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134 Cards in this Set
- Front
- Back
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What are the four links in the AHA chain of survival?
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Early access, early CPR, early defib, early advance care
pg 67 |
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What should never be attempted as there is a risk for worsening airway obstruction, in assessing the airway?
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blind finger sweep
pg 68 |
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If rescuers are reluctant to perform mouth-to-mouth ventilation, __ alone can be effective.
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CPR
pg 68 |
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What are the 4 techniques of good chest compressions?
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1) depth 2", 2) rate 100bpm
3) complete recoil, 4) no interruptions pg 68 |
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What are the rate of ventilations for single rescuers, two rescuers, intubated pts?
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Single - 30:2
Two person - 30:2 Intubated - 8-10 breathes/min, continous CPR pg 68 |
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Over how long should rescue breathes be given and how can you tell if it is effective?
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Give breath over 1 second and look for visible rise and fall of chest wall
pg 69 |
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What are two things to avoid during ventilation (by mouth or BVM)?
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Hyperinflation and Hyperventilation
pg 69 |
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In a person choking, do not interfere with pt's attempts to __ or expel the foreign body, nor perform a ___.
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cough, blind finger sweep
pg 70 |
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Regarding choking, the finger sweep is used only in the __ pt.
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unconscious
pg 71 |
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During the initiation of resuscitation attempts, efforts should be made to discover if the victim has ___ that prohibit CPR.
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advanced directives
pg 73 |
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What is the definition of futility?
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any effort to achieve a result that is possible, but that reasoning or experience suggests is highly improbable.
pg 98 |
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What is the target tempature for post cardiac arrest pts who remain comatose and how soon should it be started?
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33degrees as fast as possible (within 60min)
pg 100 |
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How long do you keep a pt hypothermic for post cardiac arrest?
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24hrs then gradually rewarm over 24hrs
pg 100 |
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One atmosphere of pressure is equal to __mmHg, __Torr, __ft of seawater, and ___lb per sq inch.
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760mmHg, 760 Torr, 33ft of sea water, and 14.7lb per sq in
pg e1 |
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A depth of 66ft in the ocean has how much atmospheric pressure on the diver?
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3 atmospheres of pressure (1 atmopshere at sea level, then 1 for each 33ft)
pg e1 |
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__ law states that for gases which are kept at a constant temperature, the volume of that gas is inversely proportional to the pressure exterted on it.
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Boyle's law
pg e1 |
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What are the basic effects of HBO therapy on tissues?
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1) effects related to the increased PO2
2) effects related to the mechanical forces of the pressure itself pg e2 |
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What are 5 effects of elevated partial pressure of oxygen?
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1) hyperoxygenation, 2) vasoconstriction, 3) Increased healing, 4) Antimicrobial synergism, 5) Toxic O2 radical suppression
pg e2 |
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What are some emergency uses of HBO therapy (8)?
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1) CO poisoning, 2) Cynaide poisoning, 3) Necrotizing soft tissue infxn, 4) gas gangrene, 5) Hypovolemic anemia, 6) Open fx, crush or compartment syndrome, 7) Decompression sickness, 8) Air-gas embolism
pg e2-e5 |
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How does HBO therapy affect CO poisoning?
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shortens carboxyhemoglobin half-life from 300min to 100min
pg e3 |
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What is the first line txmt of necrotizing fasciitis?
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surgical debridement and abx therapy, do not delay for HBO
therapy pg e3 |
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What organism is implicated in 80%-90% of gas gangrene infxns?
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Clostridium perfringens
pg e3 |
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How often does gas appear on the plain films in clostridium gas gangrene infxns?
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50% of time
pg e3 |
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How does HBO therapy benefit blood loss (hypovolemic) anemia pts?
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hyperoxygenation saturates the plasma with O2 despite lack of hemoglobin.
pg e4 |
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HBO therapy is the definitive treatment for __ __.
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decompression sickness
pg e4 |
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A diver surfaces and starts babbling incoreherantly, has difficulty standing, seizures shortly after. Pt should be assumed to have __ until proven otherwise.
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CAGE - cerebral air gas embolism
pg e5 |
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What is the only definitive txmt for acute arterial embolism?
