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Paramedic > 119 Mod 3 (Cardiology and Peds) > Flashcards

119 Mod 3 (Cardiology and Peds) Flashcards

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1
Q

Name 2 analgesics

A

nitroglycerine

narcotics - opioid/fentnyl

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2
Q

Dopamine dose

A

2-20mcg/kg/min

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3
Q

When do we use fentanyl?

A

pain management

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4
Q

What type of drug is ASA?

A

Anti-platelet

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5
Q

What class is Nitroglycerin?

A

Nitrate

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6
Q

Left Sided Heart Failure, what happens, what is treatment

A

** causes fluid backup in the lungs

  • usually due to MI, infection, or valvular diesease
  • our goal is to increase oxygenation, decrease workload of heart

Tx: )2, CPAP, nitrates, morphine

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7
Q

Define Thrombus vs embolus

A

thrombus is a mass of blood constituents; stationary, attaches to vessel wall

an embolus is a floating clot that can lodge anywhere…can be air, fluid, bone, fat, broken piece of thrombus (thromboembolism)

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8
Q

Asymptomatic 62yom with a bp of 190/110…name conditions

A

hypertension

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9
Q

How do we treat hypovolemic shock in pediatrics?

A

Up to 3 20mL/kg boluses to maintain BP…after each bolus, reassess

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10
Q

How to beta blockers work?

A

they decrease the activity of the heart by blocking the actions of hormones like adrenaline

decreased HR and BP

-olol drugs

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11
Q

Beck’s Triad

A

hypotension, JVD, muffled heart sounds

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12
Q

Vascular disorder is ____. Signs of it include (6) P’s

A

acute limb ischemia

Pain

Pallor

Paralysis

Pulselessness

Paresthesia

Poikilothermia (unable to maintain temp)

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13
Q

What is diltiazem used for? What is the dose?

A

A-fib (RVR). Dose is 0.25mg/kg max dose of 20mg

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14
Q

What chemical does the body produce to slow things down in the parasympathetic NS

A

Acetylcholine

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15
Q

Rheumatic fever usually effects the _______. This can cause _____, ____, and damage to the heart itself.

A

mitral valve, stenosis, regurgitation

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16
Q
A

Sinus Brady with 1 PVC

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17
Q

What class intervention is Dopamine and Epinephrine Infusions

A

Class IIb

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18
Q
A

Atrial Fibrillation (controlled) with 2 unifocal PVC’s

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19
Q

For Brady what is the quick treatment atde

A

All
Trained
Dogs
Eat

Atropine
TCP
Dopamine
Epinephrine

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20
Q

The sympathetic NS is mediated where?

A

by nerves in the thoracic/lumbar

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21
Q
A

A-Fib

f waves, irregular R-R
350-600 bpm Atrial rate

multiple sources trying to fire in the atrium other than SA Node

lots of squiggles

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22
Q

What is nitroglycerin used for? What is the dose?

A

Chest pain/Angina. Dose is 0.4mg up to 3 times.

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23
Q

What is adenosine used for? What is the dose?

A

SVT. Dose is 6mg then 12mg Rapid IV

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24
Q

Aortic aneurysm

A
  • dilation or out-pouching of vessel
  • at risk for rupture or dissection
  • can be treated surgically or conservatively
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25
Q

Parasympathetic Stimulation causes

A

Decreased:
Slows DOWN HR
AV conduction
Decreased Irritability

only affects the atria

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26
Q

What are classic and atypical signs of M.I.

A

classic - crushing CP radiates to L shoulder or jaw (can be both shoulders)

Atypical - nausea, epigastric pain, dizziness (women)

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27
Q

Define Dilated cardiomyopathy, what will the ECG look like

A
  • where the chambers are enlarged
  • systolic dysfunction
  • CHF-like symptoms
  • S3 and S4 sounds
  • decreased EF
  • causes include ETOH, ischemia, HTN, infections

ECG not normal, LVH, LBBB, and axis deviation

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28
Q

When a patient is presenting with acute CHF, they will benefit from what?

A

nitro and CPAP

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29
Q

Define Stroke Volume

A

amount of blood pumped in a single contraction

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30
Q

What do you do for a pt with PVCs and ankle sprain?

A

treat pt not monitor, we don’t do anything for PVCs

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31
Q

medications to treat sickle cell disease

A

Oxybryta, L-glutamine, TCAs

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32
Q

Dose for epi

A

cardiac arrest: 1mg IVP every 4 min

anaphylaxis: 0.5mg IM

Shock: 1mg epi in 100mL bag of LR, first drip 1mL/min w/ 60 drop set, titrate up

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33
Q
A

V-Tach

wide, bizarre QRS

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34
Q

How does atropine work?

A
  • blocks the effects of acetylcholine at the neuromuscular junction

“by blocking acetylcholine the heart speeds up”

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35
Q
A

Accelerated Junctional

inverted P wave

rate 61-100

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36
Q

Afterload is

A

resistance that the heart pumps against

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37
Q

Where are the 4 areas you listen to heart sounds

A

APTM

Aortic valve - right sternal border 2nd ics

Pulmonary valve - 2 ics, left sternal border

Tricuspid valve - (L) 4th ics

Mitral valve - (L) 5th ics

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38
Q

Ejection Fraction is the ______ of blood pumped in _____. The average is _____-______. Below ____ is heart failure.

