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26 Cards in this Set
- Front
- Back
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Initial management for suspected cardiac pain includes:
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Nitroglycerin 0.4 mg SL may repeat approximately every 3 minutes to a total of three doses as long as BP remains above 90mm/HG
SO-C-15 |
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What is the dose for Nitroglycerin for chest pain of cardiac origin?
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0.4 mg SL if systolic BP > 90mm/Hg
May repeat approximately every 3 minutes with a maximum of 3 doses if systolic BP remains above 90 mm/Hg This does not include possible patient doses prior to ALS arrival SO-C-15 |
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When is Morphine Sulfate administered to chest pain of cardiac origin patients?
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Chest pain is unrelieved after 3 doses of Nitro or if Nitro can not be administer such as when patient has used Viagra within 24 hours.
SO-C-15 |
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Morphine Sulfate
dosage for chest pain of cardiac origin |
5 mg (or 4 mg carpuject) IV or administer SQ if an IV cannot be established
May repeat once if systolic BP holds > 90 mm/Hg SO-C-15 |
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What are the contraindications to Aspirin?
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1. Chest pain radiating to mid-back
2. Blood thinners or antiplatelet medications 3. Aspirin allergy 4. Asthma SO-C-15 |
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What is the Aspirin dosage?
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4 (four) 81 mg chewable tablets total dose of 324mg
SO-C-15 |
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Name the common blood thinners:
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Coumadin (Warfarin)
Plavix Lovenox Pradaxa Effient SO-C-15 |
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What are the contraindications for IO?
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1. STEMI (also external jugular)
2. Acute stroke (also external jugular) 3. Neonates 4. Alert patients 5. Potential CVRC patients SO-C-15 |
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12-lead ECG indications for adults 45 years or older
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1. Known history of cardiac with complaints of chest discomfort, SOB or syncope-weakness
2. Radiation of chest pain to arm, shoulder, neck, jaw or back 3. Diaphoresis 4. Chest discomfort unrelated to injury or strain SO-C-15 |
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Describe the initial treatment for symptomatic or deteriorating bradycardia
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1. Cardiac monitor with documented rhythm strip
2. Pulse Ox; administer high flow O2 if <95% 3. Obtain 12-lead ECG if possible; contact Base for CVRC if acute MI 4. If continued symptomatic or detoriorating bradycardia, initiate pacing (Procedure # PR-110) SO-C-20 |
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Destination for symptomatic/deteriorating bradycardia patients successfully paced by pacemaker
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Base hospital contact for potential CVRC destination
SO-C-20 |
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Treatment and destination for symptomatic/deteriorating bradycardia patients NOT able to be paced
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1. Stop pacing current
2. Administer - atropine 0.5mg IV or IM every 3 minutes to max dose of 3mg 3. Contact Base for further patient stabilization orders 4. ALS escort to nearest PRC SO-C-20 |
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Premedication for pacing symptomatic/detoriorating bradycardia patients
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There is NO Standing Order for premedication prior to pacing!
IV access to administer Midazolam (Versed) 5 mg slow push only if patient has discomfort after pacing has been initiated; one dose only. **prepare to assist ventilations if respiratory depression develops If unable to establish IV access Midazolam (Versed) 5mg IN one time only if needed after pacing. May repeat once if given via IN route only. **prepare to assist ventilations if respiratory depression develops SO-C-20 |
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What is the definition of a "Narrow Complex Tachycardia"?
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A narrow QRS complex rhythm (less that 3 small boxes or 0.12 sec) with a rate greater than 100 bpm
SO-C-25 |
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What is the SO for SVT patients with mild discomfort, lightheadedness or diaphoresis?
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1. Monitor and document cardiac rhythm with strip
2. Pulse Ox; administer high-flow O2 if <95% 3. Attempt Valsalva maneuver 4. If continuing to show regular, narrow QRS >160bpm rate after Valsalva, Adenosine 6mg rapid IV, repeat single dose of 12mg IV in 1-2 minutes if tachycardia persists (May skip 6mg dose if patient has prior success with 12mg dose; may repeat x 1 if neccesary) 5. ALS escort to nearest PRC SO-C-25 |
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What is the treatment for symptomatic SVT with narrow, regular QRS and >160bpm?
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1. Synchronized cardioversion
*Biphasic 100J initial shock, may repeat once with max energy (200J) if no conversion on first shock *Premedicate if patient is alert with Midazolam 5mg slow IV 2. Contact Base for further patient stabilization orders 3. ALS escort to nearest PRC SO-C-25 |
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List the typical chief complaints of a patient with stable ventricular tachycardia
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1. Syncope
2. Weakness 3. Chest pain 4. Shortness of breath 5. Lightheadedness SO-C-40 |
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What is SO for treatment of a patient with stable V-tach with a pulse?
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1. Cardiac monitor with documented rhythm strip
2. Pulse Ox; administer high-flow O2 if <95% 3. Closely monitor vital signs 4. ALS escort to nearest PRC SO-C-40 |
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Stable v-tach with a pulse defined as
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1. Systolic BP >90mmHG
2. Good mental status 3. Minimal chest discomfort SO-C-40 |
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Unstable v-tach defined as
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1. Systolic BP<90 mmHG
2. ALOC 3. Chest pain 4. Signs of poor perfusion SO-C-40 |
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What is SO treatment for the patient with unstable v-tach?
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1. Cardioversion with 100 J Biphasic (do not delay for IV if deteriorating)
2. If patient is awake and alert with BP > 90, pre-medicate with Midazolam 5mg slow IV 3. If cardioversion is unsuccessful administer Amiodarone 150mg slow IV and allow medication to circulate for 2 minutes. If unstable v-tach persists cardioversion 200 J Biphasic If v-tach continues, repeat Amiodarone 150mg slow IV After second dose of Amiodarone, cardioversion at full voltage if v-tach persists 4. Contact Base for further orders and transport destination SO-C-40 |
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List the initial sequence of treatment for a full arrest patient with V Fib
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1. CPR until patient can be defibrillated at 120 j
2. Two minutes of CPR, IV/IO 3. Defib @ 150 j, immediate CPR. 4. Epi 1:10,000 1mg IVP, circ. two min. 5. Defib @ 200 j.immediate CPR. 6. Amiodarone 300 mg., circ two minutes. 7. Repeat 8. Assess for correctible causes if patient develops a rhythm & pulse. (SO-C-10) |
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Destination for full arrest patient who regain pulses.
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Cardiovascular Receiving Center (CVRC)
(SO-C-10) |
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When is Base Hospital contact required for full arrest patients?
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1. Patient regains a pulse.
2. Additional orders are needed, such as Bicarb or Dopamine. 3. Field pronouncement after ALS treatment. (SO-C-10) |
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List the initial sequence of treatment for full arrest patient with PEA/Asystole.
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1. High quality CPR.
2. IV/IO access and fluid bolus of 250cc and ALS Airway. 3. Assess for correctible causes. 4. Epi 1:10,000 1 mg. IV/IO every 4 minutes. 5. Repeat sequence. (SO-C-10) |
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List the correctible causes of PEA/Asystole.
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1. Hypovolemia
2. Hypoxia 3. Hypothermia 4. Acidosis 5. Tension pneumothorax 6. Toxins (SO-C-10) |
