MTB 2 Flashcards
Presentation of Heat cramps/exhaustion
Hx: exertion, high temp
Body temp: Nomral
CPK/K+ = Normal
Tx: oral fluids, electrolytes
Heatstroke
Hx: exertion, high temp
Body temp: High
CPK/K+ = High
Tx: IVF, evaporation, ice water immersion if no CNS involvement
NMS
Hx: APs
Body temp: High
CPK/K+ = High
Tx: Dantrolene or Dopamine Agonists, Bromocriptine, Cabergoline
Malignant Hyperthermia
Hx: Anesthetics
Body temp: High
CPK/K+ = High
Tx: Dantrolene
MOA of Dantrolene
Muscle relaxant
Works on Ryanodine receptors - Prevents calcium release from SR in skeletal muscle
Presentation of Hypothermia
Intoxicated person
Low body temp
MCC death hypothermia
Cardiac Arrhythmia
Best initial step in hypothermia
EKG
- J Waves - where QRS hits ST segment
TX for Frost bite
Rapid rewarming with warm water
Immerse in warm water
If systemic hypothermia - infuse warm fluids
Presentation of Salt water Drowning
Acts like CHF
Wet, heavy lungs, pulmonary edema
Presentation of Fresh water Drowning
Hemolysis from absorption of hypotonic fluid into vasculature
Role of steroids and Abx in drowning
None. They are not useful
Management in cardiac arrest
- Make sure pt is unresponsive
- Call for help
- Open airway
- Give rescue breaths if not breathing
- Check pulse, start compressions
When do we do precordial thump
Very recent onset of arrest
Less than 10 mins
No defibrillator available
Causes of pulselessness
Asystole
V Fib
V tach
PEA
Best initial management puleslessless
CPR
TX for Asystole
- Epinephrine + Atropine
- Vasopression = alternative for Epi
MOA Of epinephrine and vasopressin
Constrict BVs to shunt blood into critical central areas - heart and brain
When do we do Unsynchronized Cardioversion
V Fib
Pulseless V tach
Torsades des Pointes
Best initial Tx for V fib
- Immediate Unsynchronized Cardioversion
- If ineffective -> Resume CPR
- Shock again
- Epinephrine/Vasopressin
- Shock
- Amiodarone/Lidocaine
When is Bretyllium the correct answer
Never
Management for Pulseless V tach
- Immediate Unsynchronized Cardioversion
- If ineffective -> Resume CPR
- Shock again
- Epinephrine/Vasopressin
- Shock
- Amiodarone/Lidocaine
Management for hemodynamically stable V tach
- Amiodarone
- Lidocaine
- Procainamide
- Cardiovert
Management for hemodynamically unstable V tach
Electrical cardioversion several times
Amiodarone or Lidocaine
What makes up hemodynamic instability
Chest Pain
SOB
HypoTN
Confusion
What is PEA?
Patient presentation?
Heart is electrically normal
No motor contraction
Pt with No pulse and normal EKG
Causes PEA
T's and H's Tamponade Tension Pneumothorax Hypovolemia Hypoglycemia Hypo/Hyper kalemia Hypoxia Hypothermia PE - massive Metabolic Acidosis
Difference bt A flutter and Fib
Flutter = Regular rhythm Fib = Irregular rhythm
What is A flutter
Reentrant circuit that rotates around Tricuspid Annulus
EKG of A fib
Absent P waves
Narrow QRS complexes
What is most frequent origin for ectopic foci of A fib
Pulmonary veins
When do we do synchronized cardioversion in A fib
Hemodynamically Unstable pts
What does synchronization do
Prevents electricity from being delivered during refractory period
Helps prevent deterioration into VT or VF
Best initial TX for Chronic A fib
- Rate control
- Beta blockers
- CCBs
- Digoxin - Anticoagulate
- Warfarin
Time length for chronic A fib
2 days
Which CCBs used for A fib
MOA
Diltiazem
Verapamil
Block AV node
With A Fib, when is it necessary to use heparin before warfarin
When there is current clot in atrium
Benefits of Dabigatran
Does not need monitoring
Prevents stroke
What problem can occur in an atrial rhythm problem + Cardiomyopathy
Pulmonary Edema
- loss of atrial contribution
How much of atrium contributes to CO
10-15%
Criteria for low risk stroke from A fib
No Cardiomyopathy/CHF/Atherosclerosis No HTN 75 or younger No DM No past stroke
Lone A fib - Criteria
Management
No Risk factors
ASA
Presentation of SVT
Palpitations
Hemodynamically stable
Best initial steps in managing SVT
- Vagal maneuvers
- Carotid massage
- Valsalva
- Dive reflex
- Ice immersion - Adenosine
- Beta blockers, CCBs, Digoxin
When is Adenosine used in SVT
Vagal maneuvers are ineffective
Only therapeutically
EKG of SVT
Narrow complex Tachycardia
No P waves
No fibrillatory waves
Rate 160-180
TX for SVT with unstable Vital signs
DC Cardioversion
Presentation of Paroxysmal SVT
Benign and Abrupt attacks
HR 160-220
Reentry AV Node
Management of Paroxysmal SVT
Increased vagal tone by Valsalva, Carotid massage, cold water immersion to Decrease AV conduction
