Bb Cpr

Front 1

What should be the initial resuscitative maneuver in a newborn with bradycardia at 1 min?

Back 1

initial resuscitation must center on oxygenation and ventilation; if initial resuscitation methods including rubbing the back or slapping the feet are not successful and the patient is apneic with HR<100, positive pressure ventilation with bag and mask at a rate of 40bpm should be done

Front 2

In the monitored setting the absence of what despite cardiac activity confirms the diagnosis of cardiac arrest?

Back 2

absence of blood pressure

Front 3

what is the duration of ventilation for breaths during CPR?

Back 3

1s

Front 4

What is the depth of compression during CPR for adults, children, and infants?

Back 4

adults: 1.5-2 inches
children: 1-1.5 inches
infants: 0.5-1 inch

Front 5

what is the neonatal compression rate?

Back 5

120/min

Front 6

What is the visible goal of ventilation during CPR?

Back 6

chest rise

Front 7

What is the ratio for chest compressions:ventilation for adults, children, and newborns for 1 and 2 person CPR?

Back 7

adult - 1 person and 2 person 30:2
infant and child - 1 person 30:2, 2 person 15:2
Newborns - 1 person 30:2, 2 person 3:1

Front 8

For what age is defibrillation recommended as part of ACLS?

Back 8

>1yr

Front 9

What is the dose for the defibrillator in adults?

Back 9

- monophasic 360J,
- biphasic: if type is not known then use 200J; rectolinear 120J, biphasic truncated 150-200J

Front 10

what is the dose for the defibrillator in children and infants?

Back 10

initial dose: monophasic or biphasic 2J/kg,
subsequent doses: 4J/KG

Front 11

When do you defibrillate versus start compression first?

Back 11

- if witnessed defibrillate first,
- if unwitnessed or >4-5 min have elapsed since before CPR begins give 2 minutes of compression first

Front 12

What is the typical dose of the medications used down the endotracheal tube?

Back 12

2.5 x IV dose in 10cc diluent

Front 13

When would you consider using bicarb during CPR?

Back 13

1. pre-existing hyperkalemia,
2. overdose of TCA,
3. where there is known pre-existing bicarbonate responsive acidosis
4. some drug overdoses to alkalinize the urine

Front 14

What is the most common rhythm of patients with sudden cardiac arrest?

Back 14

Vfib (80-90%)

Front 15

If a pulse is present in a patient with Vtach and severe hypotension is present what should you do?

Back 15

synchronized cardioversion

Front 16

How does synchronized cardioversion work?

Back 16

-machine senses the peak of the QRS complex during the beginning of the isovolemic contraction
-it fires a few milliseconds after thus avoiding the delivery of the shock during the vulnerable period of cardiac repolarization

Front 17

What is the mechanism of PEA?

Back 17

dissociation between electrical and mechanical events in the heart

Front 18

In a patient with polymorphic VT should you give synchronized or unsynchronized cardioversion?

Back 18

unsynchronized cardioversion

Front 19

What dose of nitroprusside should you not exceed in a 2.5 hour period?

Back 19

1 mg/kg increased risk of toxicity (manifested by unexplained metabolic acidosis)

Front 20

What is the dose range for sodium nitroprusside?

Back 20

dose titrated up to 10 mcg/kg/min

Front 21

What is the typical mix for sodium nitroprusside and nitroglycerin?

Back 21

50mg in 250 cc

Front 22

What are indications for nitroprusside? Side effects? Mechanism?

Back 22

HTN and CHF without ischemia
- hypotension, reflex tachycardia, cyanide toxicity
- direct smooth muscle relaxation which decreased preload and afterload

Front 23

What are indications for nitroglycerin? Side effects?

Back 23

1. myocardial ischemia
2. pulm htn
3. systemic htn
- hypotension, arrhythmias, myocardial ischemia

Front 24

What are indications for epinephrine?

Back 24

1. hypotension,
2. LV failure
3. bronchospasm (used to improve LV fxn, coronary blood flow and bronchodilation)

Front 25

What are side effects of epinephrine?

