Term
| Make alrorythm flash cards |
|
Definition
|
|
Term
| 3 primary origins of stroke |
|
Definition
1)Cerebral atherosclerosis
2) Penetrating artery disease (Lacune)
3) Cardiogenic |
|
|
Term
| Describe Strokes of cerebral athersclerotic origins |
|
Definition
| Atherosclerotic lesions cause ischemia in the brain |
|
|
Term
| What is the etiology of Lacunar/Penetrating stroke? |
|
Definition
| Poorly managed HTN. This occures in the terminal portion of blood vessels burried in the brain, hard to find |
|
|
Term
| Describe how a cardiogenic stroke occures |
|
Definition
| Cardiac origin, clot forms in the heart, leaves the ehart and migrates to the brain causing a stroke. This is more common with afib or abnormal/synthetic heart valve |
|
|
Term
| What are the two types of stroke? |
|
Definition
Hemorragic stroke
Ischemic Stroke |
|
|
Term
| What is the difference in a stroke and a TIA? |
|
Definition
| Strokes are permanent/residual deficit, TIA is like brain angina |
|
|
Term
| How many hours might a TIA event last? |
|
Definition
| 24h, anything longer is considered a stroke |
|
|
Term
| What are the symptoms of stroke? |
|
Definition
| Aphagia, dysphagia, numbness, visual defects, paralysis |
|
|
Term
| Name 3 non-modifiable risk factors for stroke |
|
Definition
|
|
Term
| Name 6 modifiable risk factors for stroke |
|
Definition
| 1) blood pressure 2) cardiac disease 3) lipids 4) afib 5) alcohol consuption 6) smoking |
|
|
Term
| What are the two primary diagnostic tests done in stroke? |
|
Definition
|
|
Term
| What does a CT or MRI look for in stroke and what is it's significance? |
|
Definition
| Bleeding, if there's bleeding you need a neurosurgeon, if it's a clot causing the stroke you need drug therapy |
|
|
Term
| What drug would you use for post-stroke HTN long term? |
|
Definition
|
|
Term
| What might you use post-HEMORHAGIC stroke for HTN? |
|
Definition
| Nimodapine for 21 days (short term only) |
|
|
Term
| How would you treat an ischemic stroke? |
|
Definition
| TPA/alteplase is 1st choice |
|
|
Term
| What disqualifies someone from TPA/alteplase treatment? |
|
Definition
Ptlts <100,000
High BP (185/110)
Hemorhage/major bleed
Surgery/trauma |
|
|
Term
| What is the dose for TPA/alteplase? |
|
Definition
| 0.9mg/kg first portion given as bolus the rest over the next hr |
|
|
Term
| What are the treatment options for Cerebrovascular disease? |
|
Definition
Drug- Antiplatelet drugs
Surgery- Carotid endartectomy or stent |
|
|
Term
| Which is better for cerebrovascular disease endarderectomy or stent? |
|
Definition
| It don't make no nevermind |
|
|
Term
| What are the three main stroke types that might be able to be prevented by drug therapy? |
|
Definition
| HTN, Afib, Cerebrovascular disease |
|
|
Term
| How good is ASA at stroke prevention? |
|
Definition
| Prevents stroke 25% of the time. Lower doses (50mg) are better because the same positive outcomes with fewer bleeds |
|
|
Term
| Which should be used in stroke pt antiplatelet or anticoags? |
|
Definition
| Antiplatelet, anticoags have to much bleed risk |
|
|
Term
| What is the problematic side effect of Ticlopidine? |
|
Definition
| TTP- not common, but fatal. |
|
|
Term
| The CAPPRIE trial reviled what? |
|
Definition
| That Clopedigrel is better than ASA but not by much, price may out-weigh benefit |
|
|
Term
| Should ASA and plavix be used together for stroke? |
|
Definition
| NO! The MATCH trial showed that this only increases ADE/bleeds |
|
|
Term
| What is the minimum diparydamol dose for antiplatelet effects? |
|
Definition
|
|
Term
| Why can't regular release diparidamol be givent at doses of 400mg/day? |
|
Definition
| Headaches (main SE) are too severe. MUST USE ER dipydridamol |
|
|
Term
| What is the most common side effect of dipyridamol or Aggrenox? |
|
Definition
|
|
Term
| What did the profess trial revile? |
|
Definition
| Aggrenox and Plavix are similar in action, but aggrenox has more bleeds |
|
|
Term
| What is the best means of secondary stroke prevention? |
|
Definition
| ANTIPLATELET therapy. 1A rec. AHA 2010 guidelines. |
|
|
Term
| Would enteric coating help prevent ASA induced GI ulcers? |
|
Definition
| NO! It's a systemic prostaglandin effect |
|
|
Term
| What are the major manifestations of CVD (cerebrovascular disease) |
|
Definition
|
|
Term
| Which is more prevalent, Ischemic stroke or hemorrhagic stroke? |
|
Definition
|
|
Term
| A pt has had a non-cardioembolic stroke and has ACS (or stent) what medication should he be on? |
|
Definition
| Clopidogrel 75mg qd PLUS ASA 81mg (Grade 1A ACCP/Chest) |
|
|
Term
| What are the AHA/ASA/ACCP/CHEST guidelines for stroke? |
|
Definition