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Recompression in hyperbaric chamber
pg e6 |
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What are the 4 classes of antiarrhythmic drugs?
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I: fast Na+ blockers
II: B blockers III: Potassium efflux IV: Calcium channel blockers pg 154 |
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What was considered a second-line drug behing amiodarone for the treatment of Vfib and pulseless Vtach in 2005 ACLS guidelines?
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Lidocaine 1mg/kg
pg 155 |
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Lidocaine (Cl Ib) is contraindicated in pts w/ known sensitivities to amide-type anesthetics and those w/ __ or __ blocks.
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SA or AV blocks
pg 155 |
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When using Procainamide (Cl Ia), which dosing has fewer adverse effects, bolus or continous infusion?
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continous infusion
pg 155 |
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What condition is procainamide (Cl Ia) contraindicated in, b/c it increases weakness?
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myasthenia gravis
pg 155 |
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Propafenone and Flecanide (Cl Ic) are given by which route and should be initialy tried on an inpt basis?
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Oral route
pg 156 |
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Class II antiarrhythmics are __ and should be started PO w/in __hrs of acute myocardial infarction.
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Beta Blockers, 24hrs
pg 156 |
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Which receptor(s) does esmolol block?
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Cardioselective - B1
500mcg/kg pg 156 |
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Which receptor(s) does labetalol block?
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B1and A1 receptor blocking
B2 upregulation 20mg then doubled until effect achieved pg 156 |
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Labetalol is good for htn in pt's w/ __ __. It has little effect on __ and can be used in pts with acute neuro emergencies.
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myocardial ischemia, intracranial pressure
pg 157 |
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What may occur w/in 3hrs of IV Labetalol doses and how should you position pts?
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Supine position 3hrs due to orthostatic HoTn
pg 157 |
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Which receptor(s) does propanolol block?
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B1 and upregulates B2
pg 157 |
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Propanolol can be used in what states?
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SVTs, angina, migraines, essential tremors, anxiety d/o
pg 157 |
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What is the half life of sotalol?
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7-18hrs in normal pts and 22-97hrs in renal failure pts
pg 157 |
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__ can have proarrhythmic effects, particularly in pts with torsades de pointes, prolonged QTc, hypokalemia, or taking high doses of this drug.
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Sotalol
pg 157 |
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This is the first line antiarrhythmic drug in the ACLS for pulseless Vtach and Vfib, also treats atrial arrhythmias in pts w/ decreased EFs.
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Amiodarone 300mg then 150mg
pg 158 |
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Which antiarrhythmic is associated with thyroid d/o, pulmonary fibrosis, skin discoloration, and corneal infiltrates?
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Amiodarone contains 37% iodine
pg 158 |
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Amiodarone is contraindicated in what pt allergy?
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iodine and shellfish
pg 158 |
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Amiodarone and __ increases the risk for rhabdomyolysis.
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simvastatin
pg 158 |
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Physicians must have received educational information on dosing and administration for this antiarrhythmic CL III drug.
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Dofetilide
pg 158 |
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Defetilide is contraindicated when the QTc is longer than __ms.
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440ms
pg 158 |
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Defetilide is contraindicated if the CrCl is <__mL/min or the QTc exceeds __ms while on therapy.
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20mL/min and 500ms
pg 159 |
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Do not use __ or __to treat a wide complex tachyarrhythmia (WPW).
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Diltiazem or Verapamil
pg 159 |
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How does Verapamil affect the cardiac conduction system?
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slows conduction and prolongs refractoriness in the AV node, reduce HR
pg 160 |
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T/F: Verapamil is less effective than adenosine or diltiazem in terminating narrow-complex SVTs or rates in afib/flutter.
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False: is as effective
pg 160 |
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What is the total daily dose for the extended-release form of verapamil compared to the immediate release?
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XR is equal to the total daily dose of the IR
pg 160 |
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Why must care be taken when adding verapamil to hypertensive medications?
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additive effects
pg 160 |
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What is the dose of atropine for bradycardia via IV and ETT?
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IV- 0.5mg (max 3mg)
ETT- 2x the IV dose pg 160 |
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Atropine given <0.4mg and slowly can cause __ ___ that may be in part due to a central reflex stimulation of the vagus nerve.
