p.1
Bradycardia Management
What should be done first in a bradycardia crisis?
Inform the team and identify a leader.
p.1
Bradycardia Management
What oxygen flow rate should be administered to a bradycardia patient?
100% O2 at 10 - 15 L/min.
p.1
Pharmacological Interventions for Arrhythmias
What medication is first considered for bradycardia?
Atropine 0.5 - 1 mg IV every 3 minutes.
p.1
Pharmacological Interventions for Arrhythmias
What should be done if atropine is ineffective?
Administer epinephrine 5 - 10 mcg IV.
p.1
Bradycardia Management
What is the recommended pacing rate for a bradycardia patient?
Set pacer rate to at least 80 bpm.
p.1
Bradycardia Management
What lab tests should be sent for a bradycardia patient?
ABG, Hgb, electrolytes, troponin.
p.12
Difficult Airway Management
What is the priority action if oxygenation cannot be achieved?
Cutting the neck (performing a cricothyrotomy).
p.12
Difficult Airway Management
What should be monitored to assess oxygenation during a CICO situation?
CO2 return by capnography and SpO2.
p.11
Post-Arrest Care and Monitoring
What should be done for hypoglycemia?
Check for and correct hypoglycemia.
p.4
Cardiac Arrest Protocols
What is the recommended compression rate during CPR?
100 - 120 compressions per minute.
p.14
Pulmonary Embolism Management
What are the signs indicating a potential pulmonary embolism?
Sudden decrease in EtCO2, BP, or SpO2; sudden increase in central venous pressure; dyspnea, respiratory distress, or cough in an awake patient.
p.13
Difficult Airway Management
What is the first step in performing emergency front of neck access (eFONA)?
Expose and extend the neck, then perform a laryngeal handshake to identify the midline.
p.7
Anaphylaxis Treatment Protocols
What should be done if ventilation is possible during anaphylaxis?
Administer albuterol 4-8 puffs MDI or 2.5 mg nebulized and sevoflurane titrated to 1 MAC.
p.11
Post-Arrest Care and Monitoring
What action should be taken if a stroke is suspected?
Call Stroke Code and obtain a STAT head CT scan.
p.8
Differential Diagnosis in Cardiac Emergencies
What sequence of numbers is presented?
3, 15, 16, 5, 6, 7, 8, 9, 10, 11, 12, 13, 17, 18, 19, 20, 21, 22, 23, 24, 25, 2, 4, 14, 26, 27, 28, 29.
p.10
Differential Diagnosis in Cardiac Emergencies
What could the numbers represent in a different context?
They could correspond to letters in the alphabet (A=1, B=2, etc.).
p.11
Post-Arrest Care and Monitoring
What is a sign of delayed emergence in a patient?
Less responsive than expected during emergence.
p.5
Differential Diagnosis in Cardiac Emergencies
What is the treatment for hypoglycemia?
Administer Dextrose/D50 1 amp (25 g) and monitor glucose.
p.12
Difficult Airway Management
What is a key consideration when using a supraglottic airway (SGA/LMA)?
Optimize size and fit, and consider using a second-generation device.
p.13
Difficult Airway Management
What direction should the scalpel be rotated during eFONA?
Rotate the scalpel 90° with the blade toward the patient’s feet and pull toward you.
p.2
Synchronized Cardioversion Techniques
What should be done if there is no pulse?
Start CPR and assess for Asystole/PEA.
p.12
Difficult Airway Management
What should be done if laryngoscopy fails?
Consider alternative airway techniques or call for help.
p.3
Pharmacological Interventions for Arrhythmias
What is the initial dose of Esmolol for rate control in SVT?
0.5 mg/kg IV over 1 minute.
p.11
Post-Arrest Care and Monitoring
What should be done first in a crisis during delayed emergence?
Inform the team and stop all medications.
p.4
Cardiac Arrest Protocols
What energy levels should be used for defibrillation?
120-200 J biphasic or 360 J monophasic.
p.6
Anaphylaxis Treatment Protocols
What is the recommended initial dose of epinephrine for anaphylaxis?
10 - 100 mcg IV or 500 mcg IM if no IV access.
p.4
Post-Arrest Care and Monitoring
What is the post-arrest care if ROSC is achieved?
Arrange ICU care and consider cooling.
p.6
Anaphylaxis Treatment Protocols
What is the recommended action for fluid management in anaphylaxis?
Give a rapid IV fluid bolus, which may require many liters.
p.6
Anaphylaxis Treatment Protocols
What is the CPR rate recommended if there is no pulse during anaphylaxis?
