119 Mod 3 (Cardiology and Peds) Flashcards
1
Q
Name 2 analgesics
A
nitroglycerine
narcotics - opioid/fentnyl
2
Q
Dopamine dose
A
2-20mcg/kg/min
3
Q
When do we use fentanyl?
A
pain management
4
Q
What type of drug is ASA?
A
Anti-platelet
5
Q
What class is Nitroglycerin?
A
Nitrate
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
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)
8
Q
Asymptomatic 62yom with a bp of 190/110…name conditions
A
hypertension
9
Q
How do we treat hypovolemic shock in pediatrics?
A
Up to 3 20mL/kg boluses to maintain BP…after each bolus, reassess
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
11
Q
Beck’s Triad
A
hypotension, JVD, muffled heart sounds
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)
13
Q
What is diltiazem used for? What is the dose?
A
A-fib (RVR). Dose is 0.25mg/kg max dose of 20mg
14
Q
What chemical does the body produce to slow things down in the parasympathetic NS
A
Acetylcholine
15
Q
Rheumatic fever usually effects the _______. This can cause _____, ____, and damage to the heart itself.
A
mitral valve, stenosis, regurgitation
16
Q
A
Sinus Brady with 1 PVC
17
Q
What class intervention is Dopamine and Epinephrine Infusions
A
Class IIb
18
Q
A
Atrial Fibrillation (controlled) with 2 unifocal PVC’s
19
Q
For Brady what is the quick treatment atde
A
All
Trained
Dogs
Eat
Atropine
TCP
Dopamine
Epinephrine
20
Q
The sympathetic NS is mediated where?
A
by nerves in the thoracic/lumbar
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
22
Q
What is nitroglycerin used for? What is the dose?
A
Chest pain/Angina. Dose is 0.4mg up to 3 times.
23
Q
What is adenosine used for? What is the dose?
A
SVT. Dose is 6mg then 12mg Rapid IV
24
Q
Aortic aneurysm
A
- dilation or out-pouching of vessel
- at risk for rupture or dissection
- can be treated surgically or conservatively
25
Parasympathetic Stimulation causes
Decreased:
Slows DOWN HR
AV conduction
Decreased Irritability
only affects the atria
26
What are classic and atypical signs of M.I.
classic - crushing CP radiates to L shoulder or jaw (can be both shoulders)
Atypical - nausea, epigastric pain, dizziness (women)
27
Define Dilated cardiomyopathy, what will the ECG look like
- 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
28
When a patient is presenting with acute CHF, they will benefit from what?
nitro and CPAP
29
Define Stroke Volume
amount of blood pumped in a single contraction
30
What do you do for a pt with PVCs and ankle sprain?
treat pt not monitor, we don't do anything for PVCs
31
medications to treat sickle cell disease
Oxybryta, L-glutamine, TCAs
32
Dose for epi
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
33
V-Tach
wide, bizarre QRS
34
How does atropine work?
- blocks the effects of acetylcholine at the neuromuscular junction
"by blocking acetylcholine the heart speeds up"
35
Accelerated Junctional
inverted P wave
rate 61-100
36
Afterload is
resistance that the heart pumps against
37
Where are the 4 areas you listen to heart sounds
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
38
Ejection Fraction is the ______ of blood pumped in _____. The average is _____-______. Below ____ is heart failure.
percentage, one beat
55-70%
40%
39
What are the 3 Inherent rates of the conduction system
SA Node 60-100 bpm
AV Junction 40-60 bpm
Ventricles 20-40 bpm
40
Atherosclerosis
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
41
Which side is the aortic valve on?
Left side
42
When do we give adenosine?
SVT
43
How does fentanyl work?
binds to opioid receptors producing analgesia, euphoria, respiratory depression and sedation...50-100% more potent than morphine
44
What is another term for hypoperfusion?
Shock
45
How does diltiazem work?
calcium channel blocker, decreases conduction and ventricular rate
46
Which system is Fight or Flight and Rest and Digest?
FF - Sympathetic NS
RD - Parasympathetic NS
47
What is Fibrinolytics
meds that break up blood clots
TPA (used when no cath lab typically)
48
What does the parts of conduction does the Parasympathetic influence
Only the atria
(i.e., the SA node, the intraatrial, and internodal pathways, and the AV junction)
49
Hemophilic patients are at most risk of ____.
internal bleeding...mostly in joints, knees, ankles, and elbows
can have spontaneous brain bleeds
50
What is the dose of adenosine?
