Ref. No. 1210
Cardiac Arrest
Cardiac Arrest
What is the preferred advanced airway in cardiac arrest?
King LT
What two contraindications for nitroglycerin are noted in Ref. No. 1211?
- SBP < 100 mmHg
- use of sexually enhanced medications within 48 hrs
What is the dividing number between sinus tachycardia and SVT?
Sinus tach <150
SVT >/= 150
CPAP should be initiated for?
alert patients with moderate or severe respiratory distress and SBP >/= 90
pulmonary edema
** reassess every 250mL for pulmonary edema and changes in the pt
Name possible reversible causes of cardiac arrest? (H’s and T’s)
Hyperkalemia/hypokalemia
Hypovolemia
Hypoglycemia
Hypoxia
Hydrogen ion excess (acidosis)
Hypothermia
Tension Pneumothorax
Tamponade (pericardial)
Toxicosis
Thrombosis (pulmonary embolus)
Thrombosis (coronary embolus/ MI)
When must you notify the closest STEMI receiving center (SRC) if STEMI is noted?
- as soon as the STEMI is identified
- attempt to have initial vital signs as well
When must base contact be made for synchronized cardioversion and TCP?
concurrent(at the same time) with initial cardioversion and TCP
Fowlers or Semi-fowlers
- high flow 02 15L/m regardless of SpO2
- position in supine if respiratory status allows
- keep warm (blanket)
You have achieved ROSC and the blood pressure returned at 80 systolic. Describe the steps taken to titrate to 90 systolic or above.
-NS 1L IV/IO rapid infusion
if there is no response/improvement after 250mL use push dose epi
-push dose epi: mix 9mL of NS with 1mL of 1:10,000 epi in a 10mL syringe
-give 1ml every 1-5 minutes PRN >90 SBP
- base contact concurrent with initial dose
What is the dose for Ondansetron, indications, and contraindications?
-4mg ODT/IV/IM
- N/V and prior to administration or morphine/fentanyl
-hypersensitivity and pregnancy regardless of gestational age
What are the initial joules setting for synchronized cardioversion and what are the escalating doses followed?
- 120, 150, 200 joules
Name 3 conditions when albuterol is the first line tx?
- bronchospasms/ wheezing
- COPD exacerbation
- asthma exacerbation
** may be used in conjunction with CPAP
** wheezing may be caused by pulmonary edema
An IO may be placed in patients with hypotension and clinical evidence of poor perfusion after how many attempts of peripheral venous access?
2 attempts
What is the max total dose of epinephrine(1;10:000) given prior to base contact and why? (Applies to VFIB/PVT and ASY/PEA)
-3mg
-Epi improves outcomes if given early with chest compressions, but can worsen outcomes early in shockable rhythms
-the likelihood of meaningful survival after three doses declines
Which medication is the most important for patients with acute myocardial infarction to improve outcomes?
-Aspirin; should be administered as soon as possible unless contraindicated
- administer aspirin even if the patient already took aspirin at home or are prescribed anticoagulant medications
What is your initial dose, MAX dose, and how often may you repeat midazolam prior to base contact?
- 2mg sIV/sIO/IM/IN
-6mg max
-may repeat every 5 min prn
According to Ref. No. 1237, when should base contact be made?
- respiratory failure
- severe respiratory distress unresponsive or not amenable (responsive) to CPAP
What medication is given and the dose for IO placement in alert patients?
Lidocaine 2% 40mg sIO; may repeat once at half the initial dose
According to ref. No. 1210, What two medications are given for patients with renal failure or suspected hyperkalemia? (Include dosage and interactions between both drugs)
- calcium chloride 1gm
- sodium bicarbonate 50 mEq
- create a chalky precipitate (solid form from a solution)
In which patient should we withhold or consider withholding Nitroglycerin?
- Contraindications
- Inferior MI
-borderline hypotensive patients
- pts with HTN or taking HTN meds with a SBP <110
-abnormal HR <50 or >120
- calcium chloride 1gm sIV/sIO; may repeat 1x
- albuterol 5mg via neb continuously until hospital arrival
- sodium bicarb 50mEq sIVP with BASE CONTACT
What medication may be given prior to albuterol as the initial drug therapy and how would be the patient present?
- epi (1;1000) 0.5mg IM
- given prior to albuterol in patient with respiratory failure due to bronchospasm
** unlikely to benefit patients with COPD exacerbation
What are some etiology to consider and what should be done if your pt has hypotension/ shock of unclear etiology?
- cardiac dysrhythmias (brady/tachy)
- traumatic injuries
-OD/poisoning/ ingestion
- fever sepsis
- contact base