100 - 120 compressions per minute.
p.3
Pharmacological Interventions for Arrhythmias
What should be done if the patient has wide and irregular SVT?
Consult Cardiology STAT as it is likely polymorphic VT.
p.5
Differential Diagnosis in Cardiac Emergencies
What is the initial treatment for hypoxemia?
Administer 100% O2 at 10-15 L/min.
p.11
Post-Arrest Care and Monitoring
What are signs of high intracranial pressure (ICP)?
Widened pulse pressure, bradycardia, irregular respirations.
p.7
Anaphylaxis Treatment Protocols
What should be considered for persistent bronchospasm?
H1 antagonist (diphenhydramine 25-50 mg IV), H2 antagonist (famotidine 20 mg IV), or corticosteroid (hydrocortisone 100 mg IV or methylprednisolone 125 mg IV).
p.5
Differential Diagnosis in Cardiac Emergencies
What should be done for hyperthermia?
See Malignant Hyperthermia protocol.
p.7
Anaphylaxis Treatment Protocols
What should be added to the patient's allergy list after anaphylaxis?
Consider adding allergens.
p.10
Differential Diagnosis in Cardiac Emergencies
What does the phrase 'This space is intentionally blank' imply?
It indicates that the page is left empty for a specific purpose.
p.5
Differential Diagnosis in Cardiac Emergencies
What should be done to manage hypovolemia?
Give rapid IV fluid bolus and check Hgb.
p.4
Pharmacological Interventions for Arrhythmias
What medication should be administered after the second shock?
Epinephrine 1 mg IV every 3 - 5 minutes.
p.5
Differential Diagnosis in Cardiac Emergencies
What is the initial management for thrombosis - pulmonary?
Consider TEE/TTE to evaluate right ventricular function and RVSP.
p.7
Anaphylaxis Treatment Protocols
How long should a patient be monitored after anaphylaxis?
At least 6 hours; if severe, monitor in ICU for 12-24 hours.
p.14
Pulmonary Embolism Management
What other conditions should be considered when evaluating a patient with suspected pulmonary embolism?
Anaphylaxis, bone cement implantation syndrome, bronchospasm, cardiac tamponade, cardiogenic shock, distributive shock, hypovolemia, myocardial ischemia, pneumothorax, and pulmonary edema.
p.13
Difficult Airway Management
What medications should be administered before performing eFONA?
Give a paralytic and anesthetic.
p.15
Pharmacological Interventions for Arrhythmias
What is the dosage for thrombolysis using rtPA alteplase?
10 mg IV followed by an infusion of 90 mg over 2 hours.
p.12
Difficult Airway Management
What equipment is needed for a cricothyrotomy?
Scalpel (e.g., #10 blade), bougie, and 6.0 ET tube.
p.2
Synchronized Cardioversion Techniques
What should be done for refractory unstable SVT?
Repeat synchronized shock with increased joules and consider amiodarone 150 mg IV slow over 10 minutes.
p.7
Anaphylaxis Treatment Protocols
What lab test should be sent after an anaphylactic reaction?
Peak serum tryptase 1-2 hours after reaction onset.
p.13
Difficult Airway Management
What should be done after inserting the bougie in eFONA?
Remove the scalpel and pass a 6.0 ET tube over the bougie.
p.11
Post-Arrest Care and Monitoring
What lab tests should be sent to evaluate the patient?
ABG plus electrolytes for hypercarbia, hyponatremia, hypernatremia, and hypercalcemia.
p.13
Difficult Airway Management
What should be monitored during the eFONA procedure?
Monitor vital signs and pulse.
p.15
Pulmonary Embolism Management
What are the signs of Cement or Fat Embolism?
Petechial rash, confusion or irritability if awake.
p.5
Differential Diagnosis in Cardiac Emergencies
How can hyperkalemia be treated?
Calcium chloride 1g IV, bicarbonate 1 amp IV, and insulin with D50.
p.7
Anaphylaxis Treatment Protocols
What intravenous treatment can be given if unable to ventilate?
Epinephrine 5-10 mcg IV or ketamine 10-50 mg IV or magnesium sulfate 1-2 g IV.
p.5
Differential Diagnosis in Cardiac Emergencies
What are the signs of tension pneumothorax?
Asymmetric breath sounds, distended neck veins, and deviated trachea.
p.6
Anaphylaxis Treatment Protocols
How often should the IV dose of epinephrine be increased?