| ASA 50-325mg, clopidogrel 75mg, Aggrenox 200/50 BID is grade 1A |
|
|
Term
|
Definition
1) Hypovolemic
2) Cardiogenic
3) Distributive/vasodilatory
4) Anaphylactic |
|
|
Term
| First line treatment for Hypovolemic shock |
|
Definition
|
|
Term
| Primary alternative treatments for Hypovolemic shock |
|
Definition
|
|
Term
| First line treatment for Cardiogenic shock |
|
Definition
|
|
Term
| Primary alternative treatments for Cardiogenic shock |
|
Definition
|
|
Term
| First line treatment for Distributive/Vasodilatory shock |
|
Definition
| Norepinephrine and/or Dopamine |
|
|
Term
| Primary alternatives treatments for Distributive/vasodilatory shock |
|
Definition
| Vasopressin, Phenylephrine, epinephrine, dobutamine |
|
|
Term
| First line treatment for anaphylactic shock |
|
Definition
|
|
Term
| Primary alternative treatment for Anaphylactic shock |
|
Definition
|
|
Term
| Common causes of hypovolemic shock |
|
Definition
haemorrhage
vomiting
diarrhoea
dehydration
third-space losses during major operations |
|
|
Term
| Common causes of Cardiogenic shock |
|
Definition
| blood flow decreased due to an intrinsic heart muscle, or the valves are dysfunctional. often related to acute MI |
|
|
Term
| Common causes of Vasodilatory/Distributive shock |
|
Definition
septic shock
anaphylactic shock
acute adrenal insufficiency
neurogenic shock |
|
|
Term
| Common causes of Anaphylactic shock |
|
Definition
|
|
Term
| What class of drug used in shock must be weaned to avoid worsening hemodynamics? |
|
Definition
| All Vasopressors EXCEPT vasopressin! |
|
|
Term
| Excess peripheral vasoconstriction may cause what? |
|
Definition
| Ischemia to extremities/poorly perfused areas |
|
|
Term
| Describe the hemodynamic features of hypovolemic or cardiogenic shock |
|
Definition
| SBP <90 or >40mmHg decrease from baseline |
|
|
Term
| Describe the metabolic abnormalities seen in hypovolemic or cardiogenic shock |
|
Definition
|
|
Term
| What are the compensatory responses to hypovolemic shock? |
|
Definition
| Vasoconstriction, tachycardia, tachypnea and oliguria |
|
|
Term
| What are the signs of hypovolemic shock? |
|
Definition
| Decrease urine output, skin tuger, tachycardia, cold, modeling/poor perfusion, BP change |
|
|
Term
| Clinically, what is the most siginicant indicator of hypovolemic shock? |
|
Definition
| Light headedness, blood is being shunted else where, there is less blood and therefore less oxygent |
|
|
Term
|
Definition
| When the body loses it's ability to compensate for volume loss so the body loses it's ability to properly circulate blood |
|
|
Term
| Hypovolemic shock treatment |
|
Definition
1) Rehydrate with NS 20ml/kg
2) Look for offending drugs- Manitol and Lasix
3) Is there profuse bleeding?- admin blood |
|
|
Term
| When do you consider a transfusion? |
|
Definition
Profuse bleeding causing Hg<7 or <10 in recent MI/stroke Pt
Whole Blood is drug of choice for this! |
|
|
Term
| Is there any compensatory response from the kidneys in shock? |
|
Definition
| No, they are slow to respond acutely. They respond in days. |
|
|
Term
| What is the treatment for bleeding disorders? |
|
Definition
| FFP (composed primarily of clotting factors) |
|
|
Term
| What receptors does Norepinephrine stimulate? |
|
Definition
Alpha 1 and Alpha 2 with some Beta 1
POST SYNAPTIC (in periphery)
MOST POTENT VASOCONSTRICTOR |
|
|
Term
| What drug is the most potent vasoconstrictor? |
|
Definition
|
|
Term
| What is beta 1 agonists effect? |
|
Definition
| Chronotrope (HR) and inotrope (contactility) both increase |
|
|
Term
| What is beta 1 agonists effect? |
|
Definition
| Chronotrope (HR) and inotrope (contactility) both increase |
|
|
Term
| What does Alpha1 and Alpha2 agonists do? |
|
Definition
|
|
Term
| What receptors does Dopamine act at? |
|
Definition
Alpha1 and Alpha2 post synaptically
Beta1 stronger than with NE |
|
|
Term
| Epinephrine acts at what receptors? |
|
Definition
Alpha1 and Alpha2 to vasoconstrict
Beta 1 AND beta2 to increase HR and contractility
DON"T USE IN HYPOVOLEMIC SHOCK |
|
|
Term
| What receptors does Phenylephrine work at? |
|
Definition
| PURE ALPHA1 and ALPHA2 nooooo beta, good because it won't effect the HR |
|
|
Term
| Where are alpha 1 and 2 recepotrs found and what is the significance? |
|
Definition
| The heart, this is why many of the alpha drugs cause arrhythmias |
|
|
Term
| What class of drug is Dobutamine? |
|
Definition
|
|
Term
| What receptors does Dobutamine work at? |
|
Definition
| Beta 1 (inotropic), beta2 is weak and selective Alpha 1. Less likely to induce HTN |
|
|
Term
| Generally speaking what effects does Beta1 agonists have? |
|
Definition
| Inotropic effects (increased contractility) |
|
|