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paradoxical bradycardia
pg 160 |
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How does adenosine work?
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produces transient block of the AV node
pg 160 |
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T/F: Reentrant SVTs not involving the AV node are terminated by adenosine, ie WPW.
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False: Adenosine has no effect on the accessory pathways
pg 160 |
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Why must another antiarrhythmic be necessary once adenosine terminates the SVT?
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short half life, recurrence may occur w/in minutes
pg 161 |
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Adenosine may induce ___ in asthmatics, but responds to __ therapy.
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bronchoconstriction, bronchodilator
pg 161 |
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What are 3 basic actions of Digoxin?
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1) increases force, strength, and velocity of contractions
2) slows heart rate 3) slows conduction thru AV pg 161 |
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Why do you not use digoxin in WPW pts?
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may enhance conduction via the accessory pathway, and result in RVR
pg 161 |
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What are 3 basic actions of Digoxin?
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1) increases force, strength, and velocity of contractions
2) slows heart rate 3) slows conduction thru AV pg 161 |
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Name some drugs that can increase serum digoxin levels.
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Amiodarone, verapamil, nifedipine, diltiazem, quinidine, erythromycin, tetracycline
pg 161 |
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Why do you not use digoxin in WPW pts?
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may enhance conduction via the accessory pathway, and result in RVR
pg 161 |
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__ increases the risk of digoxin toxicity, and significant digoxin toxicity itself may produce ___.
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Hypokalemia, Hyperkalemia
pg 162 |
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Name some drugs that can increase serum digoxin levels.
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Amiodarone, verapamil, nifedipine, diltiazem, quinidine, erythromycin, tetracycline
pg 161 |
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__ use is limited to refractory torsades de pointes and refractory symptomatic bradycardia.
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Isoproterenol
pg 162 |
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__ increases the risk of digoxin toxicity, and significant digoxin toxicity itself may produce ___.
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Hypokalemia, Hyperkalemia
pg 162 |
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__ use is limited to refractory torsades de pointes and refractory symptomatic bradycardia.
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Isoproterenol
pg 162 |
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Magnesium is indicated for 3 disorders.
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1) torsades de pointes
2) seizures 2/2 eclampsia 3) asthma pg 162 |
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Match:
Dobutamine, Dopamine, Epi, Norepi, Phenylephrine : Alpha, Beta1, Beta2 receptors |
Dobutamine -Beta1 and 2
Dopamine- Alpha, Beta1 and 2 Epi- Alpha, Beta1 and 2 Norepi- Alpha, Beta1 Phenyl- Alpha pg 162 |
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This vasopressor is the drug of choice in septic shock with depressed cardiac output and cardiogenic shock.
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Dobutamine 2-20mcg/kg/min
pg 163 |
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This vasopressor is considered first line for septic shock along with norepi.
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Dopamine 3-20mcg/kg/min
pg 163 |
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When any vasopressor extravasates, what medication should be infiltrated?
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phentolamine
pg 163 |
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When is dopamine contraindicated?
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pheochromocytoma and tachyarrhythmias
pg 163 |
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Epi is an endogenous catecholamine used in ___ shock, as well as __ in asthma and a stimulant in __ arrest.
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anaphylactic shock
bronchodilator cardiac arrest pg 163 |
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When is norepi (Levophed) contraindicated?
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HoTn 2/2 cylosporin or hydrocarbon anesthesia, blood deficits, or mesenteric thrombosis
pg 164 |
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When should you not give phenylephrine (Neo-Synephrine)?
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Do not give for bradycardia b/c it can cause reflex bradycardia
pg 164 |
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When and why is Vasopressin used?
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during cardiac resus of pulseless Vtach or Vfib for its peripheral vasoconstriction
pg 165 |
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What are the clinical criteria for anaphylaxis?
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1) acute onset of illness w/ skin and/or mucosal tissue
+respiratory or HoTn or syncope pg 178 |
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Anaphylaxis should be considered when __ is observed with or without hypotension or airway compromis.
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two or more body systems
pg 178 |
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What are the first line treatments that should be initiated for anaphylaxis?
