Part 20 Flashcards
DOC for benzo overdoae
Flumazenil
Low vs high bleeding risk procedures
Low is minor derm or dental procedures, cataract, endoscopy without biopsy, high risk includes polypectomy, ortho or plastic surgery, kidney liver or spleen biopsy
INR goal for high bleeding risk procedure
<1.5
Bridging therapy is done for high risk thrombotic patients, and in moderate with a low bleeding risk. What are some examples of high risk pts?
recent VTE, known thrombophilic state, chadvasc score >5
andexanet alfa
reverses all factor xa inhibitors
Time dual antiplatelet therapy indicated for in balloon angio without Stent, drug eluting Stent, and bare metal Stent
14 days, 6 months, and 30 days
What blood pressure Med should you hold the day of surgery?
ACE inhibitor and ARBs
Most common noncardiac cause of chest pain
GERD
3 diseases within acute coronary syndrome
-Unstable angina (impending MI, no myocardial damage yet)
-STEMI
-NSTEMI
(both cases cardiac biomarkers are elevated)
Most common life threatening conditions resulting in chest pain (6)
- Acute coronary syndrome
- Cardiac tamponade with pericarditis (rare)
- aortic dissection (ripping tearing pain radiating to back)
- pulmonary embolus
- tension pneumothorax
- esophageal rupture/boorhave syndrome (thru violent vomiting or retching
Beck’s triad for cardiac tamponade
- hypotension
- muffled heart
- JVD
Aortic dissection definition, diagnosis (2), treatment (3)
- Breaking in integrity of aortic wall, often background history of marfan syndrome or hypertension, symptoms include sharp ripping shearing pain radiating to back, may have weak or absent peripheral pulses or new murmur of aortic insufficiency
- CT with contrast or Transesophageal echocardiogram
- IV labetalol or IV nitroglycerin followed by surgical approach
Pulmonary embolism definition, diagnosis (2), treatment (2)
Commonly occurs after surgery or immobilization, pain often pleuritic and described as crushing, shooting, accompanied by dyspnea, signs can include tachycardia, tachypnea, hemoptysis, hypoxemia, EKG may show sinus tach (most commonly)*** and S1Q3T3 right heart strain pattern (15%)
- D dimer highly sensitive, CT of chest is diagnostic
- anticoagulation, emboleectomy if large
Tension pneumothorax definition and treatment options (2)
Collapsed lung with air or gas trapped and allowed to move in but not out resulting in shifting of mediastinum away from affected lung compressing heart and decreasing cardiac output, sharp pleuritic chest pain with associated dyspnea, decreased or absent breath sounds, tracheal deviiation, tachycardia, tachypnea, hypotension, cyanosis, subcutaneous emphysema, JVD
-Chest tube, needle thoracotomy
Diagnostic gold standard study of choice after CXR, EKG, enzymes for CAD is….
….cardiac catheterization
Pericarditis definition and EKG finding (1)
- Inflammation of the pericardial sac most often viral in origin but can also be due to malignancy, end stage renal disease, dresslers (post MI), sees sharp crushing substernal with pleuritic component, aggravated by supine position, may hear friction rub
- sees diffuse ST segment elevation on EKG
S3 represents ___ dysfunciton, S4 represents ___ dysfunction
Systolic, diastolic
Diagnostic studies for chest pain patients (7)
- EKG
- CXR
- Cardiac enzymes, LFTs, amylase/lipase, D dimer, CBC
- stress testing
- echocardiogram
- cardiac catheterization (coronary angiography)
- CT/VQ
Pericarditis is worse in what position?
Supine
Preferred routes of administration for ACLS medications (2)
-IV or IO
In cardiac arrest (Vfib and pulseless v tach) persists after at least 1 attempt of defib and 2 min of CPR, what should be administered?
Epi 1mg IV q3-5 min while CPR is performed continuously
What may be administered in cardiac arrest (VF or pulseless VT) unresponsive to defibrillation, CPR, and epinephrine?
Amiodarone, 300mg IV, 150mg IV repeat dose
When is magnesium sulfate (2g IV) used in cardiac arrest?
Polymorphic ventricuar tachycardia with torsades de pointes
Asystole/PEA are nonshockable rhythms that after initiating CPR for 2 min can give this drug
1mg epi every 3-5min IV/IO
1st line treatment for nonstable bradycardia (BPM <50)
atropine .5mg bolus repeat every 3-5 min max 3 mg
2nd line treatment for nonstable bradycardia (BPM <50)
Dopamine infusion 2-10mcg/kg/min or epi (same dosing)
1st line treatment for nonstable tachycardia (BPM >150)
Immediate syncronized cardioversion narrow regular 50-100J or narrow irregular 120-200J
1st line treatment for narrow QRS stable SINUS tachycardia (BPM>150)
No medication indicated, just monitor
1st line treatment for narrow QRS stable nonsinus tachycardia (BPM>150)
Adenosine 6mg IV push by 20mL saline flush, 2nd dose 12mg IV (warn the patient they will experience transient chest discomfort, dyspnea, flushing, short lived tho)
2nd line treatment for narrow QRS stable nonsinus tachycardia (BPM>150) or control of heart rate in stable patients tachycardic patients (2)
- Rate control with IV nondihydropyradine ca2+ channel blocker such as diltiazem or verapamil
- B blocker (metoprolol, atenolol, labetalol)
1st line treatment for wide QRS stable nonsinus tachycardia (BPM>150)
Amiodarone (150mg/10min)
Morphine sulfate function
Opioid analgesic that also dilates blood vessels, IV morphine controls pain of MI and improves hemodynamics by promoting vasodilation, and reduces anxiety, useful in ACS but need to be cautious about respiratory depression, can reverse with naloxone (2-4mg IV)
Lidocaine function
Suppress ventricular fibrillation by raising threshold of fibrillation via same ca2+ channel activity that inhibits pain, can be used as alternative to amiodarone in cardiac arrest (Vfib or pulseless vtach)
B blocker use in ACLS
Used to suppress supraventricular tachycardia (atrial fib and flutter) and reduce myocardial ischemia in MI,
Atropine adverse effects (4)
- blurred vision
- dilated pupils
- dry mouth/nose
- difficulty urinating
Concurrent administration of ca2+ channels with IV B blockers can cause severe….
…hypotension
Red flags of headache (7)
- fixed neurological deficits
- extremely abrupt onset
- papilledema
- new onset in patients <5 or >50
- signs of infection
- altered level of consciousness
- new headache in cancer or immunocompromised patient
Primary vs secondary headaches
Primary is caused by benign intrinsic causes (migraine, tension, cluster) vs secondary caused by underlying causes (lesion, infection, etc)
Kernigs sign
Test for meningitis by seeing severe stiffness in hamstrings causing inability to straighten leg when hip is flexed to 90 degrees
Brudzinski’s sign
Test for meningitis that if positive sees patients hips and knees flex when the neck is flexed manually by the provider
Most helpful study in identifying CNS infection
Lumbar puncture (perform a CT prior to exclude any intracranial mass or bleed that could cause pressure issue and herniation of brain)
Rule of RBCs in the CSF tubes for determining a brain bleed while performing a lumbar puncture
Should normally see the number of RBCs decrease over time when drawing tubes from an LP, if consistent amount then can indicate a brain bleed presence
Decreased glucose in CSF analysis following LP is predictive of…
…infectious meningitis