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Bradycardia Heart Rate less than 50/minStable: Monitor – Seek expert help – Treat Reversible CausesUnstable Signs and Symptoms: chest pain, shortness of breath, altered mental status, weak, Hypotension, orthostatic, diaphoresis, congestion on chest X ray, Saturation <94%, Systolic BP < 90mmHgTreatment: Initial Treatment Atropine .1mg IV if ineffective may repeat up to 3mg Next Treatment: Pacing: Transcutaneous or Transvenous IV Epinephrine 2-10mcg/min or Dopamine 5-20mcg/kg/minTachycardia Narrow Complex (SVT)Heart Rate greater than 150Stable: Attempt Vagal Maneuver – Monitor - Seek expert help – Treat Reversible CausesUnstable: Hypotension/Shock, Fever, Altered Mental Status, Chest discomfort, Acute Heart Failure Saturation <94%, Systolic BP < 90mmHg Treatment: Initial treatment Adenosine 6mg – Second dose 12mg– IV fast Synchronized Cardioversion – 120 - 200J Biphasic Monophasic 200JTachycardia Wide Complex (Stable V Tach) with a pulseHeart Rate greater than 100 QRS complex greater than .12sec Stable: Treat Amiodarone IV 150mg over 10 minutes can repeat this if Tachycardia persists Maintenance Amiodarone Drip 1mg/min for first 6 hours Monitor – Seek expert help – Treat Reversible Causes Procainamide 20-50mg and Stalol 100mg can be used Unstable: Hypotension/Shock, Altered Mental Status, Chest discomfort, Acute Heart Failure with pulse present, Saturation <94%, Systolic BP < 90mmHg, Treat with Synchronized Cardioversion52043895151Pulse/Rhythm Check – Shock Shockable rhythm – CPR - Amiodarone 300mg initial dose – after 5cycles - 5-10 seconds Pulse/Rhythm Check – Shock shockable Rhythm – CPR – Give 1mg. Epi every 3-5 min. After 2 min 5-10 seconds Pulse/Rhythm check Shock shockable RhythmCPR - 150mg Amiodarone second dose - after 5cycles – Pulse/Rhythm check – 00Pulse/Rhythm Check – Shock Shockable rhythm – CPR - Amiodarone 300mg initial dose – after 5cycles - 5-10 seconds Pulse/Rhythm Check – Shock shockable Rhythm – CPR – Give 1mg. Epi every 3-5 min. After 2 min 5-10 seconds Pulse/Rhythm check Shock shockable RhythmCPR - 150mg Amiodarone second dose - after 5cycles – Pulse/Rhythm check – (Pulseless V Tach) Wide Complex Ventricular Tachycardia 3272843289827Shock –shockable Rhythm120-200J Biphasic360J Monophasic00Shock –shockable Rhythm120-200J Biphasic360J MonophasicShout for Help/Activate Emergency Response1632247100241Compressions Ratio 30:2 = 120/min10-12 breaths/min00Compressions Ratio 30:2 = 120/min10-12 breaths/min41785381172381mg Epi01mg Epi239282100242Defibrillate or Shock same thingJust Do it! 0Defibrillate or Shock same thingJust Do it! Circulate4199932702654Consider Airway00Consider Airway42203702660125cycle 2min005cycle 2min25888421301995cycles 005cycles 114513611044 Go 0 Go CPR 2minContinue this rotation. Shock any shockable rhythms. Immediately afterwards, start CPR beginning with chest compressions. You have given Vasopressin and maximum dose of Amiodarone. 1mg of Epinephrine every 3-5 minutes is recommended for the remainder of this scenario. Shockable Rhythms: Ventricular Fibrillation and Ventricular Tachycardia Consider termination of resuscitation efforts after 25minutes. Ventilation RatesAdult VentilationsChild/Infant VentilationsAdvanced Airway No interrupting compressions1 breath every 6-8 seconds 1 breath every 3-5 secondsNo Advanced AirwayCompressions are paused1 breath every 5-6 seconds 10-12 breaths/min1 breath every 6-8 seconds12-20 breaths/min5067656257205Pulse/Rhythm Check – Shock Shockable rhythm – CPR - Amiodarone 300mg initial dose – after 5cycles - 5-10 seconds Pulse/Rhythm Check – Shock shockable Rhythm – CPR – Give 1mg. Epi every 3-5 min. After 2 min 5-10 seconds Pulse/Rhythm checkShock shockable RhythmCPR - 150mg Amiodarone