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Sophomore 2 Test 3 > Critical Care Medications > Flashcards

Critical Care Medications Flashcards

1
Q

Primary Emphasis of BLS

A
  1. Removing upper airway obstruction and maintaining the patency of airway
  2. Eliminating respiratory arrest
  3. Restoring circulation
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2
Q

Steps in the BLS Assessment

A
  1. Check for responsiveness
  2. Activate the emergency response system and obtain an AEB
  3. Circulation - check carotid pulse (for no more than 5-10 sec); if no pulse, begin CPR
  4. Defibrillation - AED or begin ACLS protocol
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3
Q

The main focus of BLS

A

Early CPR and early difibrillation

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4
Q

Effective Compression

A

Maximize compression time with no pauses longer than 10 seconds

  1. Not too fast
  2. Not too deep
  3. Hand placement
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5
Q

How fast should compressions be?

A

Quality and effectiveness decreases with more than 120 compressions/min. The new target is 100-120 compression/min

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6
Q

How deep should the compressions be?

A

Maximum compression depth 2-2.4 inches

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7
Q

Describe hand placement for compressions

A

Heel of hands on lower half of sternum, fingers locked, straight arms, elbows locked, and shoulders directly over hands

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8
Q

Most Commonly Abused Opiates

A
  1. Heroin
  2. Morphine
  3. Codeine
  4. Fentanyl
  5. Meperidine
  6. Oxycodone
  7. Hydrocodone/Hydrocodeinone
  8. Hydromorphone
  9. Oxymorphone
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9
Q

Signs of Opiate Overdose

A
  1. Pinpoint pupils
  2. Breathing problems
  3. Dizziness
  4. Cold, clammy skin
  5. Seizures
  6. Skin turning blue
  7. Limp muscles
  8. Unconsciousness
  9. Bradycardia
  10. Choking sounds
  11. Vomiting
  12. Inability to talk
  13. Irregular breathing
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10
Q

Who do we use Naloxone on?

A
  • Known or suspected opioid addicts

- Patients who are not breathing normally but have a pulse

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11
Q

Who can administer Naloxone?

A

Trained lay rescuers and BLS providers can administer naloxone

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12
Q

Dosage for Naloxone

A
  • 2 mg intranasally

- 0.4 mg IM

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13
Q

If there is no response to the first dose of naloxone?

A
  • The dose can be repeated after 4 minutes

- If no response after repeat dose, continue CPR and use AED

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14
Q

What does ACLS stand for?

A

Advanced Cardiac Life Support

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15
Q

Main goal of ACLS

A

Increase patient outcomes by sustaining life and making efforts to keep neurological function intact during a medical emergency

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16
Q

ACLS Primary Survey

A 
A - Airway/cervical
B - Breathing
C - Circulation
D - Disability
E - Exposure
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17
Q

ABCDE ACLS: A

A

Assess airway with simultaneous cervical spine immobilization. Can the patient talk? If obstructed, consider chin lift, jaw thrust, suction, oropharyngeal airway, and intubation, all while keeping the neck immobilized

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18
Q

ABCDE ACLS: B

A

Assess breathing rate, depth, effort, accessory muscle use, symmetry of chest wall movement, and bilateral breath sounds
- Close any open wounds and provide oxygen, intubation, and ventilation as needed

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19
Q

ABCDE ACLS: C

A

Circulation

  • Palpate central and peripheral pulses
  • Assess level of consciousness
  • Look for obvious signs of bleeding
  • Check skin temperature and color
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20
Q

ABCDE ACLS: D

A

Disability

  • Perform a rapid neurological assessment
  • Glasgow Coma Score
  • Best eye opening
  • Best verbal response
  • Best motor response
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21
Q

ABCDE ACLS: E

A

Exposure

  • Provide exposure and environmental controls
  • Remove the patient’s clothes and keep him or her warm
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22
Q

ACLS: Secondary Assessment

A 
S - signs and symptoms
A - allergies
M - medications 
P - past medical history
L - last meal
E - events leading to presentation
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23
Q

Medications for Tachycardia

A
  1. Adenosine ***
  2. Procainamide ***
  3. Verapamil
  4. Diltiazem
  5. Amiodarone
  6. Digoxin
  7. Beta Blockers
  8. Magnesium sulfate
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24
Q

Medications for Bradycardia

A
  1. Atropine ***
  2. Epinephrine
  3. Dopamine
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25
Q

Atropine Action

A

Increases activity in the SA node, by blocking the vagus nerve and increasing heart rate
** First line medication for bradycardia

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26
Q

Atropine IV

A
  • 1st dose 0.5 mg bolus
  • Repeat every 3-5 minutes
  • Max dose: 3 mg
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27
Q

Atropine Precautions

A
  1. MI and hypoxia: increased oxygen demand
  2. Avoid hypothermia
  3. Not effective in 2nd degree type II or 3rd degree heart blocks
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28
Q

What is defibrillation?