Term
| What specific types of shock events is Dobutamine useful in? |
|
Definition
|
|
Term
| What drug is the most potent alpha1/alpha2 stimulator? |
|
Definition
|
|
Term
| List shock drugs (5) from greatest to least beta agonist |
|
Definition
Dobutamine
Epinephrine
Dopamine
Norepinephrine
Phenylephrine |
|
|
Term
| Which shock drug is pure alpha with no beta? |
|
Definition
|
|
Term
| What is the biggest problem with Beta agonists? |
|
Definition
|
|
Term
| What drug is good for refractory shock patients? |
|
Definition
|
|
Term
| Generally speaking what side effects do you see with shock-related drugs? |
|
Definition
| Arrhythmia (Beta stimulation), Anxiety, Headache, Necrosis (extravasion), SOB/Resp distress, HTN, anginal pain |
|
|
Term
| What shock drugs cause bradycardia? |
|
Definition
| Phenylephrine and Norepinephrine |
|
|
Term
| What shock drugs cause tachycardia? |
|
Definition
| Epinephrine, Dobutamine, Dopamine |
|
|
Term
| What shock drug is least likely to cause arrhythmia? |
|
Definition
| Phenylephrine, it's pure alpha stimulation |
|
|
Term
| What side effects are specific to Phenlyephrine? |
|
Definition
| Decreased cardiac output, metabolic acidosis, reduced urine output |
|
|
Term
| What two shock drugs can cause paresthesia? |
|
Definition
| Dobutamine and Phenylephrine |
|
|
Term
| What side effects are specific to Dopamine? |
|
Definition
| Hypotension, inc glucose, azotemia, polyuria, hair to stand up (piloerection) |
|
|
Term
| What shock drug might cause hypotension? |
|
Definition
|
|
Term
| Specific reactions to Norepinephrine |
|
Definition
| Bradycardia which is shared with Phenylephrine |
|
|
Term
| What side effects are specific to Dobutamine? |
|
Definition
| paresthesia, Sr potassium decrease, thrombocytopenia, leg cramps |
|
|
Term
| Side effects specific to Epinephrine |
|
Definition
| Cerebral hemorrhage, tremor/weakness, pulmonary edema, diaphoresis and inc intraocular pressure |
|
|
Term
| How are shock drugs dosed? |
|
Definition
| To effect via continuouse IV infusion, very short halflife |
|
|
Term
| What effects does Beta 1 and beta 2 have? |
|
Definition
| Vasodilation and cardiac (inotropic/chronotropic) |
|
|
Term
| What effect does Alpha1 and Alpha2 have? |
|
Definition
| Vasoconstriction (normally arteriole) |
|
|
Term
| What is a Schuanzgans cath? |
|
Definition
| Right heart cath used to measure capilary pressure etc |
|
|
Term
| How might you prevent necrosis with vasopressors? |
|
Definition
|
|
Term
| What two shock drugs might DECREASE cardiac output |
|
Definition
| Phenylephrine, vasopressin |
|
|
Term
| Which drug is more preffered Norepinephrine or Epinephrine? |
|
Definition
| Norepi, fewer advers effects |
|
|
Term
| Shock might present with perfusion abnormailities despite adequate fluid resucitation |
|
Definition
|
|
Term
| What are the three main components of the cardiovascular system? |
|
Definition
Pump- heart
Tubing- vasculature
Fluid- Blood |
|
|
Term
| What is the amount of blood ejected during a single contraction called? |
|
Definition
|
|
Term
|
Definition
| The amount of blood in the heart before it starts to contract (End Diastolic volume) |
|
|
Term
|
Definition
| The force required to overcome resistance to ejection |
|
|
Term
| What is the formula for CO? |
|
Definition
|
|
Term
| What three systems maintain circulating volume and where are they located? |
|
Definition
1) Baroreceptors- Carotids and aortic arch
2) Sr Osmolality- Brain and kidneys
3) RAAS- Kidneys |
|
|
Term
| Eitiology of shock- One of the three regulatory systems of BP have failed and the other two have lost the ability to compensate |
|
Definition
|
|
Term
| When does hypotension become shock? |
|
Definition
| When evidence of end organ insufficency (confusion, oliguria, lactic acidemia) |
|
|
Term
| What are the two cornerstone components of shock |
|
Definition
1) failure of circulation
2) failure to compensate |
|
|
Term
| Can shock be due to more than one cardiovascular system failure? |
|
Definition
|
|
Term
| What are the three primary/general compensatory mechanisms? |
|
Definition
1) SV- starlings law
2) HR
3) Vasoconstriction |
|
|
Term
| What can cause hypovolemic shock? |
|
Definition
| Hemorrhage, third spacing (severe burn), fluid loss |
|
|
Term
| What can cause cardiogenic shock? |
|
Definition
| Pumpfailure (MI, cardiac hypertrophy, BB/CCB, bacterial toxin) |
|
|
Term
| Causes of distributive shock |
|
Definition
| Vasodilation, anaphylaxis, neurogenic, septic, drug induced |
|
|
Term
| What type of shock can be drug induced? |
|
Definition
|
|
Term
| What type of shock does septicemia cause? |
|
Definition
| Distributive shock predomniently and some cardiogenic |
