A-Atropine 0.5 mg q 3-5 min (max 3mg)

E-Epinepherine 2-10mcg/min or

D-Dopamine 2-10mcg/kg/min (If bradycardia and decreased CO (decreased BP)

The atria are so irritable that a multitude of impulses causes the atria to deploarize in a fibrillatory manner.

The AV node blocks most of the impulses allowing only a limited number through to the ventricle causing an irregular ventricular rate.

Digoxin, CCB (cardizem, Verapamil)

Coumadin- b/c heart is shaky and blood can pool causing clots

Prolonged conduction between the atria and ventricles

PR interval is >0.20 seconds

Each p wave is followed by a QRS complex

It is bad! An intermittent and sudden loss of conduction between the atria and the ventricle.

Location of the block is most often below the bundle of HIS.

Potentially dangerous and more likely than mobitz 1 to progress to complete heart block or asystole without warning.

You see 2 P-waves to every QRS complex.

You see too many p-waves.

Atropine 0.5mg q 3-5 min for a max of 3 mg (because normally heart rate is slow and want to accelerate underlying sinus rate if symptomatic)

Dopamine 2-10 mcg/kg/min (if bp low)

Epinepherine 2-10mcg/min

Evaluate need for O2

Transcutaneous pacing,

Atropine 0.5mg q 3 min (3mg max) to stimulate SA node

Epinepherine- 2-10 mcg/min to try and stimulate heart

Dopamine 2-10 mcg/kg/min to try and stimulate heart

Beta Blockers to slow

Lidocaine to slow

Procainamide

Amiodarone

Oxygen-if hypoxic

Potassium-if hypokalemic

Usually regular to slightly irregular;

Ventricular rate is 150-250 bpm

No p-waves preceding QRS complexes

Wide, bizarre, ugly, look the same

Treat the same as V-Fib

1.ABC

2.CPR

3.Intubate and start IV

4.Epinepherine-1mg IV/IO q 3-5 min

5.Vasopressin 40 Units IV/IO one time only

6. Amiodarone 300 mg IV (may repeat once at 150 mg)

7.Lidocaine 1-1.5mg/kg IV/IO or

8. Mag Sulfate 1-2 grams IV/IO

Take vs (have low BP)

Support airway and breathing (tend to pass out)

Give meds for BP, HR, and run an ECG

Give Magnesium 1-2 grams IV over 5-6 min followed by an infusion

Consider Electricity

It is totally chaotic with no discernable waves or complexes.

The impulses cause the heart to fibrillate rather than contract

Dont generate a heart beat!

Call code blue

1.ABC

2.CPR

3.Intubate and start IV

4.Epinepherine-1mg IV/IO q 3-5 min

5.Vasopressin 40 Units IV/IO one time only

6. Amiodarone 300 mg IV (may repeat once at 150 mg)

7.Lidocaine 1-1.5mg/kg IV/IO or

8. Mag Sulfate 1-2 grams IV/IO

Correct the cause.

Give meds:

1. Atropine

2. Epinepherine

3. Isuprel

4. Pacing

1. CPR

2. Intubate and IV

3. Epinepherine 1 mg IV/IO q 3-5 min

4. Vasopressin 40 units IV/IO only once

5. Consider Atropine 1 mg IV/IO q 3-5 min; max 3mg.

6. CPR x2 min

7. Transcutaneous pacing

8. Consider Bicarb

Find the problem (5H's or 5Ts)

Give Epinepherine (1mg)

Atropine (1mg)

Use handheld doppler to look for cardiac activity.

1.Hypovolemia (fluids)

2. Hypoxia (Give O2, ventilation)

3. Hydrogen ion-acidosis (give bicarb, ventilation, and check if diabetic could be in DKA)

4. Hyperkalemia (Check renal, bicarb, insulin/glucose, give Kayexelate, dialysis, CaCl)

5. Hypothermia (check core temp., and warm up)

1. Tablets/Toxins overdose

2. Tamponade, Cardiac (no pulse with CPR, JVD; pericardiocentesis)

3. Tension Pneumothorax (no pulse with CPR, JVD, trachial deviation, needle thoracostomy)

4. Thrombosis, coronary

5. Thrombosis, pulmonary embolism (thrombolytics, surgery)