Cardiology Flashcards
Asystole
☆In the case of a patient with cardiac arrest where Basic Life Support (BLS) has been performed and the monitor reveals asystole, what are the following steps that typically taken as part of Advanced Cardiovascular Life Support (ACLS)?
- Continue High-Quality CPR: Ensure that chest compressions are of high quality, with a rate of 100-120 compressions per minute and a depth of at least 2 inches (5 cm) in adults, allowing full chest recoil between compressions.
- Ensure Adequate Oxygenation and Ventilation: Provide ventilation with 100% oxygen. Use a bag-mask device or an advanced airway if available. Ensure proper placement and secure the airway device.
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Epinephrine Administration:
- Administer 1 mg of epinephrine intravenously (IV) or intraosseously (IO) as soon as possible.
- Repeat every 3-5 minutes during the resuscitation efforts.
- Check for Reversible Causes (H’s and T’s): Identify and treat possible reversible causes of cardiac arrest, known as the H’s and T’s:
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H’s: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hyper-/hypokalemia, Hypothermia, Hypoglycemia
- T’s: Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary or coronary), Trauma
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Reassess Rhythm and Pulse:
- After 2 minutes of CPR, reassess the rhythm and check for a pulse.
- If asystole persists, continue CPR and administer epinephrine.
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Consider Advanced Airway and Capnography:
- If not already done, consider placing an advanced airway (endotracheal tube or supraglottic airway).
- Use waveform capnography to confirm and monitor correct placement of the airway device and effectiveness of CPR.
- Communication and Coordination: Ensure effective team communication and coordination throughout the resuscitation efforts. Assign specific roles to team members and rotate compressors every 2 minutes to avoid fatigue.
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Decisions Regarding Termination:
- If there is no return of spontaneous circulation (ROSC) after an appropriate duration of resuscitation efforts and all reversible causes have been addressed, consider discussing the potential for termination of resuscitative efforts based on the clinical situation and local protocols.
Throughout the resuscitation, it is crucial to follow ACLS guidelines and adapt the approach based on the patient’s response and any identified reversible causes.
☆What are the steps to treat VT in patients who have been saved from cardiac arrest and then develop ventricular tachycardia (VT)?
Note: The treatment approach depends on whether the VT is stable or unstable:
For Unstable Ventricular Tachycardia (with signs of hemodynamic compromise such as hypotension, altered mental status, chest pain, or heart failure):
For Stable Ventricular Tachycardia:
- Antiarrhythmic Medications:
- Amiodarone: 150 mg IV over 10 minutes, followed by an infusion of 1 mg/min for the first 6 hours.
- Lidocaine: 1-1.5 mg/kg IV bolus, followed by an infusion of 1-4 mg/min.
- Procainamide: 20-50 mg/min IV until the arrhythmia is suppressed, hypotension ensues, the QRS duration increases by more than 50%, or a maximum dose of 17 mg/kg is given.
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Observation and Monitoring:
- Continuous ECG monitoring in an ICU or similar setting.
- Frequent reassessment for any signs of hemodynamic instability.
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Immediate Synchronized Cardioversion:
- Deliver a synchronized shock starting at 100 Joules. Increase energy levels if necessary.
- Sedate the patient if time and circumstances permit, but do not delay cardioversion for sedation.
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Correct Underlying Causes:
Identify and treat reversible causes of VT, such as electrolyte imbalances (e.g., hypokalemia, hypomagnesemia), ischemia, or drug toxicity. - Advanced Airway Management and Support: Ensure the airway is secure and provide supplemental oxygen to maintain adequate oxygenation.
- Hemodynamic Support: Administer fluids or vasopressors (e.g., norepinephrine, dopamine) if the patient is hypotensive.
My answer:
Shock him by either 1 360 J monophasic or 120-200 J
Biphasic shock
Note ( Amiodarone is indicated for REFRACTORY VF at the 3rd cycle of BLS )
What is the optimal O2 saturation after successful ACLS ?
94% or above
How to treat hypotension in ptn just had cardiac arrest and you got him back ?
The systolic BP must be 90 or above.
If less then IV fluid bolus of 1-2 L of normal saline is given if BP is still low then epinephrine should be given ( 0.1-0.5 ) ugg/kg/min 0.1-0.5 ug/kg/min of norepinephrine or dopamine 5-10 ug/kg/min
Note ( Dobutamine is not part of the ttt )
How to treat hypotension in ptn just had cardiac arrest and you got him back ?
The systolic BP must be 90 or above.
If less then IV fluid bolus of 1-2 L of normal saline is given if BP is still low then epinephrine should be given ( 0.1-0.5 ) ugg/kg/min 0.1-0.5 ug/kg/min of norepinephrine or dopamine 5-10 ug/kg/min
Note ( Dobutamine is not part of the ttt )
How to treat a ptn in the ward after Having a surgery and is now having Asymptomatic bradycardia 40/min ? Then will become symptomatic?
In the beginning since the ptn is Asymptomatic just observation is enough but once we found the drop of BP for example in this case 70/35 then you must give Atropin 0.5mg IV push that can be repeated upto a limit of 3mg
عطينا اتروبين لان سبب هبوط الضغط هوا bradycardia وليس العكس
How to treat a ptn with VT but stable ( alert, BP is stable ect.) ?
Give 150 MG of Amiodarone over 10 minutes ( chemical cardioversion ) is the first line ttt in stable ptn
What does S1 represent? Ans S2? S3? S4
S1= closure of M & T valves
S2= closure of A&P valves
S3= rapid rush of blood from the atrium to the ventricle
S4= sudden slowing down of blood flow by the ventricle as the atrium contract
Explain physiological S2 splitting. when it happens?
It’s a physiological splitting . It happens when the ptn takes deep inspiration, which causes negative pressure in the chest, leading to more blood flow to the right side of the heart. Therefore, the pulmonary valve will close after the aortic valve
What’s paradoxic splitting and when do you see that?
It happens with LBBB. In this case, the pulmonary valve will close as usual during inspiration, but because of LBBB, the aortic valve is delayed
What are the right steps to hear abnormal heart sounds? And what does S3 , S4 suggest when heard ?
It’s better to have the ptn lies in the left lateral decubitus position
Because S3 and S4 are low pitched sounds, it’s better to be heard using the bill of the stethoscope
S4 comes after S1 and it suggests: Hypertrophic obstructive Cardiomypathies or LVH
S3 comes after S2 and it suggests: acute systolic heart failure, LVHF with dilatation (causing more blood filling to the LV)
What’s the average of atrial rate in Afib?
400 f wave /min
☆What’s the expected ventricular rate in patinet with atrial Fibrillation?
In patients with (AF), the expected ventricular rate can vary widely. It typically ranges from 100 to 175 beats per minute (bpm) if not controlled. The rate depends on factors such as the patient’s underlying heart condition, medications, and overall health. In well-managed cases, the ventricular rate can be brought down to a normal or near-normal range (60-100 bpm) with appropriate treatment.
What’s the expected rhythm and R-R interval in Afib?
The rhythm is totally irregular
R-R Interval is typically unequal
What do you expect the QRS to be in Afib?
Usually normal unless there’s preexisting intraventricual conduction delay
