Open Heart Gtts/standing Orders

Front 1

Nitroglycerin (Nitrate)

Back 1

Venodilator when < 100 mc
also some arterial dilation when > 100 mc.
Decreases preload

Front 2

Nitroprusside (Nipride)

Back 2

mostly arterial dilator. Decreases afterload

Front 3

Nitroglycerin dose

Back 3

open hearts: 10 - 100 mc/min

Front 4

Nipride dose

Back 4

open hearts: 0.3 - 5 mc/kg/min

Front 5

Hydralazine (Apresoline)

Back 5

direct peripheral arterial dilator

Front 6

hydralazine dose

Back 6

5 - 20 mg IVP q 4-6 hrs

Front 7

list some colloids

Back 7

blood, albumin, hexstend

Front 8

list some crystalloids

Back 8

salines, LR, Dextrose's

Front 9

What advantage does LR have over other crystalloids

Back 9

it acts as a buffer, corrects acidosis

Front 10

Milrinone (Primacor)

Back 10

peripheral arterial and venous dilator, decreases preload and afterload.

Front 11

Primacor dose

Back 11

Usually a bolus (not a gtt). 50 mc/kg

Front 12

Brevibloc (esmolol)

Back 12

Beta blocker (thus antiarrythmic too). Decreases contractility, heart rate and BP (decr. renin)

Front 13

Cleviprex/clevidipine

Back 13

Calcium channel blocker. Decreases afterload (vasodilates peripheral arterial and coronary), contractility, heartrate

Front 14

Brevibloc dose

Back 14

50 - 300 mc/kg/min
initiate for HR > 120 if SBP > 110

Front 15

Dobutamine

Back 15

B1 and mild B2 and alpha.
Increasing dose exponentially increases effect.
Increases CO, HR and contractility.
Decreases SVR

Front 16

Dobutamine doses

Back 16

open heart: 5 - 10 mc/kg/min
regular: 2-40 mc/kg/min

Front 17

dopamine

Back 17

low doses stimulate dopamine receptors, higher stimulate alpha and B1
low dose: kidney dilator
med dose: B1
high dose: alpha and B1

Front 18

dopamine dose

Back 18

Open heart: 2-7.5 mc/k/min
regular:
1-2mc/k/mi: renal
2-10mc/k/min: increase CO, SVR anad preload
>10: marked vasoconstriction (alpha)

Front 19

Norepinephrine (Levophed)

Back 19

Alpha and Beta 1
Increased contractility and vasoconstriction (nonselective)...so last resort drug

Front 20

Levophed dose

Back 20

8 - 12 mc/min

Front 21

Epinephrine

Back 21

Stimulates alpha and all betas
"selective vasoconstrictor: doesn't effect brain, heart, skeletal muscle-shunts blood.....thats why its code drug!)

Front 22

epinephrine dose

Back 22

open heart: 0.02 - 0.2 mc/kg/min
regular: 1-20mc/min

Front 23

neosynephrine

Back 23

pure alpha, peripheral vasoconstriction

Front 24

neo dose

Back 24

regular 40-200 mc/min
open heart: 20-50 mc/min

Front 25

vasopressin (pitressin)

Back 25

same as ADH
peripheral smooth muscle vasoconstriction and water reabsorption

Front 26

vasopressin dose

Back 26

40 units IVP in arrest
0.01 - 0.04 units/min

Front 27

protamine

Back 27

reverses heparin

Front 28

protamine dose

Back 28

25-50 mg IVP (usually given in OR)

Front 29

Amicar

Back 29

antifibrinolytic, preserves platelets and decreases blood loss in post operative bleeding

Front 30

Factor VII

Back 30

last resort post operative bleeding after blood has been administered. Systemic clotting! Watch CT's!

Front 31

Brevibloc (esmolol) when to initiate...

