Cardio Flashcards
defribrillator shock dosages
2J/kg then 4J/kg max 10J/kg for peds)
resume CPR after shock
epi doses during code
1mg IV/IO (0.01mg/kg) Q3-5min
amio doses during code
1) 300mg
2) 150mg
reversible causes of Cardiac arrest H’s
Hypovolemia hypoxia hyperkalemia hydrogen ion(acidosis) hypoglycemia hypothermia
reversible causes of cardiac arrest T’s
tension pneumo
tamponade
thrombosis (PE,MI)
toxins
range for therapeutic hypothermia
32-36degrees celsius for >24hrs
post arrest managment
therapeutic hypothermia
bolus fluids
vasopressors/inotropes to maintain MAP>65
electrolyte goals K>4 and Mg >2
brugada syndrome
inherited myocardial ion channel disorder –> malignant ventricular arrhythmias and sudden cardiac death
dx of brugada syndrome
ekg ST segment elevation in V1-V3 followed by negative T wave
management of brugada syndrome
ICD
congenital long QT syndrome
inherited mutations in myocardial ion channels –> prolonged QT
increased risk of torsades de pointes and sudden cardiac death
presentation of congenital long QT syndrome
syncope
torsades de pointes
sudden cardiac death
risk of dysrhythmias highest when QTc >500
management of WPW
procainamide or synchronized electrical cardioversion
management of AVRT (narrow complex tachy)
can also be wide at times
vagal maneuvers
adenosine
CCBs or BBs
DC cardioversion if unstable
VSD
mc congenital heart dz
L–> R shunt
holosystolic murmur 2-6wks og age
poor feeding, failure to thrive, hepatomegaly
ASD
fixed split S2
PDA
continuous machine like murmur
L –> R shunt
tx indomethacin or sx
left sided ductal dependent lesions
prostaglandin E1 to increased flow thru ductus arteriosus
ADR: apnea
TOF
VSD
overriding aorta
pulm stenosis
RVH
management of ruptured AAA
permissive hypotension 80-100
emergent Sx consult
types of aortic dissections
standford A: ascending aorta, emergent sx
standford B: descending aorta (less severe)
esmolol HR 60s BP 100-120
ABI for thromboembolism
<0.9 indicates impaired blood flow
management of mesenteric ischemia
broad spec (metro, etc) emegenct sux resection of necrotic bowel
wells criteria DVT
active cancer (1) bedridden or sx <4wks (1) calf swelling >3 (1) collateral superficial veins (1) entire leg swollen (1) localized tenderness (1) pitting edema (1) paralsysis (1) previous DVT (1)
wells score interpretation and tx
1-2 mod risk
>2 high risk
anticoagulation - LMWH or unfractionated heparin or NOAC
most common physical exam finding in PE pts
tachycardia
tachypnea also common
Wells criteria PE
clinical signs and symptoms of DVT (3) PE #1 dx (3) HR >100 (1.5) immobilization >3 days or sx w/in 4wks (1.5) previous DVT or PE (1.5) hemoptysis (1) malignancy w/ tx <6mnths (1)
wells PE Criteria interpretation
<5 = PE unlikely
> 4 = PE likely
PERC def
if no criteria are (+) then < 2% chance of PE so r/o basically
PERC criteria
age >50 HR >100 SaO on RA <95% unilateral leg swelling hemoptysis recent sx or trauma (w/in wks) Prior DVT or PE hormone use
most common sign on EKG for PE
sinus tachycardia
non specific ST-T changes
EKG signs for PE
sinus tachy
non specific ST-T changes
new RBBB
S1Q3T3
S1Q3T3
means PE
S wave in lead I
Q wave in lead III
T wave inversion in III
CXR of PE patient
mc - NML
hamptons hump - wedge shaped density indicated infarcted lung
westermakrs - paucity of vessel markings
echo findings of a massive PE
RV dilation
RV hypokinesis
Dilated IVC
tx of PE
anticoagulation w/ unfractionated hep or LMWH or NOACs
tPA for massive PE
embolectomy
junctional tachycardia
junctional escape
100-130
nopreceeding p waves