A

percentage, one beat

55-70%

40%

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39
Q

What are the 3 Inherent rates of the conduction system

A

SA Node 60-100 bpm
AV Junction 40-60 bpm
Ventricles 20-40 bpm

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40
Q

Atherosclerosis

A

narrowing of vessels due to fatty particle deposits

  • decreased blood flow
  • fatty deposits become “atheroma” and gradually calcifies and becomes plaque
  • is a type of arteriosclerosis
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41
Q

Which side is the aortic valve on?

A

Left side

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42
Q

When do we give adenosine?

A

SVT

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43
Q

How does fentanyl work?

A

binds to opioid receptors producing analgesia, euphoria, respiratory depression and sedation…50-100% more potent than morphine

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44
Q

What is another term for hypoperfusion?

A

Shock

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45
Q

How does diltiazem work?

A

calcium channel blocker, decreases conduction and ventricular rate

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46
Q

Which system is Fight or Flight and Rest and Digest?

A

FF - Sympathetic NS

RD - Parasympathetic NS

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47
Q

What is Fibrinolytics

A

meds that break up blood clots

TPA (used when no cath lab typically)

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48
Q

What does the parts of conduction does the Parasympathetic influence

A

Only the atria

(i.e., the SA node, the intraatrial, and internodal pathways, and the AV junction)

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49
Q

Hemophilic patients are at most risk of ____.

A

internal bleeding…mostly in joints, knees, ankles, and elbows

can have spontaneous brain bleeds

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50
Q

What is the dose of adenosine?

A

6mg, 12mg, 12mg

MUST be rapid WITH A FLUSH

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51
Q

22yo with a hx of IV drug abuse presents with fever and a new 2/6 systolic ejection murmur

A

acute endocarditis

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52
Q

What 2 valves are open during the diastolic phase?

A

Mitral valve and Tricuspid valve

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53
Q

Is truncus arteriosus a cyanotic or acyanotic heart defect?

A

cyanotic

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54
Q

What is the main heart artery that FEEDS the body

A

Aorta

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55
Q

Dopamine…how does it work?

A

depends on dose

1-2mcg/kg/min -> dilates renal, mesenteric, coronary and intracerebral vasculature

2-10mcg/kg/min -> stimulates Beta 1 receptors and increases inotropic, chronotropic, dromotropic properties. Increases automaticity

10-20mcg/kg/min -> stimulates alpha 1 receptors. Increases in vasoconstriction. Increases in SVR and a rise in BP

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56
Q

What are interventions to SLOW the heart

A

Synchronized Cardioversion

Defib

Adenosine
Diltiazem

Beta-Blockers (lol)
Lidocaine
Mag Sulfate

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57
Q

Dose for calcium chloride

A

0.5-1g SLOW over 10 min

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58
Q

The parasympathetic NS is mediated where?

A

Vagus nerve (CN X) cholinergic ns

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59
Q

The heart is under control of what system?

A

the autonomic nervous system

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60
Q

Alpha 1 adrenergic receptors are found mainly in ____ and to a lesser degree, the ____. They cause _____.

A

the blood vessels, lungs, vasoconstriction

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61
Q

What is an unstable hypertension

hypotension

A

hyper

180/120

hypo

90/60

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62
Q

When do we use morphine?

A

moderate to severe pain

pulmonary edema

CHF

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63
Q

What are the great vessels?

A

Aorta

Inferior Vena Cava

Superior Vena Cava

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64
Q

How do you treat PEA

A

CPR - compressions
IV/IO access

1mg Epinephrine (0.1mg/mL) IVP every 3/5 mins

ETT and Capno

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65
Q

Is patent ductus arteriosus a cyanotic or acyanotic heart defect?

A

acyanotic

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66
Q

Dose for sodium bicarbonate

A

full arrest: 1mEq/kg, repeat 0.5mEq/kg every 10 min

Hyperkalemia: 50mEq SLOW over 5 min, THEN 100mEq into 1000mL LR bag to run 30-60 min

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67
Q

a patient with “tearing” sensation in his lower back. He presents cool, clammy, pain in his back and flank.

A

Possible ruptured aortic aneurysm

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68
Q

Is pulmonary valve atresia a cyanotic or acyanotic heart defect?

A

cyanotic

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69
Q

What do you do for a 3rd degree heart block?

A

supportive care, pacing if unstable

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70
Q

Define

Excitability
Automaticity
Contractility
Extensibility
Conductivity

A

Excite = response to electric

Contractility = squeeze

Auto = create impulse

extense = stretch,expand

conduct = pass electric

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71
Q

What are the names and locations of the semilunar valves of the heart?

A

The semilunar valves are the pulmonary (or pulmonic) valve and the aortic valve. The pulmonic valve sits between the right ventricle and the pulmonary artery. The aortic valve sits between the left ventricle and the aorta.

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72
Q

Dose for nitro

A

chest pain 0.4mg SL (max 1.2mg)

CHF: 0.4mg ever 3-5 min (ma 1.2mg)

High dose: 0.4mg, then 0.8mg

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73
Q

Myocardium

A

Thick middle layer, contains structures enabling the heart to contract

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74
Q
A

Sinus Brady with a wide QRS

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75
Q

what is the drug dose of cardizem

when do you give

A

.35mg/kg IV

tachy

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76
Q

What is atropine used for? What is the dose?

