ADULT CARDIAC Routine Cardiac Care

Transcription

1 ADUL CADAC 2105 outine Cardiac Care Determine level of consciousness. valuate airway and confirm patency Assess breathing and circulation valuate SpO 2 Oxygen titrate O 2 to maintain SpO 2 94% Administer Aspirin 324 mg O. f the patient has taken an aspirin tablet in the last four hours, subtract that dose to administer a total dose of 324 mg. Continue care. Apply cardiac monitor and obtain 12-lead CG and transmit to receiving facility, if equipped. Administer Nitroglycerin 0.4 mg SL (f SB > 100 mmhg, and patient continues to have chest pain may repeat x3 every 5 minutes). For nausea/vomiting, refer to Nausea/Vomiting rotocol ransport as soon as possible. Continue care. erform 12-lead CG and transmit to receiving facility. f S identified go to S rotocol nitiate V/O normal saline or lactated ringer KO or saline lock. Nitroglycerin 0.4 mg SL may be administered if SB > 90 mmhg and V established. f patient continues to have pain, refer to Acute ain anagement rotocol Consider ALS intercept should the situation warrant additional medications. ransport as soon as possible. Continue LS care. ransport as soon as possible. Contact receiving hospital as soon as possible. January 2019 age 1 of 2

2 ADUL CADAC 2105 outine Cardiac Care Critical hinking lements Cardiac elated Signs and Symptoms o Substernal Chest pain o Heaviness, tightness, or discomfort in the chest o adiation and/or discomfort to the neck or jaw o ain, discomfort, or weakness in the shoulders/arms o Nausea and/or vomiting o Diaphoresis o Dyspnea f the patient s chest pain is not eliminated with oxygen or nitroglycerin, initiate an ALS intercept. Consider cardiogenic shock if the patient presents with: o Dyspnea o Diaphoresis o SB < 100 mmhg o Signs of congestive heart failure A 12/15 lead CG should be obtained as soon as possible, preferably within 5 minutes of first medical contact and immediately transmitted to medical control if possible. Limb leads should be place on the patient s limbs. edications should not be administered to patients suspected of having an A. January 2019 age 2 of 2

3 ADUL CADAC 2110 S levation yocardial nfarction erform outine Cardiac Care rotocol 2105 Continue care. ransport as soon as possible. Continue care. Once S confirmed by edical Control: stablish second V ransport as soon as possible. Continue LS care. Once S confirmed by edical Control: stablish second V Administer orphine 2 mg V Q10 min for continued pain Administer icagrelor (Brilinta) 180 mg O ransport as soon as possible. August 2018 age 1 of 1

4 ADUL DCAL 2115 Cardiogenic Shock erform outine Cardiac Care rotocol Continue care. ransport as soon as possible. Continue care. stablish an V and administer fluid bolus to maintain a systolic blood pressure of 90 mmhg. Be cautious of pulmonary edema. ransport as soon as possible. Continue LS care. reat dysrhythmias according to appropriate protocol. f patient remains hypotensive: o Administer Dopamine 2 20 mcg/kg/min ransport as soon as possible. January 2019 age 1 of 1

5 ADUL CADAC 2120 Cardiac Arrest nitiate C in accordance to AHA guidelines Follow High Quality C rocedure Apply AD and follow prompts nsure transporting ALS unit has been dispatched. Continue Care. lace BAD and ventilate at a rate of breaths per minute. nitiate ALS intercept. Continue care. reat according to ACLS guidelines. ransition to cardiac monitor. Defibrillate as indicated according to monitor guidelines. nitiate vascular access. Give pinephrine 0.1mg/mL 1 mg V/O. epeat every 3 5 minutes. Secure airway with or BAD, if not already done. Consider underlying etiology. Continue to work the patient until OSC occurs or a cease efforts order is given. Follow appropriate protocol regarding patient s rhythm. f OSC achieved, follow OSC rotocol Continue LS care. lace OG tube if time permits. Administer Sodium Bicarbonate mq V for suspected CA or ASA overdose. Administer Calcium Chloride 0.5 1g over 2 to 5 minutes for cardiac arrest in dialysis patients or suspected hyperkalemia, hypocalcemia, or hypermagnesemia. January 2019 age 1 of 2

