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
2
Q
what to do after you have started CPR
A
assess rhythm
3
Q
name 2 shockable rhythms
A
VF and pulseless VT
4
Q
what to do if someone has a shockable rhythm
A
1 shock, resume CPR for 2 mins
5
Q
no shockable rhythm x2
A
PEA and asystole
6
Q
what to do if someone has non shockable rhythm
A
continue CPR for 2 mins
7
Q
post CPR commencement some ones circulation has returned oxygen target
A
94-98%
8
Q
how to monitor CO2 during CPR
A
waveform capnography
9
Q
do you give oxygen during CPR
A
ye
10
Q
3 other things to do during CPR
A
get IV access
give adrenaline
give amiodarone
11
Q
during CPR when do you give adrenaline
A
3-5 mins/alternate shocks
12
Q
during CPR when do you give amiodarone
A
after 3 shocks
13
Q
during CPR how do you give adrenaline
A
IV
14
Q
during CPR how do you give amiodarone
A
IV
15
Q
during CPR how much adrenaline do you give
A
1mg
16
Q
during CPR how much amiodarone do you give
A
300mg IV, then 150mg IV after 5 shocks
17
Q
what is adrenaline
A
endogenous catecholamine hormone and neurotransmitter in the sympathetic nervous system
18
Q
usually where does adrenaline come from
A
noradrenaline
19
Q
where is andrenaline synthesised
A
adrenal medulla, specifically chromaffin cells
20
Q
adrenaline moa
A
α and β adrenoceptor agonist
21
Q
how does adrenaline help in a cradiac arrest senario
A
vasoconstricton increased the perfusion of the heart and brain
22
Q
adrenaline and mean BP
A
not much affet due to agonist of beta and alpha (beta = vasodilation) (aplpha =vasoconstriction)
23
Q
adrenaline and beta blocker
A
= unaposed alpha vesoconstriction
24
Q
adrenaline cautions x6
A
ischaemic heart disease cerebrovascular disease diabetes hypertension hyperthyroidism hypokalaemia
25
adrenaline side effects x5
```
Hypertension (risk of cerebral haemorrhage)
Hypokalemia
Palpitations
Tissue necrosis
Metabolic acidosis
```
26
adrenaline and peripheries
peripheral coldness
27
adrenaline and salivation
hypersalivation
28
adrenaline and sweating
hyperhidrosis
29
adrenaline and eyes x2
angle closure glaucoma and mydriasis
30
adrenaline and apetite
reduced appetite
31
adrenaline and blood glucose
hyperglycaemia
32
adrenaline and BP
hypertension
33
adrenaline interactions x3
Amitriptyline
Beta blockers
MAO inhibitors
34
adrenaline and BB interaction
hypertension
35
adrenaline and MAO inhibitors interaction
hypertensive crisis
36
adrenaline and Amitriptyline interaction
increased effects of adrenaline
37
how many ml of adrenaline do you inject
10ml
38
what to do after you have given adrenaline
20ml flush of 0.9% sodium chloride
39
why do you flush after adrenaline administration
aid etry into central circulation
40
why does MAOi inhibit increase the amount of adrenaline
this is a route of metabolizing adrenaline
41
amiodarone class
Class III anti-arrhythmic
42
amiodarone moa
Prolongs cardiac action potential and delays refractory period
Inhibits K+ channels involved in repolarisation
43
3 challenges of amiodarone
Incomplete oral absorption
Large volume of distribution
Extremely long half-life
44
amiodarone dose regimen
prolonged loading dose regimen before maintenance dose
45
amiodarone GI side effects x4
constipation, nausea, vomiting, taste disturbance
46
amiodarone affect on cornea
corneal microdeposits
47
corneal microdeposits by amiodarone reversible?
reversible on withdrawal of treatment
48
corneal microdeposits with amiodarone symptom
associated with night glare
49
when must you stop amiodarone - eyes
if vision impaired or optic neuritis/neuropathy develops amiodarone must be stopped to prevent blindness
50
amiodarone and the thyroid
= hypothyroidism - stops conversion of T4 to T3
| can cause a destructive thyroiditis leading to release of preformed thyroid hormones and refractory thyrotoxicosis
51
how to manage low thyroid when giving amiodarone
thyroxine
52
amiodarone contains something that might affect the thyroid, what is it?
