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ACLS
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114
Medical
Graduate
10/30/2011

Additional Medical Flashcards

 


 

Cards

Term
First line tx for V fib
Definition
shock
Term
First line tx for Vtach (stable)
Definition

adenosine 6 mg

amiodarone 150mg over 10 min

Term
First line tx for stable svt
Definition
vagal maneuvers
Term
First line tx for unstable svt
Definition
shock
Term
First line tx for afib
Definition
synchronized cardioversion at 120J
Term
First line tx for unstable aflutter
Definition
synchronized cardioversion
Term
First line tx for polymorphic v tach (torsades)
Definition
magnesium sulfate + unsynchronized cardioversion
Term
First line tx for moomorphic (wide complex) v tach
Definition
adenoside 6 mg
Term
First line tx for vfib or pulseless v tach
Definition
shock
Term
First line tx for asystole/PEA
Definition
intubate, epinephrine 1 mg IV
Term
First line tx for bradycardia
Definition
 atropine 0.5mg
Term
H's and T's
Definition

Hypovolemia, hydrogen ions (acidosis), hypo/hyperkalemia, hypoglycemia, hypothermia

 

toxins, tamponade, tension pneumo, thrombosis, trauma

Term
Acute STEMI tx
Definition

MONA:

Morphine 2-4 mg IV over 1-5 min

O2

Nitro 0.4 mg tab every 5 min, can be done 3x

or IV infusion 10-20 mcg/min every 5-10 min

Aspirin 162-325 mg PO (preferably chewed)

Term
opiate analgesic given to pts with ACS who are sx after Nitro
- reduces anxiety
- dilates arteries and veins
- decreases preload and afterload

SE: hypotension, resp distress, n/v
- reversed w/ naloxone
Definition
morphine
Term
non-specific vasodilateor and anit-anginal
relaxes & dilates smooth muscle
- reduces preload & afterload
- antagonizes vasospams
- increases collateral coronary blood flow

SE: hypotension #1, HA, nausea, syncope, hypoxemia, tachy, tolerance

Contraindications?
Definition

Nitro

 

contras: SBP < 90 mmHg

HR <50 or >100

taken a phosphodiesterase inhbiitor w/in 24 hr

 

place in trendelenburg if profound hypotension develops

Term
prostaglandin & platelet inhibitor used for ACS

SE: Bleeding, stoamch pain, heart burn, N/V, allergy
Definition
Term
Other STEMI tx:

1. Inhibits platelet aggregation
2. interferes w/ blood coagulation by indirectly inhibiting thrombin
3. reopro, integrilin, aggrastat. prevent platelet aggregation by inhibiting fibrinogen to glycoprotein IIb/IIIA bindgin
4. block sympathetic stimultion of heart
5. -prils
6. decreases LDL, pleotrophic effects,
Definition

1. plavix

2.heparin

3. Glycoprotein IIb/IIIA inhibitors

4. beta blockers

5. ACE-I

6. STatins

Term
Sympathomimetic catecholamine that has both alpha and beta adrenergic activities:
ncreases SVR (vasoconstriction)
Increases systolic and diastolic BP
Increases electrical activity in the myocardium
Increases coronary and cerebral blood flow
Increases myocardial contractility and HR
Increases myocardial oxygen demands—decreases subendocardial perfusion


Used in Vfib/pulseless Vtach, asystole, PEA, symptomatic bradycardia

dose?
Definition

epi

 

dose: 1mg q3-5 min of 1:10,000

Term
Naturally occuring ADH
- acts as nonadrenergic peripheral vasoconstrictor
- used in place of epi in Vfib/pulseless Vtach, asystole, PEA
- can only be used for 1st or 2nd dose
Definition

vasopressin

40IU IV x 1

Term
Sympathomimetic natural catecholamine
- alpha and beta stimulation:
- increased contractility, increased rate, increased CO

uses: hypotension as result of symptomatic bradycardia acfter return of circulation

Precautions:
Increases heart rate which may induce or exacerbate arrhythmias
Increases myocardial oxygen demand and consumption
Nausea, vomiting
Extravasation produces necrosis and sloughing
Inactivated by alkaline solutions
Definition

dopamine

2-10 mcg/kg/min

Term
Sympathomimetic synthetic catecholamine
- increases SV and reduces afterload

uses: stress test, tx of RV infarction, PUMP PROBLEMS w/ no sign of shock (SBP 70-100)

Contra: known or suspected poison/drug-induced shock
Definition
dobutamine
Term
Shifts oxyhbg curve to left
- induces hyerosmolality and hypernatremia


USES: preexisting hyperkalemia
Definition

sodium bicarb

 

