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Critical Care/Hematology/Oncology > week 2 > Flashcards

week 2 Flashcards

1
Q

cardiac arrest

A

unable to geenrate adequate CO to support o2 demands of tissue

four rhythms:
v fib
pulseless ventriculat rachycardia
pulseless electrical activity (PEA)
asystole

survivial depends on acs or bcls

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2
Q

only proven benefit of cardiac arrest

A

quality chest compressions

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3
Q

cardiac arrest treatments

A

1, start CPR

  1. determine rhythm
    shockable: VF and pVT

non shockable: asystole, PEA

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4
Q

VF or VT arrest

A
  1. provide shock
    work on establishing iv access,
    if still in shockable environent, give another shock….
    then can give epinephrine…
    if pt is still in shockable rhythm.. can give another shock, then give antiaryhmics like amiodarone or lidocaine
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5
Q

pea/asystole

A

non shockable

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6
Q

if asytole or pea admin epinehrine asap and perform cpr for 2 min

if pt still in nonshockable rhhtm, continue cpr

*note: EPNIPHERINE ONLY. vasopressin no longer epinephrine

A
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7
Q

cardiac arrest med admin routes

A

iv
io (intraosseous)
endotracheal (et)
NAVEL
naloxone
atropine
vasopressin
epinephrine
lidocaine

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8
Q

vasoactive agents

A

enhance organ profusion by increasing arterial and aortic diastolic pressures resulting in increases incoronary and cerebral perfusion pressures

ex: epineohrine

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9
Q

epinephrine

A

indications:
vf and pulseless vt
pea and asystole

dose: 1mg iv/ io q3-5 min

admin as soon as possible in pea/asystole

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10
Q

antiarrhythmics

A

no high quality evidence to suggest that any antiarryhtmics routinely during crdiac arrest increases survival

amiodarone
lidocaine

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11
Q

amiodarone

indications
dose
considerations

A

indications: vf and pulseless vt

dose: 300 mg iv bolus. may repeat 150mg iv bolus

considerations: caution in bradycardia and hypotension, possible qt prolongation

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12
Q

lidocaine

indications
dose
considerations

A

indications: vf an dpulseless vt

dose: 1.1.5 mg/kg IV/IO

considerations:
consider if amiodarone unavailable, risk/ hx of qt prolongation. study not suggests beenfit of lidocaine

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13
Q

magnesium

indications
dose
considerations

A

indications: vf, pvt associated with torsades des pointes. NOT TO BE USED IN VF,PVT W. NORMAL QT INTERVAL

dose: 2g iv bolus

considerations

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14
Q

reversible causes of arrest Hs

A

H
hypovolemia- give fluids

hypoxia-give 100% o2 by mask

hydrogen ions(acidosis)-bicarb not recomomended during o2 arrest

hyperkalemia:suspect in dialysis pts, renal insufficicnecy, drug induced (trt w. calcium chloride or gluconate
temporary measures: (bicarb, insulin and dextrose)
long term: diuresis, kayexalate
hypothermia

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15
Q

reversible causes of cardiac arrest

A

Toxins (opioids, TCA, etc.)
*give naloxone if suspected I

cardiac Tamponade:

Tenstion pneomothorax

thrombosis(PE and MI)

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16
Q

ischemic stroke SS

A

sudden onset of focal neurological defecit

dysphasia/dysarthria
hemianopia
weakness
ataxia
sensory
neglect

symptoms are unilateral

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17
Q

NIHSS stroke severity

A

0: no strok esymptons
1-4: minor stroke
5-15: moderate stroke
16-20: mod-sveere stroke
21-42 seevre stroke