A

Bradycardia. Dose is 0.4mg/kg

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77
Q

Alpha 2 adrenergic receptors are found in the ____ and _____. They inhibit the release of _____ and _____.

A

brain, periphery, norepinephrine, acetylcholine

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78
Q

Is atrioventricular septal defect a cyanotic or acyanotic heart defect?

A

acyanotic

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79
Q

How does adenosine work?

A

it slows/prevents conduction through the AV node

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80
Q

How do potassium channel blockers work?

A

block the potassium channel in the CNS and prolongs action potential

if the channels are blocked, the cells can’t repolarize and will NOT transmit another action potential

i.e. amiodarone

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81
Q

According to the CDC, name a medication that is used to treat sickle cell disease.

A

L-glutamine

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82
Q

What are the 2 shockable rhythms to DEFRIBRILLATE

A

V- Fib (squiggly worms)

Pulseless V-Tach (no pulse) (tombstones)

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83
Q

Tricuspid valve disorders are caused by _____, _____, and _____.

A

cardiomyopathy, heart failure, pulmonary HTN

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84
Q

Primary antiplatelet agent is

A

aspirin 324mg or 325mg

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85
Q

When do we use sodium bicarbonate?

A

acidosis,
hyperkalemia,
sodium channel blocker toxicity (TCA and phenobarbital)

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86
Q

how does magnesium sulfate work?

A

CNS depressant, decreases acetylcholine release, slows rate of SA nodal conduction, encourages NA/K movement

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87
Q
A

A-fib with 2 unifocal PVCs

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88
Q

how much time is between the two heavy lines on a graph

A

0.20 seconds

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89
Q

When do we use amiodarone?

A

vfib and vtach

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90
Q

What is morphine/fentanyl used for? What is the dose?

A

Pain Management. Dose is 1mcg/kg

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91
Q

Stimulation of the Beta receptors (sympathetic) will do what to the heart

A

Speeds up the

Chronotropic

Inotropic

Dromotropic

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92
Q

What does peripheral circulation do?

A

Transports oxygenated blood from the heart to the tissues and deoxygenated blood back to the heart

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93
Q

What is the dose for Dopamine

What is the dose for Epinephrine

A

Dopamine
5-20mcg/kg/min

Epinephrine
2-10mcg/min

Dopamine can be added to Epi or used alone

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94
Q

What is Systole

A

Ventricular Contraction

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95
Q
A

SVT (no P waves seen)

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96
Q

When do we use nitro?

A

pts with chest pain and CHR to reduce preload

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97
Q

What is the hr of brady

A

less than 50 (for treatment)

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98
Q

What class of drug is Albuterol

A

Beta 2 adrenergic agonist

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99
Q
A

SVT with a wide QRS

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100
Q

Define Hypertrophic cardiomyopathy, what will the ECG look like?

A

thickened myocardial wall

thickened left ventricular wall, diastolic dysfunction, risk of sudden death in young athletes

ECG signs: LVH

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101
Q

What type of angina is at rest that lasts longer than 20 minutes and new onset.

A

Unstable angina

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102
Q

Define cardiac output

A

amount of blood pumped each min

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103
Q
A

Second Degree Type II

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104
Q

What are the 4 ANTI DYSRHYTHMIA drug classes and 1 example for each

A

class I - na (sodium) channel - lidocaine

class II beta blockers - metoprolol (LOL)

class III - amiodarone

class IV - calcium ch blockers - diltiazem

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105
Q

When do we use calcium chloride?

A

hypocalcemia, hyperkalemia, calcium channel blocker toxicity, hypotension secondary to Cardizem and to help with “the bad shit from mag sulfate admin”

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106
Q

Define Ejection fraction

A

percentage of blood leaving the heart each contraction 60-65%

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107
Q

cardiogenic shock

A
  • severely impaired heart muscle function, decreasing cardiac output and resulting in inadequate tissue perfusion
  • most commonly caused by LVF from AMI, but can be caused by several issues like tamponade, trauma, etc

Possible signs: Chest pain, change in color, respiratory distress…

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108
Q

Amiodarone dose for peds (with a pulse)

A

5mg/kg over 20 min (mixed into 100mL)

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109
Q

When should you avoid Atropine

A

When there is a high degree block
(2nd type II, 3rd Degree)

go right to pacing

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110
Q

Post arrest should ETT when

A

EARLY PLACEMENT

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111
Q
A

Sinus with Atrial Pacing

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112
Q

Which nervous system slows the heart

Which nervous system speeds the heart up

A

Slows DOWN the heart - Parasympathetic

Speeds - Sympathetic

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113
Q

I have NO discernible P waves or QRS waves and look erratic. Cardiac output plummeted when I switched to this rhythm.

A

V-Fib

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114
Q

What is diastole?

A

Relaxation of the heart

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115
Q

Is Tetralogy of Fallot a cyanotic or acyanotic heart defect?

A

cyanotic

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116
Q

Stroke volume is the amount of ______ pumped out of the ____. Average stroke volume is _____.

A

blood, heart

average is between 60-100mL (avg 70mL)

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117
Q

-

A

Ventricular Tachycardia

100-250 bpm

wide tall bizarre QRS

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118
Q

What can you give a TACHY patient if you have IV access and the rhythm is regular and narrow

A

you may give

Adenosine (class I)
6mg, 12mg

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119
Q

Atropine indications

A

bradycardia, organophosphate poisoning

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120
Q

Mechanically whats happening

P wave

QRS

Twave

A

P Wave - Atrial contraction

QRS Ventricular Contraction

T Wave Ventricular relaxation

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121
Q

how many different clotting factors are there?

