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urgencias > RCP avanzada > Flashcards

RCP avanzada Flashcards

1
Q

dose, route and uses of adenosine in adults

A

use: narrow PSVT/SVT, wide QRS tachy
avoid: irregular wide QRS
dose: 6mg IV bolus (followed by flush with 20mL of saline), may repeat with 12 mg in 1-2 mins
notes: there must be continous cardiac monitoring, causes flushing and head heaviness

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2
Q

dose, route and uses of amiodarone in adults

A

use: VF / pulseless VT, VT with pulse, tachy rate control
dose: 300mg dilute in 20-30ml (may repeat 150mg in 305 mins)
notes: anticipate hipotension, bradicardia, GI toxicity. There must be continouse cardiac monitoring. Has a very long 1/2 life (up to 40 days).

DONT USE IN 2º OR 3º HEART BØ, DONT ADMIN IN ET TUBE

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3
Q

dose, route and uses of atropine in adults

A

uses:
- symptomatic bradicardia: 0.5mg IV/ET every 3-5mins, max dose 3mg
- specific toxins/overdose (ex: organophosphates): 2 - 4 mg IV/ET

notes: there must be cardiac and BP monitoring, DONT USE IN GLAUCOMA OR TACHIARRYTHMIAS, minimum dose 0.5mg

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4
Q

dose, route and uses of dopamine in adults

A

uses: shock / CHF
dose: 2 - 20 mcg/min, titrate to desired BP
notes: fluid resuscitation first, there must be cardiac and BP monitoring

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5
Q

dose, route and uses of epinephrine in adults

A

cardiac arrest:

  • initial: 1mg (1:1000) or 2-2.5mg (1:1000) ETT every 3 - 5 min
  • maintain: 0.1 - 0.5 mcg/min, titrate to desired BP

anaphylaxis:
- 0.3 - 0.5 IM, repeat every 5 min as needed

symptomatic bradycardia/shock:

  • 2 - 10 mcg/min infusion
  • titrate to response

notes: there must be continous cardiac monitoring, give via ventral line when possible

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6
Q

dose, route and uses of lidocaine in adults

A

**recommended when amiodarone isn’t available

cardiac arrest: VF/VT

  • initial: 1-1.5mg/kg IV loading
  • second: half of first dose in 5 - 10 min
  • maintain: 1 - 4 mg/min

wide complex tachicardias with pulse:

  • initial: 1 - 1.5mg/kg IV
  • second: half of first dose in 5 - 10min
  • maintain: 1 - 4mg/min

notes: must have cardiac and BP monitoring, rapid pulse can cause hipotension and bradicardia, use with caution in kidney failure, calcium chloried can reverse hipermagnesemia

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7
Q

dose, route and uses of magnesium sulfate in adults

A

cardiac arrest / puseless torsades: 1 - 2 gm diluted in 10ml

torsades de pointes with pulse: 1 - 2 gm IV over 5 - 60 min, maintain 0.5 - 1gm/hr IV

notes: must have cardiac and BP monitoring, rapid pulse can cause hipotension and bradicardia, use with caution in kidney failure, calcium chloried can reverse hipermagnesemia

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8
Q

dose, route and uses of procainamide in adults

A

use: wide QRS tachycardia, preferred for VT with pulse (stable)
dose: 20 - 50mg / min IV until rhythm improves, hypotension occurs, QRS widens by 50% or max dose is given

mas dose: 17mg/kg

drip: 1 - 2 gm in 250 - 500ml ate 1 - 4 mg/min
notes: must have cardiac and BP monitoring, caution with acute MI, may decrease dose with kidney failure, DONT COMBINE WITH AMIODARONE, DONT USE IN PROLONGED QT OR CHF

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9
Q

dose, route and uses of sotalol in adults

A

use: tachyarrhytmia, nomonorphic VT, 3rd line antiarrithmic
dose: 100mg (1.5mg/kg) IV over 5 min
notes: DONT USE IN PROLONGED QT

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10
Q

parameters that tell you oxygenation is adequate

A

oxygenated inspired air is best provided via a tight fitting oxygen reservoir face mask with a flow rate of at least 11 L/min

pulse oximetry must be used at all times

  • doesn’t measue PaO2
  • measured saturation >95% by pulse oximetry is strong coroborating evidence of adequate peripheral arterial oxygenation (PaO2 >70mmHg)
  • limited usefulness in pt with severe vasoconstriction & carbon monoxide poisoning because it can’t distinguis oxyhemoglobin from carboxyhemoglobin or methemoglobin
  • profound anemia (hb <5g/dl) and hypothermia (<30ºC or <86ºF) decrease the reliability of the technique
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11
Q

how can you tell that the ET tube is in the right place

A
  • hearing equal breathing sounds bilaterally and detecting no borboygmi in epigastrium

the presence of CO2 in exhaled air indicates that airway has been successfully intubated, but doesn’t ensure the correct position of the tube

