Cardiovascular Emergencies Flashcards
Learn about cardiovascular emergencies and their treatments
What are the three presentations of angina-type pain patients?
- Angina
- STEMI
- NSTEMI
Define:
fibrinolysis
The process of breaking down and removing blood clots in the body.
It involves the enzyme plasmin which dissolves fibrin, the protein that forms clots.
Define:
PCI
Percutaneous Coronary Intervention
Interpret what is going on in this 12-Lead.
Inferior STEMI
- Elevation in II, III, aVF.
- Reciprocal Changes in I and aVL.
- Elevation is >1 mm in two contiguous leads.
What is the treatment for inferior STEMI?
Determine if Right Ventricular Involvement is present
Immediate medical care, administer:
- Oxygen
- aspirin
- Nitroglycerine (If no RVI, or if volume replacement has been completed)
- Morphine/Fentanyl
Interpret what is going on in this 12-Lead.
Anterior STEMI
- Elevation in V3, V4.
- Reciprocal Changes in Posterior Leads if obtained.
- Elevation is >1mm in two contiguous leads.
Interpret what is going on in this 12-Lead.
Septal STEMI
- Elevation in V1, V2.
- Reciprocal changes in lateral leads.
- Elevation is >1 mm in two contiguous leads.
Interpret what is going on in this 12-Lead.
Posterior STEMI
- Depression in anterior leads (posterior 12-lead will reveal elevation).
What is a benign early repolarization?
A fishhook appearance at the J-point with a concave ST-segment.
It is often mistaken for ST Elevation.
Reciprocal changes are never present.
What pathology is in the 12-Lead?
Pericarditis
Diffuse ST segment elevation throughout.
Results from a bacterial, viral or fungal infection.
What pathology is in this 12-Lead?
Pulmonary Embolism
- S1Q3T3 Present
- Deep S Wave Lead I
- Deep Q Wave Lead III
- T wave inversion Lead III
- Thorough Hx and Exam pertinent to suspicion
What changes are seen on a 12-Lead when a patient has Hyperkalemia?
- tall, peaked T waves
- P waves can be flat
What changes are seen on a 12-Lead when a patient has Hypokalemia?
flat/absent T waves (U-wave)
What changes are seen on a 12-Lead when a patient has Hypocalcemia?
widening of QT interval
What changes are seen on a 12-Lead when a patient has Hypercalcemia?
shortened QT interval
How long is the QT interval in long QT syndrome?
>450 ms
What are the two placements for defibrillation pads?
- Anterior-Lateral
- Anterior-Posterior
What rhythm(s) is defibrillation used for?
Pulseless Rhythms
- Ventricular Tachycardia (w/o Pulse)
- Ventricular Fibrillation
What rhythm(s) is Synchronized Cardioversion used for?
Unstable Tachydysrhythmias
- SVT
- A-fib RVR
- V-tach
What energy level (in joules) is used for adult defibrillation?
200-300-360
What energy level (in joules) are used for adult synchronized cardioversion?
50-100-200-300-360
What two types of capture should you assess during transcutaneous pacing?
electrical and mechanical
What are some treatments for adult symptomatic bradycardia?
- Atropine 0.5-1mg (New ACLS indicates 1mg)
- TCP (First Line if 2nd Degree II or 3rd Degree)
- Dopamine (2-20mcg/kg/min)
- Epinephrine (2-10mcg/min)
What are the treatments for adult SVT?
- Vagal Maneuvers
- Adenosine (6mg, 12mg)
- Synchronized Cardioversion
What are the treatments of V-Tach (w/ a pulse)?
Hint: unstable vs. stable
Stable:
- Amiodarone: 150mg/10 (1mg/min maintenance infusion) or Lidocaine 1-1.5mg/kg (MAX 3mg/kg)
Unstable:
- Synchronized Cardioversion 50-100-200-300-360
What is the treatment for Asystole and PEA?
- Epinephrine: 1mg
- CPR
What are the American Heart Association’s termination criteria for conducting CPR in the field?
- No witnessed collapse
- No bystander CPR
- No ROSC after ALS care
- No shocks administered
What is the leading cause of death in the U.S.?
Coronary Artery Disease
What is the cause of Prinzmental Angina?
Coronary Artery Vasospasm
It is characterized by chest pain at rest.
Define:
Unstable Angina
It is identified by changes in duration, severity and frequency of chest pain felt by the patient.
Fill in the blank.
The therapy in which a clot is dissolved is called ______ ______.
fibrinolytic therapy
Define:
Congestive Heart Failure
The heart is unable to properly empty its chambers.
Left or right.
Pulmonary edema is a result of ____ sided heart failure
Peripheral edema is a result of ____ sided heart failure
left
right
Treatment:
Left Sided Heart Failure
- Oxygen
- CPAP
- sit patient up while feet is dangling
- Nitroglycerine .4mg
- Lasix 20-40mg
- Morphine 3mg
- Dopamine 2-20mcg/kg/min (low BP)
Define:
cardiac tamponade
Fluid accumulates in the pericardium.
What are the signs/symptoms of cardiac tamponade?
- Dyspnea
- Weakness
- Chest Pain
- Beck’s Triad
What are the clinical signs of Beck’s triad?
- Muffled heart sounds
- Jugular venous distention
- Narrowing pulse pressure
Treatment:
cardiac tamponade
pericardiocentesis
Define:
aortic aneurysm
Abnormal bulging of aortic vessel from a weak spot in the aortic wall.
What are the signs/symptoms of aortic aneurysm?
- sudden substernal “pressure”
- weakness
- sweating
What are the signs/symptoms of ruptured aortic aneurysm?
- Sudden lower back pain.
- Pain radiating into thigh and groin.
- Possible palpable mass in abdomen.
Treatment:
ruptured aortic aneurysm
- Administer oxygen.
- IV/consider crystalloid bolus if px is hypotensive.
- Keep the patient calm.
What is considered a hypertensive emergency?
A sudden elevation of BP that causes end-organ damage.
What are the signs/symptoms of hypertensive end-organ damage?
- blurred vision
- headache
- epistaxis
- tinnitus
Fill in the blank.
A MAP > ____ mmHg breaches the blood brain barrier.
Mean Arterial Pressure
150 mmHg
Define:
hypertensive encephalopathy
An acute neurological symptoms resulting from a sudden and severe elevation in blood pressure.
BP >200/130 mmHg
MAP >150 mmHg
Treatment:
hypertensive emergency
- 12-Lead
- Labetalol 20mg slow IVP
- Labetalol 2 mg/min infusion
- Nitroglycerine .4mg SL
Define:
endocarditis
Inflammation of the endocardium.
Define:
rheumatic fever
Inflammatory response to streptococcal bacteria.
It can cause stenosis of the mitral valve.
Define:
scarlet fever
An infection caused by Streptococcus Pyogenes
group A Streptococcus
What are the signs/symptoms of scarlet fever?
- sore throat
- fever
- rash
- “strawberry” tongue
