Details Title: acls Description: algorythms and drugs Total Flash Cards: 92 Created: 12/29/2008 07:10:21		New Users: To study from this flashcard set, or to create your own your own study flash cards, REGISTER HERE. Existing Users: CLICK HERE. Additional Health Care Flashcards
Cards in this set: Term         Only effective  tment for vf Definition       shock  Term • Shock only if pt has these 3 Definition     No response No breathing (agonal gasps are not breathing) No pulse Term Can u shock if pt has pacemaker Definition yes Term Why use epi in code Definition vaso constriction s coronary flow map & aortic diastolic bp Term How much epi Definition 1 mg q 3-5 min Term Anti arrhythmics to consider for vf/ pulseless vt Definition Magnesium (for torsades de pointes) 1 – 2 g in 10 cc D5W over 5 – 20 minutes Amiodarone 300mg 1x then if needed 150 mg 1x Lidocaine 1 – 1.5 mg/kg 1st then 0.5 – 0.75 @ 5 – 20 minute intervals max = 3 mg/kg Term Treatment For VF/ pulseless VT Definition     Cpr  shock Cpr shock Cpr /pressor Cpr shock Cpr / antiarrhythmic back to 2 Term If VF/ pulseless VT & body temp < 30 C/ 86F Definition = one shock No more shocks or meds till warm if no response Term Why treat VF/ pulseless VT different when cold? Definition b/c drug metabolism d drug may accumulate in body Term     If VF/ pulseless VT & 30 C/ 86 F to 34 C/93.2 Definition Shock & meds @ d intervals Term When does med take effect in code? Definition = at next cycle of CPR Term Dosage for et tube Definition   = 2 – 2.5 times reg dose IV then dilute in 5 – 10 cc NS Term Drugs for et tube Definition Narcan Atropine Vaso Epi Lidocaine Term How does Amiodarone work? Definition = affects Na, K, & ca channels has alpha & beta properties Term How is amio given? Definition = 300mg IV then 150 mg in 3-5 min max = 2.2g over 24 hrs Term How is lidocaine given? Definition = 1 – 1.5 mg/kg IV/IO over 5- 10 min then 0.5 - 0.75 mg/kg IV/IO max = 3mg/kg or 3 doses Term et dose of lidocaine Definition = 2-4mg/kg Term How is Magnesium given? Definition = 1 – 2g IV/IO diluted in 10 ml d5w over 5- 20 min Term How is Mg different from other antiarrhythmic tments? Definition = is only an adjunctive tment to Prevent recurrent VF torsades alcoholism malnutrition Term Amiodarone drip? Definition RAPID DOSE: 150 mg over 10 min LOADING DOSE: 360 over 6hrs MAINTENANCE DOSE: 540 over 18 hours Term Lidocaine drip? Definition MAINTENANCE DOSE: 1 to 4 mg/min Term Define PEA Definition Any organized rhythm w/o pulse Except VF VT & asystole Term Most common rhythm after shock? Definition PEA Term In PEA which is priority IV access or airway? Definition access Term How is Vasopressin given? Definition = 40 units IV/IO Replaces 1st or 2nd epi Give only once Term Consider what if PEA slow? Definition Atopine 1mg q 3-5 min Max 3 doses Term Algorhythm For PEA Definition 2. Cpr Cpr /epi or vaso 3. Cpr Cpr / atropine back to 2 Term Most common causes of PEA Definition Hypoxia Hypovolemia Term How can you tell if atropine will be effective? Definition Works at the av node wide complexesindicate blockage below av Term Transvenous vs transcutaneous pacing Definition transcutaneous pacing easier, faster and less risky Transvenous = through vein to RA or RV Term 3 categories of MI Definition STEMI NSTEMI depression No EKG s Term Focus of early MI treatment Definition Rapid reperfusion Relief of pain Treat complications Term 5 steps in ACS Definition Unstable plaque Plaque ruptures & platelets surround Partially occludes → ischemia need antiplatelet meds Microemboli lodge in vasculature → troponin  Completely occlusive thrombus → STEMI Term How are NSTEMI produced? Definition Intermittently occluding thrombus Term How do we decide how to treat ACS? Definition EKG only Term What does d troponins indicate Definition Cardiac necrosis Term What else causes acute chest pain besides ACS? Definition   Aortic dissection, pulmonary embolism pericardial effusion tension pneumo Term How do we treat STEMI initially? Definition   Adjunctive treatments:   Clopidogrel (plavix-anti platelets)  β blockers heparin         Pent House B Term After adjunctive therapy next step if <12hrs since STEMI Definition PCI Fibrinolysis    plus Continue adjunctive therapy ACE inhibitors Statins    Pent House B + A & C   Term After adjunctive therapy next step if >12hrs since STEMI Definition ACE inhibitors Statins Continue adjunctive therapy           Pent House B + A & C Term How do we treat NSTEMI  Definition Nitro β blockers Clopidogrel (plavix-anti platelets) Heparin Glycoprotein inhibitors         Pent House B New Guy Term After adjunctive therapy next step in NSTEMI treatment Definition ACE inhibitors Statins Continue adjunctive therapy       Pent House B +A & C Term If no EKG s how treat? Definition  troponins If + start NSTEMI treatment If – repeat troponins and ECG If Ø s discharge Term Do we give 02 to all ACS pts? Definition Yes b/c s STE in anterior infarction Stop after 6 hours Term How to give asprin Definition Chewed 160 -325 mg Rectal if N/V or GI Term When is nitro contraindicated Definition Inferior MI & RV infarction  Hypotension bradycardia tachycardia Phosphodiesterase