different for ROSC vs Bradycardia
Bradycardia = 2-10mcg/min ROSC = 0.1-0.5 mcg/kg/min
78
How much drip rate lidocaine for a ROSC pt?
1mg more than the bolus dose you gave. Set drip rate accordingly.
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