Cardiac stuff

Question 1

What is the protocol for PEA?

Answer 1

Epi 1mg IV q3-5 mins

if PEA rate slow - atropine 1mg q3-5 mins max 0,04mg/kg

Question 2

Common causes VT/VF/PEA? (Hs + Ts)

Answer 2

Hypovolemia
Hypothermia
H+ (acidosis)
Hyper/hypokalemia
Hypothermia
Tamponade
Tension pneumo
Thrombosis (coronary/PE)
Toxins (drug OD)

Question 3

What is the protocol fora systole?

Answer 3

Epi 1mg IV q3-5mins
Atropine 1mg IV q3-5 mins (max 3g)
Transcutaneous pacing

Question 4

Protocol for bradycardia

Answer 4

Atropine 0.5-1mg
transcutaneous pacing
dopamine 5-20mcg/kg/min
Epi 2-10mcg/min
Isoprotenerol 2-20mcg/min

Question 5

What tachyarrhythmias would you use SYNC cardioversion?

Answer 5

UNSTABLE

• A fib
• A flutter
• VT
• PSVT

palpable pulse and unstable = synchronize!!

Question 6

Three treatment considerations for A Fib

Answer 6

Rate control
Rhythm controol
Anticoagulate

Question 7

Avoid these classes of meds in WPW (4)

Answer 7

BBs
CCBs
Adenosine
digoxin

Question 8

What is the time cutoff for converting a fib before you should consider anticoagulation first?

Answer 8

48hrs

Question 9

If A fib ongoing >48hrs, how long should pt be anticoagulated for?

Answer 9

3 weeks

Question 10

Methods of rhythm control in a fib

Answer 10

Sync cardioversion
Amiodorone
Procainamide

Question 11

This investigation can be done in a patient with A fib who has not been anti coagulated but hoping to cardiovert safely

Answer 11

TEE to rule out atrial clot

Question 12

Why must AV node blocking meds be avoided in WPW?

Answer 12

Follows aberrant pathway and worsens dysrhythmia. Delta waves on EKG

Question 13

Initial medical management for stable SVT?

Answer 13

Vagal stimulation

Adenosine

Question 14

Best a fib management in patients with HF?

Answer 14

Digoxin or diltiazem or amiodorone

Avoid BB

Question 15

Preliminary approach to all ACS?

Answer 15

Morphine (only if pain)
Oxygen (only if decreased  sats)
Nitro
ASA
BB
ACEi
Statin
Heparin
Clopidogrel

Question 16

Management for ST elevation or new LBBB?

Answer 16

Suspect injury
IV: nitro, BB, heparin
ACEi after 8hr or when stable
<12hrs from onset - Cath or fibrinolysis
>12 hrs from onset - high risk to Cath lab or CABG; low risk = CCU

Question 17

Management for ST depression or T wave inversion

Answer 17

Suspect ischemia
Heparin, ASA, IV nitro, BBs
Stable = CCU
High risk = PCI or CABG

Question 18

What is malignant hyperthermia?

Answer 18

Defect in Ca2 metabolism = increased intracellular Ca2 = hyper catabolism and decreased ATP

Question 19

What are triggers for malignant hyperthermia

Answer 19

Inhalational agents (“ane”s)
Depolarizing muscle agents - SCh, decamethonium
Amide based local anesthetics

Question 20

Signs and symptoms of malignant hyperthermia?

Answer 20

High fever/diaphoretic
Tachydardia/dysrhythmia
HTN
Rigidity
Trismus
Tachypnea/cyanosis with resp acidosis and hypercapnia
HyperK
HyperCa
Metabolic  acidosis
Increased myoglobin
Increased CK

Question 21

Treatment for malignant hyperthermia?

Answer 21

Stop anesthetic and SCh
Hyperventilate with 100% O2
Dantrolene - 2-10mg/kg (blocks release of Ca); give in 1mg/kg increments
Active coolinng
Correct electrolyte and acid base abnormalities

Question 22

How to prevent malignant hyperthermia

Answer 22

Avoid triggers
Ppx dantrolene NOT indicated
Regional anesthesia if possible
Thiopental and propofol SAFE to use
Adrenaline NOT safe

Question 23

Complications of malignant hyperthermia

Answer 23

Death
DIC
Coma
Muscle necrosis/weakness
Myoglobin renal failure
Lyte abnomalities

Question 24

Protocol for pulseless VT/VF

Answer 24

SHOCK 200 –> 300 –> 360
Epi 1g IV q3-5 mins or vasopression 40U IV x1
Amiodorone 300 mg IV
If torsades - 5g MgSO4 IV