|
|
Term
| What type of shock does anaphylaxis cause? |
|
Definition
| Distributive shock and hypovolemic shock |
|
|
Term
| What is generally the problem in Distributive shock? |
|
Definition
|
|
Term
| What kind of shock might cardiac arrest create? |
|
Definition
| Distributive, hypovolemic and cardiogenic shock! ALL THREE TYPES |
|
|
Term
| What kind of shock might cardiac arrest create? |
|
Definition
| Distributive, hypovolemic and cardiogenic shock! ALL THREE TYPES |
|
|
Term
| What are the ABC's of shock? |
|
Definition
| Airway, breathing, circulation |
|
|
Term
| What is the rule of thumb for shock fluid resucitation? |
|
Definition
| 3:1, every 1ml blood lost replace w/ 3ml NS |
|
|
Term
| What vasopressor is the drug of choice for most shock? |
|
Definition
|
|
Term
| What vasopressor isn't recomended for kidney protection in sepsis? |
|
Definition
|
|
Term
| What is the drug of choice for anaphylaxis? |
|
Definition
|
|
Term
| What affects the dosing of Norepinephrine and how? |
|
Definition
| Sepsis and acidosis cause downregulation so you need to have higher doses of Norepinephrine |
|
|
Term
| What drug is first line for Septic shock? |
|
Definition
|
|
Term
| What decreases the effectiveness of Dopamine? |
|
Definition
|
|
Term
| Are there any ABSOLUTE contraindications for Epi in lifethreatening situations? |
|
Definition
|
|
Term
| Which drug is tachycardia more likely assocaited with Norepinephrine, Phenylephrine or Epinephrine |
|
Definition
|
|
Term
| What drug for shock is primarily and inotrope? |
|
Definition
|
|
Term
| What does synchronized cardioversion require? |
|
Definition
| A pulse with which to synchronize |
|
|
Term
| What does the AED "capture" in synchronized cardioversion? |
|
Definition
|
|
Term
| When do you use desynchronized cardioversion? |
|
Definition
| When HR is to fast to capture (Vfib/Vtach) |
|
|
Term
| When does the AED shock a person with desynchronized cardioversion? |
|
Definition
|
|
Term
| What is one of the most important things in ACLS? |
|
Definition
|
|
Term
| What do you need to remeber about drug aministration in ACLS? |
|
Definition
| 10ml NS flush after EVERY drug |
|
|
Term
| What do you do if someone has a pulseless arest? |
|
Definition
| Check for shockable rhythm |
|
|
Term
| What rhythms are shockable? |
|
Definition
|
|
Term
| What are non-shockable rhythms? |
|
Definition
| Asystole and pulseless electrical activity (PEA) |
|
|
Term
| What is the first things you do for VT/VF? |
|
Definition
1)give 1 shock
2)resume CPR |
|
|
Term
| With VT/VF after initial shock and 5 cycles of CPR whad do you do? |
|
Definition
| Check and make sure they have a shockable rhythm and shock them then admin 1mg IV Epinephrine |
|
|
Term
| After the first two shocks and administration of epinephrine with continouse CPR what do you do? |
|
Definition
1) check for shockable rhythm
2) Shock
3) Amiodarone (300mg IV once + 150mg)
4) Consider Mg (1-2gm IV) for torsades |
|
|
Term
| What do you do if a pulseless arrest is asystole/pea |
|
Definition
1) not a shockable rhythm
2) CPR for 5 cycles
3) Epinephrine 1mg IV q 3-5min
(Vasopressin 40 might replace epi 1st or 2nd dose)
4) Consider atropine 1mg IV q 3-5min 3 doses |
|
|
Term
| What do you do with Asystole/PEA after the first round of CPR and medication? |
|
Definition
| Repeate! Same step over and over until you get a shockable rhythm or they are declared dead |
|
|
Term
| What is the drug of choice for cardiac arrest? |
|
Definition
|
|
Term
| Possible causes of pulseless cardiac arrest |
|
Definition
| Hypoxia, hyperkalemia, hypothermia, durg OD (tricylcis), MI |
|
|
Term
| What is the first thing you would do in Tachycardia WITH a pulse? |
|
Definition
1)ABC's
2) Oxygen
3) Monitor ECG
4) Identify/treat reversible causes |
|
|
Term
| What do you do if symptoms persist in Tachycardia after initial treatment/monitoring? |
|
Definition
| Establish if the patient is stable |
|
|
Term
| What are signs of instability in a shock patient? |
|
Definition
| Altered mental status, chest pain, hypyotension |
|
|
Term
| What do you do for a Tachy patient that is determined to be stable? |
|
Definition
1) Establish IV access
2) Put on ECG and check QRS (Wide or narow) |
|
|
Term
| What is considered a wide QRS and a Narrow QRS? |
|
Definition
Wide- >0.12s
Narrow- <0.12s |
|
|
Term
| What do you do for a Tachycardic shock patient that proves to be unstable when assesed? |
|
Definition
| Immediate SYNCRHONIZED cadioversion |
|
|
Term
| What do you do for a tachy shock patient that has been deemed unstable and has been shocked? |
|
Definition
1) Establish IV access
2) ECG and determine if Narrow or Wide QRS |