A

Is a non-synchronized delivery of energy during any phase of the cardiac cycle

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29
Q

What is cardioversion?

A

Is the delivery of energy that is synchronized to the large R waves or QRS complex

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30
Q

How is cardioversion different from defibrillation?

A
  1. Synchronized
  2. Elective procedure, need consent
  3. Sedation
  4. 50-200 joules
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31
Q

How is defibrillation different from cardioversion?

A
  1. Non-synchronized
  2. Emergency
  3. V-fib, V-tach
  4. Client unconscious
  5. Begin with 200 joules up to 360
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32
Q

Adenosine Dosage

A
  • 1st dose: 6mg rapid IV push; follow with NS flush
  • 2nd dose (if required): 12 mg IV rapid push
    • Half life is very short: less than 10 seconds
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33
Q

Indications for Adenosine

A

1st drug of choice for stable, narrow complex, regular SVT

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34
Q

Contraindications/Precautions for Adenosine

A
  1. Poison/drug induced tachycardia is contraindicated
  2. Transient side effects; flushing, CP, asystole, brady, ectopy (random off beats)
  3. If used for VT may cause worsening of clinical condition
  4. Transient periods of sinus brady or ventricular ectopy common after termination of SVT
  5. Safe in pregnancy
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35
Q

Procainamide: Mechanism of Action

A

Suppresses intraventricular conduction

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36
Q

Procainamide: Indications

A

Stable monomorphic v-tach with normal QT interval

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37
Q

Procainamide: Contraindications

A
  1. Torsades de pointes

2. 2nd and 3rd degree AV block

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38
Q

Procainamide: Adverse Reactions

A
  1. Confusion
  2. Seizures
  3. Hypotension
  4. Bradycardia
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39
Q

Procainamide: Considerations

A
  1. Pregnancy safety: Category C

2. Potent vasodilation and negative inotropic effects

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40
Q

Procainamide: Dosage

A

ACLS guidelines: infuse 20 mg/min until arrhythmia is controlled, hypotension occurs, QRS complex widens by 50% of its original width, or total of 17 mg/kg is given

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41
Q

Medications for V-fib and Pulseless V-tach

A
  1. Epinephrine
  2. Amiodarone
  3. Lidocaine
  4. Magnesium sulfate
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42
Q

Asystole and Pulseless Electrical Activity

A

Epinephrine

43
Q

Indications for Epinephrine

A
  1. Cardiac arrest (V-fib, V-tach, asystole, PEA)
  2. Profound hypotension associated with bradycardia
  3. Anaphylaxis
  4. Bronchospasm and bronchoconstriction of bronchial asthma and COPD
44
Q

Epinephrine Dosage

A

For V-fib, PVT, asystole, and PEA

  • IV/IO: 1 mg every 3-5 minutes
    - Flush with 20 mL NS (central line preferred)
  • ET: 2-2.5 mg every 3-5 minutes
    - Dilute in 5-10 mL SW or NS
45
Q

Amiodarone Adverse Effects

A
  1. Fatal pulmonary fibrosis
  2. Abnormal liver function tests and hepatitis
  3. Photodermatitis and gray-blue skin discoloration in sun-exposed areas
  4. Corneal micro-deposits and discoloration
  5. Optic neuritis: Halos develop in the peripheral visual fields, may progress to blindness
  6. Hypothyroidism or hyperthyroidism
  7. Bradycardia and heart block
46
Q

Indications for Lidocaine

A

Alternative to amiodarone in cardiac arrest from V-fib and V-tach

47
Q

Lidocaine: Mechanism of Action

A

Anti-arrhythmic, decreases depolarization and excitability of the ventricles during diastole

48
Q

Lidocaine: Dosage

A

1-1.5 mg/kg q 3-5 min (Max 3 mg/kg)

49
Q

Lidocaine: Nursing Considerations

A
  • If received bolus, needs to receive a continuous infusion after
  • Monitor for CNS effects of toxicity (drowsiness, slurred speech, seizures, respiratory depression)
50
Q