A

12

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122
Q

What are the 2 layers of the pericardium?

A

Visceral (epicardium)- inner most layer

Parietal- fibrous outer layer

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123
Q

prolonged QT intervals (LQTS) what can it cause, and what causes it

A

can cause fainting and seizures

  • increase in risk of sudden death

-certain medications can cause LQTS

QTc (corrected QT time) Men > 0.42 s

women > 0.44 seconds

*** greater than 0.5 seconds can be fatal

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124
Q

Steps for Sync Cardio Vert

A

For unstable Tachy

  • Press Sync
  • Marker over every R wave
  • Settings
    A-fib: 120-200J -> 200J -> 300 -> 360J

A-flutter: 100J -> 200J -> 300J -> 360J

SVT w/narrow QRS: 100J -> 200J -> 300J -> 360J

V-tach: 100J -> 200J -> 300J -> 360J

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125
Q

What bad side effect can amiodarone have?

A

lengthening the QT interval

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126
Q

How do sodium channel blockers work?

A

stops sodium from coming through cell membranes

blocks the rate AND amplitude of the initial depolarization, reduces cellular excitability and reduces speed of conduction.

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127
Q

Causes of myocarditis (7)

A

viruses

parasites

bacterial infections

heart transplant rejection

exposure to chemical poisons

chronic alcoholism

radiation therapy

128
Q

What is systole?

A

Contraction of the heart

129
Q

Define Restricted cardiomyopathy

A

myocardium is stiff or scarred

RV failure, chest pain, SOB, exercise intolerance

causes: sarcoidosis and connective tissue disorder

130
Q

Pt presents with chest pain and diffuse elevation throughout 12-lead ECG. AVR shows depression. What do they likely have?

A

pericarditis

Signs:

  • Diffuse concave-upward ST-segment elevation
  • ST-segment depression in aVR
  • PR-segment depression
131
Q

Pericardium

A

Protective sac surrounding the heart.

132
Q

Your patient has a tearing chest pain with a bp of 220/150 and a hr 110. What is this?

A

aortic dissection

133
Q

How does nitro work?

A

smooth muscle relaxant…vasodilates veins more than arteries. HAs an affinity to cardiac vasculature

134
Q

What are the 2 layers of the Pericardium

what is the fluid space between called?

A

Visceral (epi cardium) - inner layer ,adhered to the heart

potential space fluid - afusion

Parietal - outer layer

135
Q

Name and define the three conditions that are part of the spectrum of diseases known as the Acute Coronary Syndromes.

A

Stable angina: transient episodic chest discomfort due to myocardial ischemia provoked by physical exertion or intense emotional stress; relieved by palliative measures such as rest or nitroglycerin

Unstable angina: chest discomfort due to myocardial ischemia different from chronic stable angina, such as new onset, lasts longer than 20 minutes, differing pattern of relief from “normal” angina, etc.

Myocardial infarction: injury and/or death of heart muscle tissue

136
Q

Fresh frozen plasma is used for what?

A

patients who need clotting factor replacement

contains fibrinogen

137
Q

What is Poiseuille’s Law?

A

As blood vessels get bigger, blood flow significantly increases

138
Q

What is ASA used for? What is the dose?

A

Chest pain. Dose is 324mg

139
Q

What is the drug dose of Amiodarone

when do you give

A

300mg

2nd dose
150mg

Code

140
Q

What causes S3?

A

Heart Failure

141
Q

Dose for magnesium sulfate

A

eclampsia: 4 g over 10 min

VF/VT and Torsades: 1-2 grams over 2 min

Bronchoconstriction: 1-2 grams over 10-20min

142
Q

Define Mitral Valve Prolapse, what is the sound?

A

Type of Mitral Valve Regurgitation

  • Murmur may occur later
  • “ejection click”
143
Q

EKG findings in cardiac tamponade

A

electrical alternans

low voltage

tachycardia

144
Q

name and dose of two meds that are used for symptomatic relief

A

nitro and fentanyl

145
Q

the majority of the clotting factors come from what organ?

A

the liver

146
Q

Cardiac output mathematical equation

A

CO = SV x HR

147
Q

Is atrial septal defect a cyanotic or acyanotic heart defect?

A

acyanotic

148
Q

55 y/o M CP and Diaphoresis began suddenly during exercise. Bp 140/90 What do you do?

A

Sinus
no blocks
normal axis

St seg depression in II, III, avf

Septal - St elevation

Peaked T waves

Give ASPIRIN, Nitro (bp 140/90) v4r

acute coronary syndrome

149
Q

Homan’s sign…what is it and what condition does it indicate?

A

ask the pt to flex their feet … do they have any pain in calf? If so, positive sign for DVT

150
Q

What is the drug dose of Lidocaine

and when do you give?

A

0.5-0.75mg/kg

Tachy

151
Q

In what phase do the coronary arteries fill?

A

Diastole, relaxation phase

152
Q
A

Sinus with PAC

early atrial activity
early p wave looks different

153
Q

What is our amiodarone dose?

A

IV push 300mg then 150mg; drip 150mg over 10 minutes

154
Q

Three types of cardiomyopathies

A

1) dilated (most common)

2) hypertrophic

3) restricted (least common)

155
Q

How do calcium channel blockers work?

