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Cardiac Emergencies > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q
  1. When treating SCAPE, PCEMS recommends that nitroglycerin be titrated towards a target SBP of — mmHg (or resolution of symptoms).
A
  1. 140

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

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2
Q
  1. A normal ejection fraction ranges from — to —.
  2. A borderline ejection fraction ranges from — to —.
  3. An ejection fraction less than — represents systolic heart failure.
A
  1. 50-70%
  2. 40-50%
  3. 50%

https://www.youtube.com/watch?v=ypYIlmLD7g&t=472s

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3
Q

Orthopnea and paroxysmal nocturnal dyspnea are symptoms of — sided heart failure (and may be present during biventricular failure).

A
  1. left-

https://creativemeddoses.com/topics-list/heart-failure-left-sided-vs-right-sided/

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4
Q
  1. The most commonly affected organ in left-sided heart failure is the —.
A
  1. lungs

i.e., pulmonary congestion

https://creativemeddoses.com/topics-list/heart-failure-left-sided-vs-right-sided/

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5
Q
  1. Ascites and peripheral edema are clinical features associated with — sided heart failure (and may be present in biventricular failure).
A
  1. right-

https://creativemeddoses.com/topics-list/heart-failure-left-sided-vs-right-sided/

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6
Q
  1. What is the recommended method for increasing FiO2 during optimized CPAP / BiPAP therapy?
A
  1. Add a nasal cannula beneath the CPAP / BiPAP mask.

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

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7
Q
  1. Name the three principle advantages of CPAP / BiPAP use in the treatment of SCAPE.
A
  1. increases oxygen delivery to the lungs
  2. pushes fluid from alveoli back into the pulmonary arteries
  3. reduces venous return to the right side of the heart, reducing pulmonary hypertension

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

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8
Q
  1. Do the PCPs allow for the use of ketamine for CPAP anxiolysis?
A
  1. No

It may be used for DSI. If CPAP is then successful, DSI may be avoided.

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

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9
Q
  1. Nitroglycerin (1.) — afterload through (2.) — dilation and (3.) — preload through (4.) — dilation. It (5.) — myocardial oxygen demand and (6.) — oxygen delivery to the myocardium via coronary artery dilation.
A
  1. decreases
  2. arterial
  3. decreases
  4. venous
  5. decreases
  6. increases

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

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10
Q
  1. “Nitroglycerin, when administered to patients with heart failure, causes a marked (1.) — in left ventricular filling pressure but [unexpectedly] often a(n) (2.) — in stroke volume…”
A
  1. reduction
  2. increase

https://pubmed.ncbi.nlm.nih.gov/6430073/

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11
Q
  1. What must be done during the preparation of IV nitroglycerin in order to best ensure that initial medication delivery is at full concentration?
A
  1. Run a few extra mLs of nitroglycerin through the drip set tubing beyond what it takes to simply expell the air bubbles.

Nitroglycerin has an affinity for plastic and adheres to IV pump tubing.

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

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12
Q
  1. Name the two short-acting phosphodiesterase inhibitors which must be taken into consideration before nitroglycerin administration (trade name and generic name).
A
  1. Viagra (sildenafil)
  2. Levitra (vardenafil)

Memory Aid: Keep Viagra handy on the window sill (sildenafil).

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

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13
Q
  1. Name the long-acting phosphodiesterase inhibitor which must be taken into consideration before nitroglycerin administration (trade name and generic name).
A
  1. Cialis (tadalafil)

Memory Aid: A tadpole (tadalafil) swims in the sea (cialis).

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

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14
Q

Nitroglycerin is contraindicated for patient’s who have ingested short-acting phosphodiesterase inhibitors within the previous (1.) — hours, or long-acting phosphodiesterase inhibitors within the previous (2.) — hours

A
  1. 24
  2. 48

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

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15
Q

In order to avoid a precipitious drop in blood pressure secondary to nitroglycerin administration, it is advisable to ask prospective patients for whom it is otherwise indicated whether or not they have recently ingested (1.) — medications, as well as whether or not they have been diagnosed with (2.) —.

A
  1. phosphodiesterase inhibitors (Viagra [sildenafil], Levitra [vardenafil] and Cialis [tadalafil])
  2. aortic stenosis

Approximately 5% of persons ≥ 65 y/o have aortic stenosis.

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

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16
Q
  1. What is the principle adverse reaction which is likely to occur as a result of administering nitroglycerin to patients diagnosed with aortic stenosis or who are therapeutically dosed with a phosphodiesterase inhibitor?
A
  1. A significant drop in blood pressure

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

17
Q
  1. The acronym SCAPE is used in place of the older term (1.) — in the majority of current medical literature.
A
  1. flash pulmonary edema (or acute pulmonary edema)

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

18
Q

1. — is a term which representes the extreme end of the acute pulmonary edema spectrum.

A
  1. SCAPE

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

19
Q

What does SCAPE stand for with respect to pulmonary edema?

A

SCAPE

  • S - Sympathetic
  • C - Crashing
  • A - Acute
  • P - Pulmonary
  • E - Edema

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

20
Q

Common signs and symptoms of SCAPE include:
* Rapid onset of respiratory distress (usually within a few [1.] —)
* Hypoxemia
* Hypertension (SBP generally over [2.] — mm Hg)
* Diffuse (3.) — heard on auscultation
* (4.) —, frothy sputum
* Diaphoresis
* Pallor
* Tachycardia
* Agitation

A
  1. hours
  2. 160
  3. rales
  4. Pink

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

21
Q

Patients with Congestive Heart Failure may experience (1.) — dyspnea as a result of (2). — changes which occur while asleep. This is the most common scenario in which SCAPE is encountered. Additional triggers may include:
* (3.) -(position)- (i.e., orthopnea)
* Hypertension secondary to missed (4.) — medications
* Volume overload (missed [5.] -[medication variant]- or [6.] -[therapy]-)
* Use of (7.) -(illicit drug)- or (8.) -(illlicit drug)-
* Withdrawal

A
  1. paroxysmal nocturnal
  2. hormonal
  3. Lying flat
  4. antihypertensive
  5. diuretics
  6. dialysis
  7. cocaine
  8. methamphetamine

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

22
Q

If significant improvement of a SCAPE patient’s condition is seen during treatment, “[r]apidly down-titrate the nitrogycerin infusion and CPAP pressures (while watching for recurrent SCAPE). this can be done by cutting the nitro infusion dose by (1.) — and titrating to maintain a SBP ≈ (2.) —. If SBP falls below (3.) — stop immediately.”

A
  1. half
  2. 140
  3. 100

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

23
Q

If during the treatment of SCAPE a patient’s “SBP falls below (1.) — and they are not recovering from simply turning the nitro off, give them a (2.) — mL bolus…”

A
  1. 100
  2. 500

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

24
Q
  1. What does the acronym FOSPE stand for with respect to CHF?
A

FOSPE

  • F - Fluid
  • O - Overload
  • S - Subacute
  • P - Pulmonary
  • E - Edema

CPFR 2023 Vector Solutions Assignment: Identification and Treatment of SCAPE

Cardiac Emergencies (4 decks)

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