CODES ALGA

HR typically less than 50 bpm

• ID and treat underlying cause:
• maintain airway, assist breathing if needed
• O2, if hypoxemic
• Cardiac monitor to ID rhythm
• Monitor BP & pulse ox
• Iv access
• 12 lead ECG if avaliable

Monitor and observe

• Hypotension
• Acutely altered mental status
• signs of shock
• Ischemic chest discomfort
• Acute heart failure

• Administer Atropine
• If uneffective:
• Transcutaneous pacing
• OR Dopamine infusion
• OR epi infusion

*Consider expert consultation

• a temporary means of pacing a patient's heart during a medical emergency.
• It is accomplished by delivering pulses of electric current through the patient's chest, which stimulates the heart to contract.
• Alternative is drug therapy

• Atropine Iv doses:
• First dose 0.5 mg bolus
• Repeat every 3-5 mins
• Max 3 mg.

*is the first drug of choice for bradycardia. Increases heart rate

• second-line drug for bradycardia when atropine is ineffective
• IV infusion:
• Usual infusion rate is 2-20 mcg/kg per min
• Titrate to pt response
• TAPER SLOWLY

• *Causes increased HR 
• also used to treat hypotension

• Alternative drug for bradycardia if atropine don't work
• 2-10 mcg per minute infusion via IV
• Titrate to pt response

• Start CPR & attach monitor/defib
• Analyze rhythm

• Epi
• Amiodarone

• EPI given via IV/IO
• 1 mg every 3-5 min

Is a vasopressor... causes vasoconstriction and increase cardiac output

• Given IV/IO
• First dose: 300 mg bolus
• 2nd dose: 150 mg

antiarrhythmic medication

• It's Asystole/PEA
• Continue CPR for 2 min
• Gain IV/IO access
• Give EPI every 3-5 min 
• Consider advanced airway & capnography

*after 2 mins, reanalyze

• Continue CPR
• Treat reversible causes
• Reanalyze after 2 mins

• *If no s/s of ROSC, continue w cpr, epi, etc.
• *If ROSC, follow Post-cardiac arrest care algorithm

• Shock!
• Give epi every 3-5 min (or amiodarone, depending on where you are with drugs)
• If haven't done so yet, consider airway and capnography
• reanalyze rhythm after 2 mins of CPR

• Shock
• continue CPR
• Give Amiodarone
• Treat reversible causes

*continue cycles of CPR and shock until ROSC

• IV/IO
• 1 mg every 3-5 mins

• IV/IO
• First dose: 300 mg bolus
• Second dose: 150 mg

*antiarrhythmic medication used to treat v-tach or v-fib

• FOR TACHYCARDIA WITH PULSE
• Narrow regular: 50-100 J
• Narrow irregular: 120-200 J for biphasic OR 200 J monophasic
• Wide regular: 100 J
• Wide irregular:  defib dose (not synchronized)

Monophasic Waveforms: A type of defibrillation waveform where a shock is delivered to the heart from one vector

Biphasic Waveforms: A type of defibrillation waveform where a shock is delivered to the heart via two vectors.

• Heart rate typically ≥ 150 bpm
• Maintain airway
• O2 if hypoxic
• Obtain cardiac moniter to ID rhythm
• monitor vitals

• Synchronized cardioversion
• Consider sedation

• Look at rhythm, specifically QRS
• Is it Wide?
• Is it ≥ 0.12 seconds?

• Obtain IV access & 12 lead ECG (if available)
• Consider adenosine (only if regular and monomorphic
• Consider antiarrhythmic infusion

• With wide QRS, ≥ 0.12 sec
• ONLY if reg and monomorphic

• *Adenosine is an antiarrhythmic that works by  slowing the electrical conduction in the heart, slowing heart rate, or normalizing heart rhythm.
• *Is the scariest drug you'll push. Monitor will show flat line, then should allow electrical component of heart to realine

• IV
• First dose: 6 mg rapid IV push, followed by NS flush

• Second dose: 12 mg, if required
• Very short half life (2 secs)
• Will stop heart, allow it to reset. Scary drug!

• With Procainamide via IV dose:
• 20-50 mg/min until arrhythmia suppressed, hypotension ensues, QRS duration increases >50% OR MAX dose of 17 mg/kg
• Maintenance infusion: 1-4 mg/min

*Avoid if prolonged QT or CHF

• Obtain IV access & 12 lead, if available
• Do vagal maneuvers
• Give Adenosine (IF REGULAR)
• Give Beta-blocker or calcium channel blocker

• USE ONLY IF REG RHYTHM
• First dose: 150 mg over 10 mins
• Repeat as needed if VT recurs
• Follow by maintenance infusion of 1 mg/min for first 6 hours

• Sotalol is beta blocker
• 100 mg (1.5 mg/kg) over 5 mins
• *Avoid if QT prolonged!

• Return of Spontaneous Circulation.. pulse and BP
• Abrupt sustained increase in PETCO2 (typically ≥40 mm Hg)
• Spontaneous arterial pressure waves with intra arterial monitoring

• Optimize ventilation and oxygenation:
• Maintain o2 sat ≥94%
• Consider airway/waveform capnography
• DON'T HYPERVENTILATE!!

Give IV/IO bolus: approx 1-2 L NS or lactated Ringer

Vasopressor infusion: either epi, dopamine, or norephiniphrine

• IV infusion
• 0.1 - 0.5 mcg/kg per min

5-10 mcg/kg per min IV

• IV infusion
• 0.1-0.5 mcg/kg per min

Any condition brought on by a sudden reduction or blockage of blood flow to the heart.

• Monitor and support ABCs
• Be prepared to provide CPR & defib
• MONA
• Obtain 12 lead; 

• IF ST ELEVATION:
• Notify hospital w transmission, note time of onset & first med contact
• Notified hospital should mobilize resources
• to respond to STEMI

• STEMI
• NSTE-ASC
• Low/intermediate-risk ACS

*a full-blown heart attack caused by the complete blockage of a heart artery. 

• ST elevation
• New or presumably new LBBB
• strongly suspicious for injury

Start adjunctive therapies, do not delay reperfusion

• Left bundle branch block
• A delay or blockage of electrical impulses to the left side of the heart.

• High-risk Non-ST Elevation ACS
• Encompass NSTE myocardial infarction (NSTEMI) and unstable angina
• Lack the declarative electrocardiographic findings that readily identify patients with STEMI

160 - 325 mg

• SBP is greater than 90 
• HR is greater than 50 - 100/min

• Don't give if:
• Pt has experienced chest discomfort for greater than 15 mins but less than 12 hrs
• ECG shows pt has NOT had STEMI or new LBBB

• SBP >180 or DBP >100
• R vs L are BP shows difference of 15mmHg
• Hx of central nervous system dx
• Sig head/facial trauma within last 3 months
• Stroke >3 hrs or <3 months
• Any hx of intracranial hemorrhage
• Bleeding, clotting prob, blood thinners
• Preg female

• Support ABC's, give O2 if needed
• Perform prehospital stroke assess
• Establish time last normal
• Triage to stroke center
• Alert hospital
• Check glucose!

• Cincinnati prehospital stroke scale:
• Facial droop
• Arm drift
• Abnormal speech

Ischemic involves occlusion of artery to region of brain. Involves 87% of all strokes

Hemorrhagic involves sudden rupture of blood vessel. Consists of 13% of all strokes