Term
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Definition
| ACTIVATE EMS system, CPR, AED, ACLS, hospital care |
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Term
| Steps in Recognition, CPR, AED |
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Definition
| Shake/shout, 10sec breathing check, ACTIVATE EMS, 10sec carotid check, C-A-B 5 cycles, AED |
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Term
Compression rate
Depth..adult, child, infant
minimize interruptions to less than... |
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Definition
AT LEAST 100/min
2+in, 2in(1/3 AP), 1.5in(1/3 AP)
10 sec |
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Term
Compression/Breath ratio
adult 1 & 2 ppl
child/infant 1 & 2 ppl |
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Definition
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Term
Breaths Per Minute/per second
adult BVM, adult intubated
child BVM, child intubated |
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Definition
10-12min(5-6sec), 8-10min(6-8sec)
12-20min(3-5sec), 8-10min(6-8sec) |
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Term
AMI Algorithm
2 shockable and 2 nonshockable rhythmns |
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Definition
VF, Vtach without a pulse
Asystole/PEA |
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Term
AMI Algorithm
shockable, biphasic/monophasic J?
3 drugs and doses |
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Definition
120-200J
360J
epinephrine 1mg q3-5min x 2
Vasopressin 40U can sub for an epi
Amiodarone 300mg, 150mg |
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Term
AMI Algorithm
nonshockable
steps and 1 drug |
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Definition
CPR 2min
epi 1mg q3-5min
shockable? |
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Term
AMI Algorithm
Always search for reversible causes to treat. 5 H, 5T?
Really 3T, 3H, 2P, 1A |
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Definition
Hypovolemia
Hypoxia
Hypothermia
Acidosis
Potassium + or _
Pneumothorax
Tamponade
Toxins
Thrombosis, Pulmonary or Coronary |
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Term
AMI Algorithm
Airway. Complete statements...
Improve CPR quality if capnography PETCO2 is less than __mmHg, or if intra-arterial diastolic pressure less than __mmHg
ROSC PETCO2 should be above __mmHg |
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Definition
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Term
Return Of Spontaneous Circulation (ROSC)Fill in the blanks...
Maintain SaO2 >__%
Give _to_ breaths/min keeping PETCO2 of _to_mmHg. If using O2, titrate FiO2 to minimum needed to achieve SaO2 >_% |
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Definition
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Term
ROSC continued...
(IV BOLUS/vasopressor infusion)
Treat Hypotension(defined as SBP<_mmHg)Give _to_Liters of _or_. If inducing hypothermia (can't follow commands), may use __degrees Celsius fluid.
3 vasopressor drugs and doses |
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Definition
90
1 to 2, NS or LR
4 degrees
Epinephrine 0.1-0.5mcg/kg/min
Dopamine 5-10mcg/kg/min
Norepinephrine 0.1-0.5mcg/kg/min |
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Term
Bradycardia Algorithm (SYMPTOMATIC!!!)
5 examples of symptomatic
Tx if not symptomatic |
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Definition
Hypotension, Altered Mental Status,
Shock, chest pain, Acute Heart Failure.
Tx is Monitor & Observe |
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Term
Bradycardia Algorithm (SYMPTOMATIC!!!)
3 drugs & dosages, electricity?
Other type of electricity if first doesn't work. |
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Definition
Atropine 0.5mg q3-5min, MAX 3mg
Infusions:Dopamine 2-10mcg/kg/min
Epinephrine 2-10mcg/min
TransCUTANEOUS pacing
TransVENOUS pacing |
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Term
Tachycardia Algorithm over 150/min
If symptomatic, Tx is....doses? |
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Definition
Synchronized Cardioversion
Regular 50-100J
Irregular 120-200J (200)
Wide Regular 100J
Wide Irregular: defibrillation |
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Term
Tachycardia Algorithm over 150/min
Not Symptomatic, Narrow QRS
Tx and drugs/doses |
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Definition
Vagal Maneuvers
Adenosine (if regular)
Bblocker or CCB
Adenosine 6mg,12mg rapid push followed by NS flush
Sotalol 100mg(1.5mg/kg)over 5min, except if long QT. |
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Term
Tachycardia Algorithm over 150/min
Not Symptomatic, WIDE QRS
Consider Adesonine ONLY if rate is ____ and also ____. Otherwise, use these 2 infusions. Doses? |
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Definition
regular & monomorphic
Procainamide: 20-50mg/min until suppressed or hypotension, 50%+ in QRS, or max dose given 17mg/kg. Maintain at 1-4mg/min Avoid in CHF, long QT.