A

prevent calcium from entering the cells of the heart and arteries…calcium causes heart to contract harder, so if channel is blocked, allows vessels to relax/open and lowers BP

ie Cardizem, verapril, amlodipine, nifedipine

156
Q

Name causes of bradycardia due to increased vagal tone. What medication and dose should you use to treat this in peds?

A

Multiple potential causes: breath-holding spells, gastric tube placement, endotracheal tube placement, prolonged airway suctioning, protracted vomiting, protracted coughing, obstructive sleep apnea, increased intracranial pressure, etc. Patient should be given

0.02 mg/kg of Atropine.

157
Q

What are two interventions that start or squeeze the heart

A

start - epi

squeeze - defib

158
Q

63 y/o male with CP what is the ecg and treatment

Bp 140/90
Hr 65

A

Sinus w/ Inferior STEMI
with Reciprocal change laterally

needs v4r

give Aspirin, Nitro and Fentanyl (will lower bp)

159
Q

Amiodarone dose for peds (without a pulse)

A

5mg/kg, max dose 300mg, may repeat TWICE to a max of 15mg/kg

160
Q

What is the treatment sequence for BRADYCARDIA

A

Atropine 1mg every (q) 3-5mins max of 3mg

TCP (pacing) start at 80bpm

DO NOT DELAY PACING FOR IV

Dopamine Infusion or Epi

161
Q

How does morphine work?

A

it binds with opiate receptors in the CNS, altering perception and emotional response to pain

162
Q

Unstable angina

A
  • change in frequency, duration and severity
  • not predictable
  • can happen at rest or awakened from sleep
  • may or may not be relieved by nitro
163
Q

Where are most blood cells produced?

A

Most blood cells are produced in the bone marrow.

164
Q

What are the DEFIBRILLATION shocks

A

200j, 300j, 360j

165
Q

what makes a hypertensive emergency?

A

end organ damage

166
Q

Right Sided Heart Failure

A

*** causes fluid backup into systematic circulation

  • usually due to left sided heart failure

-other causes may include PE and COPD

  • on assessment, you will see engorged veins and peripheral edema

Tx: no true field treatment for EMS

167
Q

Acute Coronary Syndromes

A

abrupt reduction of blood flow through one or more of the coronary arteries

if one of the vessels becomes blocked, then the muscle it supplies will become deprived of O2, causing ischemia. If not corrected, leads to infarct

168
Q

Dose for fentanyl

A

1mcg/kg max dose 200mcg…can repeat one time in 5-10min

169
Q
A

SVT

hr 160-250

cant see P waves so fast

vagal then cardiovert

170
Q

If STABLE narrow Tachy

how do you treat

(and if wide)

A

IV, 12lead
Vagal Maneuvers (blow into
Give Adenosine 6/12

(if wide give beta blocker or calcium channel blocker = Diltiazem)

171
Q
A

Junctional Tachycardia

inverted P wave
rate 101-180

172
Q

What is a Bruit and a Thrill?

A

Thrill - feel abnormal blood sound

Bruit - hear turbulent blood flow

173
Q

What does S3 heart sound indicate?

What is S3?

A

Indicates CHF (give nitro)

S3 is caused by ventricular wall vibrations.

174
Q

When is S4 heard?

What is it?

What does it indicate?

A

S4 is heard before S1

It is turbulent filling of stiff ventricle (LV) in hypertrophy

Indicating Left Ventricular hypertrophy

175
Q

SVT in Peds, treatment

A

HR > 220 in infants, > 180 in children

Non-variable R-R waves

P waves may be unidentifiable…if present, likely be inverted in II, III, AVF

QRS is usually < 0.10 seconds

vagal maneuvers in infants can be challenging

Place ice pack on their face (over eyes) for 15-30 seconds

press knees to chest for 15-30 seconds

176
Q

What disease can greatly effects clotting factors?

A

Liver disease

177
Q

What class is Adenosine?

A

Class V (5) Antidysrhythmic

178
Q

What is the most common type of shock in pediatrics? Why?

A

hypovolemic shock

secondary to dehydration from diarrhea and vomiting

179
Q

How does amiodarone work?

A

decreases the heart’s ability to respond to unwanted electrical impulses. ALSO works on potassium channels

180
Q

How does epi work?

A

increases SVR, systematic arterial pressure, HR, AV conduction, myocardial oxygen requirement

causes bronchodilation by relaxing the smooth muscles

181
Q

What is amiodarone used for? What is the cardiac arrest dose?

A

Pulseless V-tach/V-fib. Dose is 300mg then 150mg

182
Q
A

Idioventricular

  • Rate 20-40
  • QRS wide
183
Q

What do you need to monitor during a blood transfusion?

A

O negative because it does not have any A, B, or PH antigens

184
Q

How do calcium channel blockers work?

