Term
|
Definition
|
|
Term
| First line tx for Vtach (stable) |
|
Definition
adenosine 6 mg
amiodarone 150mg over 10 min |
|
|
Term
| First line tx for stable svt |
|
Definition
|
|
Term
| First line tx for unstable svt |
|
Definition
|
|
Term
|
Definition
| synchronized cardioversion at 120J |
|
|
Term
| First line tx for unstable aflutter |
|
Definition
| synchronized cardioversion |
|
|
Term
| First line tx for polymorphic v tach (torsades) |
|
Definition
| magnesium sulfate + unsynchronized cardioversion |
|
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Term
| First line tx for moomorphic (wide complex) v tach |
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Definition
|
|
Term
| First line tx for vfib or pulseless v tach |
|
Definition
|
|
Term
| First line tx for asystole/PEA |
|
Definition
| intubate, epinephrine 1 mg IV |
|
|
Term
| First line tx for bradycardia |
|
Definition
|
|
Term
|
Definition
Hypovolemia, hydrogen ions (acidosis), hypo/hyperkalemia, hypoglycemia, hypothermia
toxins, tamponade, tension pneumo, thrombosis, trauma |
|
|
Term
|
Definition
MONA:
Morphine 2-4 mg IV over 1-5 min
O2
Nitro 0.4 mg tab every 5 min, can be done 3x
or IV infusion 10-20 mcg/min every 5-10 min
Aspirin 162-325 mg PO (preferably chewed) |
|
|
Term
opiate analgesic given to pts with ACS who are sx after Nitro
- reduces anxiety
- dilates arteries and veins
- decreases preload and afterload
SE: hypotension, resp distress, n/v
- reversed w/ naloxone |
|
Definition
|
|
Term
non-specific vasodilateor and anit-anginal
relaxes & dilates smooth muscle
- reduces preload & afterload
- antagonizes vasospams
- increases collateral coronary blood flow
SE: hypotension #1, HA, nausea, syncope, hypoxemia, tachy, tolerance
Contraindications? |
|
Definition
Nitro
contras: SBP < 90 mmHg
HR <50 or >100
taken a phosphodiesterase inhbiitor w/in 24 hr
place in trendelenburg if profound hypotension develops |
|
|
Term
prostaglandin & platelet inhibitor used for ACS
SE: Bleeding, stoamch pain, heart burn, N/V, allergy |
|
Definition
|
|
Term
Other STEMI tx:
1. Inhibits platelet aggregation
2. interferes w/ blood coagulation by indirectly inhibiting thrombin
3. reopro, integrilin, aggrastat. prevent platelet aggregation by inhibiting fibrinogen to glycoprotein IIb/IIIA bindgin
4. block sympathetic stimultion of heart
5. -prils
6. decreases LDL, pleotrophic effects, |
|
Definition
1. plavix
2.heparin
3. Glycoprotein IIb/IIIA inhibitors
4. beta blockers
5. ACE-I
6. STatins |
|
|
Term
Sympathomimetic catecholamine that has both alpha and beta adrenergic activities:
ncreases SVR (vasoconstriction)
Increases systolic and diastolic BP
Increases electrical activity in the myocardium
Increases coronary and cerebral blood flow
Increases myocardial contractility and HR
Increases myocardial oxygen demands—decreases subendocardial perfusion
Used in Vfib/pulseless Vtach, asystole, PEA, symptomatic bradycardia
dose? |
|
Definition
epi
dose: 1mg q3-5 min of 1:10,000 |
|
|
Term
Naturally occuring ADH
- acts as nonadrenergic peripheral vasoconstrictor
- used in place of epi in Vfib/pulseless Vtach, asystole, PEA
- can only be used for 1st or 2nd dose |
|
Definition
|
|
Term
Sympathomimetic natural catecholamine
- alpha and beta stimulation:
- increased contractility, increased rate, increased CO
uses: hypotension as result of symptomatic bradycardia acfter return of circulation
Precautions:
Increases heart rate which may induce or exacerbate arrhythmias
Increases myocardial oxygen demand and consumption
Nausea, vomiting
Extravasation produces necrosis and sloughing
Inactivated by alkaline solutions |
|
Definition
|
|
Term
Sympathomimetic synthetic catecholamine
- increases SV and reduces afterload
uses: stress test, tx of RV infarction, PUMP PROBLEMS w/ no sign of shock (SBP 70-100)
Contra: known or suspected poison/drug-induced shock |
|
Definition
|
|
Term
Shifts oxyhbg curve to left
- induces hyerosmolality and hypernatremia
USES: preexisting hyperkalemia |
|
Definition
|
|
Term
