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TestOut LabSim

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Sinus bradycardia — what do you do after determining patient is unstable1. Option 1: administers Atropine
2. Option 2: Transcutaneous pacing

Then: reassess patient (mini physical assessment), vitals, determine hemodynamic stabilitySVT stable: what do you do after assessment?1. Give O2
2. Vagal maneuvers (blow through a straw)
3. Med: Ca2+ channel blocker, Beta blocker, OR adenosine
4. Reassessment + vitals, determine hemodynamic stabilitySVT unstable: what do you do after identifying unstable via assessment1. O2
2. Option 1: adenosine
OR
Option 2: cardioversion (synch by asking provider for energy, charge, clear, shock)
3. Reassessment + vitals + determine if hemodynamically stable

THEN pt will switch to Afib (uncrontrolled: bpm>100)
1. Ca2+ channel blocker or Beta blockerVentricular tachycardia with a pulse: what do you do after assessment and determine if stable or unstable1. administer antiarythmics = Amiodarone or Lidocaine
2. Reassessment + vitals + hemodynamically stable?V fib without a pulse: what do you do?1. Establish unresponsiveness
2. check for pulse (on neck)
3. call for help
4. start compressions immediately
5. Helper: ventilate every 30 compressions x2 breaths. Make sure ambu bag is attached to O2
6. have someone take over for you with compressions, apply the 5 leads (white over green on R, brown in middle, black over red on L side)
7. Identify rhythm — Vfib (crazy looking)
8. Continues CPR until defibrillator charged and delivers first shock ASAP
150 J if they don’t give it to you
Make sure everyone clears pt
9. Immediately resume CPR for 2 mins or 5 cycles
10. Defibrillate at higher energy (max)
11. Resume CPR for 2 min
12. Establish patent IV line
13. Give Epi — can do CPR at same time
14. Defibrillate third time max energy
15. CPR 2 min
16. Admin amiodarone or lidocaine
17. CPR 2 min
18. Defibrillate fourth time
19. CPR 2 min
–> rhythm comes back and reassess pt — hemodynamically stable?

 
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