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11 Cards in this Set
- Front
- Back
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1. What is the mechanism of action of vasopressin?
2. What are the contraindications for vasopressin infusion? 3. What is the infusion rate and how do you check efficacy? |
1. Vasopressin causes smooth muscle contraction in the arteries and bowel wall.
2. Contraindications to vasopressin include CAD, cerebrovascular disease, and severe HTN. 2. - Vasopressin infusion is started at 0.2 units/min. - Follow up arteriography is performed in 20-30 mins. - If active extravasation is still present, then the infusion is increased to 0.4 units/sec and arteriography is repeated in 20-30 mins. - If vasopressin infusion does not result in cessation of bleeding, the infusion is continued for 12-24 hours. - If infusion is successful, the infusion is slowly tapered over 12-24 hours. |
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What are the absolute contraindications for tPA?
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1. Active bleeding
2. Recent CVA (stroke w/n 6 months, TIA w/n 2 months) 3. Intracranial mets 4. Nonviable limb |
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What are the relative contraindications for tPA?
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1. Recent (10-14 days) surgery
2. OB delivery 3. Ulcer 4. GI bleeding 5. Uncontrolled HTN |
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How do you do fibrinolysis?
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1. tpa is given at 0.5mg/hr - 1mg/hr via a multiside hole catheter that is placed into the site of thrombosis.
2. Heparin is continued at 100 units/hr through a sheath. 3. Pt is admitted to the ICU. 4. Pt's hemoglobin/hematocrit and fibrinogen levels are monitored. You want fibrinogen levels to stay above 150. - If fibrinogen level goes below 150, then reduce the dose of TPA. - If fibrinogen level goes below 100, then stop TPA. 5. Discontinue the TPA after 48 hours. 6. Bring the pt back for angiography to assess residual stenosis that may need to be angioplastied. |
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What are the indications for thrombolysis for DVT?
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1. LE DVT in a young patient
2. Phlegmasia Cerulea Dolens: severe venous thrombosis preventing arterial inflow. 3. Prevention of post-phlebitic syndrome. |
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What are the indications of fibrinolytic therapy?
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1. Acute or subacute (< 2 weeks) thrombosis in native vessel or graft.
2. Clotted graft during dialysis 3. Embolic occlusion (alternative: surgical embolectomy) |
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1. What are the indications for embolization?
2. What are some embolic agents? |
1.
- Control of active bleeding - Treatment of fibroids - Palliate malignancy 2. - Liquids: alcohol and glue - Particulate: gelfoam (temporary ~2-3 weeks), PVA, embolospheres. - Coils - Balloons |
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Flow rates
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Thoracic Aorta: 60ml@30/s
Abd. Aorta: 40ml@20/s Pulm. A.: 40ml@20/s IVC: 40ml@20/s Carotid a.: Celiac/SMA: 40ml@8/s Iliac: 20ml@8/s Renal: 12ml@6/s tPA: .5mg-1.0mg/hr (5-10mg); intraarterial |
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Papaverine infusion
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Papaverine Infusion is used for non-occlusive mesenteric ischemia (i.e. diffuse vasospasm)
Test dose (60mg/20 ml nl saline) Containdicated in hypotension, complete av block 30-60 mg/hr; (240mg pap/ 240 ml nl saline) f/u angio in 12 hrs (can repeat course) |
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Atropine
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Atropine 0.6-1.0 mg IV slowly
Repeat atropine up to 0.04 mg/kg (2-3 mg in an adult) |
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Bronchospasm
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Oxygen via face mask. Monitor with ECG, pulse oximeter, and BP
Beta Agonist Inhaler – Albuterol, Metaproterenol, Terbutaline Epinepherine SC (1:1000), 0.1-0.3 ml (=0.1-0.3 mg) to max of 1mg If hypotension present, IV epi (1:10,000) 1.0 ml slowly and large vol. fluids Call for help if severe! |