Amiodarone: 150mg/10min. Repeat as needed if VT recurs. Follow by maintenance 360mg/6hr(1mg/hr). |
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Term
Synchronized Cardioversion Joules for:
Regular(flutter,reentry SVT)
Irregular(a-fib)
Regular Wide
Irregular Wide |
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Definition
50-100J
120-200J(200J)
100J
Defibrillate |
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Term
Transcutaneous Pacing Directions:
Avoid using ___pulse to confirm capture. Jerking may mimic pulse. Place pads on chest. Turn on. Set ___ rate to ___/min. Set ___(mA) by increasing from minimum. QRS will be ___ and T wave will be ___ after each pacer spike. |
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Definition
carotid
demand, 80.
wide, broad |
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Term
ACS Algorithm:
EMS can support/monitor. Admin _ of MONA, consider the rest.
ER...Hx, Exam, Cardiac enzymes(labs), CXR. MONA drugs/doses? |
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Definition
Aspirin.
Morphine 2-4mg
O2 <94%, give NC@4L/min
Nitro 0.3mg x 3(remember contras) |
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Term
ACS Algorithm: ECG interpretation
STEMI or new LBBB:
Start ___ ____ as indicate. Do NOT delay _____.
If Onset under ___hrs, then door to balloon inflation goal under ___min, door to needle(fibrinolysis) goal of __min. |
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Definition
adjunctive therapies. Reperfusion.
90. 30. |
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Term
ACS Algorithm: ECG interpretation
UA/NSTEMI(ST depressed/Twave inverted):
Troponin elevated or high risk pt.
Consider PCI if: 5 rules? |
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Definition
Ischemic Chest Pain is refractory
Persistant/recurring ST changes
Vtach
Hemodynamic instability
Signs of Heart Failure |
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Term
ACS Algorithm: ECG interpretation
UA/NSTEMI(ST depressed/Twave inverted):
Start adjunctive Tx as indicated...2 drugs and 3 more to consider.
Admit to telemetry bed and add 2 more drugs. |
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Definition
Nitro & Heparin(UFH or LMWH)
Oral BB, Clopidogrel, Glycoprotein 2b/3a inhibitors
ACE Inhibitor, HMG CoA inhibitor |
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Term
ACS Algorithm: ECG interpretation
Normal or NonDx changes in ST/T wave:
Consider admit & these 3 Dx exams.
3 findings that can deny discharge? |
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Definition
Serial Cardiac Enzymes, EKG, noninvasive Dx test.
EKG changes, Troponin++, Abnormal imaging or physiological exam. |
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Term
Fibrinolytic Dosages:
Streptokinase |
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Definition
| 1.5 million units/1hr infusion |
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Term
Fibrinolytic Dosages:
Tenecteplase |
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Definition
0.5mg/kg
Bolus admin over 5sec. Don't use Dextrose. |
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Term
Fibrinolytic Dosages:
Alteplase |
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Definition
1.5hr infusion consisting of bolus, then 30min infusion, 60min infusion.
15mg bolus
0.75mg/kg over 30min. 50mg Max
0.5 mg/kg over 90min. 35mg Max
Max 100mg |
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Term
Fibrinolytic Dosages:
Reteplase |
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Definition
Bolus: 10u over 2min
wait 30min
Bolus: 10u over 2min
NS flush before/after each bolus |
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Term
MONA detailed guidelines: Oxygen
Keep SaO2 above __%
Uncomplicated MI: use until stabilized, probably not useful beyond __hrs.
Complicated MI: Keep O2 on. |
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Definition
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Term
MONA detailed guidelines: Nitro
SBP over _, or __ below baseline.