physiologic ca-channel blocker that may induces systemic vasodilation (decrease myocardial O2 demand)
USES: Cardiac arrest with torsades or hypomagnesemia |
|
Definition
magnesium
1-2 g in 10cc D5Q IV |
|
|
Term
Rhythm drug:
ventricular antiddysrrhythmic
reduces slow of phase 4 diastolic depolarizaiton
suppresses vent ectopy after MI
may terminate reentry of vent arrhtythmia
elevates fib threshold
used as alternative to amiodarone (not first line tx)
Precautions:
Toxic reactions: slurred speech, altered mental status, muscle twitching, seizures, respiratory arrest
Metabolized in liver, so decrease dose in elderly, liver disease, with decreased cardiac output
If HR<60bpm, treat the bradycardia 1st, not the ventricular ectopy
Large doses may induce heart block, depress spontaneous SA node discharge, or alter AV conduction in some patients
dose? |
|
Definition
| Lidocaine: initial bolus 1-1.5 mg/kg IV |
|
|
Term
Rhythm drug:
effects Na, K, and Ca channels and has alpha and beta adrenergic blocking effects
- tx of atrial and vent arrhythmias
CANNOT BE USED WITH SIMVASTATIN = RHABDO
uses: recurrent vfib and pulseless v tach
Precautions:
vasodilation, hypotension
neg inotropic effects
prolonged QT
amiokeratopathy - ocular changes |
|
Definition
amiodarone
300 mg IV bolus
150mg IV in 3-5 min - only one additional dose |
|
|
Term
used to suppres atrial and vent arrhythmias
slows intraventricular conduction time
Uses: stable Vtach, PSVT, a fib, WPW
can induce arrhythmias |
|
Definition
|
|
Term
anticholinergic parasymp blocker
enhances sinus node automaticidy and AV node conduction
Vagolytic - stimulates vagus nerve
uses: first drug for symptomatic brady
avoid in hyperthermic brady |
|
Definition
atropine
0.5-1.mg IV q 3-5 min
|
|
|
Term
"reset button"
depresses av and sinus node activyt
- 1st drug for stable PSVT
NOT for afib, flutter, or vtach |
|
Definition
adenosine
1st bolus: 6 mg
2nd in 1-2 min: 12 mg
3rd in 1-2 min: 12 mg |
|
|
Term
increase vagus nerve stimulation - can cause SVT and convert to NSR
- if these work -- then tachy is supraventricular
consists of valsalva and carotid massage |
|
Definition
|
|
Term
CCBs:
1. has more effect on increasing coronary vasodilation and less on increasing peripheral vasodilation and decreasing afterload and contractility
2. opposite
used to in afib/flutter, refractory PSVT (3rd line)
Do not use for wide QRS tachy or uncertain origin |
|
Definition
1. diltiazem
2. verapamil |
|
|
Term
sympathomimetic catecholamine
pure beta adrenergic agonist
increases CO and myocardial O2 consumption
used to reverse effect of B blockers
can be used temporarily for sympatomatic brady |
|
Definition
|
|
Term
| improves HR in brady due to bb's or ccb's |
|
Definition
|
|
Term
adjuvant for CHF or pulm edema in HTN pts
or HTN emergency
Precautions: Renal failure, dehydration, hypotension, hypokalemia, or other electrolyte imbalances. |
|
Definition
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|
Term
|
Definition
1. shock at 200J
2. CPR 2 min (5 cycles)
3. Shock at 300 J
4. CPR 2 min
5. itubate, H&T, IV/O2
5. Epi 1 mg
6. CPR
7. schok 360 J
8. CPR
9. amiodarone 300 mg
10. shock
11. amiodarone 150 mg |
|
|
Term
|
Definition
1. intubate, IV, H&T
2. epi 1 mg, repeat 3-5 min
OR vasopresin 40 IU for first or second dose
CPR 5 cycles at a time |
|
|
Term
|
Definition
1. CAB, O2, vitals, H&Ts
2. atropine 0.5 mg 3-5 min
3. dopamine 2-10 ug/kg/min OR epi drip 2-10 ug/min
4. consider pacing
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|
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Term
|
Definition
1. call 911, get AED
2. CAB
3. 30 compressions, 2 breaths
4. AED- shockable give one shokc then repeat CPR x 5 cycles
if not shockable, keep doing CPR |
|
|
Term
|
Definition
| 1. synchronized cardioversion at 200J |
|
|
Term
| A flutter or unstable SVT algorithm |
|
Definition
| 1. synchronized cardioversion at 100J |
|
|
Term
| polymorphic/unstable Vtach or torsades algorithm |
|
Definition
1. mg sulfate 1-2 g
2. unsynchronized cardioversion 200J, then 300, then 360 |
|
|
Term
| narrow (stable) SVT algorithm |