6mg, 12mg, 12mg
MUST be rapid WITH A FLUSH
51
22yo with a hx of IV drug abuse presents with fever and a new 2/6 systolic ejection murmur
acute endocarditis
52
What 2 valves are open during the diastolic phase?
Mitral valve and Tricuspid valve
53
Is truncus arteriosus a cyanotic or acyanotic heart defect?
cyanotic
54
What is the main heart artery that FEEDS the body
Aorta
55
Dopamine...how does it work?
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
56
What are interventions to SLOW the heart
Synchronized Cardioversion
Defib
Adenosine
Diltiazem
Beta-Blockers (lol)
Lidocaine
Mag Sulfate
57
Dose for calcium chloride
0.5-1g SLOW over 10 min
58
The parasympathetic NS is mediated where?
Vagus nerve (CN X) cholinergic ns
59
The heart is under control of what system?
the autonomic nervous system
60
Alpha 1 adrenergic receptors are found mainly in ____ and to a lesser degree, the ____. They cause _____.
the blood vessels, lungs, vasoconstriction
61
What is an unstable hypertension
hypotension
hyper
180/120
hypo
90/60
62
When do we use morphine?
moderate to severe pain
pulmonary edema
CHF
63
What are the great vessels?
Aorta
Inferior Vena Cava
Superior Vena Cava
64
How do you treat PEA
CPR - compressions
IV/IO access
1mg Epinephrine (0.1mg/mL) IVP every 3/5 mins
ETT and Capno
65
Is patent ductus arteriosus a cyanotic or acyanotic heart defect?
acyanotic
66
Dose for sodium bicarbonate
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
67
a patient with "tearing" sensation in his lower back. He presents cool, clammy, pain in his back and flank.
Possible ruptured aortic aneurysm
68
Is pulmonary valve atresia a cyanotic or acyanotic heart defect?
cyanotic
69
What do you do for a 3rd degree heart block?
supportive care, pacing if unstable
70
Define
Excitability
Automaticity
Contractility
Extensibility
Conductivity
Excite = response to electric
Contractility = squeeze
Auto = create impulse
extense = stretch,expand
conduct = pass electric
71
What are the names and locations of the semilunar valves of the heart?
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.
72
Dose for nitro
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
73
Myocardium
Thick middle layer, contains structures enabling the heart to contract
74
Sinus Brady with a wide QRS
75
what is the drug dose of cardizem
when do you give
.35mg/kg IV
tachy
76
What is atropine used for? What is the dose?
Bradycardia. Dose is 0.4mg/kg
77
Alpha 2 adrenergic receptors are found in the ____ and _____. They inhibit the release of _____ and _____.
brain, periphery, norepinephrine, acetylcholine
78
Is atrioventricular septal defect a cyanotic or acyanotic heart defect?
acyanotic
79
How does adenosine work?
it slows/prevents conduction through the AV node
80
How do potassium channel blockers work?
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
81
According to the CDC, name a medication that is used to treat sickle cell disease.
L-glutamine
82
What are the 2 shockable rhythms to DEFRIBRILLATE
V- Fib (squiggly worms)
Pulseless V-Tach (no pulse) (tombstones)
83
Tricuspid valve disorders are caused by _____, _____, and _____.
cardiomyopathy, heart failure, pulmonary HTN
84
Primary antiplatelet agent is
aspirin 324mg or 325mg
85
When do we use sodium bicarbonate?
acidosis,
hyperkalemia,
sodium channel blocker toxicity (TCA and phenobarbital)
86
how does magnesium sulfate work?
CNS depressant, decreases acetylcholine release, slows rate of SA nodal conduction, encourages NA/K movement
87
A-fib with 2 unifocal PVCs
88
how much time is between the two heavy lines on a graph
0.20 seconds
89
When do we use amiodarone?
vfib and vtach
90
What is morphine/fentanyl used for? What is the dose?
Pain Management. Dose is 1mcg/kg
91
Stimulation of the Beta receptors (sympathetic) will do what to the heart
Speeds up the
Chronotropic
Inotropic
Dromotropic
92
What does peripheral circulation do?
