Static Cardiology

• BSI, Scene safe
• ABCs
• O2, IV, EKG

Vagal maneuvers

Adenosine 6 mg, 12 mg, 12 mg q 1-2 mins each followed by 20 mL flush

• Consider:
• Diltiazem- 0.25 mg/kg repeat in 15 mins at 0.35 mg/kg then infusion 5-15 mg/hr

Metoprolol- 5 mg over 2-5 mins q 5 mins max 15 mg

Amiodarone- 150 mg infusion over 10 mins repeat once after 10 mins then infusion 1 mg/min over 6 hours

Transport and monitor

• BSI, scene safe
• ABCs
• O2, IV, EKG

• Syncronized cardioversion
• 100, 200, 300, 360j repeat prn

Consider sedation/pain management

Transport and monitor

• BSI, scene safe
• ABCs
• O2, IV, EKG

Diltiazem- 0.25 mg/kg repeat in 15 mins at 0.35 mg/kg then infusion 5-15 mg/hr

Metoprolol- 5 mg over 2-5 mins q 5 mins max 15 mg

Transport and monitor

• BSI, scene safe
• ABCs
• O2, IV, EKG

Vagal maneuvers

Adenosine- 6 mg, 12 mg, 12 mg q 1-2 mins each followed by 20 mL flush

Amiodarone- 150 mg infusion over 10 mins repeat once after 10 mins then infusion 1 mg/min over 6 hours

OR

Procainamide- 20-50 mg/min to max of 17 mg/kg or until rhythm abolished, QRS widens by 50%, hypotension. Infusion 1-4 mg/min

Transport and monitor

• BSI, scene safe
• ABCs
• O2, IV, EKG

Amiodarone- 150 mg infusion over 10 mins repeat once after 10 mins then infusion 1 mg/min over 6 hours

OR

Lidocaine- 1-1.5 mg/kg IV q 3-5 mins at 1/2 dose max total 3 mg/kg, infusion 1-4 mg/min

OR

Procainamide- 20-50 mg/min to max of 17 mg/kg or until rhythm abolished, QRS widens by 50%, hypotension. Infusion 1-4 mg/min

Transport and monitor

BSI, scene safe

• ABC
• O2, IV, EKG

• Syncronized cardioversion
• 100, 200, 300, 360j
• Consider sedation/pain managmement

Lidocaine- 1-1.5 mg/kg IV q 3-5 mins at 1/2 dose max total 3 mg/kg, infusion 1-4 mg/min

• Amiodarone- 150 mg infusion over 10 mins repeat once after 10 mins then infusion 1 mg/min over 6
• hours

Mag sulfate- 1-2 grams in 50-100 mL over 5-60 mins

Repeat cardioversion 360j prn

Transport monitor

• BSI
• ABCs
• O2, IV, EKG

Mag sulfate- 1-2 grams in 50-100 mL over 5-60 mins


Amiodarone- 150 mg infusion over 10 mins repeat once after 10 mins then infusion 1 mg/min over 6 hours

Lidocaine- 1-1.5 mg/kg IV q 3-5 mins at 1/2 dose max total 3 mg/kg, infusion 1-4 mg/min

Transport and monitor

• BSI
• ABCs

CPR for 2 mins

Confirm VF/pulseless VT

Defibrilate 360j and continue CPR

Intubate

IV

Evaluate rhythm after 2 mins

• Epinephrine- 1 mg 1:10,000 q 3-5 mins
• (consider vasopressin)

• Lidocaine- 1-1.5 mg/kg IV q 3-5 mins at 1/2 dose max total 3 mg/kg
• Infusion if conversion 1-4 mg/min

Drug, shock, drug, shock pattern at 360j

• Amiodarone- 300 mg IV repeat in 5 mins at 150 mg
• Infusion 1 mg/min over 6 hours

Procainamide- 20-50 mg/min to max of 17 mg/kg or conversion

Consider H's and T's

Transport and monitor

• BSI
• ABCs

• CPR
• Intubate
• O2, IV, EKG
• Confirm in 2 leads

• Epinephrine- 1 mg 1:10,000 IV q 3-5 mins
• (consider vasopressin)