|
Definition
1. vagal maneuvers
2. adenosine 6 mg
3. adenosine 12 mg
4. adenosine 12 mg
5. b blocker rate control |
|
|
Term
| stable (wide complex) v tach algorithm |
|
Definition
1. adenosine 6 mg
2. amiodarone 150 mg over 10 min
3. synchronized cardioversion 100 J |
|
|
Term
| What 3 ACLS drugs can be given via the ET route? |
|
Definition
epi
lidocaine
vasopressin |
|
|
Term
| Pt w/ ACS - BP drops after giving nitro and morphine. What now? |
|
Definition
|
|
Term
| Pt in refractory vfib has been shocked, cpr, epi 1mg, amiodarone. What now? |
|
Definition
|
|
Term
| pt if vfib has 2 shocks. what now? |
|
Definition
|
|
Term
| Tachycardic pt w/ palpitatinos, chest pain, hypotension. complexes wide and irregular at 180 bpm. what first? |
|
Definition
|
|
Term
| Pt has STEMI. which is a contraindication to the use of nitro? |
|
Definition
| phosphodiesterase inhib w/in 12 hours |
|
|
Term
| sinus brady at 36 bpm. 3 mg atropine has been given. transcutaneous pacing has been given but not effective. BP 100/60. what now? |
|
Definition
|
|
Term
| narrow QRS tach at 180/min. vagal maneuvers not effective. What now? |
|
Definition
|
|
Term
| pt in asystole. shocks and cpr given. what's the first drug to give? |
|
Definition
| epi 1 mg or vasopressin 40 units |
|
|
Term
|
Definition
|
|
Term
| STEMI pt undergoing fibrinolytics. Did not take aspirin bc of hx of gastritis. What now? |
|
Definition
| aspirin 160-325 mg chewed |
|
|
Term
| Pt in pulseless vtach. 2 shocks and 1 dose epi have been given. What now? |
|
Definition
|
|
Term
| Pt w/ wide complex tachy. Stable at 110/70. Hx of angina. what now? |
|
Definition
|
|
Term
| pt has stroke. CT scan has been ordered. He is a candidate for fibrinolytics. What is a guideline for fibrinolytics? |
|
Definition
| do not give anticoagulants w/in 24 hours of rTPA |
|
|
Term
| Which is correct about vasopressin? |
|
Definition
| can only be given once at 40 units IV or IO in place of epi |
|
|
Term
| Initial dose of atropine for bradycardia? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| When does brady require tx? |
|
Definition
| when sx are present - CP, SOB |
|
|
Term
|
Definition
|
|
Term
| Pt with angina. First thing to do if no contraindications? |
|
Definition
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|
Term
| Pt becomes unresponsive. Not sure about pulses. First thing to do? |
|
Definition
|
|
Term
| Pt was resuscitated from cardiac arrest. is now in severe CP and has vtach. what to do ? |
|
Definition
| unsynchronized cardioversion |
|
|
Term
| SVT w/ no chest pain or SOB. first thing to do? |
|
Definition
|
|
Term
| SVT w/ CP and SOB. first thing to do? |
|
Definition
| synchronized cardioversion at 50-100J |
|
|
Term
| Bradycardic pt w/ weak pulses. Gave O2. Next? |
|
Definition
|
|
Term
| Pt has been resuscitated. was given 2 doses epi and one dose amiodarone. is now back in vtach and is hypotensive. What do you do? |
|
Definition
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|
Term
| Pt in PSVT has been given 6mg adenosine to no avail. what now? |
|
Definition
|
|
Term
| Pt in vtach given two shocks and CPR. Is now in vfib. Now what? |
|
Definition
|
|
Term
| Pt has STEMI. Pain has been somewhat relieved w/ nitro. What is the best way to prevent mortality? |
|
Definition
|
|
Term
| pt w/ stable (no sx) wenckebach. What do you do? |
|
Definition
| seek expert consult and continue monitoring |
|
|
Term
| Wide complex tachy. No other sx other than mild palpitations. Vitals ok. |
|
Definition
| Give adenosine 6mg and seek expert consult |
|
|
Term
| Pt suddenly goes into vfib. First thing? |
|
Definition
|
|
Term
| Pt in afib w/ irregular HB but no sx. |
|
Definition
| monitor and seek expert consult |
|
|
Term
| alcoholic in torsades w/ hx of prolonged QT |
|
Definition
| mg sulfate 1-2 mg in 10 ml D5W over 5-20 min |
|
|
Term
|
Definition
|
|
Term
| pt in vfib and now in asystole. first thing to do? |
|
Definition
|
|
Term
| Mobitz II w/ hypotension. first drug? |
|
Definition
|
|
Term
- how long should a PR interval be?
