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3MB Buzzwords > CLASP - sudden death > Flashcards

CLASP - sudden death Flashcards

1
Q

What does the following ECG show?

A

Sinus bradycardia - divide 300 by the numbers of squares in between the QRS complexes

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2
Q

Tx for bradycardia

A

1st: Atropine IV
2nd: Transcutaenous pacing or isoprenaline or adrenaline

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3
Q

What does the following ECG show?

A

A-fib

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4
Q

What type of heart block is shown here?

A

Mobitz type 2

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5
Q

What does the following ECG show?

A

Ventricular tachycardia

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6
Q

What does the following ECG show?

A

Ventricular fibrillation

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7
Q

Mx for PEA and asystole

A

CPR should be commenced immediately with interruptions minimised

Adrenaline 1mg IV is given in the first cycle and if a non-shockable rhythm persist, every other cycle (i.e. cycles 1, 3, 5 etc.)

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8
Q

Mx for V-tach and V-fib

A

Defibrillation and CPR
If persistent, Amiodarone 300mg IV and Adrenaline 1mg IV can be given after the third shock

Amiodarone is given as a one-off dose but Adrenaline may be repeated every other cycle following a shock (i.e. cycles 3, 5, 7 etc.)

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9
Q

What does the following ECG show?

A

Long QTc syndrome

QT interval is roughly equivalent to three to four large squares (600–800 ms). A prolonged QT interval is defined as being above 440 ms in men and 470 ms in women

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10
Q

Mx for acquired LQTS

A

Address underlying cause of LQTS (e.g. cease medications or address dyselectrolytaemia)

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11
Q

Mx for congenital LQTS

A

1st: beta-blockade (as long as no bradycardia)
2nd: ICD insertion (if risk of cardiac arrest) or cardiac pacing

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12
Q

What does the following ECG show?

A

Sinus tachycardia

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13
Q

Tx for sinus tachy if there are adverse signs (e.g. shock, syncope, heart failure, myocardial ischaemia)

A

1st line = synchronised DC cardioversion +/- amiodarone.

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14
Q

Tx for sinus tachy if there are no adverse signs (e.g. shock, syncope, heart failure, myocardial ischaemia) but rhythm is regular

A

1st line = vagal manouevres
2nd line = IV adenosine. 6mg >12mg > 18mg
3rd line = verapamil or beta-blocker
4th line = synchronised DC cardioversion

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15
Q

Tx for sinus tachy if there are no adverse signs (e.g. shock, syncope, heart failure, myocardial ischaemia) but rhythm is irregular

A

Probable atrial fibrillation and to treat with beta-blockers
If there are signs of heart failure digoxin may be trialled
If onset >48h the patient will need to be anticoagulated

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16
Q

What does the following ECG show?

A

Asystole

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17
Q

Reversible causes of cardiac arrest

A

“4Hs and 4Ts”

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18
Q

What does the following ECG show?

A

Narrow complex tachy

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19
Q

What does the following ECG show?

A

Torsades de pointes

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20
Q

What does the following ECG show?

A

Ventricular tachycardia

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21
Q

What does the following ECG show?

A

Brugada syndrome - ST elevation in V1–V3, followed immediately by a negative T wave, also known as the ‘Brugada sign

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22
Q

What does the following ECG show?

A

V-fib

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23
Q

What does the following ECG show?

A

Sinus rhythm

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24
Q

What does the following ECG show?

A

Torsades de pointes

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25
Q

VT vs V-fib in terms of consciousness

A

VT - conscious
V-fib - unconscious

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26
Q

What does the following ECG show?

A

V-tach

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27
Q

What does the following ECG show?

A

Polymorphic VT

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28
Q

Outline ALS/BLS

A
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29
Q

Which drugs are given during ALS in non-shockable rhythms?

A

Adrenaline as soon as possible
Repeat every 3-5 minutes whilst ALS continues

30
Q

Which drugs are given during ALS in shockable rhythms?

A

Adrenaline + amiodarone once chest compressions have restarted after the third shock
Repeat adrenaline every 3-5 minutes whilst ALS continues
Repeat amiodarone after 5 shocks administered

31
Q

Alternative to amiodarone in ALS/BLS?

A

Lidocaine

32
Q

In BLS/ALS, _________ drugs should be considered if a pulmonary embolus is suspected

A

Thrombolytic

33
Q

In ALS/BLS, if thrombolytic drugs are given, CPR should be continue for..

A

60-90 minutes

34
Q

Metabolic acidosis and raised lactate

A

Sepsis

35
Q

Most common cause of cardiac arrest in children are..

A

Respiratory - hypoxia

36
Q

What does the following ECG show?

A

SVT

37
Q

What does the following ECG show?

A

SVT

38
Q

No discernible P waves, QRS duration 90ms

A

SVT

39
Q

What does the following ECG show?

