Cardiac Treatments

Question 1

Afib

Answer 1

O2 titrate to 94-99%, 
vitals, 
fluid tko, 
12 lead, 
PMH, HPI
meds, 
allergies

Question 2

Rate for uncontrolled Afib?

Answer 2

> 100bpm

Question 3

What rate do we treat new onset uncontrolled A-Fib, and with what medication?

Answer 3

> 170 cardizem - 0.25mg/kg, transport, monitor for changes
170 verapamil - 2.5-5mg

If unstable we Cardiovert at 120-200J

Question 4

Treatment for A-Flutter

Answer 4

Stable, fluid and O2 (94-99%)

> 170 cardizem - 0.25mg/kg, transport, monitor for changes
170 verapamil - 2.5-5mg

If unstable or symptomatic cardiovert (AHA says 50-100J)

Question 5

Junctional Rhythm

Answer 5

If pt is symptomatic:

• Atropine (1mg max dose 0.04mg/kg 3mg)
• Dopamine (5-20mcg/min or Epi (2-10mcg/min Drip

Unstable - Pace (80bpm - increase J until capture)

Question 6

Ventricular Rhythms

Answer 6

Symptomatic/ unstable: Pace (80bpm, J until capture)

• Epi (2-10mcg/min)
• dopamin (5-20mcg/min)
• O2 (94-99%)
• 12-lead

Question 7

1st Degree Heart Block

Answer 7

Supportive, nothing to really do, most likely not the reason for the call.

Question 8

2nd Degree Type 1 Heart Block

Answer 8

• Supportive
• O2 (94-99%)
  HYPOXIA is normally a big reason for the Heart Block
• Aspirin (if they have chest pain, 324mg)

Question 9

2nd Degree Type 2 Heart Block

Answer 9

• Supportive if stable
• O2 (94-99%)
• chest pain (324mg aspirin)
• Slow: Epi (2-10mcg/min) or Dopamine (5-20mvg/min)
• Unstable Brady, PACE

Question 10

3rd Degree (complete heart block)

Answer 10

• O2
• IV
• Chest Pain (324mg aspirin)
• Fluid Bolus 250-500ml
• Dopamine (5-20mcg/ml) Epi (2-10mcg/min) drip

Unstable: PACE
Transport

Question 11

S/s
Cause
Treatment

for

Pulmonary Embolism

Answer 11

S/s: SOB, sudden onset, do they have a hx of recent surgery, travel, life style?

Cause: air, thrombosis, fat

Treatment: Assessment, Lung sounds, 12-Lead, O2, supportive, IV, transport

Question 12

S/s
Cause
Treatment

for

Angina Pectoris

Answer 12

S/S: Stable (< 30mins) vs Unstable (> 30mins) Substernal Chest Pain

Causes: MI, Atherosclerosis, Hypoxia, Anything that causes the hearts O2 demand to go up

Treatment: Assessment, History, Aspirin (324 mg), 12 Lead for possible MI, Nitro (0.4mg PRN), O2 (>94%), IV, Transport

Question 13

S/s
Cause
Treatment

for

Thoracic Dissection

Answer 13

SS: Acute severe pain, sensation of tearing/ ripping/ shearing/ radiates to neck or back, LOC, SOB
DIFFERENT BILATERAL BP (20 Points)

Causes: chronic hypertension, congenital (Marfan syndrom)

Treatment: O2, bilateral large bore IV, treat for shock, get to proper ED for OR.

Question 14

S/s
Cause
Treatment

for

Myocardial Infarction

Answer 14

SS: Chest Pain, chest heaviness, SOB, Radiation of pain to the back or shoulder, arm pain, nausea, anxious, lethargic, diaphoretic, ST elevation

Cause: CAD, atherosclerosis, coronary artery spasms (cocaine)

Treatment: O2 (94-99%), ECG, Assessment and History, Aspirin (324mg), 12-lead, Nitro (0.4mg) not in right sided MI, IV, fluids, analgesics (fentanyl 1-2 mcg/kg), rapid transport and alert

Question 15

S/s
Cause
Treatment

for

Abdominal Aneurysm:

Answer 15

S/S: Pain in the abdomen or back. The pain may be severe, sudden, persistent, or constant. It may spread to the groin, buttocks, or legs. Syncope, nausea/vomiting,

Causes: Smoking, chronic HTN, Male gender, Congenital.

Treatment: O2, treat for shock, get to an OR.

Question 16

S/s
Cause
Treatment

for

Valvular Diseases/ Failure:

Answer 16

Causes:
Valvular stenosis, also called heart valve disease or narrowed valve, occurs when there is narrowing, stiffening, thickening, fusion or blockage of one or more valves of your heart. As a result, the defective valve may make your heart work very hard to pump blood through it. Valvular stenosis may occur in any of the four valves of your heart: the aortic valve, the mitral valve, the tricuspid valve or the pulmonic valve.

S/S:
Mild valvular stenosis may not show any symptoms, but as the stenosis worsens, symptoms of heart failure may develop.
Shortness of breath in the middle of the night while lying down
Fatigue
Chest pain
Swelling (edema) of the legs, ankles or other parts of the body
Dizziness and fainting
Palpitations
Heavy coughing, sometimes with blood-tinged sputum
Cyanosis (a bluish tint to the lips, skin and other areas of the body)
Multiple heart failure symptoms
Stroke

Treatment:
Nitro (0.4mg)
CPAP
If symptomatic:
Cardiogenic Shock Dopamine (2-10mcg/kg/min)
Or Epi 1:1,000 (1mg in a 250mL, 2-10mcg/kg/min)

Question 17

S/s
Cause
Treatment

for

Atherosclerosis

Answer 17

S/S:
chest pain or angina.
pain in your leg, arm, and anywhere else that has a blocked artery.
shortness of breath.
fatigue.
confusion, which occurs if the blockage affects circulation to your brain.
muscle weakness in your legs from lack of circulation.

Causes:
begins with damage to the endothelium caused by high blood pressure, smoking, or high cholesterol. That damage leads to the formation of plaque. When bad cholesterol, or LDL, crosses the damaged endothelium, the cholesterol enters the wall of the artery.

Treatment:
Pre-hospital: Supportive
Long-term:
Lifestyle changes: diet, exercise and stopping smoking can prevent the progression of the disease.
Medications: Antihypertensives and antihyperlipidemics can slow or stop the progression of the disease.
Surgical intervention: angioplasty- a tube with a balloon on it, and stenting, can be used to reopen occluded arteries.

Question 18

S/s
Cause
Treatment

for

Hypertensive Crisis

Answer 18

S/S:
Headache or blurred vision.
Increasing confusion.
Seizure.
Increasing chest pain.
Increasing shortness of breath.
Swelling or edema (fluid buildup in the tissues)

Causes:
O.D.s

Treatment:
Metoprolol (5mg IV, push until desired effect.)
Furosimide (20-40mg SIVP)
Mannitol-for ICP (0.5-2 g/Kg)