Every 2 minutes until clinical improvement.
p.3
Pharmacological Interventions for Arrhythmias
What medication is used for narrow and regular SVT?
Adenosine, 6 mg IV push, followed by 12 mg IV if needed.
p.5
Differential Diagnosis in Cardiac Emergencies
What should be done for suspected cardiac tamponade?
Consider TEE/TTE and perform pericardiocentesis.
p.9
Difficult Airway Management
What is the recommended oxygen flow for airway management in bronchospasm?
100% O2 at 10 - 15 L/min.
p.14
Pulmonary Embolism Management
What advanced interventions should be considered in cases of severe decompensation?
Consider ECMO or cardiopulmonary bypass.
p.3
Pharmacological Interventions for Arrhythmias
What should be avoided when administering Adenosine?
In patients with WPW or asthma.
p.15
Pulmonary Embolism Management
What is the treatment for Amniotic Fluid Embolism?
Supportive treatment: airway, breathing, circulation; monitor fetus; consider urgent Cesarean section.
p.11
Post-Arrest Care and Monitoring
What should be done to reverse residual neuromuscular paralysis?
Use sugammadex or neostigmine with glycopyrrolate.
p.13
Difficult Airway Management
What is the technique for accessing the trachea through the cricothyroid membrane?
Stab horizontally through the cricothyroid membrane and extend to the width of the trachea.
p.9
Pharmacological Interventions for Arrhythmias
What should be monitored when administering epinephrine?
Monitor for tachycardia and hypertension.
p.3
Pharmacological Interventions for Arrhythmias
What is the recommended dose of Amiodarone for wide and regular SVT?
150 mg IV over 10 minutes.
p.10
Differential Diagnosis in Cardiac Emergencies
What is the significance of the numbers listed (3, 15, 16, etc.)?
They may represent a sequence or a coded message.
p.7
Anaphylaxis Treatment Protocols
What should be considered for additional IV access in anaphylaxis treatment?
Consider arterial line placement.
p.14
Pulmonary Embolism Management
What factors increase the risk of pulmonary embolism?
Long bone orthopedic surgery, pregnancy, cancer (especially renal tumor), high BMI, laparoscopic surgery, or surgical site above the level of the heart.
p.13
Difficult Airway Management
What should you do after making the vertical incision in eFONA?
Palpate the cricothyroid membrane.
p.14
Pulmonary Embolism Management
What actions should be taken regarding circulation in a suspected pulmonary embolism case?
Turn off volatile anesthetic and vasodilating drips, give IV vasopressor bolus, and consider rapid fluid bolus.
p.11
Pharmacological Interventions for Arrhythmias
What is the initial dose of naloxone for opioid reversal?
40 mcg IV, may double and repeat every 2 minutes up to 400 mcg.
p.13
Difficult Airway Management
What should be considered if there are risks for a difficult airway?
Make contingency plans and consider advanced airway equipment.
p.9
Pharmacological Interventions for Arrhythmias
What additional medications can be considered for bronchospasm?
Ketamine 10 - 50 mg IV, magnesium sulfate 1 - 2 g IV, or hydrocortisone 100 mg IV.
p.15
Pulmonary Embolism Management
What supportive treatments are necessary for Air or CO2 Embolism?
Airway, breathing, circulation.
p.8
Differential Diagnosis in Cardiac Emergencies
What does the phrase 'This space is intentionally blank' imply?
It indicates that the page is left empty for a specific purpose.
p.2
Synchronized Cardioversion Techniques
What indicates that a patient is unstable?
SBP < 75 mmHg, sudden SBP decrease, acute ischemia, chest pain, acute heart failure, or altered mental status.
p.12
Difficult Airway Management
What should be done if SpO2 is critically low?
Go to the red box protocol.
p.4
Cardiac Arrest Protocols
What is the priority between defibrillation and intubation?
Defibrillation is the higher priority.
p.6
Anaphylaxis Treatment Protocols
What should be done if angioedema occurs during anaphylaxis?
Consider early intubation.
p.3
Pharmacological Interventions for Arrhythmias
What should be obtained to assist in the diagnosis of SVT?
A 12-lead ECG or a print rhythm strip.
p.13
Difficult Airway Management
Who should be informed during an emergency cricothyrotomy?
Announce the emergency cric / front of neck access to the team.
p.9
Emergency Front of Neck Access (Cricothyrotomy)
What advanced interventions may be considered for severe bronchospasm?
