Cardiac Flashcards
Sign of unstable bradycardia
<60 with no traumatic cause
signs of poor perfusion
hypotension
altered conscious state
diaphoresis
SOB/ cyanosis
syncope
Signs of unstable tachy
> 100bpm signs of instability are reduced BP, altered mental state, ischaemic chest pain, syncope and signs of shock
Signs of SVT
> 150 bpm
rapid onset
regular narrow complex with p waves absent
diaphoresis
signs of reduced cardiac output
Unstable brady treatment
12 lead
access with bloods
address reversible cause- inferior or right MI consider IVT to address cardiogenic shock and follow STEMI
Atropine 0.6mg in 0.5ml undiluted 3-5 mins max dose 3 mg
Pads
ASMA or CCP for pacing
SVT treatment
12 lead
PIVC and bloods
Valsalva
pain relief
antiemetic
P1 if time critical
Valsalva contraindications
recurrent or current AMI
severe coronary artery disease
haemodynamic instability
known glaucoma or retinal myopathy
How to do the Valsalva procedure
O2 tubing connected to sphygmomanometer
semi recumbent with pads and monitor attached PIVC access preferred.
instruct to blow with attempt to reach 40mmHg maintaining pressure for 15-20 secs
lower pts head and raise legs to 45 degrees for 15 seconds
can repeat once
Clinical presentation of ACPO
SOB
orthopnoea
cyanosis
pink frothy sputum
diaphoresis
crackles
wheeze
Dose of GTN for ACPO
400mcg if BP >90mmHg
if BP maintains consider 5 minutely sprays
What is autonomic dysreflexia
acute hypertension in pts with spinal cord injury above T6 caused by a noxious stimuli below the level of the injury. Causes sympathetic activation and intense vasoconstriction below the lesion.
Clinical presentation of AD
Sudden HTN
pounding headache worsening of increase to BP
bradycardia
sweating and flushing above level of the break
pallor skin below the break
SOB
Risk assessment required with AD
consider with all SCI patients when SBP 20mmHg above normal OR SBP>160mmHg
transport pt even if symptoms resolve as cause of stimuli needs investigation
AD treatment
Position upright to aid in orthostatic reduction in BP
attempt to remove noxious stimuli
GTN
pain management
Signs of CCF
hypotension/hypoxia
increased HR as compensation for reduced CO
distended JVP
cyanosis
peripheral or central oedema
Nodal or complete AV block
severe failure may present with lethargy dyspnoea or similar presentation to cardiogenic shock
Cardiac tamponade signs
Beks triad
distention to JV
hypotension
muffled heart sounds
