Bradycardia
List three possible causes of bradicardia.
hypothermia, hypoxia, medications, toxins, MI, electrolyte problem.
Arrive to a cardiac arrest, place pads and see V-tach. What do you do within first 2 minutes?
Shock! CPR for 2 minutes and gain IV/IO access.
What is the dose and route (with the max) of nitroglycerin for a patient?
0.4mg sublingual, every 3-5 minutes up to 3 doses for 1.2mg.
Consider with pulmonary edema a 0.8mg dose with SBP>160 or 1.2mg dose with SBP>200
What is your first priority when assessing a pediatric that is tachy with a pulse?
Maintain patent airway. ABCs
What is generally considered the most important and clinically significant degree of block?
3rd deg AV block. Complete heart block
What are the three drugs involved in the bradycardia algorithm?
Atropine, epi, and dopamine.
Tachyarrhythmia typically has what heart rate? What is the difference of a wide and narrow QRS? Which drug to use for wide? Narrow?
Typically, greater than or equal to 150 HR. Wide QRS is greater than or equal to 0.12 second. Wide gets amiodarone, narrow gets adenosine.
What is the half-life of adenosine?
10 seconds. It must reach the heart before it metabolizes in the bloodstream.
Synchronized cardioversion of a pedi?
1 joule/kg, then 2 joule/kg... up to 10.
The arrhythmia that is associated with MI and is responsible for absence of cardiac output.
V-Fib
Which rhythm is most likely to be associated with symptomatic bradycardia: PEA, 2nd degree type II, V-fib, or sinus rhythm?
2nd degree type II
If you synchronize cardiovert an unstable pt with VT and they get better, but then the VT recurs, what do you do next?
Cardiovert at last successful energy level and continue protocol from there.
Define what an anticholinergic is.
parasympathetic blocker
If I need to give atropine to a child, what's the dose, how many times, and the max single dose?
0.02mg/kg. Can be repeated once. Max single dose of 0.5mg.
When managing respiratory parameters of a ROSC patient, where do you want to titrate SPO2 and PaCO2 to?
SPO2 92-98% with 10 breaths a min.
PaCO2 of 35-45mmHg.
With the decision to pace, what is the rate and output, and how would you do it?
begin with a rate of 60-80 with output starting at 20mA. Increase output every 10 seconds until capture or maximal output is reached.
If you are assessing a stable patient that you see has a narrow, fast, and irregular rhythm, how much adenosine do you start with?
Fast and irregular can indicate A-fib. Do not give adenosine.
Cardiac arrest doses and amount of Lidocaine with the max.
1-1.5mg/kg IV/IO bolus. can be repeated in 5-10 mins at 0.5-0.75mg/kg. Total max of 3mg/kg
1 minute after delivering a newborn, baby HR is 88. What do you do? What is the targeted SPO2 at the 1-minute mark?
PPV, SPO2 monitor, and consider ECG monitoring. 1-minute SPO2 should at least be 60-65%
What are the 6 H's and 5 T's?
Hypovolemia, Hypoxia, Hydrogen Ions, Hypokalemia, Hyperkalemia, and Hypothermia.
Tension Pneumothorax, Tamponade, Toxins, Thrombosis Pulmonary, and Thrombosis coronary.
Pt involved in MVA, BP is 80/60, pulse 60, RR is 18, O2 is 95, pale cool clammy above waist and can't feel legs. Why is his heart rate brady? Neurogenic shock...
Lack of catecholamines. Loss of sympathetic input of spinal cord, so fight or flight is gone. No norepi to constrict vessels.
For stable wide-QRS tachycardia, what is the IV dose for procainamide?
20-50mg/min until arrhythmia improves or pt becomes hypotensive.
Explain why etomidate would be used and give the contraindication besides hypersensitivity.
Premedication for RSI, synchronized cardioversion, and conscious sedation for bone dislocation relocation. Contraindicated with labor and delivery.
If giving epi for brady, what is the pedi dose for IV/IO and which epi are you using? If route is not in place, how can epi still be given and give dose, route, and concentration.
0.01mg/kg IV/IO (0.1mL/kg of 0.1mg/mL concentration)
May be given through ET tube at 0.1mg/kg (0.1mL/kg of 1mg/mL concentration)
Pt in PEA with suspected tricyclic antidepressant overdose. What could you do and how do you do it?
Administer Sodium bicarbonate 1mEq/kg IV/IO push.