Transports oxygenated blood from the heart to the tissues and deoxygenated blood back to the heart
93
What is the dose for Dopamine
What is the dose for Epinephrine
Dopamine
5-20mcg/kg/min
Epinephrine
2-10mcg/min
Dopamine can be added to Epi or used alone
94
What is Systole
Ventricular Contraction
95
SVT (no P waves seen)
96
When do we use nitro?
pts with chest pain and CHR to reduce preload
97
What is the hr of brady
less than 50 (for treatment)
98
What class of drug is Albuterol
Beta 2 adrenergic agonist
99
SVT with a wide QRS
100
Define Hypertrophic cardiomyopathy, what will the ECG look like?
thickened myocardial wall
thickened left ventricular wall, diastolic dysfunction, risk of sudden death in young athletes
ECG signs: LVH
101
What type of angina is at rest that lasts longer than 20 minutes and new onset.
Unstable angina
102
Define cardiac output
amount of blood pumped each min
103
Second Degree Type II
104
What are the 4 ANTI DYSRHYTHMIA drug classes and 1 example for each
class I - na (sodium) channel - lidocaine
class II beta blockers - metoprolol (LOL)
class III - amiodarone
class IV - calcium ch blockers - diltiazem
105
When do we use calcium chloride?
hypocalcemia, hyperkalemia, calcium channel blocker toxicity, hypotension secondary to Cardizem and to help with "the bad shit from mag sulfate admin"
106
Define Ejection fraction
percentage of blood leaving the heart each contraction 60-65%
107
cardiogenic shock
- 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...
108
Amiodarone dose for peds (with a pulse)
5mg/kg over 20 min (mixed into 100mL)
109
When should you avoid Atropine
When there is a high degree block
(2nd type II, 3rd Degree)
go right to pacing
110
Post arrest should ETT when
EARLY PLACEMENT
111
Sinus with Atrial Pacing
112
Which nervous system slows the heart
Which nervous system speeds the heart up
Slows DOWN the heart - Parasympathetic
Speeds - Sympathetic
113
I have NO discernible P waves or QRS waves and look erratic. Cardiac output plummeted when I switched to this rhythm.
V-Fib
114
What is diastole?
Relaxation of the heart
115
Is Tetralogy of Fallot a cyanotic or acyanotic heart defect?
cyanotic
116
Stroke volume is the amount of ______ pumped out of the ____. Average stroke volume is _____.
blood, heart
average is between 60-100mL (avg 70mL)
117
-
Ventricular Tachycardia
100-250 bpm
wide tall bizarre QRS
118
What can you give a TACHY patient if you have IV access and the rhythm is regular and narrow
you may give
Adenosine (class I)
6mg, 12mg
119
Atropine indications
bradycardia, organophosphate poisoning
120
Mechanically whats happening
P wave
QRS
Twave
P Wave - Atrial contraction
QRS Ventricular Contraction
T Wave Ventricular relaxation
121
how many different clotting factors are there?
12
122
What are the 2 layers of the pericardium?
Visceral (epicardium)- inner most layer
Parietal- fibrous outer layer
123
prolonged QT intervals (LQTS) what can it cause, and what causes it
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
124
Steps for Sync Cardio Vert
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
125
What bad side effect can amiodarone have?
lengthening the QT interval
126
How do sodium channel blockers work?
stops sodium from coming through cell membranes
blocks the rate AND amplitude of the initial depolarization, reduces cellular excitability and reduces speed of conduction.
127
Causes of myocarditis (7)
viruses
parasites
bacterial infections
heart transplant rejection
exposure to chemical poisons
chronic alcoholism
radiation therapy
128
What is systole?
Contraction of the heart
129
Define Restricted cardiomyopathy
myocardium is stiff or scarred
RV failure, chest pain, SOB, exercise intolerance
causes: sarcoidosis and connective tissue disorder
130
Pt presents with chest pain and diffuse elevation throughout 12-lead ECG. AVR shows depression. What do they likely have?
pericarditis
Signs:
- Diffuse concave-upward ST-segment elevation
- ST-segment depression in aVR
- PR-segment depression
131
Pericardium
Protective sac surrounding the heart.
