Term
| look at slide 6 for the mechanism of electrical pulse in heart |
|
Definition
|
|
Term
| atrial depolarization is noted by: |
|
Definition
| p wave (SA node does this) |
|
|
Term
| what does the btwn P and Q line show? |
|
Definition
|
|
Term
| what deos the QRS comlex represent |
|
Definition
| ventricular depolarization |
|
|
Term
| the btwn S and T is where what happens? |
|
Definition
| ventricular depoelarization comepltes |
|
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Term
|
Definition
| ventricular repolarization |
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|
Term
the boxes on an EKG represent how mnay seconds?
how mnay seconds do you count the beats for? |
|
Definition
.2
3 seconds (then double then x 10) for bpm |
|
|
Term
| how do you determine if rythm is normal on a EKG? |
|
Definition
| see if all the waves look similar |
|
|
Term
| 3 causes of tachycarrythmia |
|
Definition
increased automaticity (sinus tachy)
triggered acitvity (ectopic)
re-entry (retrograde) |
|
|
Term
| what is the most common cause of tachycardia |
|
Definition
|
|
Term
if the tachycardia is above the AV its called?
if below? |
|
Definition
supraventricular
ventricular |
|
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Term
if the QRS complex is narrow it is what kind of arrythmia?
if wide/ |
|
Definition
supraventricular
ventricular |
|
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Term
|
Definition
|
|
Term
supraventricular tachyarrythmia:
if uniform R-R what can this mean?2- |
|
Definition
|
|
Term
| if supraventricular tahcyarrythmia has non uniform R-R, what cna this mean-2 |
|
Definition
|
|
Term
| in an ICU pt sinus tachycardia cna mean03 |
|
Definition
infection
hypovolemia
drug induced (adrenergic) |
|
|
Term
| what drugs cna cause sinus tachycardia-3 |
|
Definition
| dopamaine, EPI/Ne albuterol |
|
|
Term
| body can tolerate HR of up to _ bpm |
|
Definition
|
|
Term
| what is the most common arrythmia |
|
Definition
|
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Term
| what are risks for a fib-4 |
|
Definition
age >75
ischemic heart disease
valve disease
cardiomyopathy |
|
|
Term
in the ICU pt without a fib risks, a fib can occur after?
when does it appear |
|
Definition
|
|
Term
| the a fib in ICU caused by operation is normally self limitng and returns to normal in how long? |
|
Definition
|
|
Term
| on EKG a fib has what characteristics-3 |
|
Definition
no p wave
ireregularly ireregular rhythm
uneven QRS distance |
|
|
Term
| rapid ventiruclar response (RVR) is when bpm range: |
|
Definition
|
|
Term
|
Definition
caridovert
ventricualr rate
aticaog agaisnt thrombus |
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|
Term
| what isthe only time an a fib is medical emergenyc-2 |
|
Definition
|
|
Term
| rate control, goal is HR - |
|
Definition
|
|
Term
if pt have hgiher EF like >40%, use what for rate control-2
if lower use-2 |
|
Definition
CCB, beta blocker
amiodarone, digoxin |
|
|
Term
| what do you do for rythm controo? |
|
Definition
|
|
Term
| if a fib > _ hrs need anticaog |
|
Definition
|
|
Term
this arrythmia is normal and then becomes tachycardic?
is the rhythm normal for this? |
|
Definition
paroxysmal supraventricular tachycardia
yes (R-R the same) |
|
|
Term
| what is the most common PSVT |
|
Definition
| atrial ventricular nodal reentry tachycardia |
|
|
Term
what system is activated in the body to overcome AVNRT?
examples -2 |
|
Definition
parasymapthetic
cough, cold wtaer (decrease HR) |
|
|
Term
the drugs that block AV node and can reverse AVNRT? -2
which works faster? what is it's other pro? |
|
Definition
non DHP CCBs
adenosine;
adeonsine (30 sec); less CNS depression |
|
|
Term
definition of ventricular tachyarrythmia:
at what rate? |
|
Definition
3 consecutive premature ventricular contracions (PVCs)
rate > 100 bpm |
|
|
Term
| if a VT is polymorphic what does that mean? |
|
Definition
| QRS shape changes continously |
|
|
Term
|
Definition
|
|
Term
| the bad thing of a VT is that you dont get enough _ out of ventricles |
|
Definition
|
|
Term
| ventricular fibrillation is defined as? |
|
Definition
| disorganized electric activity |
|
|
Term
|
Definition
| ventriclar depoalr to end of repolarization |
|
|
Term
| torsades de pointes is what kind of arrythmia? |
|
Definition
|
|
Term
| torsades de pointes is present when? |
|
Definition
|
|
Term
| look on slide 24 to see VT progression to VF pictures |
|
Definition
|
|
Term
| what 4 rythms cause cardiac arrest |
|
Definition
VF
pulseless VT
pulseless electrical activty (PEA)
asystole |
|
|
Term
| pulseless electical activity (PEA) is deifned as- |
|
Definition
| electrcial acitivty on EEG but cant clincally detect pulse on pt |
|
|
Term
|
Definition
| absence of ventrical acitivty w/ or w/o electric activty |
|
|
Term
| what is the end stage rhythm |
|
Definition
|
|
Term
ABC of ACLS (advanced cardaic life support)
where do pharamcists come into play in ICU? |
|
Definition
A- airway intubation
B- bag mask
C- systemic circulation;
medicaitons in the C |
|
|
Term
| what rythms do you do ACLS for?6 |
|
Definition
bradycardia
SVT
VT
Vfib
PEA
asystole |
|
|
Term
|
Definition
| high quality UNINTERRUPTED chest compressions (30 compression per 2 breaths going 1.5 in deep) |
|
|
Term
|
Definition
CPR
O2
stable or unstable
Id rhythm
5 cycles of CPR-> hands off analyze |
|
|
Term
| in ACLS when determining rhythm:=5 |
|
Definition
is ther a pulse
stable/unstable (hypotensive, chest pain)
QRS narrow/wide
rhythm reg/irregular
QRS mono/polymoprphic |
|
|
Term
reversible causes of cardaic arrest (H and Ts)
give 3 of each |
|
Definition
Hs: hypovolemia, hypothermia, hypoxia
Ts: thombosis, toxins, tamponade |
|
|
Term
| for bradycardia pt needs to be symptomatic and unstable for ACLS; what are signs of unstable?-4 |
|
Definition
| dizzy, sweat, low BP, low RR |
|
|
Term
| for bradycardia what med is used and dose |
|
Definition
atropine
0.5 mg IV q 3-5 min |
|
|
Term
| max dose of atropine fro bradycardia |
|
Definition
|
|
Term
|
Definition
|
|
Term
| if SVT is stable what do you do in ACLS-2 |
|
Definition
1) vagal manuevers
then
2) adenosine 6 mg IV |
|
|
Term
|
Definition
| shock 50 J (cardioversion) |
|
|
Term
|
Definition
|
|
Term
if VT unstable and monomorphic do?
