Megacode PEA Part 7

Tablets

·         Assess for drug overdose

·         Assess for hx of drug use

·         Consult poison control

Tablets: Calcium Channel Blockers

·         Hypotension

·         Bradycardia with variable heart block

·         Altered mental status

·         EKG: slow rate, prolonged PRI, AV blocks

·         Rx Calcium chloride 10% 1-4G slow IV

·         Fluid resuscitation, vasopressor agents, atropine, transvenous pacing

Tablets: Beta blockers

·         Hypotension

·         Bradycardia with variable heart block

·         EKG: slow rate, prolonged PRI

·         Rx Glucagon 3-10mg IV bolus followed by infusion 2-5mg/hr

Tablets: Tricyclic Antidepressants

·         Amitriptyline, Doxepine, Trazadone, Nortriptyline

·         Prolonged QT, Widened QRS

·         3Cs & 1A - Cardiac dysrhythmias, Convulsions, Coma, & Acidosis

·         Rx NaHCO3 bolus or infusions

·         Maintain pH > 7.45

Tablets: Digoxin

·         Toxicity many cause a variety of dysrhythmias

·         Rx Digibind follow normogram in PDR or drug insert for correct dosing information

Tablets: Cocaine

·         Elevates blood pressure

·         Increases cardiac contractility

·         Decreases coronary blood flow

·         Increases coronary vasoconstriction

·         Increases myocardial oxygen consumption

Tablets: Cocaine- Treatment

·         MONA

·         Benzodiazepines- modulates stimulatory effects of cocaine on CNS

·         Avoid  blockers- increases coronary vasoconstriction

·         VT/VF follow ACLS algorithm

Tamponade, cardiac

·         Hx of trauma, chest malignancy

·         Muffled heart sounds

·         Tx: pericardialcentesis

Tension Pneumothorax

·         Hx trauma, recent pacemaker or central line insertion, ventilator patient

·         Assess for tracheal deviation

·         Needle decompression 2nd intercostal space midclavicular line

·         Chest tube

Thrombosis, Coronary

·         MONA

·         Follow ACS algorithm

Thrombosis, Pulmonary

·         Thrombolytics

·         Heparin infusion

·         Surgery

Rhythm

·         Wide QRS: suggests massive myocardial injury, hyperkalemia, hypoxia, hypothermia

·         Wide QRS+Slow: consider drug OD (tricyclics, beta-blockers, Ca-blockers, digoxin)

·         Narrow complex: suggests intact heart; consider hypovolemia, infection, PE, tamponade

References

Aehlert, Barbara. ACLS Quick Review Study Guide, 2^nd edition.  Mosby, inc.  St. Louis, Mo. 1994.

Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, Kudenchuk PJ, Ornato JP, McNally B, Silvers SM, Passman RS, White RD, Hess EP, Tang W, Davis D, Sinz E, Morrison LJ. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S729–S767