NS 500 mL Bolus

Epi 1:10,000 1 mg IV;repeat every 3 minutes

Physician Options; Sodium Bicarb 50 mEq IV

Cardiac Arrest: V-Fib/V-Tach

(1)

NS 500 mL IV Bolus

Epi 1:10,000 dose 1 mg IV; repeat every 3 mins

Amiodarone (Coradone) 300 mg IV, repeat 150 mg in 3-5 mins

Amiodarone (Coradone) infusion with ROSC; 150 mg in 100 mL NS over 10 mins (10 mL/min)

Cardiac Arrest: V-Fib/V-Tach

(2)

Consider Sodium Bicarb 50 mEq for renal failure or suspected hyperkalemia

Consider Magnesium 2 g IV if suspected hypomagnesemic or torsades de pointes

Physician Options: Lido 1.5 mg/kg bolus and/or infusion, additional amiodarone (Cordarone) infusion

Cardiac Arrest: ROSC - Therapeutic Hypothermia

(1)

Chilled NS to a total of 30 mL/kg or 2 L max

Appropiate tx. of presenting rhythm

Consider Dopamine 5 mcg/kg/min if needed after fluid bolus complete, at what drip rate? How would you prepare it?

Tx of shivering and sedation: Fentanyl 50 mcg every 5 mins as needed (SBP>100) and Versed 2.5 mg IV every 5 mins as needed (SBP>100)

Cardiac Arrest: ROSC - Therapeutic Hypothermia

(2)

Physician Options; Fentanyl 50 mcg IV over 5 mins every 10 mins as needed (SBP>80)

Vecuronium 0.1 mg/kg to a max of 10 mg if shivering or ventilatory problems; ONLY if advanced airway has been placed

Antiarrhythmic (Additional Ami or Lido, what drip rate? How would you prepare it?)

Dopamine titration

Management of hypertension SBP>200 with either Nitro 0.4 mg SL or 1-2" TD

Metoprolol 5 mg IV over 5 mins; up to four doses

Aspirin 324 mg (4x81mg tabs) chewed

Nitro 0.4 mg per dose, up to 3 doses, 5 mins apart, SBP>120/MAP>80

If SBP<100, NS 250 mL IV bolus

Physician Option: Repeat Nitro 0.4 mg every 5 mins

Aspirin 324 mg(4x81mg tabs) chewed

Nitro 0.4 mg per dose, up to 3 doses, 5 mins apart, SBP>120 or MAP>80

SBP<100, NS 250 ml IV Bolus, may repeat up to 2 L provided lung sounds are clear

Pain management as needed

Cardiac: ST Elevation MI - Confirmed

(2)

Physician Options: Repeat 0.4 mg doses of Nitro every 5 mins

Additional NS

Metoprolol (Lopressor) 5 mg slow IV, if HR>80 and SBP>120 or MAP>80 to a total of 3 doses

Cardiac: Cardiogenic Shock

(1)

Aspirin 324mg (4x81mg tabs) chewed

NS 250 mL IV bolus; recheck lung sounds and repeat if unchanged

Additional NS bolus to a total of 2 L

If UNSTABLE: Dopamine infusion 5 mcg/kg/min, at what drip rate? How would you prepare it?

Cardiac: Cardiogenic Shock

(2)

500 mL NS bolus, reasses and repeat up to 1000 mL total

Physician Options: Dopamine 5-20 mcg/kg/min

If rhythm is converted: Amiodarone (Cordarone) 150 mg in 100mL NS IV over 10 mins, drip rate? How would you prepare it?

If stable: Amiodarone (Cordarone) 150 mg in 100mL NS over 10 mins

Physician Options: Adensoine (Adenocard) 6mg or 12mg IV with rapid NS flush 

Cardiac: Wide Complex Tachycardia with a pulse

(2)

Physician Options: Lidocaine 1.5 mg/kg IV

Repeat Amiodarone (Cordarone) 150 mg in 100 mL NS over 10 mins

Magnesium 2 gm IV, over 20 mins for STABLE patients, over 2 mins for UNSTABLE patient

Cardiac: Narrow Complex Tachycardia

(1)

-If Regular Rhythm: Adensoine (Adenocard) 6 mg IV with rapid NS flush, may repeat at 12mg IV if needed

-If STABLE irregular rhythm: Diltiazem 0.25mg/kg (max of 25 mg) slow IVP

Cardiac: Narrow Complex Tachycardia

(2)

Physician Options: Additional Adenosine, Diltiazem slow IVP, Metoprolol 5 mg slow IVP

Amiodarone 150 mg in 100 NS, infsued over 10 mins