proper position of the tube is confirmed by chest X-ray

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12
Q

how many joules should a shock be admin. when using a monophasic defibrillator

A

360 J

must use same energy doe on subsequent shocks

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13
Q

which kind of defibrillator is more effective for terminating a fatal arrythmia

A

the biphasic defibrillator

- use the manufacturer’s recommended energy dose

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14
Q

what are some AED keypoints

A
  • assure O2 isn’t following across the pts chess when delivering
  • don’t stop chest compressions for more than 10 sec. when assessing the rhythm
  • STAY CLEAR
  • asses pulse after the 1st 2 min of CPR
  • if the en tidal CO2 is <10mmHg during CPR, consider adding a vasopressor and improve chest compressions
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15
Q

key components of post cardiac arrest care

A 
therapeutic hypothermia (32 - 36ºC) 
- recommended for commatose individuals with return of spontaneous ciculation after a cardiac arrest event

optomization of hemodynamias and ventilation

  • 100% O2 is acceptable for early intervention but not for extended periods of time
  • oxygen should be titrated, so that the pulse oximeter >94%
  • don’t over ventilate
  • ventilation rates of 10 - 12 breaths x min to achieve ETCO2 at 35 - 40mmHg
  • IV fluids and vasoactive meds should be titrated for hemodyamic stability

Percutaneous Coronary Intevention (PCI):
- preferred over thrombolytics

Neurologic Care:

  • neurologic assessment is key
  • specialty consultation should be obtained to monitor neurologic signs and symptoms throughout the post resuscitation period
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16
Q

life threatening complications of ACS

A 
ventricular fibrillation
pulseless ventricular tachycardia
bradyarrythmias
cardiogenic shock
pulmonary edema
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17
Q

what are the 8 D’s of stoke care

A

Detection: rapid detention of S&S (<10min)
Dispatch: early activation / 911
Delivery: rapid EMS 10, management and transport
Door: transport to stroke center
Data: rapid triage, eval and management
Decision: stroke expertise and therapy selection
Drug: fibrinolytics therapy, intra-arterial strategies
Disposition: rapid admit. to stroke or critical care unit

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18
Q

what are the stoke team alert criteria

A

threatened airway or labored breathing
altered mental status
bradycardia (<40BPM) or tachycardia (>100BPM)
seizure
hypotension
symptomatic hypertension
sudden and large decrease in urine output

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19
Q

what are the reversible causes of cardiac arrest

A 
Hypovolemia
Hypoxia
Hypothermia 
H+ (acidosis)
Hypo/Hyperkalemia
Tension Pneumothorax
Tamponade
Toxins
Thrombosis (coronary / pulmonary)
Trauma (unrecognized)
20
Q

what are the most common causes of pulseless electrical activity

A

Hypovolemia

Hypoxia

21
Q

1st line treatment of adult bradycardia with pulse (when there’s altered mental status, shock, chest pain, acute heart failure) in an emergency setting

A

HR <50

Atropine
- IV: 0.5mg bolus, repeat every 3 - 5 min up to 3mg max dose

if ineffective use:

  • transcutaneous pacing
  • dopamine infusion (2-10mg/kg/min)
  • epinephrine (2 - 10mcg/min)
22
Q

characteristics of a sinus bradycardia

A

regular
rate generally 40 - <60bpm
PR interval 0.12-0.20 sec, consistent
QRS complex <0.12 sec

23
Q

characteristics of a 1ºblock

A

regular
rate depends on underlying rhythm
p wave >0.20sec, consistent
QRS complex <0.12sec

24
Q

characteristics of a type I 2ºblock (weckenbach)

A

rhythm isn’t regular but does have a pattern to it, R-R interval gets longer a PR intervals get longer
ventricular rate is usually slightly higher than the atrial rate due to some atrial beats no being conducted
the atrial rate is usually normal
P wave upright and uniform, doesn’t always proceed a QRS complex
PR interval gets progressively longer until there is a dropped QRS complex
QRS complex <0.12sec

25
Q

characteristics of a type II 2ºblock

A

the regularity depends if there is or isn’t a conduction ratio
atrial rate is normal
ventricular rate usually slower than atrial rate
P wave upright and uniform, a QRS doesn’t always follow every p wave
there is a conduction ratio (a QRS drops after “X” amount of p waves)
PR interval is constant across the strip, but not every P conducts a QRS
QRS complex <0.12 sec

26
Q

characteristics of a 3º block

A

R-R regular, P-P wave regular but independent
atrial rate regular and normally 60 - 100bpm
rate of QRS complex is dependent on the focus
- ventricular focus: 20 - 40 bpm
- junctional focus: 40 - 60 bpm
p wave upright and regular
there isn’t a QRS following every p wave
PR interval may or may not be longer that normal
QRS complex usually prolonged