high iodine content
53
amiodarone and skin reactions x2
photosensitive skin rashes and blue-grey discolouration
54
when to stop amiodarone - liver
severe LFT abnormalities or clinical signs of liver disease
55
new onset cough and SOB with amiodarone treatment
Progressive pneumonitis and lung fibrosis
56
amiodarone adverse affect on nerves
Peripheral neuropathy/myopathy
57
is amiodarone neuropathy reversible
ya
58
what to check before treatment with amiodarone
TFT
LFT
potassium levels
chest x-ray before treatment
59
when administering amiodarone IV what must be available
ECG
60
what to check 6 months into treatment with amiodarone
TFT and LFT
61
amiodarone contraindications x5
```
Severe conduction disturbances (unless pacemaker fitted)
Thyroid dysfunction
Iodine sensitivity
Severe respiratory failure
Circulatory collapse
```
62
amiodarone and contraindications post taking it
long half life so can continue causing problems for weeks
63
which drugs can interact with amiodarone to give bradycardia x3
BB
CCB
digoxin
64
which drugs can interact with amiodarone to give a long QT x2
Lithium
| Ondansetron
65
which drugs can interact with amiodarone to give hyperkalaemia x3
Steroids
Thiazide diuretics
Loop diuretics
66
amiodarone + phenytoin interaction
peripheral neuropathy
67
amiodarone + statins interaction
rhabdomyalysis
68
amiodarone + Warfarin interaction
Increased anticoagulant effect
69
name 2 vagal manouvres
carotid sinus massage or valsalva manoeuvre
70
whats valsalva manoeuvre
Holding your breath and bearing down
71
what are vagal maouvres used for
paroxysmal SVT
72
what does carotid sinus massage work on
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
high BP affect on sympathetic and parasympathetic
reduced sympathetic and increased parasympathetic response
74
carotid sinus massage summary
= increased BP = slowing of the SA node firing, AV node conduction and reduced vascular tone = reduction in HR and BP
75
how to do a carotid sinus massage
massage 5-10 second, look at ECG
76
how long to do vasavalga for
15-20 seconds
77
vasavalga affects
venous return
78
management of non AF tachycardia
adenosine 6 mg as a rapid IV bolus
79
what to tell pt when giving adenosine
feel unwell and probably experience chest discomfort
80
no response to adenosine 6 mg IV
give a 12 mg IV bolus
81
no response to a 12 mg IV bolus
give another 12 mg IV bolus
82
Apparent lack of response to adenosine will occur if x2
bolus is given too slowly or into a peripheral vein
83
Failure to terminate a regular narrow-complex tachycardia with adenosine suggests
an atrial tachycardia such as atrial flutter
84
what to give if adenosine is contraindicated
verapamil 2.5–5 mg IV over 2 min
85
adenosine class
Adenosine A1 receptor agonist
86
adenosine moa
increased potassium influx and slowed conduction at the AV node
87
adenosine affect on SA node and AV nose
sinus bradycardia and slows impulse conduction through the AV node
88
adenosine affect on the ventricles
no affect
89
adenosine indication
emergency SVT
90
adenosine target
G protein-coupled adenosine A1 receptor
91
adenosin action
agonist
92
adenosine inhibits
adenylyl cyclase enzymes
93
what does adenylyl cyclase enzymes produce
cyclic AMP (cAMP)
94
adenosine affect on cyclic AMP (cAMP)
reduced
95
adenosine overall effect
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
how long does a bolus dose of adenosine last
20-30 seconds
97
adenosine contraindications x7
Asthma/COPD
Decompensated heart failure
Long QT syndrome/AV block/sick sinus syndrome
Severe hypotension
98
adenosine interactions x3
Dipyridamole
Aminophylline/Theophylline
Some local anaesthetic agents
99
adenosine and Dipyridamole interaction
increased adenosine exposure
100
adenosine and Aminophylline/Theophylline interaction
decreased adenosine efficacy
101
adenosine and bupivicaine/mepivacaine interaction
risk of cardiodepression
102
adenosine and lidocaine interaction
there is one with this LA
103
how long do adenosine side effects last
less than 1 min
104
whats a fluid challenge
500ml of a sodium containing crystalloid given over 15 mins
105
Atropine class
Muscarinic antagonist
106
atropine moa
Increases firing of the SA node by blocking actions of the vagus nerve on the heart.
107
example of a 500ml of a sodium containing crystalloid
0.9% Sodium Chloride or Hartmann’s solution x2
108
what class is atropine
Muscarinic antagonist
109
atropine moa
Increases firing of the SA node by blocking actions of the vagus nerve on the heart
110
muscarinic receptors are part of
parasympathetic NS
111
atropine and AV node conduction
increased
112
atropine affects which channels
inhibiting potassium channels and preventing hyperpolarisation of the cell membrane
113
atropine and eye side effects x3
blurred vision
mydriasis
angle closure glaucoma
114
atropine GI tract side effects x5
```
constipation
abdominal distension
nausea
vomiting
dysphagia
```
115
atropine and CVS side effects x5
```
tachycardia
palpitations
angina
hypertension
arrhythmias
```
116
atropine and secretions x4
dry mouth
anhidrosis
thirst
increased body temperature
117
atropine and urinary tract
urinary retention
118
why do you get urinary retention with atropine
decreased detrusor function and increased sphincter tone
119
atropine and CNS side effects x2
confusion, hallucination
120
atropine GI contraindications x5
obstruction, paralytic ileus, pyloric stenosis, severe ulcerative colitis, toxic megacolon
121
atropine urinary tract contraindication x3
bladder outflow obstruction, prostatic enlargement, retention
122
atropine disease contraindication
Myasthenia gravis
123
atropine interactions x6
```
Tricyclic anti-depressants
Muscarinic antagonists
Anti-histamine
Anti-psyhotics
Phenylephrine
Levodopa
```
124
Muscarinic antagonists examples
tiotropium, solifenacin, oxybutynin, tolerodine
125
TCA examples x2
amitriptyline, nortriptyline
126
Anti-histamine examples x2
chlorphenamine, cyclizine
127
atropine and Phenylephrine interaction
severe hypertension
128
atropine and levodopa interaction
decreased absorption levodopa
129
most important drug for anaphylactic reaction
adrenaline
130
adrenaline alpha activity in anaphylaxis x2
reverses peripheral vasodilation and reduces oedema
131
adrenaline beta activity in anaphylaxis x3
dilates bronchial airways, increases force of myocardial contraction and suppresses histamine release
132
anaphylaxis adrenaline amount
500 micrograms by IM injection of 1 in 1,000 solution (1mg/mL) i.e. 0.5ml
133
anapylaxis adrenaline route
IM
134
anaphylaxis adrenaline site
Anterolateral aspect of the middle third of the thigh
135
doses available for self adrenaline in anaphylaxis
0.15mg or 0.3mg
136
what to give after initial anaphylaxis resus
anti-histamines and corticosteroids
137
how do anti histamines help in anaphylaxis
histamine-mediate vasodilation and bronchoconstriction
