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ACS and cardiopulmonary arrest Flashcards

1
Q

DDx of cardiopulmonary arrest during mechanical ventilation?

A

-misplaced ETT
-tPTX
-hypovolemia
-auto PEEP
-hypoxemia
-mucus plugging

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2
Q

DDx of cardiopulmonary arrest during CVC placement?

A

-tPTX
-tachyarrhythmia
-bradycardia/heart block

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3
Q

DDx of cardiopulmonary arrest during dialysis or plasmapheresis?

A

-hypovolemia
-transfusion rxn
-IgA deficiency/allergic rxn
-hyperkalemia

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4
Q

DDx of cardiopulmonary arrest after TBI?

A

-increased ICP (esp with bradycardia)
-DI induced hypovolemia (esp with tachycardia)

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5
Q

DDx of cardiopulmonary arrest with medication changes?

A

-anaphylaxis
-angioedema
-hypotension/vol depletion (ACE inhibitors)
-methemoglobinemia

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6
Q

DDx of cardiopulmonary arrest after MI?

A

-see tachyarrythmias VF and torsades
-tamponade
-cardiac rupture
-AV block

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7
Q

DDx of cardiopulmonary arrest after trauma?

A

-exsanguination
-TPTX
-tamponade
-abdominal compartment syndrome

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8
Q

DDx of cardiopulmonary arrest after burns?

A

-airway obstruction
-hypovolemia
-CO poisoning
-cyanide

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9
Q

What are appropriate interventions if cardiac arrest is thought to be due to auto-PEEP?

A

-reduce minute ventilation
-increase expiratory time
-bronchodilator
-suction airway

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10
Q

What is the treatment for methemoglobinemia?

A

Methylene blue

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11
Q

What is the treatment for cyclic antidepressant overdose?

A

-see seizures and tachycardia
-sodium bicarbonate

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12
Q

What is the treatment for organophosphate overdose?

A

-see severe bradycardia
-decontamination
-atropine
-pralidoxime

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13
Q

What is the treatment for CO poisoning?

A

100% O2

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14
Q

What is the treatment for cyanide overdose?

A

Hydroxocobalamin

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15
Q

What is the effect of hypoxemia on the cardiac system?

A

-initially it enhances the peripheral chemical drive to breath and increases heart rate
-profound hypoxemia depresses neural function leading to bradycardia refractory to autonomic influence

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16
Q

What is the rate that PaCO2 increases during respiratory arrest? What is the significance of this?

A

-during first apneic minute builds by 6-9mmHg
-after that increases by 3-6mmHg per minute
-this show rise in PaCO2 means life threatening hypoxemia occurs much more slowly compared to life threatening respiratory acidosis

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17
Q

What are causes of decreased LV preload sufficient enough to cause CV collapse?

A

-venodilation
-hemorrhage
-tamponade
-tension PTX

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18
Q

What are causes of increased RV afterload sufficient enough to cause CV collapse?

A

-air embolism
-PE
-RV doesn’t adjust to ejection impedance as well as LV does

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19
Q

What is the ACLS dose of epinephrine?

A

1mg q3-5min

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20
Q

What is the ACLS dose of amiodarone?

A

-first dose 300mg
-second 150mg

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21
Q

In ACLS what is the monophasic defibrillation dose?

A

360J

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22
Q

In ACLS what is the biphasic defibrillation dose?

23
Q

What is the goal PetCO2 indicating high quality CPR? The goal DBP?

A
  • > 10mmHg
  • > 20mmHg
24
Q

What PetCO2 typically indicates ROSC?

