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PPT year 4 > acute care PPT > Flashcards

acute care PPT Flashcards

1
Q

what to do if someone is unresponsive and not breathing normally x3

A

call resus team
start CPR 30:2
attatch defib

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2
Q

what to do after you have started CPR

A

assess rhythm

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3
Q

name 2 shockable rhythms

A

VF and pulseless VT

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4
Q

what to do if someone has a shockable rhythm

A

1 shock, resume CPR for 2 mins

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5
Q

no shockable rhythm x2

A

PEA and asystole

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6
Q

what to do if someone has non shockable rhythm

A

continue CPR for 2 mins

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7
Q

post CPR commencement some ones circulation has returned oxygen target

A

94-98%

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8
Q

how to monitor CO2 during CPR

A

waveform capnography

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9
Q

do you give oxygen during CPR

A

ye

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10
Q

3 other things to do during CPR

A

get IV access
give adrenaline
give amiodarone

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11
Q

during CPR when do you give adrenaline

A

3-5 mins/alternate shocks

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12
Q

during CPR when do you give amiodarone

A

after 3 shocks

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13
Q

during CPR how do you give adrenaline

A

IV

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14
Q

during CPR how do you give amiodarone

A

IV

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15
Q

during CPR how much adrenaline do you give

A

1mg

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16
Q

during CPR how much amiodarone do you give

A

300mg IV, then 150mg IV after 5 shocks

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17
Q

what is adrenaline

A

endogenous catecholamine hormone and neurotransmitter in the sympathetic nervous system

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18
Q

usually where does adrenaline come from

A

noradrenaline

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19
Q

where is andrenaline synthesised

A

adrenal medulla, specifically chromaffin cells

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20
Q

adrenaline moa

A

α and β adrenoceptor agonist

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21
Q

how does adrenaline help in a cradiac arrest senario

A

vasoconstricton increased the perfusion of the heart and brain

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22
Q

adrenaline and mean BP

A

not much affet due to agonist of beta and alpha (beta = vasodilation) (aplpha =vasoconstriction)

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23
Q

adrenaline and beta blocker

A

= unaposed alpha vesoconstriction

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24
Q

adrenaline cautions x6

A 
ischaemic heart disease
cerebrovascular disease
diabetes
hypertension
hyperthyroidism 
hypokalaemia
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25
Q

adrenaline side effects x5

A 
Hypertension (risk of cerebral haemorrhage)
Hypokalemia
Palpitations
Tissue necrosis
Metabolic acidosis
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26
Q

adrenaline and peripheries

A

peripheral coldness

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27
Q

adrenaline and salivation

A

hypersalivation

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28
Q

adrenaline and sweating

A

hyperhidrosis

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29
Q

adrenaline and eyes x2

A

angle closure glaucoma and mydriasis

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30
Q

adrenaline and apetite

A

reduced appetite

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31
Q

adrenaline and blood glucose

A

hyperglycaemia

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32
Q

adrenaline and BP

A

hypertension

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33
Q

adrenaline interactions x3

A

Amitriptyline
Beta blockers
MAO inhibitors

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34
Q

adrenaline and BB interaction

A

hypertension

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35
Q

adrenaline and MAO inhibitors interaction

A

hypertensive crisis

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36
Q

adrenaline and Amitriptyline interaction

A

increased effects of adrenaline

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37
Q

how many ml of adrenaline do you inject

A

10ml

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38
Q

what to do after you have given adrenaline

A

20ml flush of 0.9% sodium chloride

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39
Q

why do you flush after adrenaline administration

A

aid etry into central circulation

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40
Q

why does MAOi inhibit increase the amount of adrenaline

A

this is a route of metabolizing adrenaline

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41
Q

amiodarone class

A

Class III anti-arrhythmic

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42
Q

amiodarone moa

A

Prolongs cardiac action potential and delays refractory period
Inhibits K+ channels involved in repolarisation

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43
Q

3 challenges of amiodarone

A

Incomplete oral absorption
Large volume of distribution
Extremely long half-life

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44
Q

amiodarone dose regimen

A

prolonged loading dose regimen before maintenance dose

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45
Q

amiodarone GI side effects x4

A

constipation, nausea, vomiting, taste disturbance

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46
Q

amiodarone affect on cornea

A

corneal microdeposits

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47
Q

corneal microdeposits by amiodarone reversible?

