Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
48 Cards in this Set
- Front
- Back
What is a risk of isoproterenol?
|
It may decrease SVR and MAP at the same time it is increasing HR, contractility and myocardial oxygen consumption
|
|
How should you give adenosine?
|
6mg then 12mg, and then another 12mg, should be administered by rapid IV push followed by 20cc
|
|
How do you treat supraventricular arrhythmias?
|
adenosine, second line is verapamil (can be lethal in VT)
|
|
Why should you not give lidocaine when you're planning on defibrillation and cardioversion? What is this process worsened by?
|
increases current and energy requirement, a process worsened by acidosis
|
|
What is the use of lidocaine in ventricular arrhythmias?
|
suppresses ventricular arrhythmias-PVCs, Vtach, Vfib; depresses automaticity without causing myocardial depression, may block chronotropy and decrease SNS outflow
|
|
When should you use procainamide?
|
when lidocaine is ineffective, suppresses ventricular ectopy
|
|
What is the dose of procainamide?
|
1.5 mg/kg over 5 min until ventricular ectopy is suppressed or QRS is widened
|
|
What is the mechanism of action of amiodarone?
|
increase refractory period and reduce membrane excitability of the heart
|
|
What is amiodarone used for?
|
antidysrhythmic used for recurrent or refractory Vtach or Vfib
|
|
Summarize basic CPR
|
-Rate of compressions - 100/min
-Compression:Ventilation - 30:2 with 2 min requirement before rhythm check -Duration of ventilation - 1 sec -Defibrillation - one shock followed by immediate CPR for 2 min -Depth of compressions - 1.5-2 inches |
|
What can now be considered for the diagnosis and treatment of stable undifferentialed wide-complex tachycardia when the rhythm is regular and the QRS waveform is monomorphic?
|
Adenosine
|
|
Mouth to mouth resusciation delivers what FiO2?
|
approx 16%
|
|
Does sodium bicarbonate improve the ability to defibrilate and survivability?
|
No
|
|
At what pH will you begin to see a decrease in myocardial contractility and CNS depression?
|
< 7.1
|
|
What is the problem with exogenous bicarbonate?
|
When it is administered during acidemia, bicarbonate reacts with H+ ions to form carbonic acid. The carbonic acid dissociates to CO2 and water and CO2 partial pressure increases. When CO2 cannot be eliminated, the pH of the system is only minimally changed or worsened.
|
|
What is survival with VF or pulseless VT if shock is administered in <1 min?
|
>70% but drops by 10% for each minute delayed
|
|
Useful mnemonic for shockable rhythm VF/pulseless VT. Explain.
|
Shock, Rock, Walk
Shock, Rock, now EVerbody, Walk Shock, Rock, And, Lets, Moonwalk Then back to the beginning Shock - defibrillate Rock - 5 cycles of CPR (C:V 30:2 over 2 mins) Walk - check for shockable rhythm Shock - defibrillate Rock - Resume CPR EVerybody - Epi 1 mg IV q3-5 min or Vasopressin 40 U IV Walk - Check for shockable rhythm Shock - Defibrillate Rock - Resume CPR And - Amiodarone 300 mg in 30cc and flush with 10-20cc NS once OR Lets - Lidocaine 1.5 mg/kg Moonwalk - Mg 1-2 gm IV in torsades depointes or refractory Vfib Back to the beginning |
|
What are the 6 H's and 5 T's?
|
Hypovolemia
Hypoxia Hydrogen ions (acidosis) Hypo/hyperkalemia Hypoglycemia Hypothermia Toxins Tamponade Thrombosis (coronary or pulmonary) Tension pneumothorax Trauma |
|
What heart rate usually exists with a bradyarrhythmia?
|
HR <50/min
|
|
What could be the possible causes of a bradycardia?
|
Remember: "MOOVAD"
M = Myocardial disease, ischemia, or infarction O = O2 low O = Overdose of anesthesia V = Vagal phenomenon A = acidemia D = drugs |
|
Initial steps of the adult bradycardia algorithm?
|
1. Assess appropriateness for clinical scenario
2. Maintain airway, give oxygen if hypoxemic, place on cardiac monitor, IV access, 12 lead EKG 3. Are they symptomatic? Yes - drugs, No - monitor and observe |
|
What is considered symptoms of bradycardia?
|
1. hypotension
2. AMS 3. Signs of shock 4. Ischemic chest discomfort 5. acute heart failure |
|
How should you treat a symptomatic bradycardia?
|
1. First try atropine 0.5 mg IV bolus and repeat every 3-5 minutes to a max of 3 mg (ie 6 doses)
2. If atropine is ineffective transcutaneous pace or dopamine or epi infusion. 3. Consider expert consultation and transvenous pacing |
|
Doses for epi and dopamine infusions in bradycardia treatment?
|
Epi - 2-10 mcg/min
Dopamine 2-10 mcg/kg/min |
|
What is preferred when IV access is not available, IO drug injection or injection into the ETT?
|
IO
|
|
Where are the preferred IO locations?
|
1. 1 cm below the tibial tuberosity medially on the tibial plateau
2. 1 cm proximal to the medial malleolus |
|
Describe steps of IO placement using EZ-IO kit.
|
1. Anesthetize the periosteum of the bone with 2-3 cc local anesthetic
2. using a twisting action, screw the needle into the bone until a give is felt 3. Remove the trocar and the metal cannula remains standing unsupported with its tip in the bone marrow 4. aspirate bone marrow to confirm placement (might be too thick) 5. inject fluid to confirm patency - should inject easily 6. standing cannula should be taped firmly around its base with a plastic cup protecting it from accidental dislodgement |
|
What is the first goal with tachycardia?
|
Quickly categorize it as a narrow complex (SVT) tachycardia (QRS <0.12 seconds) or wide complex tachycardia (QRS >0.12 seconds)
|
|
What is the differential diagnosis for tachycardia?
|
Remember: "How Can Every System Possibly Function Adequately?"
