Cardiac stuff Flashcards
What is the protocol for PEA?
Epi 1mg IV q3-5 mins
if PEA rate slow - atropine 1mg q3-5 mins max 0,04mg/kg
Common causes VT/VF/PEA? (Hs + Ts)
Hypovolemia Hypothermia H+ (acidosis) Hyper/hypokalemia Hypothermia Tamponade Tension pneumo Thrombosis (coronary/PE) Toxins (drug OD)
What is the protocol fora systole?
Epi 1mg IV q3-5mins
Atropine 1mg IV q3-5 mins (max 3g)
Transcutaneous pacing
Protocol for bradycardia
Atropine 0.5-1mg transcutaneous pacing dopamine 5-20mcg/kg/min Epi 2-10mcg/min Isoprotenerol 2-20mcg/min
What tachyarrhythmias would you use SYNC cardioversion?
UNSTABLE
- A fib
- A flutter
- VT
- PSVT
palpable pulse and unstable = synchronize!!
Three treatment considerations for A Fib
Rate control
Rhythm controol
Anticoagulate
Avoid these classes of meds in WPW (4)
BBs
CCBs
Adenosine
digoxin
What is the time cutoff for converting a fib before you should consider anticoagulation first?
48hrs
If A fib ongoing >48hrs, how long should pt be anticoagulated for?
3 weeks
Methods of rhythm control in a fib
Sync cardioversion
Amiodorone
Procainamide
This investigation can be done in a patient with A fib who has not been anti coagulated but hoping to cardiovert safely
TEE to rule out atrial clot
Why must AV node blocking meds be avoided in WPW?
Follows aberrant pathway and worsens dysrhythmia. Delta waves on EKG
Initial medical management for stable SVT?
Vagal stimulation
Adenosine
Best a fib management in patients with HF?
Digoxin or diltiazem or amiodorone
Avoid BB
Preliminary approach to all ACS?
Morphine (only if pain) Oxygen (only if decreased sats) Nitro ASA BB ACEi Statin Heparin Clopidogrel
Management for ST elevation or new LBBB?
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
Management for ST depression or T wave inversion
Suspect ischemia
Heparin, ASA, IV nitro, BBs
Stable = CCU
High risk = PCI or CABG
What is malignant hyperthermia?
Defect in Ca2 metabolism = increased intracellular Ca2 = hyper catabolism and decreased ATP
What are triggers for malignant hyperthermia
Inhalational agents (“ane”s)
Depolarizing muscle agents - SCh, decamethonium
Amide based local anesthetics
Signs and symptoms of malignant hyperthermia?
High fever/diaphoretic Tachydardia/dysrhythmia HTN Rigidity Trismus Tachypnea/cyanosis with resp acidosis and hypercapnia HyperK HyperCa Metabolic acidosis Increased myoglobin Increased CK
Treatment for malignant hyperthermia?
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
How to prevent malignant hyperthermia
Avoid triggers Ppx dantrolene NOT indicated Regional anesthesia if possible Thiopental and propofol SAFE to use Adrenaline NOT safe
Complications of malignant hyperthermia
Death DIC Coma Muscle necrosis/weakness Myoglobin renal failure Lyte abnomalities
Protocol for pulseless VT/VF
SHOCK 200 –> 300 –> 360
Epi 1g IV q3-5 mins or vasopression 40U IV x1
Amiodorone 300 mg IV
If torsades - 5g MgSO4 IV