 

Term
physiologic ca-channel blocker that may induces systemic vasodilation (decrease myocardial O2 demand)

USES: Cardiac arrest with torsades or hypomagnesemia
Definition

magnesium

1-2 g in 10cc D5Q IV

Term
Rhythm drug:

ventricular antiddysrrhythmic
reduces slow of phase 4 diastolic depolarizaiton
suppresses vent ectopy after MI
may terminate reentry of vent arrhtythmia
elevates fib threshold

used as alternative to amiodarone (not first line tx)
Precautions:
Toxic reactions: slurred speech, altered mental status, muscle twitching, seizures, respiratory arrest
Metabolized in liver, so decrease dose in elderly, liver disease, with decreased cardiac output
If HR<60bpm, treat the bradycardia 1st, not the ventricular ectopy
Large doses may induce heart block, depress spontaneous SA node discharge, or alter AV conduction in some patients
dose?
Definition
Lidocaine: initial bolus 1-1.5 mg/kg IV
Term
Rhythm drug:

effects Na, K, and Ca channels and has alpha and beta adrenergic blocking effects
- tx of atrial and vent arrhythmias

CANNOT BE USED WITH SIMVASTATIN = RHABDO

uses: recurrent vfib and pulseless v tach

Precautions:
vasodilation, hypotension
neg inotropic effects
prolonged QT
amiokeratopathy - ocular changes
Definition

amiodarone

300 mg IV bolus

150mg IV in 3-5 min - only one additional dose

Term
used to suppres atrial and vent arrhythmias
slows intraventricular conduction time

Uses: stable Vtach, PSVT, a fib, WPW

can induce arrhythmias
Definition
procainamide
Term
anticholinergic parasymp blocker
enhances sinus node automaticidy and AV node conduction
Vagolytic - stimulates vagus nerve

uses: first drug for symptomatic brady

avoid in hyperthermic brady
Definition

atropine

 

0.5-1.mg IV q 3-5 min

 

 

Term
"reset button"
depresses av and sinus node activyt
- 1st drug for stable PSVT

NOT for afib, flutter, or vtach
Definition

adenosine

 

1st bolus: 6 mg

2nd in 1-2 min: 12 mg

3rd in 1-2 min: 12 mg

Term
increase vagus nerve stimulation - can cause SVT and convert to NSR
- if these work -- then tachy is supraventricular

consists of valsalva and carotid massage
Definition
vagal maneuvers
Term
CCBs:

1. has more effect on increasing coronary vasodilation and less on increasing peripheral vasodilation and decreasing afterload and contractility

2. opposite


used to in afib/flutter, refractory PSVT (3rd line)

Do not use for wide QRS tachy or uncertain origin
Definition

1. diltiazem

2. verapamil

Term
sympathomimetic catecholamine
pure beta adrenergic agonist
increases CO and myocardial O2 consumption

used to reverse effect of B blockers
can be used temporarily for sympatomatic brady
Definition

isoproterenol

 

Term
improves HR in brady due to bb's or ccb's
Definition
glucagon
Term
adjuvant for CHF or pulm edema in HTN pts
or HTN emergency

Precautions: Renal failure, dehydration, hypotension, hypokalemia, or other electrolyte imbalances.
Definition
furosemide
Term
algorithm for vfib
Definition

1. shock at 200J

2. CPR 2 min (5 cycles)

3. Shock at 300 J

4. CPR 2 min

5. itubate, H&T, IV/O2

5. Epi 1 mg

6. CPR

7. schok 360 J

8. CPR

9. amiodarone 300 mg

10. shock

11. amiodarone 150 mg

Term
asystole/PEA alogirthm
Definition

1. intubate, IV, H&T

2. epi 1 mg, repeat 3-5 min

OR vasopresin 40 IU for first or second dose

 

CPR 5 cycles at a time

Term
Brady algorithm
Definition

1. CAB, O2, vitals, H&Ts

2. atropine 0.5 mg 3-5 min

3. dopamine 2-10 ug/kg/min OR epi drip 2-10 ug/min

4. consider pacing

 

Term
BLS algorithm
Definition

1. call 911, get AED

2. CAB

3. 30 compressions, 2 breaths

4. AED- shockable give one shokc then repeat CPR x 5 cycles

if not shockable, keep doing CPR

Term
A fib algorithm
Definition
1. synchronized cardioversion at 200J
Term
A flutter or unstable SVT algorithm
Definition
1. synchronized cardioversion at 100J
Term
polymorphic/unstable Vtach or torsades algorithm
Definition