Back 25

myocardial ischemia, arrhythmias, htn

Front 26

What are the effects of epinephrine at various doses?

Back 26

-1-2 mcg/min - beta 2 (bronchodilation);
-4 mcg/min - beta 1 stimulation is prominent so LV function improves
-10-20 mcg/min - both alpha and beta are stimulated

Front 27

How does epi affect CO, and RBF?

Back 27

CO increases, RBF decreases

Front 28

How do you mix epinephrine?

Back 28

2 mg/250mL

Front 29

What are indications for dopamine?

Back 29

hypotension and oliguria

Front 30

What are side effects of dopamine?

Back 30

1. hypertension,
2. tachycardia,
3. arrhythmias - less so than epi,
4. myocardial ischemia

Front 31

What are beneficial effects of dopamine? What is the dose?

Back 31

increases myocardial contractility, GFR, and RBF
-1-30 mcg/kg/min
(1-2 dopaminergic, 2-10 beta, >10 alpha)

Front 32

How does dopamine affect heart rate?

Back 32

modest increase

Front 33

How do you mix dopamine and dobutamine?

Back 33

-Dopamine - 400mg in 500mL of D5W (avoid inactivation of catecholamine in alkaline solution)
-Dobutamine - 500 mg in 500 mL of D5W

Front 34

What is more arrhythmogenic dopamine or epi?

Back 34

epi

Front 35

What are the indications for dobutamine?

Back 35

heart failure

Front 36

What are the side effects of dobutamine?

Back 36

1. hypertension,
2. tachycardia,
3. arrhythmias,
4. myocardial ischemia

Front 37

What is the dose of dobutamine?

Back 37

1-15 mcg/kg/min

Front 38

How does dobutamine affect HR, CO, BP?

Back 38

-it is a selective B1 agonist
-dose dependent increases in cardiac output without marked increases in HR or bp
-especially useful if the HR and SVR are high

Front 39

Of dopamine and dobutamine which one acts directly and which one acts indirectly?

Back 39

dobutamine acts directly to increase contractility and dopamine acts indirectly to cause the release of catecholamines

Front 40

How can you use vasopressin in patients with liver failure?

Back 40

control bleeding in patients with esophageal varices

Front 41

What are indications for amrinone?

Back 41

short term treatment of CHF

Front 42

What are side effects of amrinone?

Back 42

1. thrombocytopenia,
2. tachyphylaxis,
3. hypokalemia,
4. GI effects

Front 43

What is the mechanism of action of amrinone and milrinone?

Back 43

phosphodiesterase inhibitors: PDE is responsible for the breakdown of c-AMP, PDEIs lead to increased cAMP, which then creates improved uptake, storage, and release of calcium from the sarcoplasmic reticulum during excitation-contraction coupling

Front 44

How does amrinone affect CI, SVR, HR? When is it useful?

Back 44

increases CI, decreases SVR (also decreases cardiac filling pressures), HR is unchanged or slightly increased, in pts with CHF does not significantly affect myocardial O2 consumption (both inotropy and vasodilatory effects)

Front 45

How does amrinone affect AV conduction?

Back 45

enhances AV conduction and patients with atrial arrhythmias should be pretreated with digitalis

Front 46

What is the dose of amrinone?

Back 46

0.5-0.75 mg/kg over two minutes and then 5-10 mcg/kg/min

Front 47

How does milrinone compare to amrinine in terms of vasodilation?

Back 47

greater decrease in left ventricular pressure and blood pressure (enhanced vasodilatory properties)

Front 48

How should you treat heart rate with atropine?

Back 48

0.5 mg Q2min for a total dose of 2mg

Front 49

When is MOA of isoproterenol? What is it useful for?

Back 49

-It is a powerful B1 and B2 agonist
-third degree heart block?

Front 50

What is a risk of isoproterenol?

Back 50

It may decrease SVR and MAP at the same time it is increasing HR, contractility and myocardial oxygen consumption