|
|
Term
| What do you do in Tachycardic shock for wide QRS? |
|
Definition
Expert consultation
Determine if regular or irregular |
|
|
Term
| What do you do for Tachycardic shock pt with Wide regular QRS? |
|
Definition
1) Amiodarone 150mg IV
2) Synchronized cardioversion |
|
|
Term
| What do you do for a tachycardic shock patient determined to have an irregular and wide QRS? |
|
Definition
1)Amiodarone 150mg IV
2) Mg 1-2gm for torsades |
|
|
Term
| What do you do for a tachycardic shock patient with Narrow QRS and regular ryhthm |
|
Definition
| Give adenosine 6mg then 12mg and may repeast 12mg once |
|
|
Term
| What do you do for a tachycardic shock patient with irregular rythm and narrow QRS? |
|
Definition
| Probably Afib- rate control w/ Dilt or BB |
|
|
Term
| What do you do if you have a tachycardic shock patient that has a narrow, regular QRS that doesn't convert when treated with adenosine |
|
Definition
| Consider Aflutter and try to rate control w/ BB or Dilt |
|
|
Term
| What do you do if you have a tachycardic shock patient with narrow QRS and regular rhythm that converts when given Adenosine? |
|
Definition
| Monitor for reentry and use adenosine for reocurance. BB or Dilt for longer acting control |
|
|
Term
|
Definition
|
|
Term
| What is the first thing you do for a bradycardic patient? |
|
Definition
1) Airway, breathing, oxygen
2) Monitor ECG and identify rhythm
3) Establish IV access |
|
|
Term
| What do you do for a bradycardic patient after you have done the initial airway treatment and ECG monitoring? |
|
Definition
| Asses if they have adequate prefusion |
|
|
Term
| What do you do for a Bradycardic patient after initial Airway and ECG Tx/monitoring and they prove to have adequate perfusion? |
|
Definition
|
|
Term
| What do you do for a bradycardic patient after initial airway/ECG treatment/monitoring and they prove to have poor perfusion? |
|
Definition
1) prep for II or III AV heart block
2) Consider Atropine 0.5mg IV up to 3mg max. If ineffective begine pacing (heart block)
3) Consider Epi or dopamine (2-10ug/kg) while waiting for pacer or if pacing is ineffective |
|
|
Term
| What do you do for a bradycardic patient after initial airway and ECG monitoring if they are poorly perfused and atropine and epi/dopamine fail to pace |
|
Definition
| Transvenous pacing (Pace maker) |
|
|
Term
| What method other than IV can you do on a patient that is having a code? |
|
Definition
|
|
Term
| What 4 drugs can be given endotreachealy? |
|
Definition
LEAN
L- Lidocain
E- Epinephrine
A- Atropine
N- Narcan (narc OD suspected) |
|
|
Term
| What do you do for Paroxysmal Supraventricular tachycadia (PSVT) and a low EF (<40%) |
|
Definition
No cardioversion
Dig or Amio or Dilt |
|
|
Term
| What do you do in paroxysmal supraventricular tachycardia with a normal EF? |
|
Definition
| CCB>bb>dig>DC cardioversion consider procainamide, sotalol, amio |
|
|
Term
| What is the pharmacists role in a code/cardiac arrest? |
|
Definition
| Call for help, medication managemnt (order and prep), documentation |
|
|
Term
| What are the symptoms of cardiac arrest |
|
Definition
| arm pain, jaw pain, INSTANT DEATH (50%) of the time. |
|
|
Term
| How do you dose endotracheal drugs? |
|
Definition
|
|
Term
| What should you stop while administering endotracheal drugs? |
|
Definition
|
|
Term
| When do you anticoagulate in relationship to cardioversion |
|
Definition
| Pre AND postcardioversion |
|
|
Term
| What drugs might you use to chemically cardiovert someone? |
|
Definition
| Amiodarone, dofetalide, ibutalide, propafenone, flecanide |
|
|
Term
| What drugs might you use for cardioversion in a HF pt? |
|
Definition
| Dofetalide, ibutalide, amiodarone |
|
|
Term
| What drugs might you use in a non-HF pt? |
|
Definition
| Dofetalide, ibutalide, propafenone, flecanide |
|
|
Term
| Vaughn Williams classification of antiarrhythmics |
|
Definition
I = sodium channel blockers
Ia = moderate
Ib = weak
Ic = strong
II = BB
III = K channel blocker
IV = CCB |
|
|
Term
| What portion of the ECG represents atrial fxn? |
|
Definition
|
|
Term
| What does the ECG of Afib lack? |
|
Definition
|
|
Term
| What is the corrected QTc formula? |
|
Definition
| QT/ Sqrt(RR) where RR is the length of time it takes for 1 heart beat (Milisec) |
|
|
Term
| What is the relationship between QT and heart rate? |
|
Definition
| As HR increase QT shortens. This is solved by the QTc formula using RR |
|
|
Term
| Is all sinus bradycardia abnormal? |
|
Definition
| No, often people that exercise frequently have a sinus bradycardia |
|
|
Term
| When do you treat sinus bradycardia? |
|
Definition
|
|
Term
| What do you do if bradycardia is drug related? |