27
Q

what are some of the signs and symptoms of bradycardia

A 
low blood pressure
pulmonary edema/congestion
abnormal rhythm
chest discomfort
shortness of breath
weakness/dizziness
lightheadedness
confusion
28
Q

symptoms of tachycardia

A 
low BP
sweating
pulmonary edema/congestion
jugular venous distension
chest pain discomfort
shortness of breath
weakness/diziness/lightheadedness
altered mental status
29
Q

how can you control the HR in an irregular narrow complex tachycardia in an emergency setting

A

diltiazem 15 - 20mg (0.25mg/kg) IV over 2 min or beta blockers

30
Q

how can you control the HR in an regular wide complex tachycardia in an emergency setting

A

convert rhythm using amiodarone 150mg IV over 10 min and perform efective cardioversion

31
Q

how can you control the HR in Torsades de Pointes in an emergency setting

A

magnesium sulfate 1 - 2 mg IV, may follow with 0.5 - 1mg over 60 min

32
Q

what are the rules for a sinus tachycardia

A 
regular
***rate >100BPM***
p wave normal
PR interval normal
QRS complex normal
33
Q

what are the rules for atrial flutter

A

atrial rate 250-350
ventricular rate will only be regular if the AV node conducts the impulses in a consistent manner
p wave in a “saw-tooth” pattern
QRS normal

34
Q

what are the rules for atrial fibrilation / irregular narrow complex tachycardia

A

R-R irregular
atrial rate usually >350
if ventricular rate is 60-100 = controlled A-fib
if ventricular rate is >100= uncontrolled A-fib
there are no obvious P waves in the rhythm*
QRS complex normal

35
Q

what are some of the symptoms of an acute coronary syndrome

A 
crushing chest pain
shortness of breath
pain that radiates to the jaw, arm or shoulder
sweating
nausea/vomiting

pt with DM or women may not present with these classic signS

36
Q

KEY points in the treatment of an acute coronary syndrome in an emergency setting

A

Oxygen: 4L/min nasal canular; titrate as needed

Aspirin: if no allergy 160-325mg. ASA to chew. Avoid coated ASA.

Nitroglycerin: 0.3-0.4 mg SL/spray x 2 doses at 3-5 min intervals
- dont use if SBP <90mmHg
or if phosphodiesterase inhibitor (viagra) was taken within 24 hrs

Morphine: 1-5mg IV only if symptoms not relieved by nitrates or if symptoms recur. Monitor BP closely

12 lead ECG, evaluate for ST elevation/depression

IV access: large gauge

Notify hospital

once at a hospital:

  • check vitals / O2 sat
  • IV access
  • perform targeted history / physical
  • complete fibrinolytic checklist
  • obtain preliminary cardiac marker, electrolytes, and coagulation studies
  • obtain chest X-ray
37
Q

how long is the fibronolysis window (door-to-needle)

A

≤ 30 min

38
Q

how long is the PCI (door-to-balloon inflation) window

A

< 90 min

39
Q

what are the symptoms of stroke

A 
weakness in arm, face, or leg
vision problems
confusion // change in the level of conciousness
nausea
vomiting
trouble speaking or forming the correct words
problems walking or moving
severe headache (hemorrhaigc)

**hypoglycemia can mimic stroke symptoms (which is why checking glucose level is very imp)

40
Q

T/F. All acute stroke individulas are considered NPO on admission

A

TRUE

41
Q

caracteristics of the cincinatti prehospital stroke scale

A

it is used to dx the presence in an individual of any of the following physical findings are seen:

  • facial droop
  • arm drift
  • abdomal speech

if 1/3 as new event = 72% probability of ishemic stroke

if 3/3 as new event = 85% acute stroke

42
Q

what is more common, ischemic or hemorrhagic stroke

A

ischemic stroke

43
Q

what are the time goals established by the National Institute of Neurologic Disorders and Stroke when the time of onset of stroke symptoms is known

A

10 min of arrival: general assessment by expert, order urgent CT scan w/o contrast

25 min of arrival: perform CT scan w/o contrast, neurological assessment, seat CT scan within 45 min

60 min of arrival: evaluate criteria for use and admin fibrinolytic therapy (fibrinolytic therapy may be used within 3hrs of symptom onset)

180 min of arrival: admission to stroke unit

44
Q

what are the inclusion criteria for fibrinolytic therapy criteria

A

symptom onset within the last 3 hrs (unless special circumstance)

≥ 18yrs

ischemic stroke with neurological deficit

45
Q

what are the absolute exclusion criteria for fibrinolytic therapy criteria

A

head trauma in the last 3 months

stroke in the last 3 months

subarachnoid hemorrhage

arterial puncture in last 7 days

previous intracranial hemorrhage

active bleeding

heparin in the last 2 days

increased INR

Hypoglycemia

very large brain infarct (multilobal)

platelets <100,000 /mm3

46
Q

what are the relative exclusion criteria for fibrinolytic therapy criteria

A

very minor / resolving symptoms

seizure may be affecting neurological exam

surgery or trauma in last 14 days

major hemorrhage in the last 21 days

myocardial infarction in last 3 months

urgencias (7 decks)

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