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Bradycardia Algorithm
- History/Exam, Blood Glucose, EKG, SpO2, ETCO2*If Symptomatic (poor perfusion, ALOC, Chest Pain, Dyspnea, etc.)
- Attempt to identify cause: HHHHH-TTTTT
- Maintain Airway, High flow O2
- IV Access
- CPR if HR<60 with poor perfusion
- 0.5 mg Atropine IV/IO repeated q/3 min until HR/BP improves or max. dose of 3 mg.
- 1 mg Epinephrine 1:10,000 every 3-5 min.
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Acute Coronary Syndrome
- History/"OPQRST," Blood Glucose
- ED medications?
- EKG, ETCO2, SPO2
- IV Access; 250-1000 mL bolus
- 324 mg Aspirin
- 12 Lead; Transmit STEMI/AMI level EKG to receiving center
- 0.4 mg Nitroglycerin every 5 min. to max. of 3 doses
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ROSC/Post-Cardiac Arrest management
- Focused History/Exam, Blood Glucose
- ECG, ETCO2, SPO2
- 12 Lead; Transport to STEMI/PCI receiving center
- Bilateral Large Bore IV's
-
Non-Shockable Arrest
- Focused History/Exam, Blood Glucose
- ECG, ETCO2, SPO2
- Determine presence/absence of pulse
- Begin CPR, Apply AED
- Attempt to identify cause: HHHHH-TTTTT
- Establish IV, Administer fluid bolus
- 1 mg Epinephrine 1:10,000 every 3-5 min.
-
Shockable Arrest: V-Fib or V-Tach
- Determine presence/absence of pulse, rhythm
- Begin CPR, Apply AED
- Attempt to identify cause: HHHHH-TTTTT
- Defibrillate immediately if arrest is witnessed
- 2 minutes of CPR if no AED present
- Shock every 2 min. and resume CPR immediately after each shock
- Super-plug with O2 via NRB for first 2 minutes followed by BVM every 6-8 seconds
- IV Access
- Defib at 200J
- 1 mg Epinephrine 1:10,000 every 3-5 min.
- 300 mg Amiodarone, followed by 150 mg second dose
- OR
- 1.5 mg/kg Lidocaine may repeat every 3-5 min. for max dose of 3 mg/kg.
-
Pulsatile Tachycardia
- Focused History/Exam, Blood Glucose
- ECG, ETCO2, SPO2
- Obtain 12 Lead
- Vascular Access
- Valsalva Maneuvers
-
"H's"
- Hypovolemia
- Hypoxia
- Hydrogen ion (acidosis)
- Hyper/hypokalemia
- Hypothermia
- Hypoglycemia
-
"T's"
- Toxins
- Tamponade
- Tension Pneumothorax
- Thrombosis
- Trauma
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