A

reversible on withdrawal of treatment

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48
Q

corneal microdeposits with amiodarone symptom

A

associated with night glare

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49
Q

when must you stop amiodarone - eyes

A

if vision impaired or optic neuritis/neuropathy develops amiodarone must be stopped to prevent blindness

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50
Q

amiodarone and the thyroid

A

= hypothyroidism - stops conversion of T4 to T3

can cause a destructive thyroiditis leading to release of preformed thyroid hormones and refractory thyrotoxicosis

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51
Q

how to manage low thyroid when giving amiodarone

A

thyroxine

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52
Q

amiodarone contains something that might affect the thyroid, what is it?

A

high iodine content

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53
Q

amiodarone and skin reactions x2

A

photosensitive skin rashes and blue-grey discolouration

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54
Q

when to stop amiodarone - liver

A

severe LFT abnormalities or clinical signs of liver disease

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55
Q

new onset cough and SOB with amiodarone treatment

A

Progressive pneumonitis and lung fibrosis

56
Q

amiodarone adverse affect on nerves

A

Peripheral neuropathy/myopathy

57
Q

is amiodarone neuropathy reversible

A

ya

58
Q

what to check before treatment with amiodarone

A

TFT
LFT
potassium levels
chest x-ray before treatment

59
Q

when administering amiodarone IV what must be available

A

ECG

60
Q

what to check 6 months into treatment with amiodarone

A

TFT and LFT

61
Q

amiodarone contraindications x5

A 
Severe conduction disturbances (unless pacemaker fitted)
Thyroid dysfunction
Iodine sensitivity
Severe respiratory failure
Circulatory collapse
62
Q

amiodarone and contraindications post taking it

A

long half life so can continue causing problems for weeks

63
Q

which drugs can interact with amiodarone to give bradycardia x3

A

BB
CCB
digoxin

64
Q

which drugs can interact with amiodarone to give a long QT x2

A

Lithium

Ondansetron

65
Q

which drugs can interact with amiodarone to give hyperkalaemia x3

A

Steroids
Thiazide diuretics
Loop diuretics

66
Q

amiodarone + phenytoin interaction

A

peripheral neuropathy

67
Q

amiodarone + statins interaction

A

rhabdomyalysis

68
Q

amiodarone + Warfarin interaction

A

Increased anticoagulant effect

69
Q

name 2 vagal manouvres

A

carotid sinus massage or valsalva manoeuvre

70
Q

whats valsalva manoeuvre

A

Holding your breath and bearing down

71
Q

what are vagal maouvres used for

A

paroxysmal SVT

72
Q

what does carotid sinus massage work on

A

works on the baroreceptors at the bifurcation of the common carotid artery, which control BP and HR by measuring degree of stretch within the vessels

73
Q

high BP affect on sympathetic and parasympathetic

A

reduced sympathetic and increased parasympathetic response

74
Q

carotid sinus massage summary

A

= increased BP = slowing of the SA node firing, AV node conduction and reduced vascular tone = reduction in HR and BP

75
Q

how to do a carotid sinus massage

A

massage 5-10 second, look at ECG

76
Q

how long to do vasavalga for

A

15-20 seconds

77
Q

vasavalga affects

A

venous return

78
Q

management of non AF tachycardia

A

adenosine 6 mg as a rapid IV bolus

79
Q

what to tell pt when giving adenosine

A

feel unwell and probably experience chest discomfort

80
Q

no response to adenosine 6 mg IV

A

give a 12 mg IV bolus

81
Q

no response to a 12 mg IV bolus

A

give another 12 mg IV bolus

82
Q

Apparent lack of response to adenosine will occur if x2

A

bolus is given too slowly or into a peripheral vein

83
Q

Failure to terminate a regular narrow-complex tachycardia with adenosine suggests

A

an atrial tachycardia such as atrial flutter

84
Q

what to give if adenosine is contraindicated

A

verapamil 2.5–5 mg IV over 2 min

85
Q

adenosine class

A

Adenosine A1 receptor agonist

86
Q

adenosine moa

A

increased potassium influx and slowed conduction at the AV node

87
Q

adenosine affect on SA node and AV nose

A

sinus bradycardia and slows impulse conduction through the AV node

88
Q

adenosine affect on the ventricles

A

no affect

89
Q

adenosine indication

A

emergency SVT

90
Q

adenosine target

A

G protein-coupled adenosine A1 receptor

91
Q

adenosin action

A

agonist

92
Q

adenosine inhibits

A

adenylyl cyclase enzymes

93
Q

what does adenylyl cyclase enzymes produce

A

cyclic AMP (cAMP)

94
Q

adenosine affect on cyclic AMP (cAMP)

A

reduced

95
Q

adenosine overall effect

A

Inhibits adenylyl cyclase enzymes resulting in reduced production of cyclic AMP (cAMP). This promotes opening of adenosine-sensitive potassium channels and increased K+ efflux out of myocardial cells – as a result cells become hyperpolarised. This slows the rate of rise of the pacemaker potential.

