flash cards
study
1
Q
When do you measure capnography? and what is the range
A
to measure someones CO2. The range is 35-45. When looking at the waveform on the monitor, it should rise between 20-40mm HG
- if there is less than 20 mm HG, it could mean that the ET tube is dislodged
2
Q
End tidal CO2
A
Put on PT for moderate OSA to measeure concentration CO2
3
Q
potential or reversable causes of ACS or cardiac arrest (H and T’s)
A
- hypovolemia
- hypoxia
- hydrogen ion (acidosis)
- hypo/hyperkalemia
- hypothermia
- Tension pneumothorax
- Tamponade Cardiac
- Toxins
- Thrombus (pulmonary)
- Thrombus (coronary)
4
Q
post-cardiac arrest syndrome
A
- post- brain injury
- post MI dysfunction
- systemic ischemia and reperfusion response
- persistent acute and chronic pathology that may have precipitated the MI
5
Q
ETCO2 is an indication for?
A
- cardiac output
- and can signal return of spontaneous circulation ROSC
6
Q
how deep are the chest compressions?
A
5 cm adult
7
Q
how many compressions/min
A
100-120
8
Q
if there is a pulse how many rescue breaths?
A
one every 6 seconds and check pulse every 2 min
9
Q
ROSC is unlikely if ETCO2 is less than?
A
10 mm HG
10
Q
what is agonal gasps
A
- appears to be drawing in air, slow and irregular, can be snort, snore or groan
- this is a sign of cardiac arrest
- start CPR right away
11
Q
primary assessment
A
ABCDE
airway
breathing
circulation
disability
exposure
12
Q
secondary assess (SAMPLE)
A
S- signs and symptoms
A- allergies
M- medications
P- past medical hx
L- last meal consumed
E- events leading up to current illness
H’s and T’s
13
Q
what are the two most common causes of PEA
A
- hypovolemia and hypoxia
14
Q
hypovolemia cardiac symptoms
A
- sinus tachycardia
- narrow complexes
- typically increases diastolic and decreases systolic
- blood loss
- hypovolemia causes hypotension = PEA
- replace volume
15
Q
what can an US or ECHO discover? and what would be the solution
A
- cardiac tamponade = pericardialcetesis
- tension pneumothorax = chest tube
- ECHO (echocardiographic) US for PE = fibrinolytics
16
Q
What would a large PE cause
A
- acute right heart failure bc it obstructs the pulmonary vasculature
17
Q
what do you do for drug overdoses and toxic exposures?
A
- CPR
- renal dialysis
- replace electrolytes
- drug antidotes
- trascut pacing
- adjunctive agents
18
Q
Immediate actions for STEMI or NSTEMI
A
- O2
- aspirin 160-325mg
- nitro spray
- morphine IV
- consider P2Y12- plavix (clopidogril), ticegralor
19
Q
Reperfusion goals (times)
A
- < 12 hrs
- PCI balloon inflation < 90 min
- door-to-needle fibrinolysis < 30 min
20
Q
Both morphine and nitro?
A
Venodilate- can cause hypotension
21
Q
What is classified ST elevation
A
ST elevation 2mm or more or new LBBB
Leads 2 and 3:
men J point > 2
Women > 1.5
> 1mm or more for all other leads or new LBBB
22
Q
NSTEMI ischemic ST depression
A
- 0.5 mm or greater dynamic T-wave inversion with pain or discomfort
- if trop is elevated
- transient elevation of 0.5 or greater for less than 20 min
23
Q
when to treat NSTEMI
A
- refractory ischemic chest pain
- recurrent/persistent ST-segment deviation
- vent tachy
- hemodynamic unstable
- signs of HF
- then start adjunct therapies: nitro, heparin
24
Q
what is the best treatments for STEMI?
A
-reprofusion therapies
- fibrinolytics 30 min (alteplase)
- PCI’s : balloon/stents 90 min (120 min from 1st medical contact)
25
when not to give fibrinolytics?
