Cardiac Emergencies 2

Question 1

if pt says having a heart attack…

Answer 1

• they probably are
• assume chest pain until ruled out (go to ER)
• get them to sit/rest
• **do NOT let them drive themselves (911)

Question 2

describe acute coronary syndrome

Answer 2

• 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

Question 3

acute coronary syndrome: assess for pain

Answer 3

• burning/squeezing/crushing/radiation

- exercise, cold, stress, large meal may make it worse

Question 4

acute coronary syndrome signs

Answer 4

• fatigue, SOB
• N and V
• cool extremities and perspiration
• muffled heart sounds, palpable pericordial pulse
• hypo or HTN
• feeling of doom

Question 5

if complains of chest pain…

Answer 5

• always call MD and get help

- MONA (morphine, O2, nitro, aspirin)

Question 6

actual order if c/o chest pain

Answer 6

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

Question 7

important things to remember about nitro

Answer 7

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

Question 8

ACS diagnostics

Answer 8

• cardiac markers
• 12 lead EKG
• cardiac cath asap

Question 9

ACS medications

Answer 9

• 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

Question 10

describe antiplatelets

Answer 10

• prevent platelet aggregation (from sticking together)

* does NOT make you bleed

Question 11

describe P2Y12 Inhibitors

Answer 11

• 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

Question 12

if ACS pt arrests…

Answer 12

• 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

Question 13

describe anticoagulants

Answer 13

• 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

Question 14

describe factor xa inhibitors

Answer 14

“xabans”

• Rivaroxaban (xarelto)
• Apixaban (eliquis)
• antidote= andexanet alfa

Question 15

code blue meds

Answer 15

• 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

Question 16

what do you watch for during code blue meds

Answer 16

• watch for ROSC
• return of spontaneous circulation
• monitor for CO2 being expelled (determines if sufficient breath)
• transfer to ICU, cooling blanket to decrease metabolism

Question 17

what to do during CPR

Answer 17

• 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

Question 18

causes of cardiac arrhythmias

Answer 18

fever, dehydration, stress, emboli, positional changes, fluid overload

Question 19

what to consider with cardiac arrhythmias

Answer 19

• 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

Question 20

causes of SVT

Answer 20

• hypoxia, hypokalemia, MI, anxiety

- dig toxicity, caffeine, weed, CNS stimulant

Question 21

treatment of SVT

Answer 21

• 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

Question 22

causes of sinus tachy

Answer 22

exercise, anxiety, pain, dehydration, anemia, MI, hypovolemia, L side HF

Question 23

treatment of sinus tachy

Answer 23

correct underlying cause

-BB and CCB

Question 24

causes of sinus brady

Answer 24

sleep, V, hypothyroidism, ICP, inferior wall MI, BB, CCB

Question 25

treatment of sinus brady

Answer 25

correct cause

• if BP decreases or dizzy/weak or change in LOC call RRT and start ACLS
• Pacemaker, Atropine
• dopamine or epi IV

Question 26

what is important to remember about sinus brady

Answer 26

• no way to reverse BB overdose

- if symptomatic (chest pain or BP decreases) atropine or pacemaker for brady

Question 27

causes of atrial flutter and a fib

Answer 27

HF, PE, pericarditis, COPD, HTN, alcohol

Question 28

treatment of atrial flutter and a fib

Answer 28

• CCB (diltiazem) or amiodarone
• *if meds do not work, cardioversion or ablation
• may need anticoagulant therapy
• new treatment: Tikosyn

Question 29

stable and unstable treatments for atrial flutter and a fib

Answer 29

• unstable: with VR >150, cardioversion

- if stable, ACLS and any therapy (CCB, BB, amiodarone, digoxin)

Question 30

treatment for V tach

Answer 30

• ICD if recurrent v tach

- pulseless: CPR, ACLS for epi or vasopressin, then amiodarone

Question 31

when is mg sulfate given

Answer 31

torsades de pointes only

Question 32

how much amiodarone is given for v tach

Answer 32

150 mg for v tach (IV) then 1 mg drip/hr

Question 33

if wide QRS and v tach give what

Answer 33

adenosine and cardioversion

Question 34

if irregular v tach…

Answer 34

defibrillate