- how long should a QRS be?
- when is a Q wave significant? |
|
Definition
1. <0.12s
2. <0.12s
3. when its >1/2 R-R |
|
|
Term
|
Definition
left anterior hemiblock - most common
LVH
inferior wall MI
ectopic beats |
|
|
Term
|
Definition
kids
RVH
LBBB
dextrocardia
ectopic beats |
|
|
Term
|
Definition
1. QRS >0.12
2. I & V6: slurred S wave
3. V1: RSR' - rabbit ears
NEVER neg complexes in V1 |
|
|
Term
|
Definition
1. QRS >0.12
2. I & V6: broad, monomorphic R waves
3. V1: Broad, monomorphic S waves |
|
|
Term
| Left anterior hemiblock criteria |
|
Definition
1. axis shift to pathologic left (I+, avf-, II-)
2. I: qR or large R
3. III: rS
|
|
|
Term
|
Definition
1. RAD (I-, aVF+)
2. I: s, III: q
3. exclusion of RAE and RVH |
|
|
Term
| LAE (P mitrale) and RAE (P pulmonale) criteria |
|
Definition
LAE: I & II: P wave >0.12 and notched
RAE: II & III: peaked P waves >2.5mm
biatrial enlargement is any combo of these |
|
|
Term
|
Definition
1. S in V1 or V2 + R in V5 or V6 > 35mm
2. any precordial QRS >45 mm
3. R in aVL >11mm
4. Strain pattern
will usually have LAE too |
|
|
Term
|
Definition
1. V1 or V2: R:S ratio is >1
2. RAE
3. Strain pattern |
|
|
Term
1. Definition:
ST segment elevation greater than 1 mm (0.1 mV) in 2 or more contiguous precordial leads or 2 or more adjacent limb leads
OR
New or presumed new left bundle branch block
2. Ischemic ST-segment depression of 0.5 mm (0.5 mV) or greater
OR
Dynamic T wave inversion with pain or discomfort
Transient ST elevation of 0.5 mm or greater for less than 20 minutes
3. Normal or non-diagnostic changes in ST segment or T wave that are inconclusive and require further risk stratification
Includes people with normal ECGs and those who have ST-segment deviation in either direction that is less than 0.5 mm or T wave inversion of 2 mm or 0.2 mV or less |
|
Definition
1. STEMI
2. NSTEMI or UA
2. intermediate/low risk USA |
|
|
Term
| criteria for transmural MI |
|
Definition
1. abnormal Q waves
2. ST segment elevation
3. inverted T waves |
|
|
Term
| time course of STEMI EKG changes |
|
Definition
1. ST elevation
2. Q wave
3. T wave inversion |
|
|
Term
Anterior and Inferior MIs:
affected and reciprocal leads |
|
Definition
Anterior (LAD): I, aVL, V1-V6
reciprocal: II, III, aVF
Inferior (RCA): II, III, aVF
reciprocal: I, aVL, V1-V6 |
|
|
Term
1. most common type of MI
presents w/ hypotension
fluids are great, nitrates cautiously
AV node most commonly
2. most severe MI "widowmaker"
presents w/ sudden arrhythmias
nitrates are great, spare the fluids
SA node most commonly |
|
Definition
1. inferior MI
2. anterior MI |
|
|
Term
AKA subendocardial infarction
ST depression is hallmark
sometimes T wave inversion
no Q waves
ACC def? |
|
Definition
NSTEMI
ACC def: CP + elevated enzymes
|
|
|
Term
| early repolarization (early R wave progression) is characteristic of? |
|
Definition
| normal variant or Non-ischemic ST elevation |
|
|
Term
Scooped ST segment
elevated T wave
= smiley pattern |
|
Definition
|
|
Term
caused by an accessory pathway called the bundle of kent that causes pre-excitation
key EKG finding is delta R wave
- also PR >0.12
- QRS >0.1 |
|
Definition
|
|
Term
pre-excitation syndrome where AV node is bypassed by an extension of the anterior internodal tract called the james bundle
causes significant atrial arrhythmias
Results in flutter waves |
|
Definition
|
|
Term
| visually, the ___ ventricle dominates the anterior view of the heart |
|
Definition
|
|
Term
| the ___ ventricle pumps blood through peripheral circulation |
|
Definition
|
|
Term
| The term ___ is used to describe pts with severe depression of sinus node function |
|
Definition
|
|
Term
| AV node circulation is always supplied by which artery? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| the unipolar augmented limb leads can be expressed as what equation |
|
Definition
|
|
Term
| If an EKG were obtained at half standard, a wave that is 10mm high would be described as being |
|
Definition
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