inhibitor use (Viagra) Term Why Ø nitro w/ Inferior MI & RV infarction Definition b/c dependent on RV filling Pressure for CO & BP nitro would  CO & BP worsening case Term When do we use morphine Definition If chest pain Ø respond to nitro Term Why is morphine impt for ACS Definition Pain relief Venodialtion  SVR  bd in lungs in Pulm edema Term When is morphine contraindicated Definition Inferior MI & RV infarction Hypotension bradycardia tachycardia Term 1st line tment if pressure drops from nitro or morphine in ACS treatment Definition   Fluids Term Reperfusion treatment goals for STEMI Definition Fibrinolytic w/in 30 minutes PCI w/in 90 Term How do we characterize the 3 ACSs Definition STEMI= ST elevation of 1mm in 2+ contiguous leads 2+ adjacent limb leads NSTEMI ST depression of 0.5 (transient or persistent) Twave inversion w/ pain other inconclusive EKG New LBBB Term when do we use fibrinolytic therapy for acs Definition STEMI w/in 3-12 hours Posterior MI Term When do we use iv nitro in STEMI Definition Ø response to SL nitro Pulmonary edema & STEMI Hypertension & STEMI Term What is a functional/relative brady cardia? Definition Hr in normal range but not appropriate for condition ie shock Term Symptomatic bradycardia Definition Chest pain SOB ms dizziness hypotension diaphoresis pvc or vt Term How do we treat asymptomatic bradycardia? Definition observe Term How do we treat symptomatic bradycardia? Definition Bub All People Die Eventually Atropine 0.5 up to 3 mg Pacing Dopamine 2 – 10 μg/kg/min Epi 2 – 10 μg/min (start) Term What if TCP Ø work for bradycardia? Definition Transvenous Expert consultation Term First line treatment for symptomatic bradycardia? Definition Atropine Term Indication for TCP Definition Failure to respond to atropine Can also try epi/dopa Term What happens if give < 0.5 atropine? Definition May paradoxically slow ♥ Term When is atropine dangerous Definition In MI b/c →   ischemia in 2nd degree type II or 3rd deg HB Term TCP contraindicated when Definition Hypothermia Term Where assess pulse after TCP Definition Ø carotid b/c of muscular jerking Term How to perform TCP Definition Electrodes on Pacer on Demand = 60 mA = capture setting + 2mA Term Goal of bradycardia tment Definition Get rid of symptoms Term If asymptomatic 2nd degree type II or 3rd deg HB Definition Have pacer ready for deterioration Term Which rhythms are considered unstable tachycardia? Definition A fib w/n, i A flutter n, r, Ø convert Svt n r c VT wr Term Symptomatic tachycardia? Definition Chest pain SOB ms dizziness hypotension ischemic EKG s pvc or vt Term do we cardiovert sinus tachycardia Definition no b/c  responding to need for d CO shock may  HR Term how do we evaluate tachycardia Definition S= stable N= Narrow/ wide QRS R= regular rhythm? C= Converted Term How do we treat unstable tachycardia? Definition Cardiovert Term When should we use synchronized? Definition Symptomatic stable tachycardia Unstable tachycardia with pulses Term When should we use unsynchronized? Definition Ø pulse If can’t tell if monomorphic or polymorph Term How do we treat Monomorphic unstable VT Definition Synchronized cardioversion Term How do we treat polymorphic unstable VT Definition High energy unsynchronized cardioversion Term How do we use low energy shocks? Definition Always synchronized b/c will → VF Term How do we know how much energy to use? Definition Afib , mono stable VT = 100, 300, 360 Svt, aflutter = 50, 100, 200, 300, 360 Poly vt = high energy Term If stable, narrow regular tachycardia? Definition Yes 1-2-3, think SVT, then V-A-C V= vagal maneuvers Adenosine 6 mg , 12, 12 Converts? if no Cardizem (or more adenosine or  blocker) Term Do you have stable narrow regular tachycardia resting on your hands?   Yes? Then Yes 1-2-3, think SVT, then V-A-C Definition Term 2 types of stroke Definition Ischemic 85% Hemorrhagic 15 % Term 7 D’s of stroke care Definition Detection Dispatch Delivery Door Data Decision Drug Term Goals of stroke care Definition General assess 10 min Neuro assess/ CT 25 min Interpret ct 45 min Fibrinolytic therapy 1hr Admission 3 hours Term Risk of fibrinolytic therapy Definition Intercranial bleeding Term Exclusions for fibrinolytic therapy Definition Uncontrolled bp >185/110 Seizure Bleeding Term htn in stroke if Ø elig Definition If sbp> 220 or dbp 121-140 Labetolol 10-20mg for 1-2 min Repeat q10 min up to 300 nicardipine drip 5mg/h   by 2.5 mg q 5 min up to 15 mg/h if dsp > 140 nitroprusside 0.5 g/kg/min Term Treating htn in stroke if elig Definition If sbp> 230 of dbp 121-140 Labetolol 10mg for 1-2 min Repeat q10 min up to 300 mg or initial dose drip @ 2-8 mg/min nicardipine drip 5mg/h   by 2.5 mg q 5 min up to 15 mg/h if dsp > 140 nitroprusside 0.5 μg/kg/min If sbp 180- 230 or dbp 121-140  Labetolol 10mg for 1-2 min Double q 10-20min up to 300 mg Term What if you have stable narrow irregular rocking at your crib? Then don’t be glib you’ve got afib Control rate (cardizem &  blks) Get expert Definition Term Now if your stable narrow regular tachycardia will not convert? Don’t be hurt it’s just Aflutter Expert causes rate we utter I     Definition Term Definition