second dose - after 5cycles – Pulse/Rhythm check – 00Pulse/Rhythm Check – Shock Shockable rhythm – CPR - Amiodarone 300mg initial dose – after 5cycles - 5-10 seconds Pulse/Rhythm Check – Shock shockable Rhythm – CPR – Give 1mg. Epi every 3-5 min. After 2 min 5-10 seconds Pulse/Rhythm checkShock shockable RhythmCPR - 150mg Amiodarone second dose - after 5cycles – Pulse/Rhythm check – 323885670343Shock Shockable Rhythm 120 – 200J Biphasic360 Monophasic0Shock Shockable Rhythm 120 – 200J Biphasic360 MonophasicVentricular Fibrillation 4139779652211mg Epi01mg Epi1632247100241Compressions Ratio 30:2 = 120/min10-12 breaths/min00Compressions Ratio 30:2 = 120/min10-12 breaths/min239282100242Defibrillate or Shock same thingJust Do it! 0Defibrillate or Shock same thingJust Do it! CPR Circulate40915182223565cycle 2min005cycle 2min25888421301995cycles 005cycles 114513611044 Go 0 Go 404505727305Consider Airway00Consider Airway Asystole/PEA do not shock 393075713204002042445184441After 2minRhythm/Pulse checkIs rhythm shockable00After 2minRhythm/Pulse checkIs rhythm shockableleft150258 CPR 2min IV/IO access 1mg Epi q 3-5 min 00 CPR 2min IV/IO access 1mg Epi q 3-5 min 34695393357371554777336111 Asystole PEA are Non Shockable Another-8546378085Pulse/Rhythm Check – Non Shockable rhythm – continue CPR – Give 1mg of Epi .After 5cycles/2 min of CPR Pulse/Rhythm check 5-10 secondsNon shockable RhythmContinue CPR – Give 1mg. Epi after 2 min/5cycles – Pulse/Rhythm check – Non shockable RhythmAnother 5 cycles of CPRContinue to give 1mg of Epi. Every 3-5 minutes. 00Pulse/Rhythm Check – Non Shockable rhythm – continue CPR – Give 1mg of Epi .After 5cycles/2 min of CPR Pulse/Rhythm check 5-10 secondsNon shockable RhythmContinue CPR – Give 1mg. Epi after 2 min/5cycles – Pulse/Rhythm check – Non shockable RhythmAnother 5 cycles of CPRContinue to give 1mg of Epi. Every 3-5 minutes. 2min CPRThink ReversibleCauses416978411430Reversible CausesH’s and T’sHypovolemiaHypoxiaHydrogen ions (acidosis)Hypo/HyperkalemiaHypothermiaTension PneumothoraxTamponadeToxinsThrombosis, PulmonaryThrombosis, Coronary 00Reversible CausesH’s and T’sHypovolemiaHypoxiaHydrogen ions (acidosis)Hypo/HyperkalemiaHypothermiaTension PneumothoraxTamponadeToxinsThrombosis, PulmonaryThrombosis, Coronary X5241290-88709510min Assessment Monitor VitalsGet 12 lead EKG,IV accessesLabs, History, Notify HospitalFibrinolytic Checklist0010min Assessment Monitor VitalsGet 12 lead EKG,IV accessesLabs, History, Notify HospitalFibrinolytic ChecklistAcute Coronary SyndromeChest discomfort suggestive of ischemia.Signs and SymptomsPressure, fullness, squeezing, pain in the center of the chest lasting several minutesChest discomfort spreading the shoulders, neck, one or both arms, or jawChest discomfort spreading to the back or between the shouldersChest discomfort with light – headedness, dizziness, fainting, sweating, nausea, or vomitingUnexplained shortness of breath with our without chest discomfort. Treatment of ChoiceMorphine 2-4mgOxygen Titrate to Keep Saturation level greater than 94%Nitroglycerin – tablet or spray – every 3-5min. with ongoing symptoms – Hemodynamic Stable > 90 mmHg:.4mg sublingual tablet evert 3 -5min. Do not administer Nitroglycerin with the following:Recent Phosphodiesterase InhibitorInferior Wall MI and (RV) Infarction Hypotension, Bradycardia, Tachycardia24hour wait sildenafil or vardenafilUse 48hour wait with tadalafilAspirin 162-325Treatment for STEMIFibrinolytic Therapy TPA - within 30min - door to needle timePCI (percutaneous coronary Intervention) within 90min from time of medical contact. EMS should choose a facility that provides PCI (Cath Lab) over any others considering the 90min time frame. ................
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