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18
Q

treatment options for ischemic stroke

A

within 4.5 hr of symptom onset
*fibrinolysis +/- thrombectomy

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19
Q

iv fibronylitics

A

contraindications

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20
Q

iv fibrinolytics ci

A

<18
ischemic throjke w.i 3 months

intrcranial surgery w.in 3 months

gi malignancy or hib within 21 days

lmwh within 24hrs

unclear onset time >4.5

intracranial hemmorhage

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21
Q

iv fibrinolytics

A

alteplase,
tenacteplase

moa: tpa activator, dissolves fibrin

dose:
alteplase: 0.9mg/kg
short acting. can give bolus

tenacteplase: 0.25mg/kg
can give iv push, longer t/2

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22
Q

iv fibrinolytics blood pressure control

A

goal for bolus: <185/110

goal for infusion <180/105

if pt meets exclusion criteria and alteplase not given, permissive htn is allowed

bp not treated unless >220/110 in effort to perfuse brain

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23
Q

ischemic stroke htn treatment

A

1st line: labetalol
nicardipine

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24
Q

fibrinolytic complications

A

systomatic ICH:
d/c alteplas einfusion
treat w. cryocepitate 10u

angioedema
-miantaine airway, hold acei-

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25
Q

post fibrinolytic care

A

neuro and bp monitoing for 24 hrs

dysphagia and aspiration risk

high dose statin all apts

anti platelets

dvt prophylaxis >24hr post alteplase

anticoags if cardioembolic stroke or hx of a fib

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26
Q

secondary strok erevention

A

lifestyle and nutrition

smoking cessation

limit alcohol consumption

ocunsel on substance abuse

27
Q

risk factor for breakthorugh seizures

A

provoked:
intoxication
withdrawal, etoh, benzos
trauma
meningitis
psychiatric
metabolic derangements

unprovoked
*difficultto determine

28
Q

1st line agents to stop seizures

A

benzos (lorazepan, diazepam, midazolam)

29
Q

antiepileptics for seizures

A

not first lines

do not stop seizures

prevent more seizures from occuring

30
Q

treatment of seizures

A

stage 1(0-10 min): lorazepam or midazolam

stage2: 10-30 min
phenytoin, foshenytoin

stage 3: 30-90 min
midazolam or propofol

stage 4 (90 min-many hours to days): pentobarbitokl

31
Q

benzos for seizures

A

1st line: lorazepam 4mg

second line: diazepam 5-20 mg

moa: bind to gaba receptor

ae: impaired conciousness
hypotension
resp depression

32
Q

antiepileptics for seizures

A

second seizure indicates epileptic

if on epileptic, can give small dose of at home antiepileptic

phenytoin
fosphenytoin

33
Q

pneumonic for phenytoin adr

A

PHENYTOIN

p-450 reactin
hirsutism
enalarged gums
nystahmus
yellow borwning of skin hepaptiis
teratogenecity
osteomalaciaa
inteferance w. metabolsm
neuropathies

cardio: hypotension, bradycardia, qt prolongation

saturable pk

monitinrg: goal 10-20. if seizing, goal 15-25

must correct for low for albumin

34
Q

levetiracetam

A

dose: 60mg/kg for status epilepticus

levels do not correlate w. efficacy

AE: agitation, drowsiness

35
Q

valproic acid

A

LD: 50 mg/kg

goal levels 50-100

AE: hyperamonemia
thrombocytopenia

DDI: phenytoin and valproic acid both strongly protein bound

36
Q

lacosamide

A

dose: 100-200 mg
adr: dizziness, abnormal vision

37
Q

refractory status epilepticus

A

no response to inticial anticonvulsants

seizure lasting>2 hrs OR occuring at 2 more incidences per hour

high dose benzos: ex.midazolam2mg iv bolus
propofol infusion

phenobabrb and pentobarb coma (only use dif intubated because causes severe respiratory supression

38
Q

post intubation treatment

A

paralytic used during intubation

39
Q

goal of status epilepticus

A

to attai n burst supression

40
Q

super refactory status epilepticus

A

treatment: ketamine infusion.