Magnesium Sulfate: Indications

A
  1. Torsade de pointes is suspected in cardiac arrest

2. Hypomagnesemia (Mg < 1.8 mg/dL)

51
Q

Magnesium Sulfate: Dosage

A

1-2 grams over 5-20 minutes

52
Q

Magnesium Sulfate: Precautions

A
  • Fall in BP with fast administration
  • Use extreme caution in renal failure
  • Monitor: hypotension, respiratory, and CNS depression
53
Q

Signs of Magnesium Sulfate Toxicity

A

B - blood pressure decreased
U - urine output decreased
R - respirations < 12
P - patella reflex absent

54
Q

H’s of ACLS

A
  1. Hypovolemia
  2. Hypoxia/Hypoxemia
  3. Hydrogen Ion Excess (Acidosis)
  4. Hypokalemia/Hyperkalemia
  5. Hypothermia
55
Q

Signs of Hypovolemia

A
  • Rapid HR
  • Narrow QRS
  • Blood loss
56
Q

Treatment of Hypovolema

A
  • Obtain IV access
  • Administer blood/fluid
  • Use fluid challenge
57
Q

Signs of Hypoxia/Hypoxemia

A
  • Slow HR

- Cyanosis

58
Q

Treatment of Hypoxia/Hypoxemia

A
  • Ensure airway is open
  • Ventilate
  • Ensure oxygen supply is adequate
59
Q

Signs of Acidosis

A
  • Low amplitude QRS complex
60
Q

Treatment of Acidosis

A
  • Arterial blood gas
  • Provide adequate ventilations
  • Sodium bicarbonate
61
Q

Signs of Hypokalemia

A

Flattened T waves and a U wave

62
Q

Signs of Hyperkalemia

A

Peaked T waves and a widened QRS

63
Q

Treatment of Hypokalemia/Hyperkalemia

A
  • Ventilate (respiratory)

- Sodium bicarbonate (metabolic)

64
Q

Signs of Hypothermia

A
  • Shivering

- Previous exposure to cold temperatures

65
Q

Treatment of Hypothermia

A
  • Active warming measures

- Temperature should be above 30 degrees C

66
Q

T’s ACLS

A
  1. Tamponade (cardiac)
  2. Toxins
  3. Tension pneumothorax
  4. Thrombosis (pulmonary)
  5. Thrombosis (coronary)
67
Q

Signs of Cardiac Tamponade

A
  • Rapid HR
  • Narrow QRS
  • JVD
  • No pulse
  • Muffled heart sounds
68
Q

Treatment of Cardiac Tamponade

A
  • Pericardiocentesis

- Thoracotomy

69
Q

Signs of Toxins (for T’s of ACLS)

A

Prolonged QT interval

70
Q

Treatment of Toxins (for T’s of ACLS)

A
  • Based on overdose agent

- Supportive care

71
Q

Signs of Tension Pneumothorax

A
  • Slow HR
  • Narrow QRS
  • Unequal breathing
  • JVD
  • Tracheal deviation
72
Q

Treatment of Tension Pneumothorax

A
  • Needle decompression

- Insertion of a chest tube

73
Q

Signs of Thrombosis (Pulmonary)

A
  • Rapid HR
  • Narrow QRS
  • SOB
  • Decreased oxygen
  • Chest pain
74
Q

Treatment of Thrombosis (Pulmonary)

A
  • Embolectomy
  • Fibrinolytic therapy
  • Anticoagulant therapy
75
Q

Signs of Thrombosis (Coronary)

A

Abnormal EKG

76
Q

Treatment of Thrombosis (Coronary)

A
  • Angioplasty
  • Stent placement
  • Coronary bypass surgery
77
Q

TTM

A

Targeted Temperature Management

78
Q

TTM: Indications

A
  1. Non-traumatic cardiac arrest with return of spontaneous circulation
  2. Comatose: GCS 8 or less or no purposeful movements
  3. Age 18-75 years
79
Q

TTM: optimum temperature for therapeutic hypothermia

A

32-36 degrees C (89.6 - 96.8 degrees F)

80
Q

TTN: what is temperature monitored with

A

Any of the following

  1. Esophageal thermometer
  2. Bladder catheter
  3. Pulmonary artery catheter
81
Q

TTN: Duration

A

A single target temperature, within this range should be selected, achieved, and maintained for at least 24 hours

82
Q

TTN: Contraindications

A
  1. DNR
  2. Return of spontaneous circulation > 60 minutes
  3. More than 6 hours since initial arrest
  4. Uncontrolled arrhythmias
  5. Initial temperature less than 30 degrees
  6. Coagulopathy
  7. Pregnancy
83
Q

Early Coronary Reperfusion Therapy

A
  • Initial strategy to restore blood flow to the occluded coronary arteries by two standards of care
    1. Fibrinolytic therapy
    2. Primary percutaneous transluminal coronary angioplasty (PTCA) stents
84
Q

Outcomes of Reperfusion Therapy Depend on what?

