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Cardiac Emergencies: Bradycardia
ALS:
1. IV LR KVO
2. Pacing (if hemodynamically-hmd- unstable)
3. Atropine 0.5-1mg IVP q 3-5min (if pacing fail)
*4. Dopamine 2-20mcg/kg/min
*5. 2nd type II or 3rd Block AND hmd stable PACE
5a. Morphine/Midazolam 0.1mg/kg
PALS:
1. O2 + BMV 30sec
2. CPR if HR <60
3. IV/IO
4. Epi: 0.01mg/kg - 1:10, q 3-5
5. Atropine: 0.02mg/kg, X 1
6. TCP (<1yr:120bpm, 1-11yr: 100bpm, 12+yr:80bpm)
Cardiac Emergencies: VF/VT
ALS:
1. CPR & Attach Pads
2. Shock & CPR 2min
3. Confirm Rhythm (if org check pulse)
4. Intubate
5. IV LR KVO
6. Epi 1mg (1:10) IVP, q 3-5min
7. Shock & CPR 2min
8. Lidocaine 1.5mg/kg IVP MAX 3mg/kg
*8a. NaBicarb 1mEq/kg
PALS:
1. Shock 2J/kg & CPR 2min
2. IV/IO
3. Shock 4J/kg & CPR 2min
4. Epi 0.01mg/kg (1:10) - ET 0.1mg/kg (1:1) w/ 5mL LR
5. Shock 4J/kg & CPR 2min
6. Lidocaine 1mg/kg IV/IO/ET
7. Shock 4J/kg (6, 8, 10J/kg) [2,4,4,4,6,8,10J/kg]
Cardiac Emergencies: Asystole
1. CPR
2. Intubate
3. IV LR KVO
4. CONFIRM +1 LEAD
5. H's & T's
6. Epi 1mg IVP q 3-5
PALS:
1. CPR 2min, Rhythm check every 2min.
2. H's & T's
3. IV/IO
4. Epi 0.01mg/kg (1:10), ET 0.1mg/kg (1:1) in 5mL LR
Cardiac Emergencies: PEA
1. CPR
2. Intubate
3. IV LR KVO
4. H's & T's
5. Epi 1mg IVP
PALS:
1. CPR 2min, Rhythm check every 2min.
2. H's & T's
3. IV/IO
4. Epi 0.01mg/kg (1:10), ET 0.1mg/kg (1:1) in 5mL LR
AMS: Seizures
BLS:
DO NOT RESTRAIN
1. ID & treat injuries
2. If DM - Glucose 10-15g

ALS:
1. IV LR KVO
2. BGL
3. If HoGL - D50 25mg/50mL SIVP
SUSTAINED SEIZURE
1. Midazolam 0.1mg/kg SIVP or 5mg IM
AMS: Unresponsive
BLS:
1. SpO2
2. Glucose 10-15g

ALS:
1. IV LR KVO & Blood sample
2. IF OD - Naloxone 0.4-2mg SIVP/IM/IO
3. BGL - LR if HyGL, D50 if HoGL
4. Add'l Naloxone
5. LR up to 2L
Non-Traumatic Shock: Hypoperfusion
ALS:
1. IV LR KVO
2. IF LS CTA - LR 20ml/kg TtoE SBP 100mmHg
3. IF LS Rales - 250mL LR TtoE SBP 100mmHg
4. CON - Dopamine drip 2-20mcg/kg/min
5. CON - LR up to 2L
Respiratory Distress: Asthma/COPD
1. IV LR KVO
2. If mod-severe, 15lpm/CPAP/BVM
3. DuoNeb via Neb
4. Albuterol x1
5. CPAP
6. Epi 1:1K, 0.01mg/kg IM q 5min x3
OR 6a. Terbutaline 0.25mg IM
7. Dexamethasone 10mg IV/PO
8. CON add'l Epi/Albuterol/Terbutaline
Respiratory Distress: Allergic Rxn/Anaphylaxis
Mod-Severe Distress
BLS
1. Pt's Epi-autoinjector or Albuterol
ALS
2. Epi 1:1K IM
3. IV LR TtoE SBP 100
4. Diphenhydramine (CON for +)
5. High Flow O2 (NRB/CPAP/BVM) w/ Neb
6. DuoNeb, then Albuterol ONLY
ANAPHYLAXIS
7. Epi 1:10K MAX 1mg
MILD ALLERGIC RXN
8. Diphenhydramine or Epi 1:1K
9. IV LR
Respiratory Distress: PE/CHF
1. High Fowler's
2. TBR 1-10/10
3. CPAP & High Dose NTG (x3 setup/acclimtz/apply)
3a. IV LR KVO if no Rx for NTG
*IF NO IV CON for NTG
4. Captopril SL (SBP>110)
5. NTG Paste (after 3 NTG SL)
6. Furosemide (CON)
*IF BP LOW - Dopamine TtoE SBP 100
The CHF/APE Patient: S/S
1. Hx of CHF
2. 160/100+ BP!
3. JVD
4. AFib
5. Hx Cardiac disease
6. Orthopnea (pillows)
7. PND (Sev SOB while asleep)
8. Rales/Wheezing
9. Tachypnea
The COPD Patient: S/S
1. Hx Resp Illness
2. Rx Resp NOT cardiac
3. No Orthopnea (pillows)
4. No PND
5. No HTN
Respiratory Distress: PE/CHF *PEDIATRIC*
1. Semi-Fowler's
2. IV LR KVO
3. 12 Lead
4. High Flow O2 (CPAP/BVM/NRB) w/ Neb
5. Albuterol (CON)
6. Furosemide (CON)
7. Morphine (CON)
8. Dopamine (CON)
Neurological Emergencies: Stroke
1. Stroke test (FASS)
2. O2
3. Supine or Low Semi-Fowler's
4. Fibrinolytic Checklist
5. Onset < 2 HOURS
6. CON w/ Stroke Ctr.
ALS
7. BGL <70 - D50
8. IV LR KVO
9. CON if HoTN
10. DO NOT TREAT HTN
Possible Therapies & Treatments for H's & T's
Hypovolemia - Fluids
Hypoxia - Ventilation
Acidosis - Na-Bicarb 1mEq/kg
Hy/HoKal - Na-Bicarb, CaCl 20mg/kg SIVP
HoGL - D50
Hypothermia - Warming
Tension P - ND
Toxins - Narcan,NaBicarb,CaCl
Tamponade - Diesel
Thrombus - Diesel
Trauma - Diesel
Cardiac Emergencies: Tachycardia (Unstable Adult)
ALS:
1. CAB
2. IV LR KVO
3. HR>150 & Sick - Cardioversion
Cardiac Emergencies: Tachycardia (Stable Af/AF)
*Diltiazem 10-20mg over 2min
**CaCl: 250mg if HoTN from diltiazem
STABLE Tachycardia: SVT
1. CAB
2. IV/LR/KVO
3. Valsalva Maneuvers
4. CON
5. Adenosine 6mg/12/12
6. Complex width
6a. Narrow & HoTN - Cardiovert
6b. Narrow & EuTN - Transport
6c. Wide - Lidocaine 1-1.5mg/kg + Cardiovert
PALS:
1. CAB
2. Narrow [<0.9sec] + >220/180
- Vagal
- Adenosine 0.1mg/kg, 0.2mg, 0.2mg
- Cardiovert
3. Wide [>0.9sec]
- Adenosine
- Lidocaine 1mg/kg