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ABC's always first, but therapies should be 1)epi, 2)IVF, 3) oxygen
pg 179 |
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Second line therapy for anaphylaxis include?
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steroids (methylprednisolone 125mg), Antihistamines (benadryl 25-50mg/ zantac 50), +/- albuterol (if respiratory)
pg 179-180 |
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55yo M arrives by EMS with angioedema, wheezing after eating peanuts. Past MHx HTN, GERD, BPH. Taking Toprol XL, nexium, and flomax. 87/40, 78, 22, 90% 98.9. Not responsive to 2L and epipen. Next step?
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Glucagon 1mg q 5min until responds then 5-15mcg/min
pg 180 |
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23yo AAM presents via EMS for swollen lips. 121/80, 78, 16, 93%, 98.6. EMS reports giving epipen 0.3mg in right thigh and benadryl 50mg IV. 1L NS. no improvement in symptoms. What is next step?
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Hereditary Angioedema. Give C1 esterase replacement or FFP if C1 not available
pg 181 |
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What is the cross reactivity of PCN allergies with cephalosporins?
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7%
pg 182 |
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Can you give a pt a cephalosporin who has had a life-threatening reaction to PCN?
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No
pg 182 |
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What are some contraindications to IO placement?
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Overlying infxn, exposed bone, underlying fracture, bone disorders (osteogenesis), and previous attempt
pg 215 |
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What medications can you not give via IO that you can give through IV?
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none
pg 215 |
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What labs do IO have difficulty in providing accurate information?
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WBCs, Platelets, Potassium, LFTs, PCO2, PO2
pg 216 |
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What location is best used for IO placement in children?
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Tibia, 2cm inferior to tibial tuberosity (avoids growth plate)
pg 217 |
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What is located 2cm anterior and 2cm superior to the medial malleolus and should be avoided when placing a distal IO?
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saphenous vein
pg 217 |
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How many attempts per bone is recommended for IO placement?
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One
pg 217 |
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What size catheter is used for umbilical vein access in term and preterm infants?
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Term - 5F
Preterm - 3.5F pg 222 |
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In emergency situations, advance the catheter __ to __ cm beyond the point of good blood return for umbilical access. This is typically __ to __cm from the end of the umbilical stump.
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1-2cm, 4-5cm
pg 222 |
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T/F: Hypotension is mostly pathologic and reflects a failure of normal hemostatic mechs, whereas normotension equates to cardiovascular stability.
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False: HoTn is ALWAYS, Normotension DOES NOT
pg 233 |
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How do you calcluate a MAP?
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[(DBPx2) + SBP] / 3
ie. 120/80. [(80x2) +120]/ 3 = 93.3 pg 233 |
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Palpation of the radial, femoral, and carotid pulse is estimated pressure of __, __, and __.
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80, 70, 60
pg 233 |
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In the hypotensive vasoconstricted pt, noninvasive blood pressure measurements can underestimate systolic pressure by >___ mmHg.
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30mmHg
pg 233 |
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What are the risks for radial, femoral, and axillary arterial line placements?
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Radial - temporary occlusion, hematoma
Femoral- Bleeding, pseudoaneurysm Axillary- infxn pg 234 |
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T/F: Hypotension is mostly pathologic and reflects a failure of normal hemostatic mechs, whereas normotension equates to cardiovascular stability.
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False: HoTn is ALWAYS, Normotension DOES NOT
pg 233 |
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How do you calcluate a MAP?
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[(DBPx2) + SBP] / 3
ie. 120/80. [(80x2) +120]/ 3 = 93.3 pg 233 |
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Palpation of the radial, femoral, and carotid pulse is estimated pressure of __, __, and __.
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80, 70, 60
pg 233 |
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In the hypotensive vasoconstricted pt, noninvasive blood pressure measurements can underestimate systolic pressure by >___ mmHg.
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30mmHg
pg 233 |
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What are the risks for radial, femoral, and axillary arterial line placements?
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Radial - temporary occlusion, hematoma
Femoral- Bleeding, pseudoaneurysm Axillary- infxn pg 234 |
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Organ perfusion is compromised as MAPs drop below __mmHg.
