Surgery and other stuff > Algorithms > Flashcards

Algorithms Flashcards

(59 cards)

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1
Q

What is the algorithm for VF/VT? (6)

A
  1. Shock
  2. CPR and establish IV access
  3. Shock if able
  4. CPR x 2 minutes + epi every 3-5 minutes
  5. Shock if able
  6. CPR + amiodarone

If develops into PEA or asystole, then CPR + Epi

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2
Q

What is the algorithm for Asystole/PEA?

A
  1. CPR x2 minutes + epi q 3-5 mins
  2. Shock if able + epi
  3. If no shock, CPR x 2 mins
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3
Q

What is the algorithm for Post cardiac arrest care?

A
  1. Optimize ventilation and oxygenation
  2. Treat hypotension
  3. If follow commands, and STEMI, then coronary reperfusion
  4. If no following of commands, then consider induced hypothermia
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4
Q

What should be done in post cardiac arrest patients who follow commands, but have are suspected of having a STEMI?

A

Admit to advanced critical care

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5
Q

What should be done if a patient has bradycardia, but has no s/sx?

A

Monitor and observe

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6
Q

What should be done if a patient has persistent bradycardia, but is having s/sx shock, AMS, HF, or CP?

A 
Atropine
or
Dopamine
or
Epi
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7
Q

What is the first dose of atropine in persistent bradycardias? Subsequent doses? Max amount?

A

First dose = 0.5 mg
Subsequent - 0.5 mg q3-5 mins
Max dose = 3 mg

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8
Q

What is the IV infusion rate of epinephrine in persistent bradycardias?

A

2-10 mcg per min. no max

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9
Q

What is the IV infusion rate of dopamine in persistent bradycardias?

A

2- 10 mcg/kg per minutes

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10
Q

What should be done if a patient is having persistent tachyarrhythmia that is causing s/sx of shock, chest pain, HF, or altered mental status?

A

Synchronized cardioversion

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11
Q

What is the Joule amount for the following tachyarrhythmias if cardioversion is indicated:

  • Narrow, regular rhythm
  • Narrow irregular
  • Wide regular
  • Wide irregular
A
  • Narrow, regular rhythm = 50-100 J
  • Narrow irregular = 120-200
  • Wide regular = 100
  • Wide irregular = Defibrillation dose (not synchronized)
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12
Q

What should be done if a patient is having persistent tachyarrhythmia that is NOT causing s/sx of shock, chest pain, HF, or altered mental status, and has a wide QRS complex?

A

Antiarrhythmic and adenosine iff regular and monomorphic

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13
Q

What should be done if a patient is having persistent tachyarrhythmia that is NOT causing s/sx of shock, chest pain, HF, or altered mental status, and has a narrow QRS complex?

A
  • Vagal maneuvers
  • Adenosine
  • Beta blocker
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14
Q

What is the first dose of adenosine in persistent tachyarrhythmias? Subsequent dose?

A

6 mg followed by 12 mg

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15
Q

What is the dose of amiodarone given for persistent, wide-QRS tachy arrhythmias? How often should this be given? What is the maintenance dose?

A
  • 150 mg over 10 minutes PRN.

- 1 mg/min for 6 hours for infusion

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16
Q

What is the dose of sotalol given for persistent, wide-QRS tachy arrhythmias? Over how long should this be given?

A

100 mg over 5 minutes

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17
Q

When should sotalol be avoided with wide complex QRS-tachyarrhythmias?

A

If prolonged QT

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18
Q

What is the goal oxygen saturation post cardiac arrest?

A

more than 94%

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19
Q

What is the goal SBP post cardiac arrest? What should be done to meet this goal if hypotensive?

A

90 mmHg

  • IV bolus
  • Vasopressors
  • Assess with EKG
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20
Q

When is coronary reperfusion indicated after cardiac arrest?

A

If there is either a STEMI or high suspicion of AMI

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21
Q

What should be done if a patient does not return to consciousness after ROSC post cardiac arrest?

