Exam 3 - VTach, VFib, Asystole, PEA Flashcards
2 most common causes of adult and pediatric arrest? Cause? What is blood oxygenation at arrest in each?
Adults= VT and Vfib. Due to Ischemic heart disease. Blood fully oxygenated at arrest.
Pediatric= PEA and asystole. Due to asphyxiation and acute respiratory failure. Hypoxic and/or hypovolemic at arrest.
What is CPR priority?
CAB= Compression, Airway, Breathing.
Compressions are more important than anything else. Get to get the blood moving and there is usually enough oxygen in the blood without having to spend too much time.
What are the three major types of VTach?
- Stable
- Unstable
- PEA
Stable tachycardias (such as Sinus Tachycardia) are usually managed how?
Rate control
Unstable tachycardias (such as Wide-QRS Tachycardia) are usually managed how?
Cardioversion. Multiple agents including antiarrythmics.
Treatment of Ventricular Tachycardia depends on knowing what about the QRS complex and hemodynamics?
QRS=narrow or wide. Narrow is less than 0.12s (120ms). Wide is more than 0.12s (120ms).
Hemodynamics=stable or unstable
What is a normal QRS timing? Narrow and wide?
Normal aka Narrow=less than 0.12s (120ms).
Wide=more than 0.12s (120ms)
What are the two types of morphology for VTach? Which requires more treatment?
- Monomorphic
2. Polymorphic. Requires more treatment.
Treatment for hemodynamically stable VTach with Wide-QRS and Monomorphic?
Adenosine
Treatments for hemodynamically stable VTach with Wide-QRS and Polymorphic? (Hint: three)
- Amiodarine or
- Procainamide or
- Sotalol
What is the major treatment for all unstable V-tachs?
Synched Cardioversion. Except for Wide-QRS w/irregular rate.
Treatment for Unstable, Narrow-QRS, Regular VTach? (Hint: Two)
- Synched Cardioversion 50-100J
2. Adenosine
Treatment for Unstable, Wide-QRS, Regular VTach?
Synch Cardioversion 100J
Treatment for Unstable, Narrow-QRS, Irregular VTach?
Synched Cardioversion
Mono=200J
Biphasic=120-200J
Treatment for Unstable, Wide-QRS, Irregular VTach?
NOT synched cardioversion. Instead, defibrillation dose.
Monophasic=360J
Biphasic=200J
Which VTach do you NOT use synched cardioversion? What used instead?
Unstable, Wide-QRS, Irregular VTach.
Defibrillation dose:
Monophasic=360J
Biphasic=200J
Define and describe PEA? Treatments?
Weak and disorganized electrical and cardiac activity. No palpable pulse, inadequate BP.
Tx: CPR and Epi q3-5 min. Vasopressin can take place of first or second Epi.
Is PEA shockable? What medication to avoid?
Unshockable. Avoid Atropine.
Define and describe Asystole? Treatments? What to avoid?
Flat line. Confirmation of death.
Tx: CPR and Epi q3-5 min. Vasopressin can take place of first or second Epi.
Avoid shock and Atropine.
What type of poor outcome is associated with Vasopressin?
Poor neurological outcome.
Defintion and treatment of symptomatic Bradycardia?
HR less than 50BPM with symptoms.
Symptoms: Hypotension, mental status change, CV collapse
Tx: First use Atropine q3-5min. If ineffective then Dopamine or Epi q1min OR Transvenous pacing.
When use transvenous pacing in symptomatic Bradycardia?
After Atropine fails. Can also use Dopamine or Epi q1min.
What does Epi increase during arrests?
Return of Spontaneous Circulation (ROSC)
Epi increases survival to admission in which two conditions? Poor outcome is possible due to what?
Increased survival to admission in Pulseless VT and VF.
Poor outcome possibly due to catecholamine toxicity.
Which med has improved ROSC to admission in asystole?
Vasopressin.
Vasopressin MOA?
Non-adrenergic vasoconstrictor
Pulseless VT and VF respond best to which med?
Epi
Which med offers no benefit over Epi in Pulseless VT and VF?
Vasopressin
Which med has poor neuro outcomes?
Vasopressin
Amiodarine is a _____ ________ ____-__________. What are the benefits out-of-hospital and in-hospital compared to Lidocaine?
Broad spectrum anti-arrythmic.
Out of hospital=Improved survival to admission (not discharge) better than Lidocaine
In-hospital=Same odds as Lidocaine
Beware of two problems with Amiodarine? How is it better tolated?
- Hypotension
- Bradycardia
(does Amiodarine cause them or is Amiodarine CI’d with them? I think the former)
Solvent-free Amiodarone better tolerated.
What is main alternative to Amiodarone? High familiarity with which two?
Lidocaine
High-familiarity with VF and pulseless VT.
VF arrest is sometimes linked to which electrolyte being low?
Hypomagnesemia.
Give Magnesium in VF and pulseless VT in patients with what condition?
Torsades de Pointes
Atropine MOA and acceptable primary agent in what?
MOA: Potent anticholinergic agent
Acceptable primary agent in Bradycardia/arrest.
slide 26 says “bradycardia/arrest”
Dopamine MOA (cardiac and peripheral) and indications?
Norepinepherine precursor. Cardiac alpha and beta agonist. Peripheral dopamine receptor agonist.
Used in Bradycardia/arrest.