|
Definition
| DC drug and wait 5 halflives to see if it fixes HR, if not it wasn't the offending agent and can be restarted |
|
|
Term
| When might you consider a pacemaker in bradycardia? |
|
Definition
| one major area is a person who NEEDS a BB (post MI etc) and has bradycardia |
|
|
Term
| How might you best treat a patient with bradycardia and no identifiable eitiology? |
|
Definition
| Atropine (or epi or dopamine) |
|
|
Term
| What might you look for in labs for a pt with bradycardia? |
|
Definition
| Thyroid levels (hypothyroidism) and electrolyte abnormalities |
|
|
Term
| How do you detect hypothyroidism and what can it cause? |
|
Definition
TSH- elevated above normal (Norm 0.5-5)
Causes bradycardia |
|
|
Term
| What is another name for sinus bradycardia? |
|
Definition
| SSS (Sick sinus syndrome) |
|
|
Term
| What is 1st degree AV nodal blockade? |
|
Definition
| asymptomatic, not Tx, just monitor with routein ECG |
|
|
Term
| What is 2nd degree AV nodal blockade? |
|
Definition
| Impulses by AV not conducted to ventricle properly. Look for underlyign causes |
|
|
Term
| Where does Mobitz 1/Wenchebach's occure? |
|
Definition
| Slightly further down the AV node than 1st degree. Electrical impulses slowed with each beat until it skips a beat. Not very serious |
|
|
Term
| Where does Mobitz II occure? |
|
Definition
| same skipped impulse pattern but below the bundle of hiss. Electrical impulses can't reach ventricles. More serious |
|
|
Term
| What are two types of 2nd degree AV block? |
|
Definition
Mobitz I / wenchebachs
Mobitz II |
|
|
Term
| What is 3rd degree heart block? |
|
Definition
| Total heartblock, signal doesn't pass from upper chambers to lower so independant paceing centers take control (AV and SA node) |
|
|
Term
|
Definition
| Abnormal formation of signal/conduction of signal |
|
|
Term
| Doing what will help Afib? |
|
Definition
| Slow down ventricular rate |
|
|
Term
| What are the three types of afib? |
|
Definition
Paroxmismal
Persistent
Permanent |
|
|
Term
| What is paroxmismal afib? |
|
Definition
| You go in and out of afib on your own |
|
|
Term
|
Definition
| Afib can be cardioverted and there's hope of staying in rhythm |
|
|
Term
|
Definition
| irreverible afib, failed therapy |
|
|
Term
| What are afib pt at high risk of? |
|
Definition
| STROKE, both ischemic (clot) AND hemorrhagic (due to warfarin) |
|
|
Term
| Why is lifelong anticoagulation often needed with afib? |
|
Definition
| Once a patient goes into afib they will likely have another episode, anticoag decreases the stroke risk associated with afib episodes |
|
|
Term
| What is goal INR? What is target INR? |
|
Definition
|
|
Term
| What are some benefits of Dabigatran? |
|
Definition
| Fewer INR monitoring/needle pokes, once daily, no vit K diet modification |
|
|
Term
| What is the biggest draw back of Dabigatran? |
|
Definition
|
|
Term
| Which works better Dabigatran or warfarin? |
|
Definition
| They work the same for efficacy and side effects (bleeding) |
|
|
Term
| What state might Afib lead to? |
|
Definition
| Heart failure due to uncontroled tachycardia |
|
|
Term
| How do you identify hemodynamic instability? |
|
Definition
| Mental status changes, BP <90 (hypotension), shock, ventricular rate of 150, crushing chest pain |
|
|
Term
| What do you do for hemodynamicaly unstable afib? |
|
Definition
Synchronized cardioversion, 100-200-300-360J
Usually doesn't feel good so give anasthesia |
|
|
Term
| Which is more effective in hemodynamically unstable patients, chemical cardioversion or electrical cardioversion? |
|
Definition
|
|
Term
| If possible how should DCC (DC cardioversion) be carried out? |
|
Definition
| 1) First 12h 2)TEE 3)Heparin 4) Anasthesia 5) Cardiovert 6) warfarin for atleast 4wks |
|
|
Term
| What are the goals of therapy for afib? |
|
Definition
1) Rate control
2)stroke prevention
3)restore normal sinus rhythm
4)Decrease episodes |
|
|
Term
| What does a TEE look for? |
|
Definition
|
|
Term
| If a TEE reviels a clot what do you do? |
|
Definition
| Anticoagulate and re-evaluate in 3 weeks with another TEE |
|
|
Term
| What must be administered |
|
Definition
|
|
Term
| What are the rate controlers for Afib WITHOUT HF |
|
Definition
| BB, CCB pirmarily. Also Dig or Amio |
|
|
Term
| What drugs can be used as rate controlers for Afib WITH HF |
|
Definition
|
|
Term
| What is the goal for rate redxn in Afib pt? |
|
Definition
| HR <100 or 20% rdxn from baseline |
|
|
Term
| Can rate controling drugs be added together to help lower HR? |
|
Definition
|
|
Term
| What drug should be used for long-term rate control? |
|
Definition
| What ever they cardioverted on if it's available PO |
|
|
