1.
Causes of Pulseless electrical activity: a) Hypovolemia
b) Hypoxia
c) Hydrogen ion (acidosis)
d) Hyper/hypokalemia
e) Hypothermia
f) Tablets (drug OD, accidents) - especially tricyclic antidepressants
g) Tamponade, cardiac
h) Tension pneumothorax
i) Thrombosis, coronary
j) Thrombosis, pulmonary (embolism)
2.
Define pulseless electrical activity: a) PEA is the presence of some type of electrical activity (other than VT or VF), but a pulse cannot be detected by palpation of any artery.
b) Any rhythm or electrical activity that fails to generate a pulse is PEA.
-Can be any rhythm!! Other than v-fib and v-tach
3.
Termination of resuscitation for Ventricular asystole: Persistent asystole or agonal EKG pattern despite appropriate ACLS protocol and no reversible cause identified
4.
Treatment for 1st degree AV block: Symptomatic
5.
Treatment for A-fib: Control rate: Ca channel blockers, Beta-blockers--for mild Sx, eg. mild SOB
Convert rhythm
<48 hr: Cardioversion, amiodarone
>48 hr: Anticoagulation, then cardioversion
Probably won't see this, you must consult with cardiologist first, mostly we will just try to control the rate
6.
Treatment for Atrial flutter: Same as A-fib
Control rate: Ca channel blockers, Beta-blockers--for mild Sx, eg. mild SOB
Convert rhythm
<48 hr: Cardioversion, amiodarone
>48 hr: Anticoagulation, then cardioversion
Probably won't see this, you must consult with cardiologist first, mostly we will just try to control the rate
7.
Treatment for pulseless V-tach: Same as VFib
1. Defibrillation: biphasic, monophasic, AED
2. CPR: 30 Compressions + 2 Breaths (breathes aren't so important any more)
3. Epinephrine 1 mg q3-5 min, or vasopressin 40U (in lieu of 1st or 2nd epi dose)
4. Amiodarone 300 mg IVP (repeat 150 mg) or lidocaine 1.5 mg/kg (max. 3 mg/kg)
5. Mg 1-2 g IV (polymorphic VT, hypoMg), then procainamide 30 mg/min. (max. 17 mg/kg)
6. Defibrillate after each step + CPR
8.
Treatment for Second degree Type I AV block: Symptomatic
9.
Treatment for Second degree Type II AV block: Pacemaker
10.
Treatment for stable V-tach: 1. Amiodarone 150 mg IV
2. Lidocaine 0.5-0.75 mg/kg IVP
3. Procainamide (dependent on E.F.)
11.
Treatment for Third degree AV block: Pacemaker
Atropine (max. 0.04 mg/kg) may be used
12.
Treatment for unstable V-tach: Cardioversion @ 100 J
13.
Treatment for V-fib: 1. Defibrillation: biphasic, monophasic, AED
2. CPR: 30 Compressions + 2 Breaths (breathes aren't so important any more)
3. Epinephrine 1 mg q3-5 min, or vasopressin 40U (in lieu of 1st or 2nd epi dose)
4. Amiodarone 300 mg IVP (repeat 150 mg) or lidocaine 1.5 mg/kg (max. 3 mg/kg)
5. Mg 1-2 g IV (polymorphic VT, hypoMg), then procainamide 30 mg/min. (max. 17 mg/kg)
6. Defibrillate after each step + CPR
14.
Treatment for Ventricular asystole: 1. Check leads, confirm asystole
2. Ventilatory support
3. Treat underlying causes
4. Epi 1 mg IVP (repeat every 3-5 min)
5. Or vasopressin 40 U (1 dose to replace 1st or 2nd epi dose)
15.
Treatment of pulseless electrical activity: a) Search for and treat identified reversible causes
In the meantime...
b) CPR
c) Epinephrine 1 mg IVP, repeat q 3-5 min.
c) Or vasopressin 40 U (1 dose to replace 1st or 2nd epi dose)
16.
Treatment of sinus tachycardia: Treat the underlying cause!!
-Pain relief/analgesics (for pain)
-Reassurance or anxiolytics (for anxiety)
-Antipyretics (for fever)
-Volume replacement (for hypovolemia)
-Removal of offending substances (stimulants, etc.)
17.
Treatment of stable PSVT: Vagal stimulation (on young people), adenosine (if that doesn't work double it), diltiazem, beta-blockers, cardioversion (if nothing else works)
18.
Treatment of stable Wide complex tachycardia: DC cardioversion or Amiodarone
19.
Treatment of symptomatic sinus bradycardia: If symptomatic, treat with atropine
May need pacemaker
20.
Treatment of unstable PSVT: Cardioversion
21.
Treatment of unstable Wide complex tachycardia: DC cardioversion
22.
What are the steps in synchronized cardioversion?: 1. Attach monitor leads to patient
2. Sedate as needed
3. Turn on defibrillator
4. Set for "Synchronous Mode" and verify
5. Select energy level, then charge defibrillator
6. Apply paddles/pads to chest
7. Clear area, then discharge
8. Check monitor
23.
What is the rate in atrial flutter?: Atrial rate 220-350
24.
What is the rate of sinus bradycardia?: < 60
25.
What is the rate of sinus tachycardia?: >100
26.
What is the rate of V-tach?: 100-200