1. mg sulfate 1-2 g

2. unsynchronized cardioversion 200J, then 300, then 360

Term
narrow (stable) SVT algorithm
Definition

1. vagal maneuvers

2. adenosine 6 mg

3. adenosine 12 mg

4. adenosine 12 mg

5. b blocker rate control

Term
stable (wide complex) v tach algorithm
Definition

1. adenosine 6 mg

2. amiodarone 150 mg over 10 min

3. synchronized cardioversion 100 J

Term
What 3 ACLS drugs can be given via the ET route?
Definition

epi

lidocaine

vasopressin

Term
Pt w/ ACS - BP drops after giving nitro and morphine. What now?
Definition
give NS 250-500 ml bolus
Term
Pt in refractory vfib has been shocked, cpr, epi 1mg, amiodarone. What now?
Definition
another epi 1 mg
Term
pt if vfib has 2 shocks. what now?
Definition
Epi 1 mg
Term
Tachycardic pt w/ palpitatinos, chest pain, hypotension. complexes wide and irregular at 180 bpm. what first?
Definition
shock - pt is unstable
Term
Pt has STEMI. which is a contraindication to the use of nitro?
Definition
phosphodiesterase inhib w/in 12 hours
Term
sinus brady at 36 bpm. 3 mg atropine has been given. transcutaneous pacing has been given but not effective. BP 100/60. what now?
Definition
epi drip 2-10 mcg/min
Term
narrow QRS tach at 180/min. vagal maneuvers not effective. What now?
Definition
adenosine 6 mg
Term
pt in asystole. shocks and cpr given. what's the first drug to give?
Definition
epi 1 mg or vasopressin 40 units
Term
When is Mg indicated?
Definition
torsades
Term
STEMI pt undergoing fibrinolytics. Did not take aspirin bc of hx of gastritis. What now?
Definition
aspirin 160-325 mg chewed
Term
Pt in pulseless vtach. 2 shocks and 1 dose epi have been given. What now?
Definition
amiodarone 300 mg
Term
Pt w/ wide complex tachy. Stable at 110/70. Hx of angina. what now?
Definition
seek expert consult
Term
pt has stroke. CT scan has been ordered. He is a candidate for fibrinolytics. What is a guideline for fibrinolytics?
Definition
do not give anticoagulants w/in 24 hours of rTPA
Term
Which is correct about vasopressin?
Definition
can only be given once at 40 units IV or IO in place of epi
Term
Initial dose of atropine for bradycardia?
Definition
0.5 mg
Term
2nd dose of amiodarone?
Definition
150 mg
Term
When does brady require tx?
Definition
when sx are present - CP, SOB
Term
blah blah blah NO PULSE
Definition
epi 1 mg
Term
Pt with angina. First thing to do if no contraindications?
Definition
sublingual nitro 0.4 mg
Term
Pt becomes unresponsive. Not sure about pulses. First thing to do?
Definition
CPR
Term
Pt was resuscitated from cardiac arrest. is now in severe CP and has vtach. what to do ?
Definition
unsynchronized cardioversion
Term
SVT w/ no chest pain or SOB. first thing to do?
Definition
vagals
Term
SVT w/ CP and SOB. first thing to do?
Definition
synchronized cardioversion at 50-100J
Term
Bradycardic pt w/ weak pulses. Gave O2. Next?
Definition
atropine 0.5 mg
Term
Pt has been resuscitated. was given 2 doses epi and one dose amiodarone. is now back in vtach and is hypotensive. What do you do?
Definition
1-2L NS
Term
Pt in PSVT has been given 6mg adenosine to no avail. what now?
Definition
12 mg adenosine
Term
Pt in vtach given two shocks and CPR. Is now in vfib. Now what?
Definition
epi 1 mg
Term
Pt has STEMI. Pain has been somewhat relieved w/ nitro. What is the best way to prevent mortality?
Definition
reperfusion
Term
pt w/ stable (no sx) wenckebach. What do you do?
Definition
seek expert consult and continue monitoring
Term
Wide complex tachy. No other sx other than mild palpitations. Vitals ok.
Definition
Give adenosine 6mg and seek expert consult
Term
Pt suddenly goes into vfib. First thing?
Definition
shcok
Term
Pt in afib w/ irregular HB but no sx.
Definition
monitor and seek expert consult
Term
alcoholic in torsades w/ hx of prolonged QT
Definition
mg sulfate 1-2 mg in 10 ml D5W over 5-20 min
Term
stable a flutter
Definition
seek expert consult
Term
pt in vfib and now in asystole. first thing to do?
Definition
resume CPR
Term
Mobitz II w/ hypotension. first drug?
Definition
atropine 0.5 mg
Term
- how long should a PR interval be?
- how long should a QRS be?
- when is a Q wave significant?
Definition