A

Torsades de pointes

40
Q

Tx for Torsades de pointes

A

IV magnesium sulphate

41
Q

Tx for acute SVT

A

Valsalva manoeuvre/Carotid sinus massage
IV adenosine 6mg → 12mg → 18mg (verapamil if asthmatic)
Electrical cardioversion

42
Q

Tx for prevention of SVT

A

Beta-blockers
Radio-frequency ablation

43
Q

Tx for V-tach if adverse signs (systolic BP < 90 mmHg, chest pain, heart failure)

A

Cardioversion

44
Q

Tx for V-tach if no adverse signs (systolic BP < 90 mmHg, chest pain, heart failure)

A

Amiodarone through a central line
Lidocaine (use with caution in severe left ventricular impairment)
Procainamide

If drug therapy fails:
EPS
ICD

45
Q

Differentiate between early (compensated) shock and late (decompensated) shock

A
46
Q

Sepsis is characterised by..

A

36C - 38C
HR >90 beats/min
Respiratory rate >20/min
WBC count >12,000/mm3 or < 4,000/mm3

47
Q

Neurogenic, septic, and anaphylactic shock (together are all distributive shock) will cause _________ peripheries, with the others causing _________ peripheries

A

Neurogenic, septic, and anaphylactic shock (together are all distributive shock) will cause warm peripheries, with the others causing cool peripheries

48
Q

What can cause Torsades de pointes?

A

Hypocalcaemia, hypokalaemia, hypomagnesaemia, hypothermia

49
Q

increased SVR (vasoconstriction in response to low BP)
Increased HR (sympathetic response)
Decreased cardiac output
Decreased blood pressure

A

Cardiogenic shock

50
Q

Blood volume depletion e.g. haemorrhage, vomiting, diarrhoea, dehydration, third-space losses during major operations

Increased SVR
Increased HR
Decreased cardiac output
Decreased blood pressure

A

Hypovolaemic shock

51
Q

Peripheral vascular dilatation causes a fall in SVR

Reduced SVR
Increased HR
Normal/increased cardiac output
Decreased blood pressure

A

Septic shock

52
Q
A

Hypovolaemia

53
Q
A

Cardiogenic shock

54
Q

Most common cause of neutropenic sepsis?

A

Coagulase-negative, Gram-positive bacteria such as Staphylococcus epidermidis

55
Q

Tx for neutropenic sepsis

A

Piperacillin with tazobactam (Tazocin) immediately
If still febrile and unwell after 48 hours then meropenem +/- vancomycin
If no response after 4-6 days then order investigations for fungal infections (e.g. HRCT)

56
Q

Tx for neutropenic sepsis if anticipated they will get it (i.e prophylaxis)

A

Fluoroquinolone

57
Q

Which shock is delivered in VF/pulseless VT?

A

Unsynchronized shock at 200 J

Synchronised is used in haemodynamically stable patients and can send them to VF

58
Q

In cases of hypothermia causing cardiac arrest, defibrillation is less effective and only 3 shocks should be administered before the patient is…

A

Rewarmed to 30 degrees centigrade

59
Q

Causes of Torsades de pointes

A

Antiarrhythmics: amiodarone, sotalol, class 1a
Tricyclic antidepressants
Antipsychotics
Chloroquine
Terfenadine
Erythromycin

60
Q

Congenital causes of long QT

A

Jervell-Lange-Nielsen syndrome (deafness and is due to an abnormal potassium channel)

Romano-Ward syndrome (no deafness)

61
Q

Drug causes of long QT

A

Amiodarone, sotalol, class 1a antiarrhythmic drugs
TCAs, SSRIs (citalopram)
Methadone
Chloroquine
Terfenadine
Erythromycin
Haloperidol
Ondanestron

62
Q

Other causes of long QT

A

Hypocalcaemia, hypokalaemia, hypomagnesaemia
Acute MI
Myocarditis
Hypothermia
SAH

63
Q

Long QT1 one is associated with..

A

Exertional syncope, often swimming

64
Q

Long QT2 one is associated with..

A

Syncope occurring following emotional stress, exercise or auditory stimuli

65
Q

Long QT3 one is associated with..

A

Events often occur at night or at rest

66
Q

Mx of long QT

A

Avoid drugs which prolong the QT interval and other precipitants if appropriate (e.g. Strenuous exercise)
Beta-blockers (NOT sotalol)
ICD in high risk cases

67
Q

The most common variants of LQTS are caused by defects in the alpha subunit of the slow delayed rectifier ________ channel

A

Potassium

68
Q

A normal corrected QT interval is less than ___ms in males and ___ms in females

A

A normal corrected QT interval is less than 430 ms in males and 450 ms in females

69
Q

The characteristic ECG findings of a lateral STEMI include…

A

ST elevation in the lateral leads (I, aVL, V5–V6)
Reciprocal ST depression in the inferior leads (II, III, aVF)

70
Q
A

3MB Buzzwords (13 decks)

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