Term
| What is an odd side effect of amio? |
|
Definition
|
|
Term
| What are some side effects of amio? |
|
Definition
| (thyroid effecs due to iodide component), blueman/smurf synd, corneal microposits/ophthalmic monitoring, pulmonary fibrosis, A LOT of monitoring is needed. HIGH DOSES LONG TIME. Monitor liver. Photosysativity. |
|
|
Term
| What are usual side effects of Dig/dig toxicity? |
|
Definition
| Nausa, vomiting, seeing green/yellow halos around light, Does NOT rate control active persons |
|
|
Term
| Why might you use amiodarone over dig? |
|
Definition
| Because it will rate control in active people |
|
|
Term
| What is important to know about dronederone? |
|
Definition
1) related to amio
2) less side effects than amio (no iodo grp)
3) Doesn't cardiovert, merely maintains
4) EXACERBATES HF |
|
|
Term
| What drugs might you use to cardiovert a patient with heart failure? |
|
Definition
Dofetalide
Ibutalide
Amiodarone |
|
|
Term
| What drugs might be used to cardiovert a pt w/o HF? |
|
Definition
Dofetalide
Ibutalide
Propafenon
Flecanide |
|
|
Term
| What chemical cardioversion drugs are also available PO? |
|
Definition
| Flecanide, Propafenone, Amiodarone |
|
|
Term
| What is an important monitoring parameter of Dofetalide? |
|
Definition
| Renal fxn and CrCl, must be dosed acordingly |
|
|
Term
| What is more important rate control or rhythm control? |
|
Definition
Mortality: they are equal
morbidity/hospitalization/SE: Rate control |
|
|
Term
| What does CHADS stand for? |
|
Definition
C= CHF
H= HTN
A= Age
D= Diabetes
S= Stroke |
|
|
Term
| What is the CHADS treatment protocol? |
|
Definition
0 = ASA 325
1 = ASA 325 OR Warfarin
2 = Warfarin |
|
|
Term
| What is the halflife of Amio? |
|
Definition
|
|
Term
| How often might you check the INR in a warfarin pt started on Amio? |
|
Definition
|
|
Term
| Is INR monitoring a problem with dronedarone like it is with amiodarone? |
|
Definition
|
|
Term
| What are some other names for Ventricular premature depolarization (VPD)? (Vtach) |
|
Definition
|
|
Term
|
Definition
| electrical impulse orginating in ventricular tissue with wide QRS |
|
|
Term
| Who has gerater risk for VPD? |
|
Definition
|
|
Term
| What is the biggest risk of VPD? |
|
Definition
| It's biggest symptom is often sudden death |
|
|
Term
| How do you treat an asymptomatic Vtach patient? |
|
Definition
| You don't treat it! ESPECIALLY don't use incanide or flecanide they cause more deaths |
|
|
Term
| What does treating asymptomatic Vtach patients improve? |
|
Definition
|
|
Term
| What might symptomatic Vtach pt benefit from? |
|
Definition
| BB, most of these pt have CAD and BB are beneficial for that aswell |
|
|
Term
|
Definition
Lasts longer than 30s
Requires intervtion to terminate |
|
|
Term
| Define Non-sustained Vtach |
|
Definition
Lasts less than 30s
Terminates spontaniously |
|
|
Term
|
Definition
| CAD, MI, HF, electrolyte abnormalities (ESP Mg or K), anti-arrhythmics |
|
|
Term
| How might you treat VT with ischemia unrelated to MI? |
|
Definition
|
|
Term
| What are two ways to cardiovert Vfib? |
|
Definition
1) DCC 100-200-360J (start at 200 for PEA)
2) Procainamide (drug of choice) |
|
|
Term
| What is important to remeber about chemical cardioversion? |
|
Definition
| Pt must be hemodynamically stable to do chemical cardioversion |
|
|
Term
| What might you use in a pt w/ VF and ischemia due to MI? |
|
Definition
| Lidocain, procainamide or Amio |
|
|
Term
| When should you start to worry about your QT? |
|
Definition
|
|
Term
| What is a normal QT interval? |
|
Definition
|
|
Term
| What is a supra therapeutic level of dig? |
|
Definition
|
|
Term
| What does Afib lack on an ECG? |
|
Definition
|
|
Term
| Can an AICD (implatable cardioverter) be used in conjunction with drugs? |
|
Definition
|
|
Term
| What is most effective in reducing cardiac death in VF? |
|
Definition
|
|
Term
| What does uncontrolled Vtach normally do? |
|
Definition
|
|
Term
| Is VFib a sustainable rhythm? |
|
Definition
| Nope, means you'll die if nothing happens soon |
|
|
Term
| Vfib cardioversion for hermodynamically unstable patietns |
|
Definition
| 200J then 360J then give Epinephrine or vasopressin if no respsone and Defibrilate again |
|
|
Term
| What is the role of drug therapy in hemodynamically unstable VF |
|
Definition
| augmentation of electrical cadrioversion |
|
|
Term
|
Definition
| When a person wearing ECG monitor partakes in activity that might make ECG appear to show VFib such as brushing the teeth. |
|
|
Term
| What is the VT amio dosing? |
|
Definition
| 150mg/10min then 1mg/min for 6h |
|
|
Term
| What is the VF dosing for amio? |
|
Definition
|
|
Term
