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74 Cards in this Set
- Front
- Back
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The right coronary artery supplies the SA node what percent of the time? The AV node?
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55%
90% |
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What is the primary treatment in the bradycardic patient who is unstable?
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Transcutaneous pacing
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Atropine to treat bradycardia is not useful in what type of patient?
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Cardiac transplant, they have no vagal support
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What is the dose of atropine in bradycardia?
What can you give if atropine is unsuccessful? |
0.5 mg every 5 mins, up to 3 mg total
Epinephrine and dopamine |
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Treatment of a patient with stable, narrow complex tachycardia with regular rhythm?
What is the most likely diagnosis if it converts? |
Vagal maneuvers
Adenosine 6 mg, then 12mg, then 12 mg --- IV PUSH! AVRT |
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Treatment of a patient with stable, narrow complex tachycardia with irregular rhythm?
What is the most likely diagnosis? |
Control rate with dilt or B-blockers
Probably atrial fib or flutter, consider MAT |
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What drugs do you want to avoid in WPW?
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AV nodal blockers, dilt and b-blockers
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Treatment of a patient with stable, wide complex tachycardia with regular rhythm?
What is the most likely diagnosis? |
If Vtach or uncertain rhythm, amiodarone 150 mg IV over 10 min. Prepare for cardioversion.
If known SVT, give adenosine |
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Treatment of a patient with stable, wide complex tachycardia with irregular rhythm?
What is the most likely diagnosis? |
If afib with WPW, avoid b-blockers and diltiazem. Consider amiodarone. Get a consultant.
If torsades, give magnesium 1-2 grams. If polymorphic ventricular tachycardia, cardiovert |
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What cardiac disorder is characterized by abnormalities that produce a wide variety of intermittent supraventricular tachyarrhythmias and bradyarrhythmias?
What is the treatment? |
Sick sinus syndrome
Pacemaker placement |
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What are the variations of regular, narrow complex tachycardia?
Irregular? |
Sinus tachycardia, atrial tachycardia
Atrial flutter AVRT AVnRT Junctional tachycardia Atrial fibrillation MAT |
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What is the success rate of vagal maneuvers in SVT?
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20-25%
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Any patient with a ventricular rate >300 should raise suspicion for what syndrome?
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Preexcitiation syndrome such as WPW
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When can and can't you give adenosine, calcium channel blockers, and b-blockers in people with WPW.
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Can give adenosine in narrow complex regular tachycardia
Never give B-blockers or diltiazem |
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How is atrial fibrillation or atrial flutter with WPW treated?
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With cardioversion, but can also consider procainamide
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What are the doses for treating rate control of Atrial Fibrillation in the ED?
Diltiazem? Metoprolol? |
Diltiazem: 15 mg once over 2 minutes with a continuous infusion at 5 mg/h
Metoprolol: 5 mg IV every 5 minutes up to 15 mg. |
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What happens to the PR interval in junctional rhythm? Where are the beats arising?
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PR interval shortens
They start from the AV node. |
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What other rhythm can ventricular tachycardia be confused with?
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SVT with aberrancy
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What is the first line treatment for unstable ventricular fibrillation?
Stable? 2nd line in stable? |
cardioversion
amiodarone 150 mg every 10 minutes up to 2 g Next procainamide 50 mg/min 2nd line: Lidocaine |
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Treatment of torsades de pointes?
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Magnesium sulfate 2 g IV over 60-90 minutes
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Treatment of ventricular fibrillation?
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Defibrillation: 360 J if monophasic, 200 J if biphasic
CPR Check pulse If it continues Amdiodarone 300 mg IV bolus or Lidocaine 1.5mg/kg IV followed by halving the dose for 2 more doses. |
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1st degree block is characterized by a PR interval > __ seconds.
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0.20
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Widened QRS complexes, wide S leads in lead 1, V5, V6, and triphasic QRS in V1 is seen in what disease?
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RBBB
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Describe EKG findings for LBBB.
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Large and wide R waves - lead I, avl, v5, v6
Small R wave follwed by deep S wave - leads II, III, avf, and V1-V3 |
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What do patients with Brugada syndrome present with?
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Syncope
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When is lidocaine used in cardiac arrhythmias?
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2nd line to amiodarone for vfib and pulseless vtach
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Beta Blockers with Beta only activity such as atenolol, esmolol, and metoprolol are better choices (less likely to causes side effects) for patients with history of what diseases?
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asthma, copd, diabetes - they are B1 only and don't affect B2
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How fast is the onset of labetolol?
What is the initial IV dose and subsequent dosing? |
2-5 minutes
20 mg, then double dose if not responding |
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Other than typical beta blocker side effects such as nausea, vomiting, bronchospasm, hyperglycemia, what symptom can sotalol produce?
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It has pro-arrythmic properties
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What is the dosing of amioderone in pulseless vtach and vfib?
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300 mg bolus, which can be followed with another 150 mg bolus
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What are the side effects of long term amioderone usage?
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Thyroid
Pulmonary fibrosis Liver damage corneal infiltrates |
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Amiodarone is contraindicated in people with what allergies?
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shellfish, iodone
Amiodarone contains iodine |
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What is the dose for atropine in bradycardia? How does atropine work?
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0.5mg IV every 5 minutes
It is anticholinergic - also could be called an antiparasympathetic |
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T/F Atropine can be used in the stable, bradycardic patient.
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False
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Describe the dosing and time of adenosine in SVT.
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6 mg, then 12 mg 2 minutes later, and then 12 mg again 2 minutes later if not responding
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Other than standard flushing, headache, chest pain, what side effect can adenosine have?