41
Q

how to wean off antiepileptics for seizures

A

wean off meds tht have high risk AE

42
Q

status epilepticus outcomes

A

repeat full neuro examinations

43
Q

shock

A

sbp<90 mmhg
decrease by 40 mmhg from baseline

44
Q

end organ dysfunctions in shock

A

cns
cardiac
pulmonary (acute resp failure)
renal(AKI, ATN
GI(erosive gastritis)
hepatic
hematologic
metabolic
immune system

45
Q

hemodynamic parametes

A

BP=COxSVR(systemic vascular resistance)

CO: HR x SV

stroke volume: preload, instrinsic contractility, afterload

mean arterial pressure(MAP)
calculation= 1//3SBP+2/3DBP

46
Q

mean arterial pressure calculation

A

1/3 SBP+2/3 DBP

47
Q

goals for shochk mgt

A

determien etiology (hypovolemic, cardiogenic, distributive, obstructive

maintian adequate perfusion (assess preload, restore mean artieral pressure (GOALMAP
normalize lactate: goal<2

48
Q

devices used in recognizing and magaing shock states

A

central venous catheyer
*measures central venous o2 sat
admin of fluids

pulmonary artery catheters
*measures pulmonary pressure, CO, mixed venous sat
not commonly used due to severe complications

49
Q

Shocks

hypovolemic
what is it
cause
treatment

A

Shocks

what is it: low and sudden loss of iv volume

cause: hemorrhage, gi loss, severe dehydration, burns
#1 cause of death<45y.o

preload:decrease
CO: decrease
SVR increase
o2 sat decreases

treatment
REPLACE blood loss(PRBCS)
aniticoag reversal etc.

50
Q

Shocks

CARDIOGENIC SHOCK
what is it
cause
treatment

A

Shocks

what is it: failure of left ventricle

cause: ACUTE MI
arrythimas, etc.

treatment.
preload increase
CO: decreaseSVR: increase

treatment: treat underlying cause (mi:recatheterization)

51
Q

Shocks

disitributive shock

what is it
cause
treatment

A

Shocks

what is it: septic shock classic. pronounced vasodilation

cause: septic shock most common cause

preload: low
aterload: decrease
decreased or increased CO
decreased or increased tissue perfusion

treatment

52
Q

Shocks

obstructive
what is it
cause
treatment

A

Shocks

what is itdecrease din lv stroke volume

cause
PE
pulmonary hypertension
tension pneumothorax
treatment

preload: high
CO:decrease
svr: increase
tissue perfusion: decreased

53
Q

shock therapy

A

fluid challenge(generlly w. sepsis): crystalloid 30ml/kg over 25 min-30 min

54
Q

pharm theraoy of shock

A

initiation of vasoactive agents when map remains <65 despite fluid admin

vasopressors: norepinehpine
epinehorine
dopamine
phenylephrine
vasopressin

55
Q

NE for shock theraopy

A

alpha adrenergic agonist: causes peripheral vasoconstriction

56
Q

epinephrine

A

b2 agonists

may increase aerobic lactate production

also useful in anaphylactic shock

57
Q

dopamine in use for shock

A

dose dependent pharm

most effective in hypotensive ots w. depressed function

58
Q

phenylephrine

A

reflex bradycardia
CO is hih and bp is low

59
Q

dobutamine:

A

inotrope

60
Q

vasopressin

A

goal: reduce concurrent vasopressor doses
o.3-0.4 u/min

61
Q

septic shock mgt

A

correction of underliying cause (abx, source control)
abx timing: sepsis is deifnite: admin abx immediately
sepsis is possible: if present, give abx w.in an hour, if not present, reassess, admin abx w.in 3 hrs if ocncern of infeciton persisst

fluid resucitation: crystalloid 30ml/kg bolus (fluid of choice for initial recussiatiairon
1L of crystallid gives ~250ml o fintravascular volume

vasopressors

inotropes

corticosteroids

62
Q

what is sepsis

A

lifethreartening organ dysfunction caused by a dysregulated host response to infection

63
Q

SIRS criteria for spetic shock

A

atleast 2 of following
1. temp >38 C or < 36 C

hr: > 90 bpm

Rr: >20

wbc>12 or <4

64
Q

pharm of septic shock

A

initiate when map <65 despite fluid amdin

1dt line: norepinehprine

vasopressin: an be added if pt has inadequate map while on norepinephrine

glucocorticoids( hydrocortisone)
improves ohysiologic response to sepsis, regulation of proinflammatory state
improve time to shock resolution
added when pt is still hypotensice despite increasing norepinephrine and assing

Critical Care/Hematology/Oncology (4 decks)

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