- typically after the first 12 hrs of symptoms
- Those with ST depression, unless its true posterior MI
26
when do you use IV nitro
- chest pain that isnt responsive to subling nitro
- pulmonary edema
- HTN complicating MI
27
rules for IV nitro
- titrate
- keep SBP > 90mm HG
- limit drop in SBP 30 mm Hg below baseline in HTN PTs
28
drugs for strokes
- fibrinolytic
- glucose D10/D50
- labetolol
- hydralazine
- ASA
29
critical time periods stroke:
- assess 10 min
- CT/MRI 15 min
- interpret CT/MRI 45 min
- fibrinolytic therapy 30 min (door to needle)
- fibrinolytics need to be started 4.5 hrs from time of onset
-EVT (endovascular thombolectomy)- up to 6 - 24 hrs
30
EVT, CTA and CTP
EVT- endovascular thombolectomy
CT angio - diagnose vasculature
CT perfusion
31
to start fibrolytic therapy BP has to be...
systolic < 185
diastolic < 110
32
if BP is > 185 treat with
labetolol 10-20 mg IV over 1-2 min
33
meds for bradycardia
- atropine
- dopamine (infusion)
- epi (infusion)
34
signs and symptoms of bradycardia
- hypotension
- altered LOC
- signs of shock
- ischemic chest discomfort
- acute HF
if bradycardia not causing these (poor perfusion) then just monitor
35
if atropine is ineffective then
- consider transcutaneous pacing or dop/epi inf
36
what to do for bradycardia
- maintain airway
- O2
- cardiac monitor
- IV
- 12 lead
- consider hypoxic/toxic causes
37
what is a normal atropine dose and how often can you admin?
1st dose: 1 mg
repeat 3-5 min up to 3 mg
38
is the bradycardia causing...
1. hypo
39
If atropine doesn’t work and u use TCP what setting do you use?
The lowest possible. Also give sedatives and analgesics.
- use only as an emergent bridge to TVP (transvenous pacing)
- you can do TVP with dop or epi infusion
40
No atropine in which PTs
Heart transplant
41
What do u need to give bfr TCP
- analgesic
- benzo (Midaz) for anxiety and muscle contractions
- use chronotropic drugs (dopamine and epi also vasoconstrictors)
- need expert consult for TVP
42
When do you want to use dobutamine
When you don’t want to vasoconstrict by using dopamine and epi
43
Dopamine low dose and high dose
5-20mcg/kg/min
Low- selective affect on inotropy and HR
High- also has vasoconstriction effects
44
Chrinotropic
Inotropic
Chrono- rate
Inotropic- force
45
Set up TCP
- place electrodes by picture
- turn on
- set demand rate btwn 60-80/min
- set milliamperes output 2mA above the does at which consistent capture is observed
46
Unstable tachycardia causes
(decreases CO )
- hypotension
- acutely altered mental status
- signs of shock (pale, diaphoretic, tachipnea, N/V, enlarged pupils, weak, dizzy, fainting, anxious)
- ischemic chest discomfort
- acute heart failure
47
When to cardiovert
- when HR > 150 and symptomatic
- if the PT is serious I’ll or has cardiac disease, they might be symptomatic at lower rates
48
Never cardiovert when…
A person is in sinus rhythm
49
Tachycardia algorithms
1) identify underlying cause and do basic: O2, maintain airway, cardiac monitor, IV, 12 lead
- if PT persist and is unstable then
2) synchronized cardio version with sedation and adenosine if narrow QRS
3) - if wide QRS > 0.12 then adenosine if regular and monomorphic (no cardiovert if wide QRS and biphasic)
- vagal maneuvers, BB’s, CCB’s
50
Most wide QRS stem from
Ventricles
51
If the PT is pulseless tachycardia treat them as
Ventricular fibrillation
52
If the PT has a wide QRS tachy and is unstable treat them as
Vent tachy VT
53
If the PT has polymorphic vent tachy treat as:
VF with high energy unsynchronized shocks
If you don’t know if the unstable Pt has polymorphic or monomorphic VT, = high energy unsync shocks
54
Why do you synchronize
To prevent R on T. When the heart is depolarizing (t-wave) - can cause VF
- synch uses lower energy level
- unless polymorphic or pulseless, you can’t synch
55
What med might the dr. Trial as you wait for cardio version?