A

prevent calcium from entering the cells of the heart and arteries…calcium causes heart to contract harder, so if channel is blocked, allows vessels to relax/open and lowers BP

ie Cardizem, verapril, amlodipine, nifedipine

185
Q

Pediatric defib dosing

A

2j/kg

4j/kg

6j/kg

8j/kg

10j/kg

186
Q

Define Valvular stenosis

A

a type of valvular disease

a condition in which there is narrowing, stiffening, thickening, or blockage of one or more valves of the heart

187
Q

Sympathetic Stimulation causes

A

Increased:
Speeds UP HR
AV conduction
Increased Irritability

affects both atria and ventricles

188
Q

Stable angina

A
  • usually follows a pattern
  • predictable
  • usually caused by physical activity
  • nitroglycerin rx
  • NTG/rest relieves symptoms
189
Q

Aortic dissection

A
  • separation of arterial wall
  • can be precipitated by aneurysm, chronic NTN, age
  • can be treated surgically or conservatively

Potential assessment findings: unequal distal pulses, “tearing” feeling in leg or radiating to back, may find BP differences between arms

Treatment: RAPID TRANSPORT

190
Q

How does sodium bicarbonate work?

A

corrects acidosis and raises blood pH

191
Q

Interventions to SPEED up the heart

A

TCP

Atropine
Epi infusion
Dopamine infusion

192
Q

Your 42yof has blue cold fingers. What does she have?

A

Raynauds

193
Q

Minimum perfusing systolic BP in pediatrics equation

A

70 + (Age x 2)

194
Q

Steps for Pacing

A
  • Pads on
  • Limb leads on
  • Set pace to 80 for adults
  • Increase mA until electrical capture achieved
  • Then palpate femoral pulse and increase until mechanical capture
  • Then add 10% to final setting
  • Patient codes, turn pacing off
195
Q

When do we use epi?

A

cardiac arrest,
anaphylaxis,
croup

196
Q

What are the two types of Heart Disease risk factors

A

Modifiable - poor diet

Nonmodifiable - family hx

197
Q

When do we use magnesium sulfate?

A

severe bronchoconstriction,
seizures associated with pregnancy,
torsades,
refractory VF/VT

198
Q

Which side is the tricuspid valve on?

A

right side

199
Q

If SVT give

A

Amiodarone

150mg over 10mins

200
Q

Identify and define the different classes of antidysrhythmic medications and give example of each.

A

Class 1: Sodium channel blockers; examples: Lidocaine and procainamide

Class 2: Beta-blockers; examples: metoprolol, atenolol

Class 3: Potassium channel blockers: examples: amiodarone, bretylium, sotalol

Class 4: Calcium-channel blockers; examples: diltiazem, verapamil

201
Q

what 2 valves are closed during the diastolic phase?

A

Pulmonic valve and Aortic valve

202
Q
A

A flutter

instead of P waves there are F waves,

sawtooth or sharkfin f waves

203
Q

What class intervention is TCP according to ACLS

A

Class I

204
Q

Which layer of a blood vessel gives it its strength and contractility?

A

The tunica media is the layer that has smooth muscle.

205
Q

Is ventricular septal defect a cyanotic or acyanotic heart defect?

A

acyanotic

206
Q

What class intervention is Atropine according to ACLS

A

Class IIa

207
Q

Name 3 Antiplatelets/anticoagulants

A

aspirin
plavix- clopidogrel
Heparin

208
Q

Endocardium

A

innermost layer, it lines the hearts chambers

209
Q
A

A fib, with bigeminy of PVC’s

afib - f waves, irregular R-R
350-600 bpm Atrial rate

multiple sources trying to fire in the atrium other than SA Node

lots of squiggles

PVC - premature ventricular contractions, wide bizarre, early

210
Q

Preload is

A

blood return to the heart

211
Q

What class of drug is morphine/fentanyl

A

Opioid Agonist

212
Q

Atropine dose

A

0.5mg-1mg for brady

a shit ton for organophosphate poisoning

213
Q

What is Epinephrine 1:10000 used for? What is the dose?

A

Cardiac Arrest. Dose is 0.1mg/mL

214
Q

Is aortic stenosis a cyanotic or acyanotic heart defect?

A

acyanotic

215
Q

arteriosclerosis

A

Arteriosclerosis is a type of vascular disease where the blood vessels carrying oxygen away from the heart (arteries) become damaged from factors such as high cholesterol, high blood pressure, diabetes and certain genetic influences.

216
Q
A

Junctional with P waves after QRS

rate 40-60 bpm

217
Q

What type of blood vessel contains valves? What is the purpose of these valves?

A

Veins contain valves. The valves prevent backflow of blood (they keeps blood moving forwards

218
Q

what 2 valves are closed during the systolic phase?

A

Mitral valve and Tricuspid valve

219
Q

-

A

A Fib

fast atrial activity, lots of f waves R_R irregular,

220
Q

Clues that you have right sided involvement in an inferior MI (there are 3):

A
  1. ST segment elevation in lead III are greater than lead II
  2. isolated ST elevation in V1
  3. relative ST segment depression in V2 compared to V1
221
Q

When do we use diltiazem?

A

symptomatic afib and aflutter

222
Q

What class is diltiazem?

A

Class IV (4) Antidysrhythmic

223
Q
A

V- Tach (with possible CPR artifact)

224
Q

What 2 valves are open during the systolic phase?

A

Pulmonic valve and Aortic valve

225
Q

Aspirin

A

classified as an NSAID

blocks production of ptrostaglandins (the on/off switch ofinflammation and pain)

mild blood thinner by targeting the smallest blood cells and preventing them from clotting

226
Q

What is Phenylephrine?

A

Its Afrin - has A1 properties, for nose bleeds and for sinuses, potent vasoconstrictor.

227
Q

What is a normal ejection fraction?

