Cardiology Flashcards
1
Q
If a patient presents with bradycardia, what should you look for?
A
Adverse Features
2
Q
What are the four adverse features
A
HF
Myocardial ischaemia
Shock
Syncope
3
Q
If a patient has bradycardia with adverse features what should you do
A
IV atropine 500mcg
4
Q
What dose of atropine is given
A
IV 500mcg
5
Q
If a patient with bradycardia has a satisfactory response to 500mcg IV atropine what is done
A
Assess if they are at-risk of asystole
6
Q
What 4 factors make a patient at-risk of asystole
A
- Recent asystole
- Ventricular pause >3s
- Mobitz II AV block
- Complete HB, Broad QRS
7
Q
If a patient is not at risk of asystole what is done
A
Observe
8
Q
If a patient is at-risk of asystole what is done
A
Repeat IV atropine 500mcg IV
9
Q
what is the maximum dose of atropine that can be given
A
Up to 3mg
10
Q
what happens if there is not a satisfactory response to atropine
A
Repeat up to 3mg IV
11
Q
what is an alternative approach to repeating atropine
A
Transcutaenous Pacing
12
Q
what other drugs can be given as an alternative to atropine
A
Adrenaline
Isoprenaline
13
Q
what is the mnemonic to remember STEMI management
A
MONARTH
14
Q
what is given in a STEMI
A
Morphine, Metclopramide Oxygen GTN Aspirin Reperfusion Ticagrelor Heparin
15
Q
what dose of morphine is given
A
5mg IV morphine (4-hourly)
16
Q
what should be given with IV morphine
A
IV Metclopramide
17
Q
what dose of metclopramide is given
A
10mg
18
Q
what dose of GTN is given
A
500mcg sublingual
19
Q
how often can GTN spray be repeated
A
every 5-minutes
20
Q
what is the maximum dose of GTN spray that can be given
A
3 doses
21
Q
what loading dose of aspirin is given
A
300mg PO
22
Q
what is the long-term dose of aspirin
A
75mg OD
23
Q
what is the loading dose of ticagrelor
A
180mg PO
24
Q
what dose of fondaparinux is given
A
2.5mg SC
25
when should fondaparinux be stopped
Continue for 8-days. Stop 24h before CABG surgery if intended
26
when is PCI attempted
- STEMI on ECG
| - Can reach reperfusion centre in 120min
27
if PCI is not available what is performed
Fibrinolysis
28
what is used for fibrinolysis
Tenectaplase
29
what time frame should tenectplase be implemented
WITHIN 6-HOURS OF SYMPTOMS
30
how is tenectplase given
30-60mg over 10s
31
what should be ordered after tenectplase
ECG
32
what are you looking for on post-tenectplase ECG
50% resolution in ST elevation
33
if there is not 50% reduction in ST elevation, what is done
Rescue PCI
34
how is a patient with NSTEMI initially managed
Initial drug-management
35
what is included in the initial drug-treatment of NSTEMI
```
IV morphine, IV metoclopramide
Sublingual GTN
Aspirin (300mg)
Ticagrelor (180mg)
Fondaparinux (2.5mg)
```
36
what dose of morphine is given
5mg IV
37
what dose of sublingual GTN is given
500mcg
38
what dose of aspirin is given
300mg
39
what dose of ticagrelor is given
180mg
40
when is fondaparinux not given
Do not give unless angiography in next 24h is planned
41
after initial management of NSTEMI what is performed
Calculate GRACE score
42
what dose the GRACE score calculate
Risk of in-hospital mortality and 6-month mortality
43
what is required to calculate GRACE score
```
Age
HR
BP
Cardiac enzymes
Creatinine
Cardiac arrest on admission
Killip class
ST segmenet elevation
```
44
what GRACE score indicates a high-risk of mortality
More than 1.5
45
what is given if a high GRACE score
Clopidogrel 300mg
46
what is given if GRACE score is more than 3
Clopidogrel 300mg
| Glycoprotein Inhibitors
47
name two glycoprotein inhibitors
Tirofiban
| Eptifbatide
48
what is the criteria for giving glycoprotein inhibitors
- GRACE score more than 3
| - Due to have PCI
49
if GRACE score less than 1.5 what is done
Clopidogrel 300mg - if PCI in next 24 hours
50
how is a NSTEMI with GRACE score less than 1.5 managed
Outpatient
- Stress test
- Elective angiography and PCI
51
how should patients with tachyarrythmias be approached
A-E
52
what is first looked for in patients with tachyarrythmias
