Dysrhythmias Flashcards by AIyssa Agustin

Treatment for symptomatic SVT/AT

Cardioversion

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Treatment for asymptomatic SVT/AT

Adenosine 6mg, repeat 12mg x1
O2
Betablockers
CCB
Amioderone

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Treatment for Aflutter

CCB, BB
Convert rhythm: amio or sync cardioversion
Anticoags

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Treatment for Afib

Long term: Digitalis
Acute: CCB/BB
Convert rhythm: Amio or cardioversion (Symptomatic: anticoags first)

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Characteristics of WAP

At least 3 diff P waves

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Treatment for Bradycardia

Atropine max 3mg/Pacing

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What rate is junctional rhythm?

40-60

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Treatment for Accelerated Junctional

Amioderone or procainamide

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Rate of accelerated junctional

60-100

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Rate of Juntional Tachy

> 100

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Rate of Idioventricular rhythm

20-40

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Treatment of symptomatic VT w/ pulse

Sedate - Cardioversion 100J

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Treatment of pulseless VT

Defib 200J w/ biphasic, 360J w/ monoophasic
5 cycles CPR
Shock
Epi 1mg q3-5 mins
Opt: Amio 300mg>150mg or Lidocaine (1-1.5mg/kg, 0.5-0.75mg/kg, max 3mg)

Adv airway

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Treatment for torsades

Mag, 1-2gm in 10cc d5w over 5-20 mins

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In what leads are p Waves upright?

I, II, aVF, V5, V6

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Which pattern of aberrancy is more common?

RBBB

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If the QRS complex is negative in leads I/aVF, what most likely is the rhythm?

Vtach

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Normal QT interval

0.36-0.44

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When is QTc prolonged?

0.419-0.440

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Causes of Torasades de Pointes

Slow HR
Drugs (Class AI antiarrhythmics - procainamide, quinidine; adenosine, amioderone, tricyclic antidepressants, haloperidol; antifungals + -mycin abx)
Electrolyte imbalance
Congenital
Acute MI
Metabolic disorders

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Causes of monomorphic vtach

acute MI or ischemia
cardiomyopathies
myocarditis
arrythmogenic RV dyspasia
idiopathic
drugs (cocaine)
electrolyte disorder

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What to monitor for with epi administration?

Glucose levels, UO, Metabolic acidosis

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Dopamine effects with high doses?

alpha agonist

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Side effects of dopamine

limb ischemia, widened QRS, vasoconstriction, tachycardia, ventricular arrhythmias

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Effects of dobutamine

reduces afterload via mild vasodilation, increase HR, increase contractility

What is vasopressin?

antidiruetic hormone that retains water and vasoconstricts - decreases HR, but increases SVR - use if levo/dopa ineffective

What is nipride?

- used for HTN, pulm edema, CHF | - decreases afterload

Effects of nitroglycerin

- vasodilator (esp coronary art), decreases preload - used in HTN, pulm edema, CHF, MI (esp cocaine induced) - make sure pt hasnt taken viagra

What is diltiazem?

- antiarrhythmic CCB - HR control in rapid afib/flutter, MAT - DONT use for wide QRS tachys

Antidote for dilt

-Calcium

Uses for amioderone?

-recurrent VF, unstable VT, cardiac arrest,

Uses for lidocaine

-ventricular antiarrythmic (1-1.5mg/kg IV bolus max of 2mg/kg)

Uses for esmolol

- ST, control ventricular response, SVT, HTN | - Decreases HR, CO, SVR

Uses for adenosine

-anti-arrhythmic used for pSVT, Wolff-Parkinson-White syndrome

Adenosine dosing

-6mg rapid IVP > 10cc flush> no effect can repeat 12mgx2

Drugs that increase preload

Volume expanders: NS, LR, hetastarch, albumin, blood

Drugs that decrease preload

Diuretics: lasix Vasodilators: NTG, Nipride

Drugs that increase afterload

Vasopressors: Dopa, Epi, Levo, Neo

Drugs that decrease afterload

Vasodilators: NTG (high dose), Nipride, PDE, Ca+ Channel blockers, ACE inhibitors, Hydralazine

Drugs that increase contractility

+inotropes: Dobutamine, dopamine, epi, dig, levo, isuprel, PDE, digoxin

Drugs that decrease contractility

-inotropes: beta blockers, Ca+ Channel blockers

When would you use a positive inotrope?

- low CO when normal volume status or corrected afterload status - Ex: Phosphodiesterase inhibitors, Beta Agonist, Digoxin

What do PDE inhibitors do?

- Enhance amount of intracellular cyclic AMP/Ca. - useful for increase CO but not HR - May cause thrombocytopenia

At what dose does dopamine affect renal/mesenteric vasculator?

Lowest dose <2mcg/kg/min | -used for oliguria, ARF, Mesenteric ischemia, increase UO

At what dose does dopamine effect alpha and B1 receptors

High doses>5mcg/kg/m | -med to high doses used for cardio genic/septic shock to increase CO

What receptors does epi stimulate?

A, B1, B2

What does neosynephrine stimulate?

A onlly

When do you use vasopressin

LAST LINE at low dose - decreases need for other pressors - used to be for GI bleeds/Vfib/flutter @ 40u IVP - side effects: cardiac/gut ischemia

Negative potential side effect of nipride?

-Thiocynate toxicity: metabolic acidosis, confusion, seizures

Treatment for symptomatic bradycardia

atropine 0.5-1mg, max .03mg/kg

What is isuprel?

B1/B2 receptor stimulant: -increase contractility/HR can cause V arrhythmias -used in heart transplants/pt w/ beta blocker overdoses

Indications for digoxin:

SVT, a fib/flutter - Slows HR (PNS activation) - Toxcity signs: GI upset, anorexia, confusion, diplopia, syncope - Therapeutic level 0.5-2mg/ml

Amioderone dosing

150mg/100cc bolus - 1mg/min (6hrs) > 0.5mg/min (18hrs) - In VT/VF 300mg push

What is the effect of stimulating alpha receptor?

arteriole vasoconstriction of skin, mucosa, gut, kidny, eyes, bladder

What is effect of stimulating beta1 receptors?

Increase HR, contractility, AV conductin of heart muscle tissue/system

Effect of stimulating beta 2 receptors?

Vasodilation (vascular smooth muscles, bronchi, liver), bronchodiation

Effect of stimulating dopaminergic receptors?

Renal/mesenteric vasodilation, coronary vessels

What is cholinergic referring to?

- Cells of the ANS using acetylchoine as neurotransmitter | - PNS (Rest/digest)

What are catecholamines?

Amine agent demonstrating SNS activity

What is adrenergic referring to?

- Cells of ANS that use epi/norepi as neurotransmitter, | - SNS (fight/flight)