Adenosine first dose 6mg fast with fast NS flush and immediate elevate arm
Second dose 12 mg if needed
May cause: asystole, flushing, chest pain, moment bradycardia, bronchospasm
56
When can you use adenosine: if the QRS is…
Narrow, regular and monomorphic
Can use on wide QRS only if regular and monomorphic
Then use antiarrhythmic infusion: procainamide or adenosine
57
If the tachycardia is polymorphic with a wide QRS then
Cardiovert unsynch shock
58
For wide complex tachy’s consult professional bc
- treatment has potential for harm
59
What do you do first for tachy with narrow QRS with regular rhythm - symptomatic but stable
- vagal maneuvers
- adenosine
- BB CCB
60
You have a pulse with no breathing.
- get an airway and give one breath every 6 seconds checking pulse every 2 min
61
Post-cardiac care what do you want o2 to be at
92-98%
62
What % O2 do you want for ACS?
Stroke?
Post cardiac arrest
ACS 90%
Stroke 95-98%
Post cardiac 92-98%
63
CCF
Chest compression fraction
Time during cardiac arrest resuscitation during chest compressions
CCF= actual chest compression time / total code time
64
Drugs for VF/pVT
- Epi 1mg Q3-5min
- amiodarone 300mg, then 150mg or
- lidocaine 1-1.5mg/kg, second dose 0.5-0.75mg/kg
- magnesium sulfate: hypomag or torsades de pointes 1-2g (2-4ml of 50% solution in 10mls NS or D5W)
- dopamine: for Brady and hypotension
- O2
- others….
65
When you have an advanced airway how often are breaths
Every 6 seconds
66
when does brain damage start and when is it irreversible?
6-10
after 10
67
when do you check for a pulse?
only if you see an organized rhythm
68
if you have a rhythm with a pulse?
proceed to post-cardiac arrest care
-O2 >or = to 92-98%
-advanced airway
-treat hypotension SBP <90 1-2L
: Epi/dopamine/levo inf
-12 lead
-TTM
69
if the rhythm is non-shockable and there is no pulse?
follow asystole/PEA
CPR/IV EPI, shockable? CPR treat causes
70
if the rhythm is shockable?
continue to VF/VT pathway
give one shock and resume CPR
71
when do you give Epi?
after the second shock repeat Q4 min
72
what does EPi do?
- vasoconstricts and increases blood flow to the brain/coronary
- improves aortic diastolic pressure
73
when should antiarrhythmics be given?
what should you give?
- before or after a shock.
- use when VF/VT unresponsive to shocks
amiodarone or lidocaine.
(these are better used if it was witnessed)
74
amiodarone
for VF/VT
1) 300 mg
2) 150mg
blocks Na channels, lengthens cardiac action potential
75
lidocaine
1) 1-1.5 mg/kg
2) 0.5-0.75 mg/kg max dose 3 mg/kg
76
magnesium sulfate
- for torsades de pointes associated with long QT interval
1) 1-2 grams over 20 min
Na/K+ pump agonist
surpresses cardiac calcium channels
77
how do you give each IV drug
- bolus and flush with 20ml NS
- elevate arm to get into central circulation (for 10-20 seconds) ya right
78
targeted temp managment
esophageal, rectal, bladder
32-36 degrees for 24 hrs
79
what else should you do/monitor in post-cardiac arrest care
- EEGs
- TTM
- brain CT
- lung protective ventilation
- elevate HOB 30 degree to prevent cerebral edema/aspiration and vent acquired pneumonia
- O2 92-98%
- start ventilation at 10 breaths/min and adjust to PaCO2 35-45
- SBP >90 or MAP 65
- ECGs for ST elevation or new LBBB- treat coronary angiography
80
signs of ROSC
- breathing
- movement
- palpable pulse
- measurable blood pressure
