Term
Only effective tment for vf |
|
Definition
|
|
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
|
|
Term
|
Definition
vaso constriction s coronary flow map & aortic diastolic bp |
|
|
Term
|
Definition
|
|
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
|
|
Term
|
Definition
= 2 – 2.5 times reg dose IV then dilute in 5 – 10 cc NS |
|
|
Term
|
Definition
Narcan Atropine Vaso Epi Lidocaine |
|
|
Term
| How does Amiodarone work? |
|
Definition
| = affects Na, K, & ca channels has alpha & beta properties |
|
|
Term
|
Definition
= 300mg IV then 150 mg in 3-5 min max = 2.2g over 24 hrs |
|
|
Term
|
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
|
Definition
|
|
Term
|
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
|
Definition
RAPID DOSE: 150 mg over 10 min LOADING DOSE: 360 over 6hrs MAINTENANCE DOSE: 540 over 18 hours |
|
|
Term
|
Definition
| MAINTENANCE DOSE: 1 to 4 mg/min |
|
|
Term
|
Definition
Any organized rhythm w/o pulse Except VF VT & asystole |
|
|
Term
| Most common rhythm after shock? |
|
Definition
|
|
Term
| In PEA which is priority IV access or airway? |
|
Definition
|
|
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
|
Definition
2. Cpr Cpr /epi or vaso 3. Cpr Cpr / atropine back to 2 |
|
|
Term
| Most common causes of PEA |
|
Definition
|
|
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
|
Definition
STEMI NSTEMI depression No EKG s |
|
|
Term
| Focus of early MI treatment |
|
Definition
Rapid reperfusion Relief of pain Treat complications |
|
|
Term
|
Definition
- Unstable plaque
- Plaque ruptures & platelets surround
- Partially occludes → ischemia need antiplatelet meds
- Microemboli lodge in vasculature → troponin
- Completely occlusive thrombus → STEMI
|
|
|
Term
|
Definition
| Intermittently occluding thrombus |
|
|
Term
| How do we decide how to treat ACS? |
|
Definition
|
|
Term
| What does d troponins indicate |
|
Definition
|
|
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
|
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
|
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
|
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
|
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
|
|
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
|
Definition
Chest pain SOB ms dizziness hypotension diaphoresis pvc or vt |
|
|
Term
| How do we treat asymptomatic bradycardia? |
|
Definition
|
|
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
|
|
Term
|
Definition
Failure to respond to atropine Can also try epi/dopa |
|
|
Term
| What happens if give < 0.5 atropine? |
|
Definition
|
|
Term
| When is atropine dangerous |
|
Definition
- In MI
- b/c → ischemia in 2nd degree type II or 3rd deg HB
|
|
|
Term
|
Definition
|
|
Term
| Where assess pulse after TCP |
|
Definition
| Ø carotid b/c of muscular jerking |
|
|
Term
|
Definition
Electrodes on Pacer on Demand = 60 mA = capture setting + 2mA |
|
|
Term
| Goal of bradycardia tment |
|
Definition
|
|
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
|
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
|
|
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
|
Definition
Ischemic 85% Hemorrhagic 15 % |
|
|
Term
|
Definition
Detection Dispatch Delivery Door Data Decision Drug |
|
|
Term
|
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
|
|
Term
| Exclusions for fibrinolytic therapy |
|
Definition
Uncontrolled bp >185/110 Seizure Bleeding |
|
|
Term
|
Definition
- If sbp> 220 or dbp 121-140
- Labetolol 10-20mg for 1-2 min
- 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
- 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
|
|