96
Q

how long does a bolus dose of adenosine last

A

20-30 seconds

97
Q

adenosine contraindications x7

A

Asthma/COPD
Decompensated heart failure
Long QT syndrome/AV block/sick sinus syndrome
Severe hypotension

98
Q

adenosine interactions x3

A

Dipyridamole
Aminophylline/Theophylline
Some local anaesthetic agents

99
Q

adenosine and Dipyridamole interaction

A

increased adenosine exposure

100
Q

adenosine and Aminophylline/Theophylline interaction

A

decreased adenosine efficacy

101
Q

adenosine and bupivicaine/mepivacaine interaction

A

risk of cardiodepression

102
Q

adenosine and lidocaine interaction

A

there is one with this LA

103
Q

how long do adenosine side effects last

A

less than 1 min

104
Q

whats a fluid challenge

A

500ml of a sodium containing crystalloid given over 15 mins

105
Q

Atropine class

A

Muscarinic antagonist

106
Q

atropine moa

A

Increases firing of the SA node by blocking actions of the vagus nerve on the heart.

107
Q

example of a 500ml of a sodium containing crystalloid

A

0.9% Sodium Chloride or Hartmann’s solution x2

108
Q

what class is atropine

A

Muscarinic antagonist

109
Q

atropine moa

A

Increases firing of the SA node by blocking actions of the vagus nerve on the heart

110
Q

muscarinic receptors are part of

A

parasympathetic NS

111
Q

atropine and AV node conduction

A

increased

112
Q

atropine affects which channels

A

inhibiting potassium channels and preventing hyperpolarisation of the cell membrane

113
Q

atropine and eye side effects x3

A

blurred vision
mydriasis
angle closure glaucoma

114
Q

atropine GI tract side effects x5

A 
constipation
abdominal distension
nausea
vomiting
dysphagia
115
Q

atropine and CVS side effects x5

A 
tachycardia
palpitations
angina
hypertension
arrhythmias
116
Q

atropine and secretions x4

A

dry mouth
anhidrosis
thirst
increased body temperature

117
Q

atropine and urinary tract

A

urinary retention

118
Q

why do you get urinary retention with atropine

A

decreased detrusor function and increased sphincter tone

119
Q

atropine and CNS side effects x2

A

confusion, hallucination

120
Q

atropine GI contraindications x5

A

obstruction, paralytic ileus, pyloric stenosis, severe ulcerative colitis, toxic megacolon

121
Q

atropine urinary tract contraindication x3

A

bladder outflow obstruction, prostatic enlargement, retention

122
Q

atropine disease contraindication

A

Myasthenia gravis

123
Q

atropine interactions x6

A 
Tricyclic anti-depressants
Muscarinic antagonists
Anti-histamine
Anti-psyhotics
Phenylephrine
Levodopa
124
Q

Muscarinic antagonists examples

A

tiotropium, solifenacin, oxybutynin, tolerodine

125
Q

TCA examples x2

A

amitriptyline, nortriptyline

126
Q

Anti-histamine examples x2

A

chlorphenamine, cyclizine

127
Q

atropine and Phenylephrine interaction

A

severe hypertension

128
Q

atropine and levodopa interaction

A

decreased absorption levodopa

129
Q

most important drug for anaphylactic reaction

A

adrenaline

130
Q

adrenaline alpha activity in anaphylaxis x2

A

reverses peripheral vasodilation and reduces oedema

131
Q

adrenaline beta activity in anaphylaxis x3

A

dilates bronchial airways, increases force of myocardial contraction and suppresses histamine release

132
Q

anaphylaxis adrenaline amount

A

500 micrograms by IM injection of 1 in 1,000 solution (1mg/mL) i.e. 0.5ml

133
Q

anapylaxis adrenaline route

A

IM

134
Q

anaphylaxis adrenaline site

A

Anterolateral aspect of the middle third of the thigh

135
Q

doses available for self adrenaline in anaphylaxis

A

0.15mg or 0.3mg

136
Q

what to give after initial anaphylaxis resus

A

anti-histamines and corticosteroids

137
Q

how do anti histamines help in anaphylaxis

A

histamine-mediate vasodilation and bronchoconstriction

PPT year 4 (7 decks)

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