132
Your patient has a tearing chest pain with a bp of 220/150 and a hr 110. What is this?
aortic dissection
133
How does nitro work?
smooth muscle relaxant...vasodilates veins more than arteries. HAs an affinity to cardiac vasculature
134
What are the 2 layers of the Pericardium
what is the fluid space between called?
Visceral (epi cardium) - inner layer ,adhered to the heart
potential space fluid - afusion
Parietal - outer layer
135
Name and define the three conditions that are part of the spectrum of diseases known as the Acute Coronary Syndromes.
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
Fresh frozen plasma is used for what?
patients who need clotting factor replacement
contains fibrinogen
137
What is Poiseuille's Law?
As blood vessels get bigger, blood flow significantly increases
138
What is ASA used for? What is the dose?
Chest pain. Dose is 324mg
139
What is the drug dose of Amiodarone
when do you give
300mg
2nd dose
150mg
Code
140
What causes S3?
Heart Failure
141
Dose for magnesium sulfate
eclampsia: 4 g over 10 min
VF/VT and Torsades: 1-2 grams over 2 min
Bronchoconstriction: 1-2 grams over 10-20min
142
Define Mitral Valve Prolapse, what is the sound?
Type of Mitral Valve Regurgitation
* Murmur may occur later
* “ejection click”
143
EKG findings in cardiac tamponade
electrical alternans
low voltage
tachycardia
144
name and dose of two meds that are used for symptomatic relief
nitro and fentanyl
145
the majority of the clotting factors come from what organ?
the liver
146
Cardiac output mathematical equation
CO = SV x HR
147
Is atrial septal defect a cyanotic or acyanotic heart defect?
acyanotic
148
55 y/o M CP and Diaphoresis began suddenly during exercise. Bp 140/90 What do you do?
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
Homan's sign...what is it and what condition does it indicate?
ask the pt to flex their feet ... do they have any pain in calf? If so, positive sign for DVT
150
What is the drug dose of Lidocaine
and when do you give?
0.5-0.75mg/kg
Tachy
151
In what phase do the coronary arteries fill?
Diastole, relaxation phase
152
Sinus with PAC
early atrial activity
early p wave looks different
153
What is our amiodarone dose?
IV push 300mg then 150mg; drip 150mg over 10 minutes
154
Three types of cardiomyopathies
1) dilated (most common)
2) hypertrophic
3) restricted (least common)
155
How do calcium channel blockers work?
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
Name causes of bradycardia due to increased vagal tone. What medication and dose should you use to treat this in peds?
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
What are two interventions that start or squeeze the heart
start - epi
squeeze - defib
158
63 y/o male with CP what is the ecg and treatment
Bp 140/90
Hr 65
Sinus w/ Inferior STEMI
with Reciprocal change laterally
needs v4r
give Aspirin, Nitro and Fentanyl (will lower bp)
159
Amiodarone dose for peds (without a pulse)
5mg/kg, max dose 300mg, may repeat TWICE to a max of 15mg/kg
160
What is the treatment sequence for BRADYCARDIA
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
How does morphine work?
it binds with opiate receptors in the CNS, altering perception and emotional response to pain
162
Unstable angina
- 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
Where are most blood cells produced?
Most blood cells are produced in the bone marrow.
164
What are the DEFIBRILLATION shocks
200j, 300j, 360j
165
what makes a hypertensive emergency?
end organ damage
166
Right Sided Heart Failure
*** 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
Acute Coronary Syndromes
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
Dose for fentanyl
1mcg/kg max dose 200mcg...can repeat one time in 5-10min
169
SVT
hr 160-250
cant see P waves so fast
vagal then cardiovert
170
If STABLE narrow Tachy
how do you treat
(and if wide)
IV, 12lead
Vagal Maneuvers (blow into
Give Adenosine 6/12
(if wide give beta blocker or calcium channel blocker = Diltiazem)
171
Junctional Tachycardia
inverted P wave
rate 101-180
172
What is a Bruit and a Thrill?
Thrill - feel abnormal blood sound
Bruit - hear turbulent blood flow
173
What does S3 heart sound indicate?
What is S3?
Indicates CHF (give nitro)
S3 is caused by ventricular wall vibrations.
174
When is S4 heard?
What is it?
What does it indicate?