6 ADUL CADAC 2120 Cardiac Arrest Critical hinking lements regnancy and cardiac arrest. o Continuous manual Left Uterine Displacement should be performed on all pregnant women who are in cardiac arrest in which the uterus is palpated at or above the umbilicus to relieve aortocaval compression during resuscitation. o f the uterus is difficult to assess (eg, in the morbidly obese), attempts should be made to perform manual LUD if technically feasible. January 2019 age 2 of 2

7 ADUL CADAC 2125 Ventricular Fibrillation / ulseless Ventricular achycardia Follow Cardiac Arrest rotocol Follow Cardiac Arrest rotocol Continue care. reat according to ACLS guidelines. erform two minutes of C. valuate rhythm. f VF or pulseless V defibrillate per manufactures recommendation for biphasic monitors or 360 J for monophasic defibrillator. mmediately resume compressions after defibrillation. nitiate V/O access. Administer fluid bolus. Be cautious with dialysis patients. Administer pinephrine 0.1mg/mL 1 mg V/O. epeat every 3 5 minutes. epeat C in two minute cycles. valuate rhythm. f VF or pulseless V defibrillate per manufactures recommendation for biphasic monitors or 360 J for monophasic defibrillator. f rhythm converts, refer to appropriate protocol. After three cycles and patient remains in VF / pulseless V, administer Amiodarone. 300 mg V. Second dose of Amiodarone 150 mg V if initial dose does not convert arrhythmia. ntubate if able to perform without interrupting chest compressions. f unable to intubate place BAD. onitor CO2. Consider possible causes and treat appropriately. Continue LS care. Administer Sodium Bicarbonate 1 mq / kg for tricyclic antidepressant overdose, aspirin overdose, or known chronic renal failure patient. Contact the receiving hospital as soon as possible. January 2019 age 1 of 1

8 ADUL CADAC 2130 ulseless lectrical Activity Follow Cardiac Arrest rotocol Follow Cardiac Arrest rotocol Continue care. reat according to ACLS guidelines. erform two minutes of C. valuate rhythm. nitiate V/O access. Administer fluid bolus. Be cautious with dialysis patients. Administer pinephrine 0.1 mg/ml. 1mg V/O. epeat every 3 5 minutes. epeat C in two minute cycles. valuate rhythm. f rhythm converts, refer to appropriate protocol. ntubate if able to perform without interrupting chest compressions. f unable to intubate place BAD. onitor CO2. Consider possible causes and treat appropriately. Continue LS care. Administer Sodium Bicarbonate 1 mq / kg for tricyclic antidepressant overdose, aspirin overdose, or known chronic renal failure patient. Contact the receiving hospital as soon as possible. January 2019 age 1 of 1

9 ADUL CADAC 2135 Asystole Follow Cardiac Arrest rotocol Follow Cardiac Arrest rotocol Continue care. Confirm Asystole in 2 leads. Go to Cardiac Arrest rotocol f resuscitation efforts are indicated. Consider cease efforts order, see esuscitation vs Cease fforts olicy Continue LS care. January 2019 age 1 of 1

10 ADUL CADAC 2140 eturn of Spontaneous Circulation Open and/or maintain an open airway. Continue ventilations (1 breath every 6 seconds). f patient is breathing, titrate O2 to 94 99% SpO2. onitor vitals for any acute changes. Continue care. nsert BAD if applicable. onitor CO2, target range mmhg if applicable. Obtain and transmit a 12 lead CG, if applicable. ransport as soon as possible. Continue care. Attempt to intubate if the patient is not regaining consciousness. onitor CO2, target range mmhg. stablish V/O access and infuse 1 2 L of normal saline or lactated ringers as a bolus. atients on dialysis and/or history of CHF, be cautious of fluid overload. ransport as soon as possible. Continue LS care. Apply ice packs to arm pits, behind neck, and groin area. f patient regains consciousness, do not continue cooling process. reat symptoms as appropriate. ransport as soon as possible. January 2019 age 1 of 2