Pulse below __ or over __ without HF is contraindicated. Caution for ___wall MI and pts taking these drugs.
Doses for SL and IV |
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Definition
90mmHg, 30mmHg
50bpm, 100bpm
inferior
PDE5 Inhibitor. Viagra24, Cialis48
SL: 0.3mg q3-5min x 3.
IV: 12.5-25mcg bolus(skip if already SL), 10mcg/min increasing q3-5min up to 200mcg until relief or desired BP. |
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Term
MONA detailed guidelines: Morphine
Avoid with this vital sign?
STEMI dose:
UA/NSTEMI dose: |
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Definition
Hypotension
2-4mg, add 2-8mg q5-15min PRN.
1-5mg only if nitro doesnt work. |
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Term
MONA detailed guidelines: Aspirin
Use this if aspirin allergy?
Contraindications/cautions?
Dose |
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Definition
Clopidogrel
allergy,Peptic Ulcer(use suppository)
160-325mg crushed or chewed |
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Term
ACE Inhibitors: Indications
Reduce M__ and improve LV D__ post-AMI.
Help prevent adverse R___, delay progression of H__ F__, decrease S_D_ and recurrent AMI |
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Definition
mortality, dysfunction,
remodeling, heart failure, sudden death |
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Term
ACE Inhibitor: PRECAUTIONS/CONTRAS:
-PREGNANCY!!! (fetal injury or death)
-Reduce dose in R__F__
-Hyper levels of this electrolyte.
-SBP under this, drop from normal of?
-Usually not started in ED, these 2 things occur first within 24hrs? |
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Definition
renal failure
potassium
100mmHg, 30mmHg
reperfusion therapy, BP stabilized |
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Term
ACE Inhibitor: DOSES
Enalapril
Captopril
Lisinopril |
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Definition
Start low dose increasing steadily to full dose within 14-48hrs.
E: 2.5mg dose, then titrate to 20mg BID
C: 6.25mg dose, 25mgTID, 50mgTID,
L: 5mg/day then 10mg starting day 3. |
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Term
ACE Inhibitor: DOSES
Enalapril
Captopril
Lisinopril |
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Definition
Start low dose increasing steadily to full dose within 14-48hrs.
E: 2.5mg dose, then titrate to 20mg BID
C: 6.25mg dose, 25mgTID, 50mgTID,
L: 5mg/day then 10mg starting day 3. |
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Term
ACE Inhibitor: DOSES
Enalapril
Captopril
Lisinopril |
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Definition
Start low dose increasing steadily to full dose within 14-48hrs.
E: 2.5mg dose, then titrate to 20mg BID
C: 6.25mg dose, 25mgTID, 50mgTID,
L: 5mg/day then 10mg starting day 3. |
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Term
Adenosine: INDICATIONS
1st drug for most regular or wide SVT.
-Consider for unstable while waiting for C__.
Does it convert a-fib/flutter/VT? |
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Definition
cardioversion
It doesn't convert. |
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Term
Adenosine PRECAUTIONS/CONTRAS
-These HBs & induced type of tachy?
-Less effective if pt taking 2 drugs?
-Side effects on Rhythm and superficial? |
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Definition
2nd/3rd degree & drug induced
caffeine, theophylline
Transient Asystole, Brady, Ventricular Ectopy. Flushing, chest pain, tightness |
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Term
Adenosine DOSE & ADMIN TECHNIQUE
Bolus of _mg over _sec followed by __bolus of __mL, then __extremity.
2nd dose of __mg after __min, if needed
Draw up adenosine and flush in 2 syrines. Attach both to IV port closest to pt. Clamp IV fluid. Push adenosine, hold plunger down, push flush ASAP, unclamp IV. |
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Definition
6mg, 1-3sec, NS bolus, 20mL, elevate
12mg, 1-2min |
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Term
Clopidogrel(Plavix) ADP Antagonist
Indication: Antiplatelet therapy for ACS. Limited data for >75yr old pts.
Precautions: Active bleed, liver impairment. Withhold for _days before CABG.