S4 is heard before S1
It is turbulent filling of stiff ventricle (LV) in hypertrophy
Indicating Left Ventricular hypertrophy
175
SVT in Peds, treatment
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
What disease can greatly effects clotting factors?
Liver disease
177
What class is Adenosine?
Class V (5) Antidysrhythmic
178
What is the most common type of shock in pediatrics? Why?
hypovolemic shock
secondary to dehydration from diarrhea and vomiting
179
How does amiodarone work?
decreases the heart's ability to respond to unwanted electrical impulses. ALSO works on potassium channels
180
How does epi work?
increases SVR, systematic arterial pressure, HR, AV conduction, myocardial oxygen requirement
causes bronchodilation by relaxing the smooth muscles
181
What is amiodarone used for? What is the cardiac arrest dose?
Pulseless V-tach/V-fib. Dose is 300mg then 150mg
182
Idioventricular
- Rate 20-40
- QRS wide
183
What do you need to monitor during a blood transfusion?
O negative because it does not have any A, B, or PH antigens
184
How do calcium channel blockers work?
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
Pediatric defib dosing
2j/kg
4j/kg
6j/kg
8j/kg
10j/kg
186
Define Valvular stenosis
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
Sympathetic Stimulation causes
Increased:
Speeds UP HR
AV conduction
Increased Irritability
affects both atria and ventricles
188
Stable angina
- usually follows a pattern
- predictable
- usually caused by physical activity
- nitroglycerin rx
- NTG/rest relieves symptoms
189
Aortic dissection
- 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
How does sodium bicarbonate work?
corrects acidosis and raises blood pH
191
Interventions to SPEED up the heart
TCP
Atropine
Epi infusion
Dopamine infusion
192
Your 42yof has blue cold fingers. What does she have?
Raynauds
193
Minimum perfusing systolic BP in pediatrics equation
70 + (Age x 2)
194
Steps for Pacing
- 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
When do we use epi?
cardiac arrest,
anaphylaxis,
croup
196
What are the two types of Heart Disease risk factors
Modifiable - poor diet
Nonmodifiable - family hx
197
When do we use magnesium sulfate?
severe bronchoconstriction,
seizures associated with pregnancy,
torsades,
refractory VF/VT
198
Which side is the tricuspid valve on?
right side
199
If SVT give
Amiodarone
150mg over 10mins
200
Identify and define the different classes of antidysrhythmic medications and give example of each.
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
what 2 valves are closed during the diastolic phase?
Pulmonic valve and Aortic valve
202
A flutter
instead of P waves there are F waves,
sawtooth or sharkfin f waves
203
What class intervention is TCP according to ACLS
Class I
204
Which layer of a blood vessel gives it its strength and contractility?
The tunica media is the layer that has smooth muscle.
205
Is ventricular septal defect a cyanotic or acyanotic heart defect?
acyanotic
206
What class intervention is Atropine according to ACLS
Class IIa
207
Name 3 Antiplatelets/anticoagulants
aspirin
plavix- clopidogrel
Heparin
208
Endocardium
innermost layer, it lines the hearts chambers
209
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
Preload is
blood return to the heart
211
What class of drug is morphine/fentanyl
Opioid Agonist
212
Atropine dose
0.5mg-1mg for brady
a shit ton for organophosphate poisoning
213
What is Epinephrine 1:10000 used for? What is the dose?
Cardiac Arrest. Dose is 0.1mg/mL
214
Is aortic stenosis a cyanotic or acyanotic heart defect?
acyanotic
215
arteriosclerosis
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
Junctional with P waves after QRS
rate 40-60 bpm
217
What type of blood vessel contains valves? What is the purpose of these valves?
Veins contain valves. The valves prevent backflow of blood (they keeps blood moving forwards
218
what 2 valves are closed during the systolic phase?
Mitral valve and Tricuspid valve
219
-
A Fib
fast atrial activity, lots of f waves R_R irregular,
220
Clues that you have right sided involvement in an inferior MI (there are 3):
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
When do we use diltiazem?
symptomatic afib and aflutter
222
What class is diltiazem?
Class IV (4) Antidysrhythmic
223
V- Tach (with possible CPR artifact)
224
What 2 valves are open during the systolic phase?
Pulmonic valve and Aortic valve
225
Aspirin
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
What is Phenylephrine?
