Cardiac Emergencies 2 Flashcards
if pt says having a heart attack…
- they probably are
- assume chest pain until ruled out (go to ER)
- get them to sit/rest
- **do NOT let them drive themselves (911)
describe acute coronary syndrome
- women have vague/GI symptoms
- diabetic have decreased pain and muffled chest pain (may not be aware d/t neuropathy)
- assess for pain and the s/s of acute coronary syndrome
acute coronary syndrome: assess for pain
- burning/squeezing/crushing/radiation
- exercise, cold, stress, large meal may make it worse
acute coronary syndrome signs
- fatigue, SOB
- N and V
- cool extremities and perspiration
- muffled heart sounds, palpable pericordial pulse
- hypo or HTN
- feeling of doom
if complains of chest pain…
- always call MD and get help
- MONA (morphine, O2, nitro, aspirin)
actual order if c/o chest pain
1) O2 2 l
2) chewable aspirin 4 x 81 mg (324 mg), stops prostaglandin from sticking (anti platelet)
3) nitro sublingual 0.04 mg x3 (every 3-5 min)
4) morphine 2-4 mg IV
5) heparin drip (bolus then drip)
6) go to catheter lab (only have 90 min to get there, <1hr best)
7) Integrilin, Repro (prevent more clot formation, on for 24 hrs) **big risk factor= bleeding
important things to remember about nitro
SE: tingling under tongue, headache, decreased bP
- check BP BEFORE giving nitro (need baseline)
- do not give nitro once BP is less than 100 (systolic), will drop BP too much
- may need nitro drip
ACS diagnostics
- cardiac markers
- 12 lead EKG
- cardiac cath asap
ACS medications
- nitrates first
- BB to decrease workload (Metoprolol)
- CCB (amlodipine) for vessel spasms
- antiplatelets (aspirin)
- antilipemics (statins)
- Glycoprotein lib inhibitors (Integrilin, Repro): after cath to decrease platelet aggregation, used 12-24 hrs after
- thrombin inhibitors (Bivairudin/Angiomax), keep vessels open
describe antiplatelets
- prevent platelet aggregation (from sticking together)
* does NOT make you bleed
describe P2Y12 Inhibitors
- Clopidogrel (Plavix): used for stroked, post MI
- Prasugrel (Effient)
- Ticagrelor (Brilmta)
- used with ASA for 12 mos in pt w/ NSTEMI
- Plavix shown to increase outcome after STEMI and PCI
if ACS pt arrests…
- 5 cycles CPR all compressions
- then 30:2 with breathing
- use cart: hook up pad (defib for vfib)
- more CPR, shock again
- meds (epi, no limit)
- amiodarone (300 mg for code): vtach (150 mg), bolus then drip
describe anticoagulants
- inhibit clotting at factor x-anticoagulants
- will cause you to bleed (risk)
- increase PT and PTT
- works quickly but stays in system for long time
- replacing coumadin
- given to HF pts
- must wean off
describe factor xa inhibitors
“xabans”
- Rivaroxaban (xarelto)
- Apixaban (eliquis)
- antidote= andexanet alfa
code blue meds
- epi 1 mg IVP every 3-5 min
- lidocaine if epi is unsuccessful
- amiodarone 300 mg in arrest bolus then 150 mg drip
- potentially ordered: NaHCO3, Ca, Mg
what do you watch for during code blue meds
- watch for ROSC
- return of spontaneous circulation
- monitor for CO2 being expelled (determines if sufficient breath)
- transfer to ICU, cooling blanket to decrease metabolism
what to do during CPR
- stay with pt call for help
- call code
- bring cash cart
- leads, assess rhythm, shock
- compressions: 30:2
- code team: head, checks pulse, starts Ambu
- don’t let the RN leave, answer questions about what happened
causes of cardiac arrhythmias
fever, dehydration, stress, emboli, positional changes, fluid overload
what to consider with cardiac arrhythmias
- chest pain? change in BP?
- think about Hs and Ts
- tachycardia caused by pain and dehydration
- a fib= HF
- heart block, v tach, PVS = post MI
causes of SVT
- hypoxia, hypokalemia, MI, anxiety
- dig toxicity, caffeine, weed, CNS stimulant
treatment of SVT
- if unstable: cardioversion
- if stable: vagal stimulation, valsalva maneuver, carotid sinus massage or Adenosine
- after rhythm converts, CCB and BB
- start with drug then electricity
causes of sinus tachy
exercise, anxiety, pain, dehydration, anemia, MI, hypovolemia, L side HF
treatment of sinus tachy
correct underlying cause
-BB and CCB
causes of sinus brady
sleep, V, hypothyroidism, ICP, inferior wall MI, BB, CCB
treatment of sinus brady
correct cause
- if BP decreases or dizzy/weak or change in LOC call RRT and start ACLS
- Pacemaker, Atropine
- dopamine or epi IV
what is important to remember about sinus brady
- no way to reverse BB overdose
- if symptomatic (chest pain or BP decreases) atropine or pacemaker for brady
causes of atrial flutter and a fib
HF, PE, pericarditis, COPD, HTN, alcohol
treatment of atrial flutter and a fib
- CCB (diltiazem) or amiodarone
- *if meds do not work, cardioversion or ablation
- may need anticoagulant therapy
- new treatment: Tikosyn
stable and unstable treatments for atrial flutter and a fib
- unstable: with VR >150, cardioversion
- if stable, ACLS and any therapy (CCB, BB, amiodarone, digoxin)
treatment for V tach
- ICD if recurrent v tach
- pulseless: CPR, ACLS for epi or vasopressin, then amiodarone
when is mg sulfate given
torsades de pointes only
how much amiodarone is given for v tach
150 mg for v tach (IV) then 1 mg drip/hr
if wide QRS and v tach give what
adenosine and cardioversion
if irregular v tach…
defibrillate
