Cardiac Emergencies 3

Question 1

treatment of junctional and heart block

Answer 1

• atropine for junctional and first degree only
• pacemkaer if no response to meds
• dopamine or epi IV if 2nd or 3rd degree for symptomatic brady

Question 2

what are the doses for atropine if brady

Answer 2

3 doses at 3-5 min apart, then pacemaker, then dopamine

Question 3

treatment for V fib

Answer 3

• CPR, ACLS protocol
• DEFIB
• ICD

Question 4

early signs of HF

Answer 4

• dyspnea
• orthopnea
• fatigue
• nonproductive cough

Question 5

describe right sided HF

Answer 5

• diastolic HF
• r/t rest of body, ascites
• r/t fluid
• increase in preload (amount that stays in R side of heart, end diastolic volume)
• affected by back flow of heart into R side

Question 6

signs of R sided HF

Answer 6

-JVD
-hepatomegaly
-RUQ pain
-anorexia
-nausea
-nocturia
-pitting edema
-ascites
S3

Question 7

EF is lower in….

Answer 7

L sided HF

Question 8

how is R sided HF treated

Answer 8

-diuretics (lasix and bumex)
(bumetatide works on abdomen)
(useful as tend to hold fluid in abdomen)

Question 9

describe L sided HF

Answer 9

• systolic HF
• pulmonary (LUNGS)
• low ejection fraction (normal is 60-70%)
• EF becomes 20-30% with L HF (once < 20%, very serious signs)

Question 10

signs of L sided HF

Answer 10

• crackles
• hemophysis
• displaced PMI
• tachycardia
• S3 and S4
• confusion
• cyanosis
• SOB

Question 11

diagnostics for HF

Answer 11

• CXR
• EKG for dysrhythmias
• labs: liver enzyme, BUN, CR, BNP
• ECHO (EF and wall size)
• ABGs

Question 12

once EF is <20%…

Answer 12

you have BOTH systolic and diastolic BP

Question 13

treatment of both L and R HF

Answer 13

1) ACE inhibitors/ARB, aldosterone (work on renin, blockes angio tensin 2, vasoconstrict)
2) CCB (amlodipine)-vasodilate
BB (Carrvedolol, COrreg): decrease workload, good for A Fib and decrease HR

Question 14

HF progression

Answer 14

1) L sided starts t/t chronic HTN (narrow vessels) or MI
2) L ventricle has to push harder to get blood out
3) afterload increases (systolic BP)
4) L ventricle enlarges, compensates for push needed to get blood out (eventually muscle cannot stretch anymore)
5) blood starts to backflow into L atrium and pulmonary veins
6) fluid backs up in lungs (pulmonary s/s)
7) lungs then put pressure on R ventricle (pulmonary arteries)
8) R side fills up with fluid, increase pressure and affects preload (diastolic BP)

Question 15

what is BNP

Answer 15

• brain naturetic peptide
• elevated when heart is enlarged
• normal is < 100
• may be in 1000s
• as EF decreases, brain thinks needs more Na and H2O so increases BNP

Question 16

treatment for HF

Answer 16

• sit upright, give O2, monitor HR and pulse Ox
• diuretics: lasix or bumex IV
• ACE inhibitors, BB, digoxin if needed
• NOAC: non vitamin K, oral anticoagulants
• Natrector

Question 17

what are NOACs

Answer 17

• dabigatron (pradaxa)
• rivaroxaban (xaralto)
• apixaban (eliquis)

Question 18

what is natrector for

Answer 18

for elevated BNP or Milrione inotrope increases push

Question 19

if pulmonary edema fills up quickly give..

Answer 19

diuretics
nitrates
morphine
O2

Question 20

describe HTN crisis

Answer 20

• BP too high (ie/ 200/100)

- causes: not taking meds, CVA, autonomic dysreflexia, cushings

Question 21

signs of HTN crisis

Answer 21

• throbbing headache
• V
• irritability
• confusion
• blurred vision
• SOB
• angina
• S4
• *retinopathy with retinal hemorrhages

Question 22

what is important to remember about HTN crisis

Answer 22

• need to bring BP down but not too dramatically

- will become unconscious if too much fluid is pulled from the brain too fast

Question 23

if retinopathy with retinal hemorrhages..

Answer 23

go go ER!

will strok or MI

Question 24

what to do for HTN crisis:

Answer 24

• decrease BP with IV meds
• monitor HR and ABGs
• transfer to acute unit, initiate an arterial line for BP monitoring
• reduce BP by no more than 25% of MAP over the first 2 hrs (drop NP slowly over 4 hrs, once systolic is 130 stop)

Question 25

signs of aortic aneurysm

Answer 25

• severe substernal pain, radiates to neck, back, andomen, or shoulder
• hoarseness/cough
• difficulty swallowing
• difficulty breathing
• unequal BP in both arms
• aortic murmur

Question 26

meds for HTN crisis

Answer 26

• Nitroprusside IV, titrate slowly or Nitro
• Labetalol
• Hydralazine

Question 27

aortic aneurysm if ruptures…

Answer 27

• monitor BP, rhythm, pulse Ox
• get ABGs, labs for CBC and coag
• need 2 large IV sites
• give IV fluid bolus and blood replacement
• initiate art line, foley, and get pt to surgery
• IV nitro to keep BP down and decrease chest pain
• IV BB to decrease workload on heart

Question 28

aortic aneurysm diagnosis

Answer 28

• ECHO

- angiogram

Question 29

if aortic aneurysm ruptures..

Answer 29

need help immediately, may have rapid decrease in BP (need surgery)