25
What fraction of the normal cardiac output is delivered during closed chest compressions?
⅓
26
After how long of CPR do you predictably see tissue acidosis?
10 - 15 minutes
27
What is the ideal CPR compression rate?
100 - 120 bpm
28
By what account should the anterior chest be compressed during CPR?
2 inches
29
Failure to fully release compressions during CPR is equivalent to what?
Pericardial tamponade or excessive PEEP
30
What pressures regulate brain blood flow?
Difference between mean aortic pressure and right atrial pressure
31
What pressures regulate coronary blood flow?
Difference between diastolic aortic pressure and right atrial pressure
32
By how much should the dose of a medication be increased compared to IV if given intratracheal?
2 - 2.5x
33
Which medications can be given intratracheal?
"NAVEL" -naloxone -atropine -vasopressin -epinephrine -lidocaine
34
For which medications is the intratracheal route contraindicated?
-norepinephrine (lung necrosis) -CaCl2 (lung necrosis) -NaHCO3 (inactivates surfactant)
35
What are the reversible, precipitating factors for torsades?
-hypomagnesemia -TCAs -haloperidol -type 1a antiarrhythmics -quinolone antibiotics
36
What are the "H's" of reversible causes of VT/VF?
-hypovolemia -hypoxia -acidosis (H+) -hypokalemia -hyperkalemia -hypothermia
37
What are the "T's" of reversible causes of VT/VF?
-tPTX -tamponade -toxins -thrombosis (pulmonary) -thrombosis (coronary)
38
What voltage setting should be used in open chest defibrillation?
10 - 20J
39
If cardioversion continues to produce bradyarrythmias that degenerate into VF what treatment should be attempted and what causes should be considered?
-increasing HR with atropine epinephrine or pacing -overdose of digitalis CA channel blockers or beta-blockers
40
How much MgSO4 should be given to a patient with refractory VT/VF?
1 - 2gm over several minutes
41
If cardioversion continues to produce tachyarrythmias that degenerate into VF what treatment should be attempted and what causes should be considered?
-amiodarone 300mg, procainamide 20 - 50mg/min, lidocaine 1 - 1.5mg/kg -excessive catecholamine stimulation
42
Which EKG leads are best for detecting VF?
2 and 3
43
For which conditions is NaHCO3 administration useful?
-severe acidosis -hyperkalemia -TCA overdose
44
What is the origin of narrow QRS complex PEA?
Noncardiac
45
What are some initial therapies that can be effective in regular, stable, wide-complex ventricular tachycardia?
adenosine and vagal maneuvers
46
What is the initial treatment for irregular, stable, wide-complex ventricular tachycardia?
amiodarone 150mg IV -if the pt is unstable they should not receive amiodarone but be cardioverted instead
47
On the oxygen dissociation curve, what can cause a left shift?
left shift indicates increased Hgb affinity for oxygen and an increased reluctance to release oxygen -CO poisoning -hypothermia -alkalosis -decrease pCO2 -decreased 2,3-disphosphoglycerate -Hgb-f
48
On the oxygen dissociation curve, what can cause a right shift?
right shift indicates that Hgb has a decreased affinity for oxygen (so off loaded more easily) -hyperthermia -acidosis -increased pCO2 -increased 2,3-disphosphoglycerate -Hgb-SS
49
What is the pathophysiology behind neurogenic shock?
sudden loss of sympathetic tone w/ preserved parasympathetic activity and autonomic instability -systemic hypotension d/t decreased sympathetic fiber-mediated arterial and venous vascular resistance w/ venous pooling and loss of preload
50
What level of spinal cord injury is most typically associated with neurogenic shock?
an injury to the cord above T6
51
What are the contraindications to LVAD placement?
-ESRD (GFR < 30) -severe bleeding -chronic thrombocytopenia -refusal of blood transfusion -severe liver disease (bili > 2.5, INR > 2 w/ cirrhosis or portal HTN) -ongoing smoking, EtOH, IVDU -inability to adhere to medical regimen or poor social support
52
What beta-blockers are useful in the setting of SVT w/ reactive airway disease?
cardioselective beta-blockers -esmolol -metoprolol -atenolol
53
What medication is preferred in SVT due to Wolfe-Parkinson White?
amiodarone
54
If a patient develops new onset type II second degree block the lesion is likely where?
-occlusion of a septal branch off LAD -can progress to 3rd degree block -has a poorer prognosis than type I second degree block

Cardiovascular (6 decks)

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