11 ADUL CADAC 2140 eturn of Spontaneous Circulation Critical hinking lements ndications for therapeutic hypothermia: o eturn of spontaneous circulation post cardiac arrest of medical origin, near drowning or strangulation (hanging). o Age greater than 18 years of age. o erisistent coma with no eye opening to pain or GCS < 9 o nitial temperature > 34 C (93.2 F) o Advanced airway in place (King LS-D, ) Contraindications for therapeutic hypothermia: o raumatic arrest due to penetrating or blunt trauma. o nability to place advanced airway. o resence of DN or other advanced directive o Known patient pregnancy. f patient regains consciousness, discontinue cooling process. t s imperative to obtain a 12 lead CG and complete set of vitals following return of spontaneous circulation. January 2019 age 2 of 2

12 ADUL CADAC 2145 Unstable Bradycardia erform outine Cardiac Care rotocol Continue care. Obtain and transmit 12 lead CG if possible. ransport as soon as possible. Continue care. stablish V/O and administer 500 ml fluid bolus. Administer Atropine 0.5 mg V/O edical Control Order equired. ay repeat every 5 minutes with edical Control Order to a max dose of 3 mg. Begin transcutaneous pacing if the patient is in a 3 rd degree AV block or 2 nd degree type block. ate should be 70 bpm. Start current low and increase until mechanical and electrical capture is obtained. Consider sedation Versed 2 mg V, if time permits ransport as soon as possible. Continue LS care. Begin transcutaneous pacing if the patient is in a 3 rd degree AV block or 2 nd degree type block. ate should be 70 bpm. Start current low and increase until mechanical and electrical capture is obtained. Consider sedation Ketamine 4-5 mg/kg or 1-2 mg/kg V. Administer Dopamine 2-20 mcg/kg/min. ransport as soon as possible. Contact the receiving hospital as soon as possible. January 2019 age 1 of 2

13 ADUL CADAC 2145 Unstable Bradycardia Critical hinking lements Bradycardia does not necessarily mean that a patient is unstable or requires interventions. atients are considered stable if they are asymptomatic (i.e. alert, oriented, normal skin, and SB > 100 mmhg). he patient is unstable if he/she presents with: o Altered level of consciousness o Diaphoresis o Dizziness o Chest pain or discomfort o Ventricular ectopy o Hypotension (SB < 100 mmhg) reat underlying etiologies according to appropriate protocol. Atropine is contraindicated in patients with normal or elevated blood pressure. Consider other factors when assessing bradycardic patients such as: o Health and physical condition (Athlete) o Current medications (Beta blockers) o Head trauma or injury (Cushing s triad) January 2019 age 2 of 2

14 ADUL CADAC 2150 Narrow Complex achycardia (>150 B) - Stable erform outine Cardiac Care rotocol 2105 Continue care. Apply 12 lead CG. Obtain a 12 lead CG and transmit, if available. ransport as soon as possible. f patient becomes unstable, refer to 2155 Narrow Complex achycardia Unstable. Continue care. stablish V access. Administer a 500 cc V fluid bolus. f the patient is stable and pulse is greater than 150 beats per minute. Administer Adenosine. 6 mg V. f no response after 2 minutes. Administer Adenosine. 12 mg V. ransport as soon as possible. Continue LS care. f the patient is stable and pulse is greater than 150 beats per minute. Administer Adenosine 6 mg V. f no response after 2 minutes. Administer Adenosine. 12 mg V. ransport as soon as possible. Contact the receiving hospital as soon as possible. January 2019 age 1 of 2

15 ADUL CADAC 2150 Narrow Complex achycardia (>150 B) - Stable Critical hinking lements achycardia does not necessarily mean that a patient is unstable or requires interventions. atients are considered stable if they are asymptomatic (i.e. alert, oriented, normal skin, and SB > 100 mmhg). he patient is unstable if he/she presents with: o Altered level of consciousness o Diaphoresis o Dizziness o Chest pain or discomfort o Ventricular ectopy o Hypotension (SB < 100 mmhg) reat underlying etiologies according to appropriate protocol. January 2019 age 2 of 2

16 ADUL CADAC 2155 Narrow Complex achycardia (>150 B) Unstable erform outine Cardiac Care rotocol Continue care. Apply 12 lead CG. Obtain a 12 lead CG and transmit, if available. ransport as soon as possible. Continue care. stablish V access. Administer 500 cc V fluid bolus. Consider sedation Versed 2 mg V if time permits Synchronize Cardioversion Apply defibrillator pads and limb leads. nsure synchronize mode is selected. For narrow and regular rhythm, administer J. For narrow and irregular rhythm, administer J. ransport as soon as possible. Continue LS care. Consider sedation Ketamine 4-5 mg/kg or 1-2 mg/kg V. Synchronize Cardioversion Apply defibrillator pads and limb leads. nsure synchronize mode is selected. For narrow and regular rhythm, administer J. For narrow and irregular rhythm, administer J. ransport as soon as possible. January 2019 age 1 of 1