SVT (AVnRT)
150-250
regular
no discernable pwaves
management of SVT (AVnRT)
stable pts = (1)vagal maneuvers –> (2)
adenosine 6-12mg bolus IV –> (3)
CCBs (dil, verap) or
Beta Blockers
SVT (WPW, LGL)
narrow = orthodromic
wide-complex = antidromic
AVnRT vs Afib
AVnRT = regular, very faster
Afib = irregular, fast or nml
synchronized cardioversion is performed at what voltage
120-200 and can if needed go to 360J
causes of atrial flutter
idiopathic valvular heart dz cardiomyopathy hyperthyroidism PE chronic lung disease `
? aflutter vs SVT next step
use adenosine to block AV node and visualize the saw tooth waves
tx of atrial flutter
unstable - synchronized cardioversion (25-50J) sensitive to low voltages
stable - diltiazem or beta blockers
causes of V tach
structural heart dz trauma hypothermia hypoxia severe electrolyte issues brugada congenital long GT QT prolonging meds
tx of VTach
pulseless - defib CPR
unstable - syn cardiovert start at 100J (sedate if time)
stable- (1) procainamide 100mg IV over 2min Q5min or continuous infusion
(2) amio 150mg IV over 10min then infusion
(3) lido 1mg/kg IV over 5min then infusion
causes of Pulseless electrical activity
H’s and T’s
tx - CPR, IV epi
NIPPV for CHF
decreases preload and afterload
improves work of breathing
PEEP = most important, decreases preload and stents open airways
when should you be weary of CHF without fluid overload
in new onset afib with RVR since patient is not fluid overloaded
pressors for CHF with hypotension
NE - reduced risk for arrhythmias but increases afterload
Dopamine w/ dobutamine has greater inotropy than NE (but will initially decrease BP so no use if sys <70)
initial management of ACS
aspirin (162-324mg)
nitro
oxygen (only if hypoxemic)
pain control (morphine watch BP)
wellens syndrome
- biphasic T waves
- deep symmetric T wave inversions in anterior precordial leads
= proximal LAD occlusion HIGH irsk for progression to anterior MI
inferior STEMI
ST elevation in II, III and aVF
anterior MI
ST elevation in V2-4
septal MI
ST elevation V1-2
lateral MI
ST elevation in I, aVL, V5, V6
posterior MI
ST depression in V1-V4
earliest finding on EKG for STEMI
HYPER acute T waves
sgarbossa criteria for STEMI with preexisting LBBB
concordant ST Elevation >1mm in leads with (+) QRS complex (5pts)
ST depression >1mm in V1-3 (3pts)
Excessive discordant ST elevation >5mm in leads with (-) QRS (2pts)
sgarbossa score interpretation
score >2 = 90% specificity for dx of MI
complications of STEMI
- cardiogenic shock from LV failure
- Heart Block
Tachydysrhythmias (Vfib mc complication)
LV wall rupture
papillary muscle rupture
ventricular aneury
echo of myocarditis
dilated chambers
hypokinesis
myocardial biopsy is gold standard
tx of refractory pericarditis
steroids
physical exam finding of aortic stenosis
crescendo decresendo systolic murmur radiating to carotids
aortic stenosis on EKG
LVH with strain
LBBB
management of aortic stenosis
- avoid nitrates
- give gentle fluids if hypotensive
- diuresis if CHF
valves affected by infective endocarditis
mitral regurg —> mitral stenosis with time
mcc of chronic mitral regurgitation
afib
causes of narrow QRS PEA arrest
- hypovolemia
- pericardial effusion leading to tamponade
- PE
- pneumo
management of TOF
- flex knees to chest
- morphine/ intranasal fentanyl to decrease pulm vasc resistance
- phenylepi/ NE to increase SVR
- IVF for volume expansion
mc tachydysrthmia in WPW patients
SVT
followed by afib and then atrial flutter 3rd
what is targeted temp for post ROSC following cardiac arrest
32-34
89.6-96.8
