cardiac interventions
Terms
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- V-fib/Pulseless V-tach
-
•Defibrillation
•Epinephrine 1 mg q 3-5 min
•Choose:
Lidocaine 1 – 1.5 mg/kg (max dose 3 mg/kg) q 3-5 min
drip 1-4 mg/min
Procainamide 20-50 mg/min (max dose 17 mg/kg or other endpoints)
drip 1-4 mg/min
Amiodarone 300 mg
drip 150 mg over 10 min (15 mg/min)
•*Sodium Bicarbonate 1 mEq/kg -
Pulseless Polymorphic Vtach/
Torsades de Pointes -
⬢Defibrillation
⬢Magnesium Sulfate 1-2 g in 10mL over 1-2 min - Asystole
-
⬢Epinephrine 1 mg q 3-5 min
⬢Atropine 1 mg q 3-5 min (max 0.04 mg/kg)
⬢*Sodium Bicarbonate 1 mEq/kg
⬢Transcutaneous Pacing (if used VERY soon after asystole begins) - PEA
-
⬢Epinephrine 1 mg q 3-5 min
⬢Atropine 1 mg q 3-5 min (max 0.04 mg/kg)
only if HR < 60
⬢*Sodium Bicarbonate 1 mEq/kg - Bradycardia
-
•Atropine 0.5 – 1 mg
if heart transplant, consider Isproteranol 2-10 mcg/min
do not use with 2 Degree Type II or Type III HB
•Transcutaneous Pacing
•Dopamine drip 5 mcg/kg/min (titrate up to 20 mcg/kg/min)
only if BP > 70
•Epinephrine drip 2-10 mcg/min
only if BP < 70 - Unstable SVT/A-flutter with a Pulse
-
⬢Synchronized Cardioversion 50 Joules and up
⬢*Diazepam or Midazolam - Unstable Tachycardias with a Pulse (besides SVT/PSVT/A-flutter)
-
⬢Synchronized Cardioversion 100 Joules and up
⬢*Diazepam or Midazolam - Unstable Polymorphic Vtach/Torsades de Pointes with a Pulse
-
⬢Defibrillation 200 Joules and up
⬢*Diazepam or Midazolam - Stable A-fib/A-flutter
-
⬢Diltiazem 0.25 mg/kg, repeat at 0.35 mg/kg
⬢Amiodarone 150 mg
only if conversion needed
only if < 48hrs - EAT/MAT/Junctional Tachycardia
-
(eat matt's junk - don't convert)
•Vagal Maneuver
•Adenosine 6mg – 12 mg – 12 mg (flush with 10-20 mL)
•Diltiazem 0.25 mg/kg, repeat at 0.35 mg/kg
OR
•Amiodarone 150 mg - Undetermined Narrow Tachycardias
-
•Vagal Maneuver
•Adenosine 6mg – 12 mg – 12 mg (flush with 10-20 mL)
•Diltiazem 0.25 mg/kg, repeat at 0.35 mg/kg
•Amiodarone 150 mg - WPW
-
⬢Synchronized Cardioversion 100 Joules and up
OR
⬢Amiodarone 150 mg
OR
⬢Procainamide 20-50 mg/min (max 17 mg/kg) - Stable V-tach with a Pulse
-
⬢Choose:
Amiodarone 150 mg over 10 min
Lidocaine 0.5-0.75 mg/kg
Procainamide 20-50 mg/min (max 17 mg/kg)