Unstable: Hypotension/Shock, Fever, Altered Mental Status, Chest discomfort, Acute Heart Failure Saturation <94%, Systolic BP < 90mmHg

Transcription

1 Bradycardia Heart Rate less than 50/min Stable: Monitor Seek expert help Treat Reversible Causes Unstable Signs and Symptoms: chest pain, shortness of breath, altered mental status, weak, Hypotension, orthostatic, diaphoresis, congestion on chest X ray, Saturation <94%, Systolic BP < 90mmHg Treatment: Initial Treatment Atropine.5mg IV if ineffective may repeat up to 3mg Next Treatment: Pacing: Transcutaneous or Transvenous IV Epinephrine 2-10mcg/min or Dopamine 2-10mcg/kg/min Tachycardia Narrow Complex (SVT) Heart Rate greater than 150 Stable: Attempt Vagal Maneuver Monitor - Seek expert help Treat Reversible Causes Unstable: Hypotension/Shock, Fever, Altered Mental Status, Chest discomfort, Acute Heart Failure Saturation <94%, Systolic BP < 90mmHg Treatment: Initial treatment Adenosine 6mg Second dose 12mg 12mg IV fast Synchronized Cardioversion J Biphasic Monophasic 200J

2 Tachycardia Wide Complex (Stable V Tach) with a pulse Heart Rate greater than 100 QRS complex greater than.12sec Stable: Treat Amiodarone IV 150mg over 10 minutes can repeat this if Tachycardia persists Maintenance Amiodarone Drip 1mg/min for first 6 hours Monitor Seek expert help Treat Reversible Causes Procainamide 20-50mg and Stalol 100mg can be used Unstable: Hypotension/Shock, Altered Mental Status, Chest discomfort, Acute Heart Failure with pulse present, Saturation <94%, Systolic BP < 90mmHg, Treat with Synchronized Cardioversion (Pulseless V Tach) Wide Complex Ventricular Tachycardia Shout for Help/Activate Emergency Response Pulse/Rhythm Check Shock Shockable rhythm CPR - Amiodarone 300mg initial dose after 5cycles seconds Pulse/Rhythm Check Shock shockable Rhythm CPR Give 1mg. Epi every 3-5 min. After 2 min 5-10 seconds Pulse/Rhythm check Defibrillate or Shock same thing Just Do it! Go Compressions Ratio 30:2 = 120/min breaths/min CPR 2min 5cycles Shock shockable Rhythm J Biphasic 360J Monophasic Circulate 5cycle 2min 1mg Epi Shock shockable Rhythm CPR - 150mg Amiodarone second dose - after 5cycles Pulse/Rhythm check

3 Continue this rotation. Shock any shockable rhythms. Immediately afterwards, start CPR beginning with chest compressions. You have given maximum dose of Amiodarone. 1mg of Epinephrine every 3-5 minutes is recommended for the remainder of this scenario. Shockable Rhythms: Ventricular Fibrillation and Ventricular Tachycardia Consider termination of resuscitation efforts after 25minutes. Ventilation Rates Adult Ventilations Child/Infant Ventilations Advanced Airway No interrupting compressions No Advanced Airway Compressions are paused 1 breath every 6-8 seconds 1 breath every 3-5 seconds 1 breath every 5-6 seconds breaths/min 1 breath every 6-8 seconds breaths/min Ventricular Fibrillation Defibrillate or Shock same thing Just Do it! Go Compressions Ratio 30:2 = 120/min breaths/min CPR 5cycles Shock Shockable Rhythm J Biphasic 360 Monophasic Circulate 1mg Epi 5cycle 2min Pulse/Rhythm Check Shock Shockable rhythm CPR - Amiodarone 300mg initial dose after 5cycles seconds Pulse/Rhythm Check Shock shockable Rhythm CPR Give 1mg. Epi every 3-5 min. After 2 min 5-10 seconds Pulse/Rhythm check Shock shockable Rhythm CPR - 150mg Amiodarone second dose - after 5cycles Pulse/Rhythm check

4 Asystole/PEA do not shock CPR 2min IV/IO access 1mg Epi q 3-5 min Pulse/Rhythm Check Non Shockable rhythm continue CPR Give 1mg of Epi. After 5cycles/2 min of CPR Pulse/Rhythm check 5-10 seconds Non shockable Rhythm Continue CPR Give 1mg. Epi after 2 min/5cycles Pulse/Rhythm check Non shockable Rhythm Another 5 cycles of CPR Continue to give 1mg of Epi. Every 3-5 minutes. After 2min Rhythm/Pulse check Is rhythm shockable Asystole PEA are Non Shockable Another 2min CPR Think Reversible Causes Reversible Causes X H s and T s Hypovolemia Hypoxia Hydrogen ions (acidosis) Hypo/Hyperkalemia Hypothermia Tension Pneumothorax Tamponade Toxins Thrombosis, Pulmonary Thrombosis, Coronary

5 Acute Coronary Syndrome Chest discomfort suggestive of ischemia. Signs and Symptoms Pressure, fullness, squeezing, pain in the center of the chest lasting several minutes Chest discomfort spreading the shoulders, neck, one or both arms, or jaw Chest discomfort spreading to the back or between the shoulders Chest discomfort with light headedness, dizziness, fainting, sweating, nausea, or vomiting Unexplained shortness of breath with or without chest discomfort. Treatment of Choice Morphine Oxygen Nitroglycerin tablet or spray every 3-5min. with ongoing symptoms Hemodynamic Stable > 90 mmhg: 2-4mg Titrate to Keep Saturation level greater than 94%.4mg sublingual tablet evert 3-5min. Do not administer Nitroglycerin with the following: Recent Phosphodiesterase Inhibitor Inferior Wall MI and (RV) Infarction Hypotension, Bradycardia, Tachycardia

6 Aspirin hour wait sildenafil or vardenafil 48hour wait with tadalafil Treatment for STEMI Fibrinolytic Therapy TPA - within 30min - door to needle time PCI (percutaneous coronary Intervention) within 90min from time of medical contact. EMS should choose a facility that provides PCI (Cath Lab) over any others considering the 90min time frame.