SESAP ICU - Cardiac

Question 1

Cardiac Arrest - What is TTM

Answer 1

Targeted temperature management. A management strategy for out of hospital cardiac arrest to improve short term and long term survival and neurologic recovery.

Question 2

TTM Trial

Answer 2

TTM - benefits of 36 C is equivalent to 33 C. Cool to 33-36 C for 24 hours.

Question 3

What is an inotrope?

examples?

Answer 3

Increases cardiac contraction –> increases cardiac output without a change in BP.
ex. dopamine, dobutamine, milrinone, epinephrine

Question 4

what is a chronotrope?

examples?

Answer 4

Increases heart rate to increase cardiac contractility. Increase CO and increase HR
ex. Isoproperonol, dopamine, high level of dobutamine, atropine

Question 5

What is dromotropy?

Answer 5

Increasing actual conduction between nodes

ex. phenytoin

Question 6

Pressors:
Which act on heart?
Which act on periphery?

Answer 6

1. epinephrine, dopamine, dobutamine, milrinone

2. norephinephrine, vasopressin, phenylephrine

Question 7

Pressors:

Pressor to receptor

Answer 7

1. Norepinephrine: primary alpha 1 agonists > dopamine, (inc SVR, inc BP)
2. Epinephrine: A1 = B1 > B2 (inc svr, inc hr, inc cp
3. Phenylephrine: only alpha –> can result in bradycardia when tone is lacking.
4. Vasopressin: V1a receptor –> constrict arterioles.

Question 8

Pressors:
First line sepsis treatment
Second line

Answer 8

1. norephinephrine

2. dopamine

Question 9

SEPSIS fluid rate?

goals:

Answer 9

per 2016 guidelines - at least 30 ml/kg for the first 3 hours. e.g. 100 kg patient –> 3000 mL of crystalloid.

goals of resuscitation - MAP > 60, maintain UO > 0.5 -1 ml/kg/hr. (source control, early antibiotics)

bonus - hetastarch not recommended for anything. increased risk of AKI and death.

Question 10

ACLS review - treatment?

1. Monomorphic ventricular tachycardiac w/ hypotension
2. Monomorphinc ventricular ectopy, sustained
3. Torsades de pointe ( wide complex)
4. Symptomatic bradycardia w/ hypotension
5. Narrow complex tachycardias

Answer 10

1. Cardioversion
2. fix electrolytes. If sustained, give Amiodarone
3. Remove medication (haldol, methadone, levofloxacin). IV magnesium
4. Atropine then transcutaneous pacing
5. Blocker –> CCB (AV nodal block), BB

Question 11

MTP - what does it mean?

Answer 11

1. Massive transfusion protocol activated to deliver a 1:1:1 ratio.
2. Decreases death from exsanguination and improves 24 hour survival (not 30 day mortality)

Question 12

what is 1:1:1

Answer 12

6 U PRBC. 6 pack of Tb. 6 U FFP.

Question 13

Sepsis - what is SOFA?

Answer 13

Sequential organ failure assessment - qSOFA (quick).

1. Altered mental status
2. RR > 22
3. SBP < 100

Question 14

Sepsis versus septic shock

Answer 14

Sepsis - SOFA of 2 with a suspicion for infection

Septic shock - sepsis with sustained hypotension requiring pressor support to maintain MAP > 65 and lactate of 2 mmol/L.

Question 15

Fat embolus syndrome -

1. Definition
2. Clinical scenario
3. Treatment

Answer 15

1. mechanical theory of fat globules blocking the systemic circulation, biochemical theory of fats –> FFA and causing profound inflammatory state.
2. young patient, long bone/pelvic fractures, hypoxic respiratory failure/distress with petechial rash over thorax/axilla.
3. Supportive.