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It may induce bronchospasm
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What are the basic signs of digitalis toxicity?
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mental status changes
confusion ha anorexia n v weakness visual disturbances seizures |
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What electrolyte abnormality increased the risk of digoxin toxicity?
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Hypokalemia
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Dobutamine has activity against which receptors?
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B1, B2
Increased cardiac output and decreased peripheral resistance up to 20 mcg/kg/min, above that will increase HR and induce arrhythmias. |
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Under what situations is dobutamine the preferred agent in cardiogenic shock?
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septic shock with low cardiac output ... cold septic shock
cardiogenic shock |
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Dobutamine has activity against which receptors?
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B1, dopamine, alpha
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Epinephrine is a non-selective alpha and beta adrenergic agonist that is useful in what clinical scenarios?
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Anaphylactic shock
Asthma exacerbation Myocardial stimulant in cardiac arrest |
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What is the dose, concentration, and route of epinephrine to be used in asthma?
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0.3 to 0.5 mg 1:1000 SubQ every 20 to 30 minutes
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What drug is used when dopamine or epinephrine infiltrate?
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Phentolamine (Regitine)
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What receptors dose norepinephrine stimulate? How does this differ from epinephrine?
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Alpha and Beta-1
Levophed does not stimulate B2 |
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What is the starting dose of norephinephrine?
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2mcg/min ... titrate by 1-2 mcg every 3-5 minutes
Max dose 30 mcg/min |
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What receptors dose phenylephrine stimulate? Therefore, what is the mechanism of action?
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Primarily alpha receptors with minimal B1 or B2
Peripheral vasocontrictor |
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Name the preferred medication in these scenarios:
1) Septic shock patient with bradycardia 2) Septic shock with asthma exacerbation 3) Septic shock with severe tachycardia 3) Infiltration of IV with epinephrine |
1) norepinephrine or possibly dobutamine...Not phenylephrine as it can cause reflex bradycardia
2) epinephrine 3) phenylephrine 4) Phentolamine |
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Define shock.
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Shock is a circulatory insufficiency that creates an imbalance betweeen tissue oxygen supply (delivery) and oxygen demand (consumption).
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What is the normal central venous/mixed veous oxygen saturation?
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65 - 75 %
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What situations shift the oxygen dissocation curve to the right?
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decreased pH
increased co2 increased temp increased 2,3 - DPG |
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What are the 4 factors that make up SIRS?
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Temperature <36 or > 38
RR > 20 HR > 90 WBC > 12, <4, > 10% immature cells |
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Dopamine does what to vessels at a dose of 0.5 to 5 mcg/kg/min? At > 10 mcg/kg/min?
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Vasodiliation
Vasoconstriction |
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What does vasopression work on when used in sepsis?
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It is a pure vasoconstrictor
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What receptors does isoproterenol work at?
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B1 with minimal B2...Opposite of phenylephrine
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What drug is receptor opposite of isoproterenol?
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phenylephrine
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What is the purpose of intubation during shock?
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Decreased work of breathing
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In shock:
You want to maintain artial O2 saturations > __%. Transfuse hgb if it is below __ g/dl. |
93%
10 |
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A goal directed approach to septic shock includes what variables?
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Urine output >0.5 ml/kg/hr
MAPs 65 to 90 CVP 8 to 12 Sv02 > 70% |
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What is the advantage of LR over NS in shock patients?
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LR can buffer acidosis
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What is a safe pH in which bicarbonate can be used in sepsis? Why would you not want to use it before then?
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<7.25
Shifts oxygen curve to left. Less O2 delivery. |
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What are some of the causes of coagulopathy in trauma?
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Massive hemorrhage
Hypothermia Consumption of clotting factors, platelets Dilution of clotting factors Massive blood transfusions Hypocalcemai |
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Define class I,II, III and IV hemorrhage by percentages.
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Class I: <15%
Class II: 15 - 30 % Class III: 30 - 40% Class IV: >40% |
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Bradycardia or lack of tachycardia can occur in up to 30% of patient with what type of bleed into this body cavity? Why?
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Intrabdominal
Increased vagal tone |
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What is the concern for starting PPV in a patient who has not had sufficient IV fluids?
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PPV in the setting of hypovolemia can diminish venous return and decrease cardiac output
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What is the ratio of IV fluid to blood in the hemorrhaging patient?
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3:1
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In addition to pRBCs in massive trauma, what else is given and what is the ratio?
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1:1:1
pRBCs, FFP, platelets |
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With suspected anaphylaxis, the single most important treatment in the ED is what?
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epinephrine
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What is the dose, route, and formula of epinephrine in anaphylaxic shock? What are second line therapies?
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0.3 to 0.5 mg of 1:1000 dilution IM repeated every 5-10 minutes.
IV fluids, methylprednisolone (solumedrol 125 mg IV), benadryl 50 mg IV. |
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Explain the differences between IM and SC epinephrine in anaphylaxic shock?
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IM is faster, more consistant than SC doses.
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What is the next step if patient is refactory to IM epinephrine in anaphylaxic shock?
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Epinephrine IV 100 mcg bolus, then drip at 1 -4 mcg/min
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What are second line therapies and doses in anaphylaxic shock?
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IV fluids, methylprednisolone (solumedrol 125 mg IV), benadryl 50 mg IV. H2 blockers, albuterol
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What medications are given when discharging a patient with anaphylactic reaction?
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Epipen
Benadryl for several days Prednisone burst Instructions |
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What medications are useful in treating angioedema related to ACEi use?
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None really.
Antihistamines and steriods don't work because it is not an IgE response. Epinephrine has also not shown to be useful. |