A

Consider induced hypothermia, and evaluate for a STEMI

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22
Q

What should be done with a patient following ROSC post cardiac arrest if there is no suspicion of a STEMI or AMI?

A

Admit to critical care

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23
Q

What is the target PETCO2 with ROSC?

A

35-40

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24
Q

What is the timeframe for the ED assessment of a suspected MI?

Study These Flashcards
A

Less than 10 minutes

25
How fast should a CXR be obtained with a suspected MI?
10 minutes from ED arrival
26
What should be done in a STEMI patient if the time of onset is less than 12 hours?
PCI
27
What is the goal PCI time for a STEMI?
90 minutes from door
28
What is the goal fibrinolysis time for a STEMI?
30 minutes from door
29
If a pt has a STEMI, but it has been longer than 12 hours, what should be done?
- Obtain troponin - Start adjuvant therapy with platelet blockers - Admit with continued ASA, heparin, and other therapies PRN
30
What should be done with a pt with ST depression, T wave inversion, or o/w suspicious for NSTEMI or unstable angina?
- Start adjuvant therapy with platelet blockers | - Admit with continued ASA, heparin, and other therapies PRN
31
What should be done for patients who have no ST/T wave changes, and/or who are o/w low risk for ACS?
Admit with serial troponins and EKGs
32
What should be done for patients who were admitted as low risk risk for ACS, but develop elevated trop, EKG changes or other concerning findings?
- Start adjuvant therapy with platelet blockers | - Admit with continued ASA, heparin, and other therapies PRN
33
What should be done for patients who were admitted as low risk risk for ACS, but show an abnormal stress test?
-Admit with continued ASA, heparin, and other therapies PRN
34
How often should NTG be given for chest pain patients? How many doses is max?
1 dose q3-5 minutes, max 3 doses
35
What are the BP and HR contraindications for NTG use?
Less than 90 SBP or 30 below baseline -∉[50-100 bpm]
36
What is the amount of fluid given post cardiac arrest if there is hypotension?
1-2 L
37
What is the epi infusion rate for post ROSC?
0.1-.05 mcg/kg
38
What is the norepi infusion rate for post ROSC?
0.1-.05 mcg/kg
39
What is the dopamine infusion rate for post ROSC?
5-10 mcg/kg
40
What is the shock dose for monophasic shock?
360 J
41
What should be done if a patient has an ischemic stroke, but is not a candidate for fibrinolytics?
ASA and admit to ICU
42
What should be aggressively monitored when administering tPA?
BP and neuro
43
How long should anticoagulants / antiplatelets be avoided in pts who receive tPA?
24 hours
44
In a stroke, what is the timeframe for: general assessment
10 minutes
45
In a stroke, what is the timeframe for: neurological assessment
25 minutes
46
In a stroke, what is the timeframe for: Acquisition of a head CT?
25 minutes
47
In a stroke, what is the timeframe for: interpretation of a head CT?
45 minutes
48
In a stroke, what is the timeframe for: administration of fibrinolytic therapy, (timed from ED arrival)?
60 minutes
49
In a stroke, what is the timeframe for: administration of fibrinolytic therapy (timed from symptom onset)
3-4.5 hours
50
What are the three components of the cincinnati stroke scale?
Facial droop Arm drift Abnormal speech
51
True or false: any previous h/o intracranial hemorrhage is a contraindication for fibrinolytics
true
52
Arterial puncture within how many days is a contraindication to fibrinolytics?
7 days
53
What is the BP that is a contraindication for fibrinolytics?
More than 185/110
54
Platelet count below what value is a contraindication to tPA?
100000
55
Heparin received within what timeframe is a contraindication to tPA
48 hours
56
true or false: current use of an anticoagulant is a contraindication to tPA
True
57
BG under what value is a contraindication for fibrinolytics?
50 mg/dL
58
True or false: CT demonstrating a multilobar infarction is an absolute contraindication for tPA
True
59
What is the only indication for adenosine in patients who are asymptomatic and have tachyarrhythmia with a wide QRS?
If regular and monomorphic
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