| Does VT and VF amio dosing differ? |
|
Definition
YES
VT- 150mg/10min 1mg/min for 6h
VF- 300mg then 150mg |
|
|
Term
| What might you do if you have shocked the Pt and administered epi and shocked again with no results? |
|
Definition
|
|
Term
| Is torsades life threatening? |
|
Definition
|
|
Term
| Torsades is related to Vtach, Vtach is the precursor to Vfib and Vfib is unsustainable = death |
|
Definition
|
|
Term
| What are some risk factors for Torsades? |
|
Definition
| Age (>65), QT >500 or Inc by 60ms, female, HF, hypokalemia, hypomagnesimia, bradycardia, elevetaed concentration of QT prolonging drugs or rapid infusion |
|
|
Term
| Where might you go to access good information on torsades? |
|
Definition
| torsades.org hosted online by the university of arizona |
|
|
Term
| What two drugs have an important reaction for torsades? |
|
Definition
| Terfinidine and fexofenodine had addative effects and caused alot of torsades |
|
|
Term
| What is the drug of choice for hemodynamically stable Torsades? |
|
Definition
| Magnessium 1-2gm in D5w up to 12gm |
|
|
Term
| Do you use Mg to treat torsades after Mg levels have been corrected? |
|
Definition
|
|
Term
| What do you do to treat hemodynamically unstable Torsades? |
|
Definition
|
|
Term
| What are second and third line for cardioversion in hemodynamically stable torsades? |
|
Definition
| Isoperterinol, lidocain, phenotoin |
|
|
Term
| How do you determine if a pt has HF? |
|
Definition
|
|
Term
| What are the most common shock heart rhythms/beats |
|
Definition
Unstable VT/VF
Asystole
Afib/Aflutter
Bradycardia
Narrow-complex SVT
Tachycardia
PSVT
Stable VT
PEA |
|
|
Term
|
Definition
1) Fluid challenge
2) DEAD: Double check rhythm
3) Epinephrine 1mg IV q 3-5min
2) Atropine if bradycardic 1mg q 3-5min
3) Determine underlying cause |
|
|
Term
| what are some underying causes of PEA? |
|
Definition
| Hypovolemia, tamponade (fluid in paricardium), tension pnemothorax, PE, hypoxia, hypothermia, acidosis, MI, hyPERkalemia, drug overdose |
|
|
Term
|
Definition
1) cardioversion
2) procainabimide (drug of choice), sotalol (both 2a) or amiodarone, lidocaine (both 2b) |
|
|
Term
| What do you do for PSVT with normal EF? |
|
Definition
1) CCB>BB>dig>DCC
2) consider procainamide, sotalol or amio
3) proceed to cardioversion if unstable |
|
|
Term
|
Definition
1) no DCC, use dig, amio or dilt
2) If unstable proceed to cardioversion |
|
|
Term
| What is MAT in reference to PSVT? |
|
Definition
| Multi-focal Atrial Tachycardia |
|
|
Term
| How do you treat MAT PSVT? |
|
Definition
Normal EF= CCB, BB, amio
EF<40 = amio and dilt
NO DCC |
|
|
Term
| How do you treat junctional PSVT? |
|
Definition
EF normal = amio, bb, ccb
EF <40% = amio |
|
|
Term
|
Definition
| atrial nodal reentry trachycardia |
|
|
Term
| What treatment might you use to treat narrow-complex SVT |
|
Definition
1) Vagal stimulation (cough)
2) Adenosine
3) Dilt
4) Metoprolol |
|
|
Term
| What is the dosing for Adenosine in SVT? |
|
Definition
|
|
Term
|
Definition
HR <150 do nothing
HR >150 Immediate DCC, medicate if possible |
|
|
Term
| What is the drug of choice in VT w/o pulse and VF |
|
Definition
|
|
Term
| What are the 4 non-perfusing rhythms? (you'll use CPR for them) |
|
Definition
| PEA, VT w/o pulse, VF, Asystole |
|
|
Term
| What if you have an asystole Pt and it's possible they are in a fine VFib? |
|
Definition
| Move the leads and check the heart from another angle, important because shocking VFib is good, shocking asystole is useless |
|
|
Term
| What do you do for asystole? |
|
Definition
1) double check not Vfib
2) give epi
3) do CPR |
|
|
Term
|
Definition
D- double check
E- Epinephrine
A- Atropine
D- do it again |
|
|
Term
| Is Vfib w/o pulse shockable? |
|
Definition
|
|
Term
| What do you use desynchronized cardioversion for? |
|
Definition
|
|
Term
|
Definition
| Shock, Epi, CPR, Recheck pulse, Shock, Amio, Epi |
|
|
Term
| What are comon causes of Vfib? |
|
Definition
| Electrolytes and heart attack |
|
|
Term
| Is VTach w/o pulse shockable? |
|
Definition
|
|
Term
| Is VTach w/ a pulse shockable? |
|
Definition
| Yes- use SYNCHRONIZED cardioversion |
|
|
Term
| What type of DCC is used for Vtach w/o pulse? |
|
Definition
|
|
Term
| What drugs can be used in VF? |
|
Definition
| Epinephrine, vasopressin, amiodarone, lidocain, magnesium, hypothermia? |
|
|
Term
| What drugs can be used in PVT? |
|
Definition
| Epinephrine, vasopressin, amiodarone, lidocaine, Mg |
|
|
Term
| What drugs do you use for PEA? |
|
Definition
|
|
Term
| What drugs might you use for asystole? |
|
Definition
| Epinephrine, vasopressin, Atropine |
|
|
Term
| what drug might you give when PE is suspected? |
|
Definition
|
|