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60mmHg
pg 234 |
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T/F: Optimal MAPs do not vary from >65mmHg despite underlying causes of the hemodynamic instability.
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False: MAPs vary depending on the underlying causes
pg 234 |
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Which MAPs do the International Consensus Conference recommend for hemorrhage in trauma, TBI, and shock?
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Trauma - >40mmHg
TBI - >90mmHg Shock- > 65mmHg pg 234 |
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A pulsation > __cm vertically above the sternal angle when the pt is sitting at 45degrees indicates a CVP of >__cm H2O.
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4.5cm and 9.5cm H2O
pg 235 |
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What is the CVP if the IJ is larger than the carotid in the transverse plane on US w/ the pt sitting semi-upright?
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>10cmH2O
pg 236 |
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A nearly collapsed IJ on the transverse view on US w/ pt laying flat indicates what?
|
A very low CVP
pg 236 |
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A CVP <__cmH2O in a critically ill pt should prompt fluid resus w/ careful monitoring.
|
<4cm H2O
pg 236 |
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Concerning fluid challenges, an increase of > 5cmH2O from baseline CVP w/ 250ml challenge means what?
|
means volume overload
pg 236 |
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Concerning fluid challenges, an increase of < 2cmH2O from baseline CVP w/ 250ml challenge means what?
|
means hypovolemia and continue fluid challenges
pg 236 |
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When should you measure CVP during respiration (mechanically or natural)?
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during end-expiration
pg 236 |
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What measurement is used to determine adequate oxygen delivery to tissue and organs?
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SCVO2 - normally 70% O2 returned via central venous system
pg 239 |
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What are the EGDT goals for shock pts; CVP, SCVO2, MAP?
|
CVP - 8-12mmHg
SCVO2- >70% MAP- >65mmHg |
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Indications for emergency cardiac pacing (6).
|
1) symptomatic bradycardia
2) Sick Sinus Syndrome 3) Complete heart block 4) Torsades Pointe 5) Vtach 6) Unstable SVT pg 240 |
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What is the risk w/ asynchronous pacing?
|
precipitating dysrrhythmia
pg 241 |
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How far should defib paddles be placed in a pt w/ a permanent pacemaker?
|
10cm from the pulse generator
pg 242 |
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|
Malfunction of a permanent pacemaker can be summerized what 5 problems?
|
1) pocket problems, 2) lead problems, 3) failure to pace, 4) failure to sense, 5) malfunction of runaway pacing
pg 244 |
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How long does it take for ST changes to resolve s/p ICD defibrillation?
|
15minutes and repeat ECG
pg 244 |
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72yo M c/o multiple shocks from ICD, despite a stable rhythm on monitoring. What can be done to temporilary deactivate the device?
|
place a magnet over the device.
pg 244 |
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When is defibrillation contraindicated?
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asystole, PEA, NSR, conscious pt w/ pulse, danger to operator or others (water, not clear)
pg 246 |
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Why is important to stop all movement and confirm cardiac arrest before initiating analysis mode with AEDs?
|
movement artifact or loose leads can show false rhythm
pg 247 |
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What do you need to remove to avoid skin burns before defibrillation?
|
O2, nitro patches, metallic objects
pg 247 |
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Avoid _ _ in CPR when defibrillating.
|
prolonged pauses
pg 247 |
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Begin w/ __ joules for defib in vtach/ vfib w/o pulse and open thoracotomy.
|
10J
pg 249 |
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If a pericardial effusion compromises hemodynamics, __ can be lifesaving.
|
pericardiocentesis
pg 250 |
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During an acute rapidly expanding pericardial effusion, __ __ will increase removal of even a small amount of fluid from the pericardial sac.
|
stroke volume
pg 251 |
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Who comprises the largest group with pericardial effusions leading to hemodynamic compromise?
|
oncology pts
pg 251 |
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The combination of pulsus paradoxus and Beck's Triad should prompt imaging with __ to search for pericardial effusion.
|
bedside US
pg 251 |
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Do not delay pt transport to OR for __ unless the pt is hemodynamically compromised from pericardial effusion.
|
pericardiocentesis
pg 252 |