17 ADUL CADAC 2160 Wide Complex achycardia (QS 0.12)- Stable erform outine Cardiac Care rotocol Continue care. Apply cardiac monitor and obtain 12-lead CG and transmit to receiving facility, if equipped. ransport as soon as possible. Continue care. lace defibrillation patches as soon as possible in the event that the patient becomes unstable. erform 12-lead CG and transmit to receiving facility. nitiate V/O normal saline or lactated ringer KO or saline lock. Consult edical Control. edical control may order Amiodarone o 150 mg V over 10 minutes. ransport as soon as possible. Continue LS care. ransport as soon as possible. January 2019 age 1 of 1

18 ADUL CADAC 2165 Wide Complex achycardia (QS 0.12)- Unstable erform outine Cardiac Care rotocol Continue care. Apply cardiac monitor and obtain 12-lead CG and transmit to receiving facility, if equipped. ransport as soon as possible. Continue care. lace defibrillation patches. erform 12-lead CG and transmit to receiving facility. nitiate V/O normal saline or lactated ringer KO or saline lock. Consider sedation Versed 2 mg V, if time permits; f wide complex and regular, perform synchronized cardioversion at 100J. f wide complex and irregular, defibrillate. ransport as soon as possible. Continue LS care. Consider sedation Ketamine 4-5 mg/kg or 1-2 mg/kg V. ransport as soon as possible. January 2019 age 1 of 1

19 ADUL CADAC 2170 mplanted Cardiac Defibrillator erform outine Cardiac Care rotocol Continue care. Apply cardiac monitor and obtain 12-lead CG and transmit to receiving facility, if equipped. ransport as soon as possible. Continue care. reat arrhythmias according to appropriate protocol. Consider sedation Versed 2 mg V, if time permits ransport as soon as possible. Continue LS care. Consider sedation Ketamine 4-5 mg/kg or 1-2 mg/kg V. ransport as soon as possible. January 2019 age 1 of 1

20 DAC CADAC 2205 Cardiac Arrest nitiate C in accordance to AHA guidelines Follow High Quality C rocedure Apply AD and follow prompts nsure transporting ALS unit has been dispatched. Continue Care. ransport as soon as possible. Continue care. reat according to ALS guidelines. ransition to cardiac monitor. Defibrillate as indicated according to monitor guidelines. nitiate vascular access. Give pinephrine 0.1mg/mL 1 mg V/O. epeat every 3 5 minutes. Secure airway with or King Airway. Consider underlying etiology. Continue to work the patient until OSC occurs or a cease efforts order is given. Follow appropriate protocol regarding patient s rhythm. ransport as soon as possible. Continue LS care. lace OG tube if time permits. ransport as soon as possible. January 2019 age 1 of 1

21 DAC CADAC 2210 Ventricular Fibrillation / ulseless Ventricular achycardia Follow Cardiac Arrest rotocol Follow Cardiac Arrest rotocol Continue care. reat according to ALS guidelines. erform two minutes of C. valuate rhythm. f VF or pulseless V defibrillate at 2 j/kg, subsequent defibrillations should increase by 2 j/kg each time with a max dose of 10j/kg. mmediately resume compressions after defibrillation. nitiate V/O access. Administer fluid bolus. Be cautious with dialysis patients. Administer pinephrine 0.1mg/mL 0.01 mg/kg V/O. epeat every 3 5 minutes. epeat C in two minute cycles. valuate rhythm. f VF or pulseless V defibrillate. After three cycles and patient remains in VF / pulseless V, administer Amiodarone 5mg/kg V may repeat twice if initial dose does not convert arrhythmia. ntubate in able to perform without interrupting chest compressions. f unable to intubate place BAD. onitor CO2. Consider possible causes and treat appropriately. ransport as soon as possible. Continue LS care. lace OG tube if time permits. ransport as soon as possible. January 2019 age 1 of 1