Its Afrin - has A1 properties, for nose bleeds and for sinuses, potent vasoconstrictor.
227
What is a normal ejection fraction?
60-65%
228
Which side is the Mitral valve on?
Left side
229
Difference between an aneurysm vs dissection
aneurysm is the weakening of ALL three layers of blood vessel
dissection is tear through the intima (inner layer)
230
When do we use dopamine?
cardiogenic shock, distributive shock, hypotension with low cardiac output.
National registry: second-line drug for symptomatic bradycardia
231
Atrial Flutter
F waves, saws,
QRS narrow
atrial rate 250-350
232
Sinus Tachycardia in Peds, treatment
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
Name the 3 common cardiomyopathies
dilated
hypertrophic
restrictive
234
What do you do for a sinus with a first degree heart block?
supportive care, transport...treat the pt not the monitor
235
Which side is fed by the vena cavas
Right (atrium)
236
Define Preload
Amount of blood delivered to the heart by venous Return
237
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
According to the CDC, what is the number one reason that people with Sickle Cell Disease (SCD) go to the Emergency Room or hospital?
pain
239
What is the inherent rate of
SA Node
AV
Ventricles
SA 60-100
AV 40-60
Ventricles 20-40
240
Name three symptoms of isolated left heart failure
tachypnea
dyspnea
cyanosis
crackles/rales
cough
pink frothy sputum
241
How does calcium chloride work?
a mineral that increases the amount of circulating calcium...increases cardiac contractility and ventricular automaticity
242
What are the 3 Acute Coronary Syndromes
Stable Angina - transient, predictable, resolved
Unstable angina - longer than 20 mins, new, worsens
Acute Myocardial Infarction
243
Define Supraventricular Rhythms
Rates over 150, narrow QRS
244
What class is epinephrine?
Alpha and Beta agonist
245
Diltiazem dose
0.25mg/kg (max 20mg)...if no response, 0.35mg/kg (max dose 25mg)
Patients OVER 50, 5-10mg over 2 min
246
How do you manage/treat sickle cell disease?
O2
hydration
pain management
warm compresses where it hurts
underlying cause (infection)
most go to the ED due to pain and dehydration
247
What medications cause QT prolongation?
Zofran, methadone, antipsychotics (droperidol, Haldol)
248
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?
24 joules (round up, if 24 is not available/selectable)
249
What do you do for a pt with "chest pain" and a 12 lead showing LBBB with ST elevation, but negative for scarbossa?
non-diagnostic 12 lead
treat pt's symptoms, transport, ASA, consider nitro etc
250
What do you do for torsades?
Magnesium - 102g IV over 2 minutes
amiodarone AFTER mag if persists
251
Define Mitral valve regurgitation
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
What is the cardiac cycle?
The period from the end of one ventricular contraction to the end of the next ventricular contraction.
253
What is this 12 lead showing and why?
Acute Myocardial Infarction
St elevation in = II III avf with recip in I, avl
need v4r
axis normal
254
What is our dose for morphine?
0.1mg/kg (max dose 20mg)
255
point of maximum impulse of the heart
the apex
256
What divides the heart in half?
