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CSC Prep > Ch. 8 Electrical issues > Flashcards

Ch. 8 Electrical issues Flashcards

1
Q

Atrial fibrillation risk factors - why do the following put someone at risk for atrial fibrillation
1. valvular disease - mitral regurgitation
2. mitral valve disease
3. MI/CAD
4. HTN/LVH
5. OSA
6. Lung Disease/COPD
7. Rheumatic heart disease
8. Increased age
9. Pre-op enlarged atrium
10. RCA stenosis
11. Low electrolytes
12. Inadequate cardiac protection intraoperativey
13. prolonged CPB time
14. Long aortic clamp time

A
  1. Leads to atrial enlargement/dilation
  2. leads to atrial enlargement
  3. can cause ischemic damage which damages hearts conduction pathway
  4. back flow of pressure puts pressure on AV valves - enlargement
  5. prolonged decreased oxygenation in the body
  6. decreased O2 in the body causes ischemic changes
  7. causes physical damage inside the heart
  8. decreased healing / decreased function related to age
  9. structural damage
  10. feeds atrium
  11. impairs cardiac function
  12. ischemic cardiac damage
  13. ischemia
  14. ischemia
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2
Q

Precursors to Postop Arrhytthmias (2)
High risk POAF patient recieve what postop

A
  • PACs
  • ST - pain, fever, anxiety, anemia
  • Beta blockers
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3
Q

Atrial fibrillation
* Rate control options (4)

A
  1. Beta blockers (metoprolol, esmolol)
  2. Amiodarone
  3. Calcium channel blockers (dilt, verapimil)
  4. Digoxin (lanoxin)
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4
Q

Sotalol (betapace) use in Afib
* Action
* Dosing
* Monitor for

A
  • Has BB properties, increases repolarization time
  • Initially 112.5 mg IV, maintenance 112.5 to 150 mg IV BID
  • Monitor for QTc prolongation and bradycardias
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5
Q

Ibutilide (Corvert)
* Action
* Dose
* Monitor for

A
  • Antiarrhythmic potassium channel blocker with fewer hemodynamic side effects compared to amio
  • 1mg over 10 min IV
  • Monitor for prolongation of QT / torsades
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6
Q

Side effects of antiarrhythmics =
What are these drugs used for?
* Quinidine (cardioquin)
* Procainimide (Pronestyl)
* Lidocaine (xylocaine)
* Tocainamide (toinocard)
* mexiletin (mexitil)
* Flecainide (tambocor)
* Propafenone (rhythmol)

A
  • Risk of QT prolongation
  • ventricular dysrhythmias
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7
Q

What type of drugs are these?
* Amiodarone (cordarone)
* Ibutilide (corvert)
* Dofetilide (tikosyn)
* Bretylium (bretylol)
* Sotalol (Betapace)
* Verapamil (Calan)
* Digoxin (lanoxin)
* Adenosine (adenocard)

A

Antiarrhythmics, blocking either potassium or calcium slowing the conduction process

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8
Q

Calcium Channel Blockers
* indication
* Action
* Examples 2
* How to give in general and what to watch out for

A
  • Used to treat tachyarrhythmias, HCM, angina, vasospasm
  • Cardio selective and vasoselective, blocks calcium channels in the vessel wall (remember what calcium IV does)
  • Verapamil (calan, Isoptin), Diltiazem (cardizem)
  • Give a dose of 5-20 mg IV then start continuous infusion
  • Watch out for hypotension, bradycardia, heart block and HF
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9
Q

Digoxin
1. Therapeutic Range of Digoxin
2. what vital are you targeting
3. Action
4. Toxicity tymptoms

A
  1. 0.5 0 2.0 ng/ml
  2. targeting heart rate goal
  3. Slows conduction of impulse through AV node while increasing myocardial contractility
  4. PR interval prolongation, Nausea, ST segment depression, vision changes
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10
Q

Atrial Flutter
* What is this thought to be an issue with
* Rate
* Symptoms
* Treatment
* Risks asoc.

A
  • Thought to be an atrial re-entry issue
  • Atrial rate 250-350
  • Syncope, palpitations, fatigue, exercise intolerance, SOB, chest pain. decreased CO
  • Cardioversion, anticoagulation, overdrive pacing, surgery
  • Thrombus, Stroke, heart failure if prolonged
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11
Q

Cardioversion Safety
* Oh Say it isn’t so!