A

60-65%

228
Q

Which side is the Mitral valve on?

A

Left side

229
Q

Difference between an aneurysm vs dissection

A

aneurysm is the weakening of ALL three layers of blood vessel

dissection is tear through the intima (inner layer)

230
Q

When do we use dopamine?

A

cardiogenic shock, distributive shock, hypotension with low cardiac output.

National registry: second-line drug for symptomatic bradycardia

231
Q
A

Atrial Flutter

F waves, saws,

QRS narrow
atrial rate 250-350

232
Q

Sinus Tachycardia in Peds, treatment

A

HR < 200 in infants, < 180 in children

Variable R-R waves

P waves present and upright

take a good history…has the kid been sick?? Think dehydration…fever present? Hypoxic? Anemic?

ST is not uncommon in children and is usually caused by contributing factors.

233
Q

Name the 3 common cardiomyopathies

A

dilated

hypertrophic

restrictive

234
Q

What do you do for a sinus with a first degree heart block?

A

supportive care, transport…treat the pt not the monitor

235
Q

Which side is fed by the vena cavas

A

Right (atrium)

236
Q

Define Preload

A

Amount of blood delivered to the heart by venous Return

237
Q
A

Accelerated Junctional

Can’t see the p waves so it’s junctional and the hr is 80

60-100 accelerated

40-60 junctional escape

100-180 junctional tachy

238
Q

According to the CDC, what is the number one reason that people with Sickle Cell Disease (SCD) go to the Emergency Room or hospital?

A

pain

239
Q

What is the inherent rate of

SA Node

AV

Ventricles

A

SA 60-100

AV 40-60

Ventricles 20-40

240
Q

Name three symptoms of isolated left heart failure

A

tachypnea

dyspnea

cyanosis

crackles/rales

cough

pink frothy sputum

241
Q

How does calcium chloride work?

A

a mineral that increases the amount of circulating calcium…increases cardiac contractility and ventricular automaticity

242
Q

What are the 3 Acute Coronary Syndromes

A

Stable Angina - transient, predictable, resolved

Unstable angina - longer than 20 mins, new, worsens

Acute Myocardial Infarction

243
Q

Define Supraventricular Rhythms

A

Rates over 150, narrow QRS

244
Q

What class is epinephrine?

A

Alpha and Beta agonist

245
Q

Diltiazem dose

A

0.25mg/kg (max 20mg)…if no response, 0.35mg/kg (max dose 25mg)

Patients OVER 50, 5-10mg over 2 min

246
Q

How do you manage/treat sickle cell disease?

A

O2

hydration

pain management

warm compresses where it hurts

underlying cause (infection)

most go to the ED due to pain and dehydration

247
Q

What medications cause QT prolongation?

A

Zofran, methadone, antipsychotics (droperidol, Haldol)

248
Q

You are treating a 1-year-old patient in ventricular fibrillation. The patient weighs 12 Kg. What is the energy level of your first defibrillation?

A

24 joules (round up, if 24 is not available/selectable)

249
Q

What do you do for a pt with “chest pain” and a 12 lead showing LBBB with ST elevation, but negative for scarbossa?

A

non-diagnostic 12 lead

treat pt’s symptoms, transport, ASA, consider nitro etc

250
Q

What do you do for torsades?

A

Magnesium - 102g IV over 2 minutes

amiodarone AFTER mag if persists

251
Q

Define Mitral valve regurgitation

A

a type of valvular disease

Pathophysiology

  • Regurgitant blood flow

can be 3-4 times the

amount of forward flow

  • The left ventricle tries to

compensate by

increasing stroke volume

and cardiac output

  • May result in left

ventricular and atrial

enlargement

  • Dysrhythmias: atrial

fibrillation

252
Q

What is the cardiac cycle?

A

The period from the end of one ventricular contraction to the end of the next ventricular contraction.

253
Q

What is this 12 lead showing and why?

A

Acute Myocardial Infarction

St elevation in = II III avf with recip in I, avl

need v4r

axis normal

254
Q

What is our dose for morphine?

A

0.1mg/kg (max dose 20mg)

255
Q

point of maximum impulse of the heart

A

the apex

256
Q

What divides the heart in half?

A

The septum

257
Q

Why do we give Nitro

A

It reduces workload of the heart and vasodilates

258
Q

What are the differentiating signs and symptoms of aortic dissection

A

Tearing pain and blood pressure different in both arms

259
Q

What is ACS what is it made of (3)

A

Acute coronary syndrome

Unstable angina stable angina and Ami stemi and nstemi

260
Q

Where do the coronary arteries originate

A

The base of the aorta

261
Q

What does the left ventricle push against

A

Afterload

262
Q

If I have right-sided heart failure where will I see signs and symptoms

A

Jvd and pedal edema

263
Q

If I have left ventricular failure where will I see the symptoms

A

Cyanosis and lungs crackle sounds

264
Q

If I sleep propped up on pillows what should you be worried about

A

Heart failure

265
Q

What is pnd paroxysmal nocturnal Dyspnea

A

Severe shortness of breath occurring at night after several hours of recumbency

Caused by left heart failure or chronic obstructive pulmonary disease

266
Q

What color sputum would you expect with pulmonary edema

A

Pink frothy sputum

267
Q

When would you use defibrillation

A

V-fib or pulses VTach

268
Q

When do you synchronize cardioversion

A

Unstable patients with a flutter ATACh afib or any patient with SVT or other ventricular tachycardia

