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Residency prep eg ACLS > Cardiac Arrest and Chest Pain (Emerg flash cards) > Flashcards

Cardiac Arrest and Chest Pain (Emerg flash cards)

1
Q

What are the indications for electrical cardioversion?

A

“Paroxysmal SVT
Atrial fibrillation/Atrial flutter
Ventricular tachycardia”

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2
Q

What are the pre-medication options before electrical cardioversion?

A

“Midazolam 1-5mg (+/- fentanyl 50-200mcg)
Propofol 50-150mg IV
Ketamine 0.25-1.5mg/kg IV
Etomidate 20mg IV”

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3
Q

What is synchronized cardioversion?

A

Delivery of a low-energy shock that is timed with the patient’s cardiac cycle (synchronized with the peak of the QRS complex)

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4
Q

What is unsynchronized cardioversion?

A

Delivery of a high-energy shock, with no time delay (delivered as soon as button is pressed on defibrillator)

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5
Q

What can happen if a low-energy shock is delivered at the wrong point in the cycle?

A

If the shock occurs on the t-wave (during repolarization), there is a high likelihood that the shock can precipitate VF (Ventricular Fibrillation)

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6
Q

What are the indications for synchronized cardioversion?

A

“unstable atrial fibrillation
atrial flutter
atrial tachycardia
supraventricular tachycardias”

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7
Q

When is unsynchronized cardioversion used?

A
  • there is no coordinated intrinsic electrical activity in the heart (pulseless VT/VF), or
  • the defibrillator fails to synchronize in an unstable patient
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8
Q

What “dose” of electricity is given in synchronized cardioversion?

A

pSVT/Aflutter: 150J biphasic or 300J monophasic

Vtach/Afib: 200J biphasic or 360J monophasic

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9
Q

What is the management of stable atrial fibrillation or flutter?

A

If HR > 120: rate control

Then consider rhythm control

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10
Q

What are the medical management options for acute narrow complex afib with HR >120?

A 
"Diltiazem 20mg IV
Verapamil 2.5-4mg IV
Metoprolol 5mg IV
Amiodarone 150mg over 10min
Digoxin 0.5mg IV"
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11
Q

What are the medical management options for acute wide complex afib with HR >120?

A

“Procainamide 30mg/min to 17mg/kg

Amiodarone 150mg over 10min”

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12
Q

What is the general initial management of Vfib or pulseless vtach?

A

“Intubate, ventilate, early IV/IO access (med admin)

Treat reversible causes”

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13
Q

Name 7 reversible causes of Vfib/Vtach

A 
"Hypovolemia
Hypoxia
Acidosis
Hyper/o kalemia
Hypothermia
Toxins
Ischemia"
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14
Q

Should you start CPR or shock first?

A

Shock first if defibrillator is immediately available; if not start CPR and interrupt for defibrillator

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15
Q

Describe key features of high-quality CPR

A

5cm compression, 100-120/min, with complete chest recoil. Change compressors q2min.
Minimize interruptions, avoid ventilation >10/min, monitor end-tidal CO2

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16
Q

For what ECG findings do you initiate CPR?

A

VFib and pulseless VTach

17
Q

What are the two preferred medications that can be provided during CPR?

A

Epinephrine: 1mg IV q3-5min
Amiodarone: 300mg IV bolus, can add 150mg IV (2nd dose)

18
Q

What alternate medications can be provided during CPR?

A

“Refractory VFib: lidocaine, 1.5mg/kg IV, q3-5min (max 3mg/kg)
Polymorphic VTach: Magnesium sulfate, 2g IV”

19
Q

What “dose” of electricity is given for vfib or pulseless vtach?

A

200J biphasic or 360J monophasic

20
Q

What “dose” of electricity is given for unstable afib?

A

200J biphasic or 360J monophasic

21
Q

For wide-complex tachycardia, when should you consider synchronized cardioversion?

A

Early: meds only revert VT 30% of the time

22
Q

What medications can be used for wide-complex tachycardia?

A

“Procainamide 30mg/min (max 17mg/kg)

Amiodarone 150mg over 10min (repeat x2 PRN)”

23
Q

What is the next step after one antidysrhythmic fails?

A

Electric cardioversion: multiple antidysrhythmics can have proarrythmogenic effects

24
Q

What is the first step for a stable patient in paroxysmal supraventricular tachycardia (pSVT)?

A

Vagal manoeuvres

25
Q

What vagal maneouvres can stop SVT?

A

“Bearing down
Carotid massage
Cold wet face towel (cold face stimulus)
Coughing, gagging”

26
Q

What are the medication options for pSVT?

A

“Adenosine: 6mg IV over 3 secs (1st dose), 12mg IV (2nd dose)
Diltiazem: 20mg IV over 2 min (1st dose), 25mg IV (2nd dose)
Metoprolol: 5mg IV (max 15mg)
Verapamil: 2.5-5mg IV over 2 min, repeat 5-10mg in 10 mins”

27
Q

What is the stepwise treatment progression for pSVT?

A

“Vagal manoeuvres
Medication
Synchronized cardioversion (if unstable)”

28
Q

What are the “5Hs and 5Ts” used to remember?

A

Reversible causes of Pulseless Electrical Activity, Asystole

29
Q

What are the 5 Hs?

A 
"Hypovolemia
Hypoxia
Hydrogen (Acidosis)
Hyper/o kalemia
Hypothermia"
30
Q

What are the 5 Ts?

A 
"Toxins
Tamponade
Tension pneumo
Thrombosis: coronary (MI)
Thrombosis: pulmonary (PE)"
31
Q

What is the management of PEA/Asystole?

A

“Ongoing CPR
Treat reversible causes
Epinephrine 1mg IV q3-5min
Re-evaluate for shockable rhythm

Until ROSC or it’s called”

32
Q

What is the management of stable bradycardia due to first degree block or type I second degree block?

A

Observe

33
Q

What is the management of stable bradycardia due to type II second degree block or third degree block?

A

Transcutaneous pacing –> transvenous pacing

34
Q

What is the management of unstable bradycardia?

A

“Atropine 0.5mg q3-5min (max 3mg)

If not effective consider one of:

  • transcutaneous pacing
  • dopamine 2-10 mcg/kg/min
  • epinephrine 2-10 mcg/min”
35
Q

What are the signs of cardiac instability (for ACLS)?

A 
"Chest pain
Shortness of breath
Loss of consciousness
Low BP
CHF
Acute MI"

Residency prep eg ACLS (2 decks)

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