A
  • Oxygen
  • Sedation
  • Intubation/airway supplies
  • IV
  • Synch
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12
Q

Atrial Overdrive Pacing
* Purpose
* Definition

A
  • Used in attempt to terminate afib or aflutter
  • Pacing the patient rapidly above their current rate for a time and is then released
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13
Q

Maze procedure
* Definition
* what does it have in common with overdrive pacing

A
  • Used for treatment of Afib, incision made to left and right atrium to form scar tissue that doesn’t conduct erratic impulses to atrium
  • Both treatments are hoping SA node takes over as pacer of the heart
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14
Q

SVT
* Treatment of Unstable vs Stable

A
  • Unstable: Cardioversion
  • Stable: VAD - Vagal maneuvers, Adenosine 6mg rapid, Diltiazem or beta blockers
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15
Q

Indications for Pacemaker
(permanent or temporary)

A
  • Symptomatic Bradycardia
  • 2nd degree AV block
  • Third degree AV block
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16
Q

Atropine
* treatment for what
* action
* dose
* side effects

A
  • Symptomatic bradycardia
  • Inhibits parasympathetic nervous system
  • 1.0 mg IV push q3-5 min
  • Tachycardia, Dry mouth, urinary retention, demand ischemia
17
Q

Transcutaneous Pacing
* Pad placement
* Settings
* Transvenous and transcutaneous pacing only use what mode
* Starting amps

A
  • Anterior - posterior, anterior - lateral
  • VVI mode only, demand pacing, start @ 50 mA and increase uintil captuire
  • VVI
18
Q

What do the letters mean in VVI

A
  • V paced
  • V sensed
  • Inhibit pace on intrinsic rhythm
19
Q

Epicardial wire removal
* Done by who
* how
* if resistance is met
* post removal monitor for

A
  • RN or PA/NP, MD
  • Aseptic technique, constant gentle traction to remove
  • If resistance is met, stop. Could be stuck on graft or pt anatomy
  • Monitor for Temponade, bleeding, arrhythmias
20
Q

Magnet operation with PPM/ICD’
* What does the magent do

A
  • over PPM causes asynchronous pacing at designated magnet rate
  • Over ICD inhibits defib
21
Q

Chest compressions
* how deep
* rate

A
  • 2 - 2.4 inches deep
  • 100 - 120 /min
22
Q

Vfib or VT
* first
* cpr for how long
* rhythm check how often
* which drug and how much
* last drug

A
  • Shock x3, shock again q2min
  • cpr for 2 min
  • Rhythm check Q2 min
  • Epi 1 mg or Amio 300 mg
  • Lidocaine if VF/VT persists
23
Q

Emergency drug of choice for torsades is

A

Magnesium

24
Q

PEA & Asystole
* Three steps

A
  1. Start compressions
  2. Epi 1mg q3-5 min
  3. Differential diagnosis with H’s and T’s
25
Q

What are the 5H’s and 5T’s

A
  • Hypovolemia, hypoxia, hypokalemia, H+ ion(acidosis), hypothermia
  • Thrombus (MI, PE), Tension pneumothorax, Tamponade, Toxicologfy (drug OD)
26
Q

Know the CALS pathway for
1. Vfib/VT
2. asystole or severe bradycardia
3. PEA

A
27
Q

Internal Defibrillation
* Placement
* joules

A
  • Open chest, one paddle over RA, one paddle at apex
  • 5-20 joules
28
Q

Capnography during resuscitation
* Used as a marker for what
* Normal PEtCO2
* Goal during cardiac arrest

A
  • Used as a marker of perfusion and CPR quality
  • Norkmal PEtCo2 is 35 - 45 mm Hg
  • Goal during cardiac arrest: >10 mmHg
29
Q

Post Arrest TTM
* Cool to what temperature
* Why
* In which post arrest patients
* Side effects

A
  • 32-36 C
  • To minimize reperfusion injury, promote neuroprotection
  • Only in patients remaining comatose post arrest
  • Shivering is common, bradycardia, vasoconstriction/hypertension, diuresis, hypokalemia
30
Q

Drug used for shivering
* name
* class

A
  • Demerol (meperidine)
  • this is an opioid
31
Q

Know how to fill this out and what it means

A

CSC Prep (8 decks)

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