269
Q

When do you do transcutaneous pacing

A

Bradycardia

270
Q

Does the monitor look at the electrical system or blood pumping through the heart

A

The electrical system

271
Q

What is pulses paradoxus

A

A drop in blood pressure greater than 10 mmhg with inspiration

272
Q

What is pulses alternans

A

Regular rhythm but force of pulse fairies with alternating beats of large and small amplitude

273
Q

What is a normal pulse pressure

A

30 to 40
highs above 40 Narrows below 30

274
Q

What is S1

A

The first heart sound heard when the atrioventricular valves close mitral and tricuspid

275
Q

What is S2

A

This corresponds with pulmonary and aortic valves closing

276
Q

What is S3

A

It’s caused by ventricular wall vibrations

277
Q

What is S4

A

Heard just before S1 turbulent filling of Still ventricular hypertrophy

278
Q

What flows into the cell to initiate depolarization

A

Sodium

279
Q

What flows out of the cell to initiate repolarization

A

Potassium

280
Q

When is the absolute refractory period

A

The upstroke of the T wave

281
Q

What has a critical role in depolarization of pacemaker cells

A

Calcium

282
Q

What are Baro receptors and where are they located

A

They are pressure sensitive nerve receptors located in the aortic Arch and the carotid sinus

283
Q

What are chemo receptors and where are they located

A

The internal carotid arteries aortic Arch and medulla detect changes in the concentration of hydrogen ions pH oxygen and carbon dioxide in the blood

284
Q

Why do we listen for Bruit in the neck

A

Turbulent flow of blood

285
Q

What are the indications for procainamide

A

Stable wide complex QRS and it’s an alternative to amiodarone

286
Q

What are the clues for hypovolemia and treatment

A

The history flat neck veins and volume replacement

287
Q

What is brugada syndrome

A

It’s a rare genetic disorder involving sodium channels in the heart the condition is characterized by incomplete right bundle branch block and ST segment elevation the returns aggressively to Baseline

288
Q

What is atherosclerosis

A

It’s a condition in which fatty deposits plaque buildup in the inner walls of the arteries

289
Q

What is atheroma

A

A deposit of plaque on or within the arterial wall

290
Q

What is PrinzMetal angina

A

It’s a type of angina caused by coronary artery vasospasm

291
Q

Besides ED drugs what what other type of medication is contraindicated with Nitro

A

Pulmonary hypertension meds

292
Q

Define cor pulmonale

A

It’s a heart disease that develops because of chronic lung disease and affects primarily the right side of the heart

293
Q

What are signs and symptoms of left ventricular heart failure. Name 4.

A

Sweating labored breathing third heart sounds cough with frothy sputum crackles pulses alternans Restless anxiety fatigue difficulty breathing paradoxical nocturnal dyspnea

294
Q

What are signs and symptoms of right ventricular heart failure

A

Weight gain dependent edema fatigue nausea loss of appetite right or left upper quadrant pain liver enlargement spleen enlargement

295
Q

Define cardiac tamponade

A

It occurs when excessive fluid accumulates within the pericardium

296
Q

What are the three signs for Beck’s Triad

A

Jvd hypotension and muffled heart sounds

297
Q

Why do we give IV fluids for cardiac tamponade

A

To try to keep the pressure in the body greater than that of the heart

298
Q

What is the most common cause of cardiogenic shock

A

Myocardial infarction

299
Q

What is a hypertensive emergency

A

And organ damage parent or suspected

300
Q

What are the signs of cardiac tamponade

A

Cold pale model cyanotic skin tachycardia weak or absent peripheral pulses narrowing pulse pressure pulseless paradoxes JVD orthopenea

301
Q

For hypertensive crisis what is your diastolic pressure

A

Over 90

302
Q

When the map exceeds _________ mmhg, the pressure breaches the blood-brain barrier and fluid leaks out increasing ICP

A

150

303
Q

What drug do you give for hypertensive encephalopathy

A

Labetalol

304
Q

Where is The myocardium

A

It’s the thick middle layer of the heart

305
Q

What does somebody with myocarditis have

A

Flu-like symptoms sometimes have a second or third degree AV block left bundle branch block or right bundle branch block may be seen

306
Q

What is endocarditis

A

An infection of the lining of the heart

307
Q

What is pericarditis

A

And inflammation of the double walled Sac pericardium that envelops the heart

308
Q

What is the defibrillation dose for Peds

A

2J 4J 6j 8j10j

309
Q

How do ACE inhibitors work
(what word do they end with)

A

They prevent the conversion of angiotensin 1 to Angiotensin 2 which prevents vasoconstriction

they also end in the word Prill

310
Q

What is a hemophiliac

A

Suffers from a disease that’s caused uncontrollable bleeding

311
Q

How do you tell if transcutaneous pacing is working

A

Check both for mechanical and electrical capture

312
Q

What is leukemia

A

Cancer of white blood cells

313
Q

What is multiple myeloma

A

It’s a malignant tumor of bone marrow cells

314
Q

If someone is anemic what are they low on what Might they complain of

A

Iron
Constipation

315
Q

How does hemostasis work and what are the steps (4)

A

Inflammation vasoconstriction
Platelet aggregation
Fibrinogen
Neovascularization

Paramedic (24 decks)

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