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EKG > Dysrhythmias > Flashcards

Dysrhythmias Flashcards

1
Q

Treatment for symptomatic SVT/AT

A

Cardioversion

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2
Q

Treatment for asymptomatic SVT/AT

A 
Adenosine 6mg, repeat 12mg x1
O2
Betablockers
CCB
Amioderone
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3
Q

Treatment for Aflutter

A

CCB, BB
Convert rhythm: amio or sync cardioversion
Anticoags

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4
Q

Treatment for Afib

A

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

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5
Q

Characteristics of WAP

A

At least 3 diff P waves

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6
Q

Treatment for Bradycardia

A

Atropine max 3mg/Pacing

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7
Q

What rate is junctional rhythm?

A

40-60

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8
Q

Treatment for Accelerated Junctional

A

Amioderone or procainamide

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9
Q

Rate of accelerated junctional

A

60-100

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10
Q

Rate of Juntional Tachy

A

> 100

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11
Q

Rate of Idioventricular rhythm

A

20-40

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12
Q

Treatment of symptomatic VT w/ pulse

A

Sedate - Cardioversion 100J

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13
Q

Treatment of pulseless VT

A

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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14
Q

Treatment for torsades

A

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

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15
Q

In what leads are p Waves upright?

A

I, II, aVF, V5, V6

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16
Q

Which pattern of aberrancy is more common?

A

RBBB

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17
Q

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

A

Vtach

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18
Q

Normal QT interval

A

0.36-0.44

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19
Q

When is QTc prolonged?

A

0.419-0.440

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20
Q

Causes of Torasades de Pointes

A
  • 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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21
Q

Causes of monomorphic vtach

A
  • acute MI or ischemia
  • cardiomyopathies
  • myocarditis
  • arrythmogenic RV dyspasia
  • idiopathic
  • drugs (cocaine)
  • electrolyte disorder
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22
Q

What to monitor for with epi administration?

A

Glucose levels, UO, Metabolic acidosis

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23
Q

Dopamine effects with high doses?

A

alpha agonist

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24
Q

Side effects of dopamine

A

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

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25
Q

Effects of dobutamine

A

reduces afterload via mild vasodilation, increase HR, increase contractility

26
Q

What is vasopressin?

A

antidiruetic hormone that retains water and vasoconstricts

  • decreases HR, but increases SVR
  • use if levo/dopa ineffective
27
Q

What is nipride?

A
  • used for HTN, pulm edema, CHF

- decreases afterload

28
Q

Effects of nitroglycerin

A
  • vasodilator (esp coronary art), decreases preload
  • used in HTN, pulm edema, CHF, MI (esp cocaine induced)
  • make sure pt hasnt taken viagra
29
Q

What is diltiazem?

A
  • antiarrhythmic CCB
  • HR control in rapid afib/flutter, MAT
  • DONT use for wide QRS tachys
30
Q

Antidote for dilt

A

-Calcium

31
Q

Uses for amioderone?

A

-recurrent VF, unstable VT, cardiac arrest,

32
Q

Uses for lidocaine

A

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

33
Q

Uses for esmolol

A
  • ST, control ventricular response, SVT, HTN

- Decreases HR, CO, SVR

34
Q

Uses for adenosine

A

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

35
Q

Adenosine dosing

A

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

36
Q

Drugs that increase preload

A

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

37
Q

Drugs that decrease preload

A

Diuretics: lasix
Vasodilators: NTG, Nipride

38
Q

Drugs that increase afterload

A

Vasopressors: Dopa, Epi, Levo, Neo

39
Q

Drugs that decrease afterload

A

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

40
Q

Drugs that increase contractility

A

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

41
Q

Drugs that decrease contractility

A

-inotropes: beta blockers, Ca+ Channel blockers

42
Q

When would you use a positive inotrope?

A
  • low CO when normal volume status or corrected afterload status
  • Ex: Phosphodiesterase inhibitors, Beta Agonist, Digoxin
43
Q

What do PDE inhibitors do?

A
  • Enhance amount of intracellular cyclic AMP/Ca.
  • useful for increase CO but not HR
  • May cause thrombocytopenia
44
Q

At what dose does dopamine affect renal/mesenteric vasculator?

A

Lowest dose <2mcg/kg/min

-used for oliguria, ARF, Mesenteric ischemia, increase UO

45
Q

At what dose does dopamine effect alpha and B1 receptors

A

High doses>5mcg/kg/m

-med to high doses used for cardio genic/septic shock to increase CO

46
Q

What receptors does epi stimulate?

A

A, B1, B2

47
Q

What does neosynephrine stimulate?

A

A onlly

48
Q

When do you use vasopressin

A

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
49
Q

Negative potential side effect of nipride?

A

-Thiocynate toxicity: metabolic acidosis, confusion, seizures

50
Q

Treatment for symptomatic bradycardia

A

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

51
Q

What is isuprel?

A

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

52
Q

Indications for digoxin:

A

SVT, a fib/flutter

  • Slows HR (PNS activation)
  • Toxcity signs: GI upset, anorexia, confusion, diplopia, syncope
  • Therapeutic level 0.5-2mg/ml
53
Q

Amioderone dosing

A

150mg/100cc bolus

  • 1mg/min (6hrs) > 0.5mg/min (18hrs)
  • In VT/VF 300mg push
54
Q

What is the effect of stimulating alpha receptor?

A

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

55
Q

What is effect of stimulating beta1 receptors?

A

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

56
Q

Effect of stimulating beta 2 receptors?

A

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

57
Q

Effect of stimulating dopaminergic receptors?

A

Renal/mesenteric vasodilation, coronary vessels

58
Q

What is cholinergic referring to?

A
  • Cells of the ANS using acetylchoine as neurotransmitter

- PNS (Rest/digest)

59
Q

What are catecholamines?

A

Amine agent demonstrating SNS activity

60
Q

What is adrenergic referring to?

A
  • Cells of ANS that use epi/norepi as neurotransmitter,

- SNS (fight/flight)

EKG (1 decks)

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