Cardiovascular Flashcards
Indications for Adrenaline 1:10,000?
Cardiac arrest.
Post-ROSC.
Cautions for Adrenaline 1:10,000?
Hypertension may occur in patients on non-cardioselective beta blockers (e.g. propranolol)
Actions of Adrenaline 1:10,000?
It is a sympathomimetic that stimulates alpha and beta adrenergic receptors.
Enhances myocardial and cerebral blood flow.
Increases peripheral resistance and perfusion pressure.
Contra-indications for Adrenaline 1:10,000?
Do not give if core temp <30.
Between 30-35, double the dose period.
Dose of Adrenaline 1:10,000 for cardiac arrest and post-ROSC?
Cardiac arrest: 1 mg in 10 ml repeated every 3-5 minutes, with no limit.
Post-ROSC: 50 mcg in 0.5 ml, and a repeat dose of 50-100 mcg in 0.5-1 ml every 3-5 minutes with no limit.
Indications for Amiodarone?
Shockable rhythms. After the 3rd and 5th shock.
Actions of Amiodarone?
Anti-arrhythmic. Lengthens cardiac action potential and refractory period. Prolongs QT interval.
Blocks Na and K channels in cardiac muscle, reduces electrical irritability.
Contra-indications of Amiodarone?
Core temp <30.
Side effects of Amiodarone?
Bradycardia.
Vasodilation - hypotension.
Bronchospasm.
Arrhythmias - Torsades de pointes.
Dose of Amiodarone?
Administer into large veins, and flush with 20 ml fluid.
300 mg after 3rd shock, 150 mg after 5th shock.
Indications of Aspirin?
Clinical evidence of MI or ischaemia.
Suspected TIA and: symptoms fully resolved, patient is not being conveyed, and referred to TIA pathway.
Actions of Aspirin?
Anti-platelet, reduces clot formation.
Contra-indications of Aspirin?
Known allergy or sensitivity.
<16 years.
Active GI bleed.
Haemophilia or clotting disorder.
Severe hepatic failure with jaundice.
Side effects of Aspirin?
Increased risk of GI bleeding.
Wheezing in some asthmatics.
Indications of Atropine?
Symptomatic bradycardia, to include:
Absolute bradycardia (<40 bpm).
Systolic BP below expected for age.
Paroxysmal ventricular arrhythmias.
Inadequate perfusion causing confusion, etc.
Bradycardia following ROSC.
Contra-indications of Atropine?
Suspected hypothermia.
Cardiac transplant - hearts will not respond to vagal blocking.
Actions of Atropine?
Blocks vagal activity and increases heart rate.
Side effects of Atropine?
Dry mouth, visual blurring and pupil dilation.
Confusion and hallucinations.
Tachycardia.
No <100 mcg doses, can cause bradycardia.
Dose for Atropine?
600 mcg every 3-5 minutes, to a max of 3 mg.
Administer as rapid bolus.
Indications for Furosemide?
Pulmonary oedema and/or respiratory distress in acute heart failure.
Actions of Furosemide?
Potent diuretic with a rapid onset and short duration.
Contra-indications of Furosemide?
Reduced GCS with liver cirrhosis.
Cardiogenic shock.
Severe renal failure with anuria.
<18 years.
Cautions of Furosemide?
Hypokalaemia can induce arrhythmias.
Pregnancy.
Hypotension.
Side effects of Furosemide?
Hypotension.
GI disturbance.
Dose of Furosemide?
40 mg in 4ml, slowly over 2 minutes.
Indications of GTN?
Cardiac chest pain due to angina or MI, when systolic BP >90.
Consider GTN in heart failure with ischaemia or hypertension.
Chest pain and suspected cocaine toxicity.
Actions of GTN?
Potent vasodilator.
Dilates coronary arteries/relieves coronary spasm.
Dilates systemic veins resulting in lower pre-load.
Lowers BP.
Cautions of GTN?
Suspected posterior MI or right-ventricular infarction.
Contra-indications of GTN?
Hypotension, <90 in angina/MI, or <110 in heart failure.
Hypovolaemia.
Head trauma.
Cerebral haemorrhage.
Viagra and related drugs taken within 24 hours.
Unconscious.
Severe aortic or mitral stenosis.
Side effects of GTN?
Headaches.
Dizziness.
Hypotension.
Dose for GTN?
400-800 mcg, or 1-2 sprays, every 5-10 minutes with no limit.
Indications for TXA?
Actual or suspected severe haemorrhage:
- Time critical injury where significant internal haemorrhage is known/suspected
- >18 with known/suspected head injury, GCS 12 or less, within the last 3 hours
- PPH after misoprostol, if bleeding continues after 15 minutes.
In trauma:
- BP <90 or absent radial pulse or pulse >110 believed to be due to bleeding
- Haemostatic gauze, tourniquet, chest dressing, or pressure dressing applied
- Traumatic cardiac arrest
Side effects of TXA?
Nausea.
Vomiting.
Diarrhoea.
Rapid injection may cause hypotension.
Dose of TXA?
500 mg in 5 ml, over 10 minutes.