A
  • Time to treatment

- Early and full restoration of blood flow

85
Q

What do we give a patient who is post arrest hypotension not responsive to fluid bolus?

A
  1. Epinephrine 0.1 - 0.5 mcg/kg/min
  2. Dopamine 5 - 10 mcg/kg/min
  3. Norepinephrine 0.1 - 0.5 mcg/kg/min
86
Q

Dopamine: Indications

A
  1. Second line drug for symptomatic bradycardia

2. Hypotension with signs and symptoms of shock

87
Q

Dopamine: Precautions

A
  1. Correct hypovolemia with volume before initializing
  2. Extravasation of tissues!! Use central line!!
  3. May cause tachydysrrhythmias; excessive vasoconstriction
  4. If extravasation occurs: The area should be treated with phentolamine to prevent tissue necrosis in the ischemic area
  5. Need to request central line insertion for infusion
88
Q

Dopamine: IV Administration

A
  1. Infusion at 2 - 20 mcg/kg/min

2. Titrate to patient response; taper slowly

89
Q

Norepinephrine: Dosage

A

0.1 - 0.5 mcg/kg/min (in 70 kg patient usually 7-35 mcg/min)

90
Q

Norepinephrine: Indications

A

Treatment of severe non-volume related hypotension usually after Dopamine

91
Q

Norepinephrine: Contraindications

A
  1. Do not give if hypotension is due to low blood volume (can lead to tissue hypoxia and decreased renal perfusion)
  2. Excessive infusion rate can result in severe hypertension and tissue necrosis
  3. Need to use a central line to prevent tissue damage from extravasation
  4. If extravasation occurs: the area should be treated with phentolamine to prevent tissue necrosis in the ischemic area
92
Q

Extravasation

A

The inadvertent administration of a vesicant solution or medication into surrounding tissue

93
Q

Infiltration

A

The inadvertent administration of a non-vesicant solution/medication into a surrounding tissue

94
Q

Vesicant

A

A solution or medication that causes a blistering process when inadvertently administered into the surrounding tissue

95
Q

Hypertensive Crisis Symptoms

A
  1. BP > 180/110
  2. HA/blurred vision
  3. Seizures
  4. Focal neuro deficits
  5. Chest pain/SOB
  6. Renal failure
96
Q

Nitroglycerin: Indications

A

Relief of acute angina pain and decrease hypertension

97
Q

Nitroglycerin: Dosage

A

5 - 100 mcg/min as IV infusion

** Increase by 5 mcg/min every 5 -10 minutes based on BP

98
Q

Nitroglycerin: Onset of Action

A

2 - 5 minutes

99
Q

Nitroglycerin: Adverse Effects

A
  1. Headache ***
  2. Hypotension
  3. Facial flushing
  4. Tachycardia
100
Q

Nitroglycerin: Contraindications

A
  1. Hypotension (SBP < 90 mm Hg)
  2. Bradycardia (HR < 50)
  3. Tachycardia (HR > 100)
  4. Patients who have taken phosphodiesterase inhibitors (vardenafil, sildenafil, tadalafil) within the past 24 hours
101
Q

Sodium Nitroprusside: Indications

A

Potent vasodilator used in hypertensive emergencies (BP > 180/110)

102
Q

Sodium Nitroprusside: Dosage and Administration

A
  1. 0.5 mcg/kg/min (Max dose is 10 mcg/kg/min)
  2. Very rapid onset of action; effects stop 3 min. after infusion discontinued
  3. Given in 5% Dextrose- Must be protected from light so bag must be opaque or covered. Only good for 24 hours
  4. Should be a faint brown color- is solution is red, blue, or green the medication has been inactivated with contaminants
  5. DO NOT mix with any other drugs in the same line
  6. Arterial line required to monitor continuous BP
  7. Administered in ICU, OR, and ED
103
Q

Sodium Nitroprusside: Side Effects

A
  1. Byproduct of breakdown is cyanide (toxic)
  2. Use only for a short period of time (< 72 hours)
  3. Measure cyanide levels by measuring thiocyanate levels and lactate levels
  4. Hypotension if dose is too high

Sophomore 2 Test 3 (4 decks)

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