H = Hypovolemia, Hypoxia, Hypercarbia, Hyperthermia (malignant) C = CHF, Catecholamines E = Endocrine problems S = Sepsis, Surgery P = PE, Pneumothorax F = Fever A = Anemia, Anxiety, Anesthetic agents |
|
When HR is < ____ it is unlikely that symptoms of instability are caused primarily by the tachycardia unless there is impaired LV function.
|
<150
|
|
If not hypotensive, how should a pt with a narrow complex tachycardia be treated?
|
With adenosine while preparations are made for synchronized cardioversion
|
|
How many narrow complex tachycardias are there? Name them in order of frequency.
|
1. Sinus Tach
2. Afib 3. Aflutter 4. AV nodal re-entry 5. Accessory pathway mediated tachycardia 6. Atrial or multifocal atrial tachycardia 7. Junctional tachycardia |
|
How many wide complex tachycardias are there? Name them in order of frequency.
|
1. Vtach
2. Vfib 3. SVT with aberrancy 4. pre-excitation tachycardias (WPW) 5. Ventricular paced rhythms |
|
For a pt with stable, narrow complex SVTs or paroxysmal SVTs, what is the first line of defense?
|
1. Vagal maneuvers - will terminate 25%
2. If ineffective, Adenosine 6 mg, followed by 12 mg if there is no response within 1-2 min 3. If this fails, reasonable to use longer acting AV nodal blocking agents, specifically CCBs such as Verapamil (2.5-5 mg) and diltiazem (15-20 mg) along with BBs such as esmolol or metoprolol |
|
When should adenosine NOT be used for a tachycardia?
|
For a wide complex unstable, irregular, or polymorphic tachycardia since it may cause degeneration of the arrhythmia to Vfib
|
|
What type of tachycardia is verapamil contraindicated in?
|
wide complex tachycardia, unless known to be supraventricular in origin
|
|
For pts who are stable with likely VT, what is the preferred treatment strategy?
|
IV antiarrhythmic drugs or elective cardioversion is the preferred treatment strategy.
- If antiarrhythmics chosen, procainamide, amiodorone, or sotalol can be considered |
|
What drugs are useful for rate control for irregular tachycardias in the setting of CHF?
|
Digoxin and amiodarone
|
|
What drugs should be avoided in wide complex irregular rhythms?
|
AV nodal blocking agents such as adenosine, CCBs, digoxin, and possibly even BBs since they may paradoxically increase ventricular response.
|
|
What has been reported as effective in treating torsades de pointe?
|
Magnesium, isoproterenol, and ventricular pacing
|
|
Polymorphic Vtach in the absence of prolonged QT interval is most often due to ___.
|
Myocardial ischemia
|
|
Tachycardia with pulses algorithm
|
1. ABCs, give O2
2. Stable or Unstable? 3. Unstable - perform immediate synchronized cardioversion, Stable - Is it narrow or wide complex? 4. If it's narrow is it regular or irregular? 5. If regular and narrow, attempt vagal maneuvers, if that fails give adenosine 6 mg rapid IV push, if failed give 12 mg (may repeat 12 mg once). If it converts observe for recurrence. If it recurrs tx with adenosine or longer AV nodal blocking agent (diltiazem, BBs). If it does not convert, control rate with diltiazem or BBs. 6. If irregular and narrow, control rate (diltiazem or BBs), consider expert consult 7. If it's wide complex, is it regular or irregular? 8. If regular, prepare for elective synchronized cardioversion. Give Amiodarone 150 mg IV over 10 min. Rpt as needed to max dose of 2.2g/24 hrs. If SVT w/ aberrancy give adenosine. 9. If irregular and wide, get expert consult, avoid AV nodal blocking agents, consider antiarrhythmics |
|
If a narrow, regular complex tachycardia converts with vagal maneuvers or adenosine, what is the likely rhythm?
|
Probably reentry SVT
|
|
If a narrow, regular complex tachycardia does not convert with vagal maneuvers or adenosine, what is the likely rhythm?
|
Possibly aflutter, ectopic atrial tachycardia, or junctional tachycardia
|
|
What is the likely rhythm if it is an irregular narrow-complex tachycardia?
|
Probable afib or possible aflutter or multifocal atrial tachycardia
|
|
What are the possible causes of an irregular wide complex tachycardia?
|
AFib with aberrancy
Pre-excited afib Recurrent polymorphic VT Torsades de pointes |
|
What may improve outcomes prior to a 3rd or 4th counter-shock in refractory VF/VT?
|
antiarrhythmic agents such as amiodarn one
|
|
In the presence of VF, the beneficial effects of epi derives from...
|
increased myocardial contractility, NOT increased SVR
|