Back 31

beta blocker (B1 and B2)
initiate for HR > 120 if SBP is > 110

Front 32

Esmolol gtt dose

Back 32

50 mc/k/min - 300 mc/k/min to maintain HR < 120

Front 33

Esmolol when to notify MD

Back 33

notify before intiating
Notify if near max dose
notify with onset of 2nd/3rd degree HB

Front 34

milrinone (Primacor)

Back 34

usually just bolus,
incr. contractility and peripheral vasodilator (arterial & venous)

Front 35

milrinone (Primacor) dose

Back 35

50 mc/kg

Front 36

Calcium channel blockers: list em

Back 36

norvasc
cleviprex
cardizem
nicardepene (cardene)
Procardia
verapamil

Front 37

Ca channel blocker

Back 37

decreases afterload (SVR), decr. contractility, decr. HR, vasodilates (peripheral artery and coronary)

Front 38

Beta 1 vs Beta 2

Back 38

heart and kidnyes is B1
B2 is bronchial & vascular smooth muscle dilator

Front 39

strict Beta 1's

Back 39

metropolol
atenolol
esmolol

Front 40

Nitro bag concentration

Back 40

50 mg/ 250

Front 41

nitroprusside concentration

Back 41

50 mg/ 250

Front 42

dobutamine concentration

Back 42

250 mg /250 ml

Front 43

dopamine concentration

Back 43

400 mg/250 ml (1600 mc/ml)

Front 44

norepi (levo) bag concentration

Back 44

4 mg/ 250 ml (16 mc/ml)

Front 45

epi bag concentration

Back 45

2 mg/ 250 ml (8mc/ ml)

Front 46

Neo bag concentration

Back 46

20 mg/ 250 ml (80 mc/ml)

Front 47

Vasopressin bag concentration

Back 47

50 units/ 250 ml

Front 48

Esmolol (Brevibloc) bag concentration

Back 48

2.5 mg/ 250 ml (10 mc/ml)

Front 49

Open heart target SBP

Back 49

90-120

Front 50

Open heart target SVR vs. normal

Back 50

800 - 1400 (normal 900 - 1300)

Front 51

Open heart target PAD vs. normal

Back 51

10 -15 (normal 6 - 12)

Front 52

Open heart target PCWP vs normal

Back 52

10-15 (normal 8-12)

Front 53

Open heart target Cardiac index

Back 53

> 2 (normal 2.5 - 4)

Front 54

open heart target urine output

Back 54

> 30 ml/hr

Front 55

open heart target SV02

Back 55

> 65 % (normal 60 - 80%)

Front 56

open heart target CVP

Back 56

8-12 (normal 2-8)

Front 57

SVO2

Back 57

mixed venous oxygen saturation
the % of oxygen bound to hgb returning to right side of heart
especially useful if measured before and after changes are made to vent/gtts etc.
Tells us if tissues are getting enough oxygen

Front 58

what does low SVO2 mean? high?

Back 58

tissues are extracting more O2 than normal
a rise in SVO2 is usually good unless there is a concurrent rise in lactic acid (anaerobic metabolism!)

Front 59

per standing orders, when would one want to initiate dopamine gtt? what gtt would you add next if ineffective?

Back 59

HR < 100
SVR < 800
SBP < 90
if more required add epinephrine infusion

Front 60

Per standing orders, when would one initiate epinephrine gtt?

Back 60

HR < 100
SVR < 800
SBP < 90
titrate to keep SBP > 90

Front 61

per standing orders, when would I initiate Nicardipine (Cardene) infusion?

Back 61

SBP > 120
titrate for SBP 90 - 120

Front 62

nicardepene (cardene) dose

Back 62

1 mg/hr, max dose 12 mg/hr

Front 63

per standing orders, when could I initiate Cleviprex gtt?

Back 63

SBP > 120, titrate for SBP 90 -120

Front 64

Cleviprex gtt dosing

Back 64

2 mg/hr, max 10 mg/hr

Front 65

Per standing orders, when could I initiate Nitroglycerin gtt?

Back 65

SBP > 120, titrate SBP 90-120

Front 66

Per standing orders when could I initiate Brevibloc (esmolol)?

Back 66

Notify surgeon first
initiate for HR > 120 only if SBP > 110
to maintain HR < 120

Front 67

Per standing orders, when could I initiate dobutamine gtt?

Back 67

Notify surgeon first
initiate for CI < 2
SVR > 1400
SBP < 90
titrate to keep SBP > 90

Front 68

Per standing orders, when could I initiate phenylephrine (neo) gtt?

Back 68

notify surgeon before initiating
for SVR < 800
titrate for SBP > 90

Front 69

Per standing orders, when can I initiate amiodarone gtt?

Back 69

Notify surgeon first
for new onset a -fib

Front 70

Per standing orders, when can I give sodium bicarbonate?

Back 70

1 amp IV q hour PRN for pH < 7.32
and
base excess < -5 in addition to vent changes to correct acidosis

Front 71

3 vaso gtts that are in mc/min

Back 71

Neo
Norepi (levo)
Nitro