Atropine- 1 mg IV q 3-5 mins max total 0.04 mg/kg

Consider H's and T's

Transport or consider termination of efforts

• BSI
• ABCs
• O2, IV, EKG

• Attach TCP pads
• Consider:
• Dopamine- 2-10 mcg/kg/min
• Epinephrine- 2-10 mcg/min

Transport and monitor

• BSI
• ABCs
• O2, IV, EKG

• TCP starting at lowest setting increasing until electrical and mechanical capture at 70-80 bpm
• (consider sedation/pain management)

• Consider:
• Dopamine- 2-10 mcg/kg/min
• Epinephrine- 2-10 mcg/min
• Glucagon- 2-5 mg IV/IM/SC for BB or CCB OD
• Calcium chloride- 8-16 mg/kg IV for CCB OD

Transport and monitor

• BSI
• ABCs
• O2, IV, EKG

Atropine- 0.5 mg q 3-5 mins max 0.04 mg/kg

• Consider:
• Dopamine- 2-10 mcg/kg/min
• Epinephrine- 2-10 mcg/min
• Glucagon for BB OD
• Calcium chloride for CCB OD

Transport and monitor

• BSI
• ABCs
• O2, IV, EKG

Allergies?

Aspirin 324 mg PO

• With systolic > 90mmhg:
• Nitroglycerin- 0.4 mg SL q 5 mins PRN
• Morphine- 1-5 mg IV q 5 mins up to 15 mg

• 12-lead
• Blood draw

• Consider:
• Nitroglycerin drip- 10-20 mcg/min increasing by 5-10 mcg/min q 5 mins
• Nitroglycerin paste- 1-2 inches
• Metoprolol- 5 mg over 2-5 mins q 5 max 15 mg

Transport and monitor

• BSI
• ABCs
• O2, IV, EKG

Nitroglycerin- 0.4 mg SL q 5 x 3 (systolic >90 mmhg)

Furosemide- 0.5-1 mg/kg IV

• Consider:
• CPAP
• Morphine- 1-5 mg IV q 5 max 15 mg
• Nitroglycerin drip- 10-20 mcg/min increasing 5-10 mcg/min q 5
• Nitroglycerin paste- 1-2 inches
• Dobutamine- 2-20 mcg/kg/min

Reassess, transport and monitor

• BSI
• ABCs
• O2, IV, EKG

Albuterol- 2.5 mg via nebulizer with 8 lpm O2 prn

Ipratropium bromide- 0.5 mg via nebulizer q 6 hours

• Consider:
• Methylprednisolone- 125-250 mg IV
• Epinephrine- 0.3-0.5 mg 1:1,000 IM/SC q 15-20 mins or 0.1 mg 1:10,000 IV
• CPAP

Transport and monitor

• BSI
• ABCs
• O2, IV, EKG

Epinephrine- 0.3-0.5 mg 1:1,000 IM/SC q 15-20 mins if ineffective 0.1-0.5 mg 1:10,000 IV

Albuterol- 2.5 mg via nebulizer with 8 lpm O2 prn

Ipratropium- 0.5 mg via nebulizer q 6 hours

Benadryl- 25-50 mg PO/IV/IM

• Consider:
• Methylprednisolone- 125-250 mg IV
• Epinephrine drip- 1-4 mcg/min

Transport and monitor

• BSI
• ABCs
• O2, IV, EKG

BGL check

• If febrile:
• Cool patient
• Acetaminophen- 15 mg/kg PO/PR q 4-6 hours

And/Or

Ibruprofen- 10 mg/kg PO q 6-8 hours

• If refractory:
• Diazepam- 0.2 mg/kg IV (max 5 mg) or 0.5 mg/kg PR q 5 mins x 1
• Lorazepam- 0.1 mg/kg IV/IM (max 2 mg) q 5 mins x 1
• Midazolam- 0.1 mg/kg IV/IM (max 6 mg) q 5 mins x 1

Transport and monitor

• BSI
• O2, IV, EKG

BGL check

• If hypoglycemic:
• Dextrose 50%- 25 g IV
• Glucagon- 1 mg IM/SC

• If refractory:
• Diazepam- 5 mg IV q 5 at 2.5 mg max total 10 mg
• Lorazepam- 1-2 mg IV/IM q 5 max 8 mg
• Midazolam- 1-2.5 mg IV/IM q 5 mins

Transport and monitor