22 DAC CADAC 2215 ulseless lectrical Activity and Asystole Follow Cardiac Arrest rotocol Follow Cardiac Arrest rotocol Continue care. reat according to ALS guidelines. nitiate V/O access. Administer fluid bolus 20mL/kg, may repeat once. Any bolus >40mL/kg, consult edical Control. Administer pinephrine 0.1 mg/ml 0.01 mg/kg V/O. epeat every 3 5 minutes. ntubate in able to perform without interrupting chest compressions. f unable to intubate place King Airway. onitor CO 2. Consider possible causes and treat appropriately. ransport as soon as possible. Continue LS care. lace OG tube if time permits. ransport as soon as possible. January 2019 age 1 of 1

23 DAC CADAC 2220 Bradycardia Follow outine atient Care dentify state of Hypoperfusion espiratory Difficulty Cyanosis Cool Skin Hypotension Decreased Level of Consciousness Support respirations, if indicated. f the child is less than 12 months old and despite oxygen and ventilation the child continues to be hypo-perfused and has pulse less than 60 beats per minute, initiate chest compressions. Continue care. ransport as soon as possible. Continue care. nitiate V/O access. Administer fluid bolus 20mL/kg, may repeat once. Any bolus >40mL/kg, consult edical Control. Administer pinephrine 0.1 mg/ml 0.01 mg/kg V/O. edical Control order required. epeat every 3-5 minutes as necessary. Administer Atropine 0.02 mg/kg V/O. edical Control order required. ransport as soon as possible. Continue LS care. f patient continues to be bradycardic with hypo-perfusion, initiate transcutaneous pacing. Contact edical Control for rate. ay administer idazolam for sedation. 0.1 mg/kg V. ransport as soon as possible. January 2019 age 1 of 1

24 DAC CADAC 2225 Narrow Complex achycardia Follow outine atient Care Continue care. Attempt vagal maneuver. ransport as soon as possible. Continue care. nitiate V/O access. Administer fluid bolus 20mL/kg, may repeat once. Any bolus >40mL/kg, consult edical Control. Administer Adenosine 0.1 mg/kg V. edical Control order required. epeat at 0.2 mg/kg V with edical Control order. ransport as soon as possible. Continue LS care. f patient continues to be tachycardic with hypo-perfusion, initiate synchronized cardioversion, begin with 1 J/kg and then increase to 2 J/kg if needed. ay administer idazolam for sedation. 0.1 mg/kg V. ransport as soon as possible. January 2019 age 1 of 1

25 DAC CADAC 2230 Wide Complex achycardia Follow outine atient Care Continue care. Attempt vagal maneuver. ransport as soon as possible. Continue care. nitiate V/O access. Administer fluid bolus 20mL/kg, may repeat once. Any bolus >40mL/kg, consult edical Control. Administer Lidocaine 1 mg/kg V over 2 minutes. edical Control order required. epeat every 5 minutes at 0.5 mg/kg V with edical Control order. ax dose administered is 3 mg/kg. ransport as soon as possible. Continue LS care. f patient continues to be tachycardic with hypo-perfusion, initiate synchronized cardioversion, begin with 1 J/kg and then increase to 2 J/kg if needed. ay administer idazolam for sedation. 0.1 mg/kg V. ransport as soon as possible. January 2019 age 1 of 1

26 DAC CADAC 2235 Neonatal esuscitation Follow outine atient Care Warm and maintain normal temperature, position airway, clear secretions if needed, dry and, stimulate. After stimulation: f the baby develops labored breathing or persistent cyanosis: position and clear airway, monitor SpO2, administer supplemental O2. f the baby continues to be apneic, is gasping, or heart rate is below 100 bpm: administer positive pressure ventilations and monitor SpO2. f the baby s heart rate stays below 100 bpm: check chest movement, and ventilate. f the heart rate is below 60 bpm: begin chest compressions, coordinate with positive pressure ventilations with 100% oxygen. Continue care. ransport as soon as possible. Continue care. nitiate V/O access. Administer fluid bolus 20mL/kg, may repeat once. Any bolus >40mL/kg, consult edical Control. Administer pinephrine 0.1 mg/ml 0.01 mg/kg V. ransport as soon as possible. Continue LS care. ransport as soon as possible. January 2019 age 1 of 1