ECMO or cardiopulmonary bypass.
p.12
Difficult Airway Management
What should be done to optimize conditions before attempting intubation?
Ensure paralysis, anesthetic depth, and optimize positioning.
p.7
Anaphylaxis Treatment Protocols
What medication should be continued if hypotension occurs during anaphylaxis?
Continue epinephrine infusion.
p.11
Post-Arrest Care and Monitoring
What vital signs should be checked and corrected?
Hypoxemia, hypercarbia, hypothermia, or hypotension.
p.14
Pulmonary Embolism Management
What should be done if there is no pulse in a patient suspected of having a pulmonary embolism?
Start CPR, check rhythm, and follow the appropriate algorithm.
p.4
Pharmacological Interventions for Arrhythmias
What should be done if hypomagnesemia or torsades is suspected?
Administer magnesium 1 - 2 g IV.
p.6
Anaphylaxis Treatment Protocols
What should be done if the patient is hypotensive during anaphylaxis?
Turn off volatile anesthetics and vasodilating drips, and consider an amnestic agent.
p.13
Difficult Airway Management
What should be confirmed after inflating the cuff and ventilating in eFONA?
Confirm CO2 and check breath sounds.
p.6
Anaphylaxis Treatment Protocols
What should be monitored to check for signs of return of spontaneous circulation (ROSC)?
Sustained increased EtCO2, spontaneous arterial waveform, rhythm change.
p.4
Cardiac Arrest Protocols
When should pulse checks be performed?
Only if there are signs of ROSC.
p.14
Pulmonary Embolism Management
What is the first action to take in a crisis situation involving a suspected pulmonary embolism?
Inform the team and identify a leader.
p.9
Differential Diagnosis in Cardiac Emergencies
What are the signs of bronchospasm?
Inability to ventilate, high peak inspiratory pressure, wheezing, absent breath sounds if severe, increased expiratory time, increased EtCO2, upsloping EtCO2 waveform, decreased tidal volumes, hypotension if air-trapping.
p.11
Post-Arrest Care and Monitoring
What should be checked during a neurological exam?
Pupil changes, motor asymmetry, and gag reflex.
p.3
Pharmacological Interventions for Arrhythmias
What is the first step in managing stable SVT?
Consult STAT Expert for rhythm diagnosis and medication selection.
p.7
Anaphylaxis Treatment Protocols
What conditions should be ruled out during anaphylaxis treatment?
Anesthetic overdose, aspiration, distributive or obstructive shock, embolism, hemorrhage, hypotension, myocardial infarction, pneumothorax, and sepsis.
p.11
Post-Arrest Care and Monitoring
What should be done if there are residual mental status abnormalities?
Monitor the patient in ICU with neurologic follow-up.
p.15
Pulmonary Embolism Management
What is the initial treatment for Pulmonary Thromboembolism?
Discuss feasibility and safety of urgent thrombolysis vs. thrombectomy with the surgical team.
p.9
Emergency Front of Neck Access (Cricothyrotomy)
What should be done if hypotension is observed during bronchospasm?
Briefly disconnect the circuit if air-trapping is suspected.
p.14
Pulmonary Embolism Management
What should be evaluated in the right heart if instability or decreased RV function is suspected?
Use medication and diuresis to maintain sinus rhythm, normal RV volume status, RV contractility, and decrease RV afterload.
p.6
Anaphylaxis Treatment Protocols
What should be done to stop allergens during anaphylaxis?
Remove allergens such as antibiotics, muscle relaxants, and latex.
p.9
Difficult Airway Management
What should be checked to confirm airway placement?
Check CO2 waveform and auscultate lungs.
p.15
Pulmonary Embolism Management
What are the risk factors for Pulmonary Thromboembolism?
Chronic illness, neoplasm, immobility, missed anticoagulation.
p.9
Pharmacological Interventions for Arrhythmias
What medications are recommended for severe bronchospasm?
Epinephrine 5 - 10 mcg IV every 3 - 5 min or 200 mcg subcutaneously, with possible addition of glycopyrrolate 0.2 - 0.4 mg IV.
p.11
Differential Diagnosis in Cardiac Emergencies
What rare causes should be considered in delayed emergence?
High spinal, serotonin syndrome, malignant hyperthermia, myxedema coma, seizure, thyroid storm, hepatic/uremic encephalopathy.
p.15
Pulmonary Embolism Management
What are the signs of Amniotic Fluid Embolism?
Altered mental status, hypotension, hypoxemia, seizures, coagulopathy in a peripartum patient.