if polymorphic? |
|
Definition
synchronized cardiovesion 100J
defibrillation 200 J |
|
|
Term
|
Definition
|
|
Term
after confirm its Vfib what do you do?
1)
2)
3) |
|
Definition
1) start CPR-> shock w/ defib 200 J
2)resume CPR 5 cycles
3) hand off analyze
**** dont looka t screen until analyze |
|
|
Term
if pt in v fib after 5 cycles of CPR what is next line?
1)
2) |
|
Definition
shock-> CPR 5 more cycles
admin epi after 2nd shock |
|
|
Term
| how much epi do you give for v fib? |
|
Definition
|
|
Term
after 3rd shock during second cycle of v fib what med and dose do you give?
second dose of this would be? |
|
Definition
amiodarone 300 mg IV
150 mg IV |
|
|
Term
for PEA what med can be given?
how muhc? |
|
Definition
|
|
Term
| for PEA try to disocer the _s and fix them |
|
Definition
|
|
Term
| asystole and PEA ACLS steps-5 |
|
Definition
hands off
confirm
CPR
Hs and Ts
epi |
|
|
Term
|
Definition
|
|
Term
| the vasopressor therapies work by- |
|
Definition
| increase preload to enhance perfusion |
|
|
Term
|
Definition
alpha (vasooconstrict to increaseBP)
beta1-2 agonist (increase cardiac contraciton) |
|
|
Term
|
Definition
| imrpove perfusion to heart nad brain |
|
|
Term
dose for Epi in asystole, PEA, VT:
how often repeated? |
|
Definition
1 mg Iv push w/ 20 cc Ns flush
rpeeat 3-5 min |
|
|
Term
when can you do continuous epi?
dose? |
|
Definition
symptoamtic bradycardia
2 mcg/min |
|
|
Term
|
Definition
|
|
Term
|
Definition
| ADH and vascoonstrict at high dose on V1 recpt |
|
|
Term
| Advg of vasopressin over Epi:-3 |
|
Definition
longer hlaf life
not affected by acidosis
nonardenergic MOA |
|
|
Term
give as alternative to ePi in VT, ssytole, PEA
dose:
how mnay vials is this?
how mnay times repeaT? |
|
Definition
|
|
Term
|
Definition
| antag of ACH to stop ventricualr and supravent pacemakers |
|
|
Term
|
Definition
symtpomatic bradycardia
increases HR(max 3 mg) |
|
|
Term
dose of atropine used?
rpeat? |
|
Definition
|
|
Term
|
Definition
slows conduction of AV to restore SA node
(D= decrease HR) |
|
|
Term
| when is adeonsine used?-2 |
|
Definition
stable PSVT
stable monomorphic VT |
|
|
Term
dose of adensoine 1st:
2nd:
** use larger dose it pt taking caffeine/theophylline |
|
Definition
6 mg rapid IV
12 mg rapid IV |
|
|
Term
MOA of amiodarone?
what does this do? |
|
Definition
alpha and beta blocking
prolong action potention and refractory to decrease AV and increase SA |
|
|
Term
| whihc drug is not for ET admin? |
|
Definition
|
|
Term
| amiodarone is used for?-3 |
|
Definition
vfib
pulseless VT
stable VT |
|
|
Term
|
Definition
vfib/pulseless VT: 300 mg IV
stable VT: 150 mg over 10 min |
|
|
Term
| max dose of amiodarone in 24 hrs |
|
Definition
|
|
Term
|
Definition
| increases conduction to prolong AP and QT |
|
|
Term
|
Definition
|
|
Term
Mg for cardaic arrest dose
for stabel torsades/AMI |
|
Definition
1gm over 5 min
1 gm over 5 min |
|
|
Term
|
Definition
| supresses conduction of tissue to block impulses |
|
|
Term
dose of lidocaine
what is it an alternative for? |
|
Definition
1 mg/kg Iv x 1 dose
amiodarone |
|
|
Term
for drug admin:
-usually thru want line?
they all need what?
peak effect? |
|
Definition
peripheral vein
20 mL saline flush
1-2 min |
|
|
Term
| if have to use endotracheal route for meds doses need to be- |
|
Definition
|
|
Term
| post resuscitavte care for ACLS-3 |
|
Definition
MAP>65 (can use epi/NE)
O2>94%
therpaeutic hypothermia |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what medds cna be used in endotracheal -5 |
|
Definition
LEAN-V
L-lidocaine
Epi
Atropine
Nalaxone
Vasporessin |
|
|