1. <0.12s

2. <0.12s

3. when its >1/2 R-R

Term
causes of LAD?
Definition

left anterior hemiblock - most common

LVH

inferior wall MI

ectopic beats

Term
causes of RAD
Definition

kids

RVH

LBBB

dextrocardia

ectopic beats

Term
criteria for RBBB
Definition

1. QRS >0.12

2. I & V6: slurred S wave

3. V1: RSR' - rabbit ears

 

NEVER neg complexes in V1

Term
LBBB criteria
Definition

1. QRS >0.12

2. I & V6: broad, monomorphic R waves

3. V1: Broad, monomorphic S waves

Term
Left anterior hemiblock criteria
Definition

1. axis shift to pathologic left (I+, avf-, II-)

2. I: qR or large R

3. III: rS

 

 

 

Term
LPHB criteria
Definition

1. RAD (I-, aVF+)

2. I: s, III: q

3. exclusion of RAE and RVH

Term
LAE (P mitrale) and RAE (P pulmonale) criteria
Definition

LAE: I & II: P wave >0.12 and notched

 

RAE: II & III: peaked P waves >2.5mm

 

biatrial enlargement is any combo of these

Term
LVH criteria
Definition

1. S in V1 or V2 + R in V5 or V6 > 35mm

2. any precordial QRS >45 mm

3. R in aVL >11mm

4. Strain pattern

 

will usually have LAE too

Term
RVH criteria
Definition

1. V1 or V2: R:S ratio is >1

2. RAE

3. Strain pattern

Term
1. Definition:
ST segment elevation greater than 1 mm (0.1 mV) in 2 or more contiguous precordial leads or 2 or more adjacent limb leads
OR
New or presumed new left bundle branch block

2. Ischemic ST-segment depression of 0.5 mm (0.5 mV) or greater
OR
Dynamic T wave inversion with pain or discomfort
Transient ST elevation of 0.5 mm or greater for less than 20 minutes

3. Normal or non-diagnostic changes in ST segment or T wave that are inconclusive and require further risk stratification
Includes people with normal ECGs and those who have ST-segment deviation in either direction that is less than 0.5 mm or T wave inversion of 2 mm or 0.2 mV or less
Definition

1. STEMI

2. NSTEMI or UA

2. intermediate/low risk USA

Term
criteria for transmural MI
Definition

1. abnormal Q waves

2. ST segment elevation

3. inverted T waves

Term
time course of STEMI EKG changes
Definition

1. ST elevation

2. Q wave

3. T wave inversion

Term
Anterior and Inferior MIs:
affected and reciprocal leads
Definition

Anterior (LAD): I, aVL, V1-V6

reciprocal: II, III, aVF

 

Inferior (RCA): II, III, aVF

reciprocal: I, aVL, V1-V6

Term
1. most common type of MI
presents w/ hypotension
fluids are great, nitrates cautiously
AV node most commonly

2. most severe MI "widowmaker"
presents w/ sudden arrhythmias
nitrates are great, spare the fluids
SA node most commonly
Definition

1. inferior MI

2. anterior MI

Term
AKA subendocardial infarction

ST depression is hallmark
sometimes T wave inversion
no Q waves

ACC def?
Definition

NSTEMI

 

ACC def: CP + elevated enzymes

 

Term
early repolarization (early R wave progression) is characteristic of?
Definition
normal variant or Non-ischemic ST elevation
Term
Scooped ST segment
elevated T wave

= smiley pattern
Definition
acute pericarditis
Term
caused by an accessory pathway called the bundle of kent that causes pre-excitation

key EKG finding is delta R wave
- also PR >0.12
- QRS >0.1
Definition
WPW syndrome
Term
pre-excitation syndrome where AV node is bypassed by an extension of the anterior internodal tract called the james bundle
causes significant atrial arrhythmias
Results in flutter waves
Definition
LGL syndrome
Term
visually, the ___ ventricle dominates the anterior view of the heart
Definition
right
Term
the ___ ventricle pumps blood through peripheral circulation
Definition
right
Term
The term ___ is used to describe pts with severe depression of sinus node function
Definition
sick sinus syndrome
Term
AV node circulation is always supplied by which artery?
Definition
RCA
Term
einthoven's equation
Definition
I+III = II
Term
the unipolar augmented limb leads can be expressed as what equation
Definition
aVR + aVL + aVF = 0
Term
If an EKG were obtained at half standard, a wave that is 10mm high would be described as being
Definition
20mm
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