Adverse Features
53
what are the 4 adverse features of tachyarrhythmias
HF
Myocardial Ischaemia
Shock
Syncope
54
if a patient has any adverse features what should be done
DC Cardioversion
55
how many attempts of DC cardioversion should be conducted
3
56
what is given after third attempt of DC cardioversion if not responding
300mg IV amiodarone over 10-20min
57
what dose of amiodarone is given
300mg IV, 10-20min
58
if not responding to 300mg IV amiodarone what is given
900mg IV amiodarone over 24h
59
if patient is stable with tachycarrythmia was is assessed
Narrow or Broad QRS
60
what defines a narrow QRS complex
Less than 0. 12s
61
if a broad QRS what then needs to be looked at
Regular or irregular
62
what does a regular broad-QRS tachyarrythmia likely indicate
VT
63
how is VT managed
IV amiodarone over 20-60 minutes
64
what dose of amiodarone is given for VT
300mg over 20-60 minutes
65
what is an alternative regular broad-complex tachycardia to VT
SVT with BBB
66
how is SVT with bundle branch block managed
As a narrow-complex tachycardia
67
what is an irregular broad-complex tachyarrythmia
AF with BBB
| Pre-excited AF
68
what defines a narrow complex tachycardia
<0.12s QRS
69
what is an irregular narrow-complex tachycardia
AF
70
how is AF managed
B-blocker or diltiazem
71
if a patient has an irregular narrow-complex tachycardia AND HF - what is used?
Digoxin or amiodarone
72
what is a narrow-complex regular tachyarrythmia
SVT
73
how is a narrow-complex tachyarrythmia initially managed
Vagal manouveres
74
name 2 vagal manouveres
Vasaval maneurvre
| Carotid sinus massage
75
if vagal manouveres fail what is given
6mg IV adenosine
76
what dose of adenosine is given
6mg IV
77
if no effect after 6mg iV adenosine, what is given
12mg IV adenosine
78
if no effect after 12mg IV adenosine, what is given
12mg IV adenosine
79
if sinus rythm is achieved after adenosine what does it likely indicate
re-entry SVT
80
if sinus rythm does not return after adenosine what may it indicate
Atrial Flutter
81
what is a CI to adenosine
Asthma
82
what is a mneumonic to remember the causes of cardiac arrest
4Hs
| 4Ts
83
what are the 4Hs that can cause cardiac arrest
- Hypoxia
- Hypothermia
- Hypoglycaemia, Hypocalcaemia, Hyperkalaemia
- Hypovolaemia
84
what are the 4Ts that can cause cardiac arrest
- Thrombosis
- Tension pneumothorax
- Toxins
- Tamponade - cardiac
85
how are rhythms associated with cardiac arrest divided
1. Shockable
| 2. Non-Shockable
86
what are the two non-shockable rhythms
PEA
| Asystole
87
what are the two shockable rhythms
pulseless VT
| VF
88
if a patient is unresponsive and not-breathing what should be done first
Call resuscitation team
89
what is done after resuscitation team are called
Start chest compressions
90
what is the ratio of chest compressions
30:2
91
what should be done whilst CPR is ongoing
Attach self-adhesive defibrillator pads
92
where are the defibrillation pads attached
1. Below right clavicle
| 2. V6 Mid-Axillary Line
93
what should be done once defibrillation pads attached
Stop CPR (5 seconds) to assess the rhythm
94
what is done if rhythm is shockable
Shock
95
how long is CPR continued for before the next shock
2-minutes
96
how many shocks are performed before adrenaline is given
3 shocks
97
what dose of adrenaline is given
1mg IV (1:10,000)
98
what is given in addition to adrenaline
Amiodarone 300mg IV
99
how often is IV adrenaline given
every 3-5 minutes
100
when is further amiodarone considered and what dose
After the 5th shock (150mg)
101
if a patient has witnessed (on cardiac monitoring) episode of VT or VF what is done
3 successive shocks then start CPR for 2-minutes
102
what is PEA
electrical activity that would normally be associated with a palpable pulse. There is electrical activity but not enough to maintain SBP above 80mmHg
103
how are non-shockable rhythms managed
- CPR 30:2
- 1mg adrenaline IV as soon as access achieved
- Continue CPR 30:2
- Give adrenaline every 3-5 minutes