The septum
257
Why do we give Nitro
It reduces workload of the heart and vasodilates
258
What are the differentiating signs and symptoms of aortic dissection
Tearing pain and blood pressure different in both arms
259
What is ACS what is it made of (3)
Acute coronary syndrome
Unstable angina stable angina and Ami stemi and nstemi
260
Where do the coronary arteries originate
The base of the aorta
261
What does the left ventricle push against
Afterload
262
If I have right-sided heart failure where will I see signs and symptoms
Jvd and pedal edema
263
If I have left ventricular failure where will I see the symptoms
Cyanosis and lungs crackle sounds
264
If I sleep propped up on pillows what should you be worried about
Heart failure
265
What is pnd paroxysmal nocturnal Dyspnea
Severe shortness of breath occurring at night after several hours of recumbency
Caused by left heart failure or chronic obstructive pulmonary disease
266
What color sputum would you expect with pulmonary edema
Pink frothy sputum
267
When would you use defibrillation
V-fib or pulses VTach
268
When do you synchronize cardioversion
Unstable patients with a flutter ATACh afib or any patient with SVT or other ventricular tachycardia
269
When do you do transcutaneous pacing
Bradycardia
270
Does the monitor look at the electrical system or blood pumping through the heart
The electrical system
271
What is pulses paradoxus
A drop in blood pressure greater than 10 mmhg with inspiration
272
What is pulses alternans
Regular rhythm but force of pulse fairies with alternating beats of large and small amplitude
273
What is a normal pulse pressure
30 to 40
highs above 40 Narrows below 30
274
What is S1
The first heart sound heard when the atrioventricular valves close mitral and tricuspid
275
What is S2
This corresponds with pulmonary and aortic valves closing
276
What is S3
It's caused by ventricular wall vibrations
277
What is S4
Heard just before S1 turbulent filling of Still ventricular hypertrophy
278
What flows into the cell to initiate depolarization
Sodium
279
What flows out of the cell to initiate repolarization
Potassium
280
When is the absolute refractory period
The upstroke of the T wave
281
What has a critical role in depolarization of pacemaker cells
Calcium
282
What are Baro receptors and where are they located
They are pressure sensitive nerve receptors located in the aortic Arch and the carotid sinus
283
What are chemo receptors and where are they located
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
Why do we listen for Bruit in the neck
Turbulent flow of blood
285
What are the indications for procainamide
Stable wide complex QRS and it's an alternative to amiodarone
286
What are the clues for hypovolemia and treatment
The history flat neck veins and volume replacement
287
What is brugada syndrome
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
What is atherosclerosis
It's a condition in which fatty deposits plaque buildup in the inner walls of the arteries
289
What is atheroma
A deposit of plaque on or within the arterial wall
290
What is PrinzMetal angina
It's a type of angina caused by coronary artery vasospasm
291
Besides ED drugs what what other type of medication is contraindicated with Nitro
Pulmonary hypertension meds
292
Define cor pulmonale
It's a heart disease that develops because of chronic lung disease and affects primarily the right side of the heart
293
What are signs and symptoms of left ventricular heart failure. Name 4.
Sweating labored breathing third heart sounds cough with frothy sputum crackles pulses alternans Restless anxiety fatigue difficulty breathing paradoxical nocturnal dyspnea
294
What are signs and symptoms of right ventricular heart failure
Weight gain dependent edema fatigue nausea loss of appetite right or left upper quadrant pain liver enlargement spleen enlargement
295
Define cardiac tamponade
It occurs when excessive fluid accumulates within the pericardium
296
What are the three signs for Beck's Triad
Jvd hypotension and muffled heart sounds
297
Why do we give IV fluids for cardiac tamponade
To try to keep the pressure in the body greater than that of the heart
298
What is the most common cause of cardiogenic shock
Myocardial infarction
299
What is a hypertensive emergency
And organ damage parent or suspected
300
What are the signs of cardiac tamponade
Cold pale model cyanotic skin tachycardia weak or absent peripheral pulses narrowing pulse pressure pulseless paradoxes JVD orthopenea
301
For hypertensive crisis what is your diastolic pressure
Over 90
302
When the map exceeds _________ mmhg, the pressure breaches the blood-brain barrier and fluid leaks out increasing ICP
150
303
What drug do you give for hypertensive encephalopathy
Labetalol
304
Where is The myocardium
It's the thick middle layer of the heart
305
What does somebody with myocarditis have
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
What is endocarditis
An infection of the lining of the heart
307
What is pericarditis
And inflammation of the double walled Sac pericardium that envelops the heart
308
What is the defibrillation dose for Peds
2J 4J 6j 8j10j
309
How do ACE inhibitors work
(what word do they end with)
They prevent the conversion of angiotensin 1 to Angiotensin 2 which prevents vasoconstriction
they also end in the word Prill
310
What is a hemophiliac
Suffers from a disease that's caused uncontrollable bleeding
311
How do you tell if transcutaneous pacing is working
Check both for mechanical and electrical capture
312
What is leukemia
Cancer of white blood cells
313
What is multiple myeloma
It's a malignant tumor of bone marrow cells
314
If someone is anemic what are they low on what Might they complain of
Iron
Constipation
315
How does hemostasis work and what are the steps (4)
Inflammation vasoconstriction
Platelet aggregation
Fibrinogen
Neovascularization