DOSE: loading dose of __mg, daily __mg |
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Definition
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Term
Amiodarone Description:
Effects on __,__,__ channels as well as __ & __ blocking properties. Patients must be ___ while loading.
Should only be prescribed by physcians experienced in it's use and access to labs to monitor effects. |
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Definition
Na, K, Ca, Alpha, Beta
hospitalized |
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Term
Amiodarone INDICATIONS:
Because it's associated with ___, only advised for pts with ___arrhythmias.
2 rhythms AFTER unresponsive to these 3 things?
With expert consult, may use for other rhythms. |
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Definition
toxicity, life-threatening
CPR, shock, vasopressor |
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Term
Amiodarone PRECAUTIONS
-rapid infusion may cause?
-daily dose over __ linked to hypo
-Do not admin with drugs prolonging__?
-Extremely long half life up to __days. |
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Definition
hypotension
2.2grams
QT Interval
40 |
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Term
Amiodarone DOSES:
VF/VT arrest: 1st and 2nd dose?
Arrhythmias:
Rapid infusion __mg over __min, PRN.
Slow infusion __mg over __hours
Maintenance __mg over __hours |
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Definition
300mg push, 150mg push
150mg, 10 (15mg/min)
360mg, 6 (1mg/min)
540mg, 18 (0.5mg/min) |
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Term
ASPIRIN
Indications: Admin to all pts. with ACS
-Blocks formation of T___, which causes P___ to aggregate and arteries to C___.
-Any person C/O of "pressure,crushing"
DOSE: 160-325mg of what type. Route if unable to PO? |
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Definition
Thromboxane A2, platelets, constrict
non-enteric coated, chewable,
rectal suppository |
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Term
ATROPINE
1st choice for S__B__. Won't work on which bradys?
Update removes use from these rhythms?
-+O2 demand so caution with H__ & I__
DOSE: __mg q3-5min, Max: __mg
-Use S___ dosing interval and H__ doses in severe clinical conditions |
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Definition
symptomatic bradycardia
2nd type 2, 3rd degree
PEA/Asystole
hypoxia, ischemia
0.5mg q3-5min, MAX 3mg.
shorter, higher |
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Term
BETABLOCKERS
Admin to all pts with A__or U__ if no contraindications. Reduces incidence of V_, I_, reinfarction.
-2nd choice in SVTs after A__, to slow to NSR or slow V_R_.
-Early aggressive BB use may be hazardous in H_U_ patients.
-Avoid if signs H_F_ or low C_O_.
-IV BB risk hypo/brady mixed with IV ___. |
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Definition
AMI, UA
Vfib, ischemia
Adenosine, ventricular response.
hemodynamically unstable
heart failure, cardiac output
CCB |
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Term
BETABLOCKER DOSES
Metoprolol
Atenolol
Labetalol |
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Definition
M: IV,5mg,5mg,5mg,(5min/dose), 50mg PO
A: IV,5mg,10min,5mg,10min, 50mg PO
L: IV,10mg bolus, 2-8mg/min infusion |
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Term
| Door to fibrinolytic therapy for STROKE |
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Definition
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Term
8 D's of Stroke, describe
Detection
Dispatch
Delivery
Door
Data
Decision
Drug
Disposition |
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Definition
Rapid recogntion of symptoms
Early dispatch of 911
Rapid EMS ID, Mgmt, transport
taken to a stroke center
rapid mgmt in ED
stroke expertise and therapy selection
fibrinolytic therapy
rapid admission to stroke unit, CCU |
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Term
Cincinnati Prehospital Stroke Scale
Just 1 indicator equals 72% probability of stroke |
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Definition
Facial Droop
Arm Drift
Abnormal Speech |
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Term
Glasgow Coma Scale Max 15
Eyes 1-4
Verbal 1-5
Motor 1-6 |
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Definition
Eyes..none, pain, verbal, alert
Verbal..none, sounds, words, confused,
normal
Motor...none, extend,flex, withdraw,
localize, obey |
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Term
STROKE chain of survival
4 steps |
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Definition
| Recogniton, EMS dispatch, Transport, Dx/Tx at hospital |
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