Float Nurse

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 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 Resusci...

Hypokalemia ·          Slow rhythm with ST segment depression, flattened waves, prominent U wave ·          Potassium replacement either orally or IV ·          No IV push boluses! 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...

Evaluate:   5Hs & 5Ts ·          Hypoxia ·          Hypovolemia ·          Hyper/hypokalemia ·          Hydrogen ions (acidosis) ·          Hypothermia Evaluate:   5Hs & 5Ts ·          Tension pneumothorax ·          Thrombosis: coronary ·          Thrombosis: pulmonary ·          Thrombosis: Tables/toxins ·          Tamponade, cardiac Hypoxia ·          Hypoventilation and hypoxia can lead to bradycardia ·          Assess ABCs ·      ...

Chronotropic drugs ·          For the treatment of adults with symptomatic and unstable bradycardia ·          Recommended as an alternative to pacing Dopamine 5-20ug/kg/min Low dose 1-5ug/kg/min Moderate dose 5-10ug/kg/min High dose 10-20ug/kg/min Note: At lower doses dopamine has a more selective effect on inotropy and heart rate; at higher doses (>10 mcg/kg per minute), it also has vasoconstrictive effects. Dopamine infusion may be used for patients with symptomatic bradycardia, particularly if associated with hypotension, in whom atropine may be inappropriate or after atropine fails Epinephrine 2-10ug/min ·          Epinephrine infusion ·          Mix 1mg in 250 NS Note Epinephrine infusion may be used for patients with symptomatic bradycardia, particularly if associated with ...

Electrical Capture ·          Electrical capture is observed when a pacer spike is immediately followed by a QRS complex ·          Notice that the QRS complex is wide and there is ST elevation. Increase mA by 5-10mA Until Electrical Capture is Obtained Mechanical Capture ·          Improved BP ·          Palpable pulse ·          Improved level of consciousness ·          Improved respiratory status ·          Cessation of chest pain ·          Improvement in skin color Note:  Pulse rate should equal that of the rate set by the pacemaker.  Monitoring continuous pulse oximetry is a good way of verifying the pulse rae and...

Transcutaneous pacing ·          TCP should not be delayed while waiting for an IV and Atropine ·          Set rate between 60-80/min ·          Begin at lowest mA and increase ·          Observe for electrical capture ·          Assess for mechanical capture ·          Consider analgesics and sedation for pain Combo Pad Placement ·          Avoids pacemakers and ICDs ·          Insure the skin is dry ·          Shave excess hair if needed ·          Avoid medication patches ·          Avoid letting patches touch ·   ...

Primary Survey ·          Assess ABCs ·          Breathing-secure noninvasive airway ·          Call for monitor/defibrillator Note: Because hypoxemia is a common cause of bradycardia, initial evaluation of any patient with bradycardia should focus on signs of increased work of breathing (tachypnea, intercostal retractions, suprasternal retractions, paradoxical abdominal breathing) and oxyhemoglobin saturation as determined by pulse oximetry Secondary Survey ·          Oxygen ·          IV access-fluids ·          Vital signs, pulse oximeter, BP ·          Obtain 12 lead ·          Differential diagnosis Bradycardia Intervention Mnemonic: PACE...

Management of Bradycardia Causes of Bradycardia ·          Acute myocardial infarction ·          Drugs:  blockers, digoxin, Amiodarone ·          Increased intracranial pressure ·          Sick sinus syndrome ·          Hypothermia ·          Hypothyroidism   Common Bradycardic Rhythms ·          Sinus bradycardia ·          NSR with sinus arrest ·          2 nd degree heart block type II ·          3 rd degree heart block   Sinus Bradycardia       ECG  Characteristics   Rate: The atrial an...