Test 4: Cardiac ACLS Flashcards
Ecotopic Focus
Different Focus, Extra Beat
This is bad for perfusion, preload and afterload
Frequent extra beats = decrease Q
PVC
PAC
Bigemminy
Every 2 beats - this is the wrost
nEnEnE
Trigemminy
Every 3 beats
nnEnnEnnEnnE
Quadgemminy
Every 4 Beats
nnnEnnnEnnnE
Couplets
2 back-to-back PVC then normal rhythm
Unifocal
All PVC going in same direction - up or down
multifocal
PVC go in different directions
What causes ecotopic focus? How do we fix?
MI
Cardiogenic Shock
Electrolyte Imbalance
Electrical Burn
Heart Failure
Inflammation
Infection
Hemorrhage
Dehydration
We try to CORRECT the underlying “focus” BUT if we cannot then we use pacemaker
Brady: What is it? S/Sx? Good/Bad
HR <60 b/c heart block or sinus rhythm
S/Sx:
- Increase RR
- SOB
-Cool extremities, clammy
- Pallor/ “dusky”
- fatigue, anxiety
- lethargy, dizzy
Good: Increase diastole, decrease myocardial demand
But overtime…. Decrease CO, HR, SV, Q, BP
Symptomatic Brady Interventions
If symptomatic
A:
Atropine (max dose 3mg - start with 1mg
If atropine works…ABCs
1 O2
2 IV Fluids - large bore
3 Dopamine Drip
If atropine does not work…shock
Sedate
Transcutaneous pacing
If systolic is <90 pt is unstable and we move straight to cables - no medicine, use synchronous/ autodemand pacing
Transcutaneous Pacing: Synchronous vs Asynchronous, Good to knows
Synchronous:
- Demand PM
- Demand HR @ fixed rate
Asynchronous:
- Let pt fire, then inhibit if they drop below set rate, i.e. if demand rate is 70, and they only give 50, PM gives 20
Good to Know:
- Spikes on PM mean it is working
- Should have P or QRS after spike
- If there is no rhythm behind, then failed or no fire
- Pt should always carry PM card
Tachycardia:
HR >100
Types:
- Sinus
- Afib with RVR
- SVT
Sinus Tachycardia: Causes/Treatment
Caused by stress, pain, exercise, fever, infection, med/drugs, dehydration, blood loss - so to fix TREAT THE CAUSE
P and QRS visible
Afib w/ RVR: How to fix
**#1 cardizipam/diltiazem
**#2 amiodarone
#3Procanamide
Supraventricular Tachycardia: What is it? S/Sx, Why is it bad?
- No discernable P -wave or QRS
- Beat starts from SV NOT AV
S/Sx:
- Increase RR, SOB
- Diaphoresis
- Flushed
- Palpitations/CP
Bad:
- Decrease diastole, not enough adequate fil time
- Increased myocardial demand
- Sustains CO, but then drops
SVT Treatment
If they are UNSTABLE (systolic <90) GET CABLE
If Stable (systolic >90)…
Assess pt to see if leads are in place
A:
Vagal
Adenosine - 6mg, 12mg, 12mg
must be given rapid or in CL or it will not work by the time it gets to heart
chase w/ fluids via large bore
Connect to ECG if not already
Synchronized Cardioversion - SHOCK ON THE R OR THEY WILL DIE
After Pacing
Amiodarone gttp
If it does not work…DEFIB
PVT w/ No Pulse
Vfib
- CPR
- Defib
If you witness vtach with pulse to NO pulse…go straight to shock…if you do not witness…call CODE and initiate 2 min of CPR w/ defib
Cardiac Arrest Algorhythm
Round 1 We notice VFib…CPR (2minutes) - 1:45 (precharge) - 2:00 3C’s
CPR @ 100-120bpm - continuous compressions w/ 1 breath every 6 seconds (10pm)
3Cs - check rhythm, pulse, change compressors
Round 2 If still vfib…shock….CPR…place ET tube…1:45 precharge…2:00 3C’s
Round 3 Vfib–shock–CPR–Epi (1mg)–1:45 pre charge—2:00 3C’s
medicine not given until round 3
Round 4 VF – shock – CPR – amiodarone 300mg – 1:45 precharge – 2:00 3Cs
Round 5 VF – shock – CPR – Epi 1mg – 1:45 precharge – 2:00 3Cs
Round 6 VF – shock – CPR – Amio 150mg – 1:45 precharge – 2:00 3Cs
Round 7 VF - shock – CPR – Epi 1mg – 1:45 precharge – 2:00 3Cs
Round 8 VF – shock – CPR – H/T Intervention – 1:45 precharge – 2:00 3Cs
ROund 9 ST (pea/asystole) - CPR - epi 1mg – 1:45 precharge – 2:00 3Cs
** if there is NO pulse - CPR/epi only**, no defib, turn off
Round 10 aystole - cpr – 1:45 pre charge – 2:00 3Cs
no epi b/c given last round
Must have cause of death to call
Cardiac Arrest Medications
Not given until round 3
Epi:
- Given every-other-round
- 1mg
Amiodarone:
-300 mg
-150mg
Lidocaine (not commonly used b/c weight based)
What happens if ROSC not achieved?
Call ME
Call organ procurement who will not take case until cleared ME
Cardiac Arrest Medications
Not given until round 3
Epi:
- Given every-other-round
- 1mg
Amiodarone:
-300 mg
-150mg
Lidocaine (not commonly used b/c weight based)
What happens if ROSC not achieved?
Call ME
Call organ procurement who will not take case until cleared ME
p wave
Atria contracting (depolarization)
QRS Complex
Ventricle contraction (depolarization)
QRS Complex
Ventricle contraction (depolarization)
T Wave
Ventricle relaxing (repolarization/refilling)
When do we use Defib?
Pulseless Vtach
Vfib
If it has a V, give them the D
