UNIVERSAL CARDIAC
CARE
Assess ABCs
Secure Airway
Administer
O2
Start IV
Attach monitor,
pulse oximeter and auto B/P
Assess Vital
Signs
Review Hx
Physical Exam
12 Lead EKG
Chest X-Ray
V-FIB or PULSELESS
V-TACH (precordial thump may be benificial if witnessed)
BLS until defibrillator
attached
Defib 200-300-360
CPR
Intubate with
ET
Start IV
Epi 1:10000
1mg q 3-5 min IVP
Defib 360
Lidocaine 1.5mg/kg
IVP or ET *
Defib 360
Lidocaine 1.5mg/kg
IVP or ET (max 3mg/kg) *
Defib 360
Bretylium 5mg/kg
IVP *
Defib 360
Bretylium 10mg/kg
IVP (max 30-35mg/kg) *
Defib 360
Consider:
Magnesium Sulfate
1-2 grams
Procainamide
30mg/min (max 15mg/kg)
Sodium Bicarb
1 mEq /kg
remember:
a) CPR and
pulsechecks after each intervention
except the
initial 3 stacked defibs attempts.
b) Defib should
be performed within 30-60 sec
after drug
Tx
c) * Start
a maintence drip of last drug that converted
rhythm (Lidocaine,
Bretylium, Procainamide)
d) Sequence
is Drug-Shock-Drug-Shock-Drug-Shock..
PEA Pulseless
Electrical Activity (formally EMD) (Problem Epi Atropine)
CPR
Intubate
IV
Assess bloodflow
with Doppler
Consider causes
and treat:
Hypoxia, Hypovolemia,
Hypothermia, Hyperkalemia,
PE, Acidosis,
Tension Pneumo, Cardiac Tamponade,
Overdose. MI
(4H P.A.T.C.H. Of Mine)
(the H. in
PATCH is to remind of the 4-Hs prior)
EPI 1:10000
1 mg q 3-5 minutes IV or ET
ATROPINE 1mg
q 3-5 minutes (max of 0.04 mg/kg ig HR < 60)
Consider Sodium
Bicarb 1 mEq/kg
ASYSTOLE (Problem-Transcutaneous
pacing-Epi-Atropine) P T E A
CPR
ET
IV
Confirm in
another lead that it is not fine V-fib
Consider possible
causes:
Hypoxia, Hypovolemia,
Hypokalemia, Hyperkalemia
Acidoses, Overdose
Consider immediate
TCP (Trancutaneous pacing)
EPI 1mg q 3-5
minutes IV or ET
ATROPINE 1mg
q 3-5 minutes (max 0.04mg/kg)
Consider Sodium
Bicarb 1mEq/kg
BRADYCARDIA
(Symptomatic)
Universal Cardiac
Care
Atropine 0.5-1mg
q 3-5 minutes (max0.04mg/kg)
TCP if available
Dopamine drip
5-20 mcg/kg/min (400mg in 250cc = 1600mcg/ml)
Epi drip 2-10
mcg/min (1mg in 100cc)
Isoprel drip
2-10 mcg/min (1mg in 100cc)
Prepare for
TRANSVENOUS PACER
STABLE V-TACH
Universal Cardiac
Care
Lidocaine 1-1.5mg/kg
IVP *
Lidocaine 0.5-0.75
mg/kg every 5-10 min (max is 3mg/kg) *
Procainamide
20-30 mg/min IV (max is 17mg/kg) *
Bretylium 5-10
mg/kg (max is 30-35 mg/kg) *
Sychronized
Cardioversion 100 200 300 360 (sedate prior)
* Maintenance
drip after conversions
PSVT
Universal Cardiac
Care
Vagal manuevers
ADENOSINE 6mg
IVP
ADENOSINE 12
mg
ADENOSINE 12
mg
VERAPAMIL 2.5
- 5mg
VERAPAMIL 5-10
mg
Consider: Digoxin,
betablockers, Diltiazem,
(have O2 checked,
suction IV access is good, suction and ET available)
premedicate
SYNCRONIZED CARDIOVERSION 50 100 200 300 360
WIDE QRS COMPLEX
TACH (unknown orgin) NO VERAPAMIL
Universal Cardiac
Care
Lidocaine 1-1.5
mg/kg may repeat (max is 3 mg/kg) *
Adenosine 6,12,12
mg IVP fast
Procainamide
20-30 mg/min (max 17 mg/kg) *
Bretylium 5,
10 mg/kg (max 30-35mg/kg) *
Syncronized
Cardioversion 100 200 300 360
start maintenance
dose of drug if converted
A-FIB or A-FLUTTER
with SYMPTOMS
Universal Cardiac
Care
Consider: Diltiazem,
Betablockers, Verapamil, Digoxin,
Procainamide,
Quinidine, Anticoagulants, CardioVersion
Starting at
50 -100 -200 - 300 - 360
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