1
Q
mainstay of acs management
A
aspirin, oxygen, morphine
ecg!!
2
Q
molecules to watch in nstemi/ua
A
nitroglycerin, heparin, oral beta blockers, clopidogrel, glycoprotein IIb/IIIa inhibitor
3
Q
functions of molecules in nstemi
A
- improve blood flow
- dissolve clots
- reduce burden of heart
4
Q
drugs/molecules involved in acs management
A
- oxygen
- acetylsalicylic acid
- nitroglycerin/nitrates
- morphine
- fibrinolytic therapy
- heparin
- beta blockers
5
Q
t/f as long as the patient is breathing, has a heart rate, do an ecg
A
true
6
Q
molecules involved in the management of vt
A
adenosine and beta blockers, amiodarone
7
Q
indication for adenosine
A
supraventricular tachycardia (stable)
8
Q
actions of adenosine
A
- stimulates adenosine receptors in heart and sm
- blocks conduction node through av node
- decreases sinus node automaticity
9
Q
special considerations for adenosine
A
- record rhythm strip during administration
- administer via central venous access
- theophylline (adenosine receptor antagonist) reduced adenosine effectiveness
10
Q
indication for amiodarone
A
- supraventricular tachycardia
- pulseless arrest (vf or pulseless vt)
11
Q
t/f amiodarone can be used in pts with polymorphic vt (torsades)
A
false, it’s associated with prolonged qt interval which is made worse with antiarrhythmic drugs
12
Q
t/f amiodarone should ONLY be used after defib/cardioversion and after first line drugs (epi or vasopressin) have failed to convert vt/vf
A
true
13
Q
actions of amiodarone
A
- prolongs action potential duration and effective refractory period
- slows sinus rate
- prolongs pr and qt intervals
- noncompet inhib of a-adrenergic and b-adrenergic receptors
14
Q
contraindications for amiodarone
A
sinus node dysfunction and 2nd degree and 3rd degree av block
15
Q
precautions for amiodarone
A
- procainamide
- hepatic failure
- inc toxicity for other drugs
- long half life and drug interactions
16
Q
primary management for adult bradycardia with pulse
A
atropine (atropa belladonna)
17
Q
indication for atropine
A
- symptomatic bradycardia
- toxins/overdose (organophosphate, carbamate)
18
Q
actions of atropine
A
- anticholinergic (sns stimulant)
- blocks acetylcholine and other muscarinic agonists at pns sites
- increases hr and co (blocks vagal stimulation)
- reduces saliva production, mydriasis
19
Q
special considerations for atropine
A
- blocks bradycardic response to hypoxia = MONITOR WITH PULSE OXIMETER
- use in child with bradycardia during et intubation
- document when used in pts with head injury (due to dilation)
20
Q
contraindications for atropine
A
- angle closure glaucoma
- tachyarrhythmias
- thyrotoxicosis
21
Q
indication for dopamine
A
cardiogenic shock and distributive shock
22
Q
actions of dopamine
A
- catecholamine, vasopressor, inotrope
- stimulates a-adrenergic receptors (inc svr)
- stimulates b1-adrenergic receptors
- sa node = inc hr
- ventricular effect = inc myocardial contractility, automaticity, conduction velocity
- stimulates b2-adrenergic receptors (inc hr, dec svr)
- stimulates dopaminergic receptors (renal, splanchnic dilation)
23
Q
special considerations for dopamine
A
- do not mix with nahco3 (inactivates)
- inhibits tsh
- dose dependent effects (low dose = dopaminergic and b-adrenergic, high dose = a-adrenergic)
24
Q
indications for epinephrine
A
- anaphylaxis
- bradycardia
- croup
- pulseless arrest
- shock / hypotension
- toxins/overdose
25
actions of epinephrine
- stimulates a-adrenergic receptors = inc svr
- stimulates b1 adrenergic receptors = inc hr, inc myocardial activity
- stimulates b2 adrenergic receptors = inc hr, bronchodilation, vasodilation of arterioles
INC HR, BRONCHODILATION, VASODILATION OF ARTERIOLES
26
precautions for epinephrine
- inactivated in alkaline solutions
- dose dependent effects
- increased o2 reqs
- anaphylaxis = im @ thigh
- rebound effect
27
categories of cardiac arrest
- asystole or pulseless electrical activity
| - vtach or vfib (need to shock immediately)
28
molecules involved in cardiac arrest
epi = first line after cpr, both asystole and vtach/vfib
| amiodarone or lidocaine = for refractory vtach/vfib
29
indication for lidocaine
- vfib/pulseless vtach
| - wide complex tach with pulses
30
actions of lidocaine
- inc electrical stimulation of ventricle and his-purkinje system = stabilize cardiac membrane
- reduces intracranial pressure via inhibition of sodium channels = reduced metabolic activity
31
post-cardiac arrest algorithm
- optimize ventilation and oxygenation (92%)
| - treat hypotension ( sbp <90 mmhg) = iv/io bolus, vasopressor infusion, ecg
32
when the patient can follow commands, he can go to __
cardiac catheterization lab and advanced critical care
33
advanced critical care
read
34
indications for dobutamine
congestive heart failure and cardiogenic shock
35
actions of dobutamine
- catecholamine, b-adrenergic
- b1 = inc myocardial, inc hr
- b2 = inc hr, vasodilation, contraction
- zero net a-receptor effect
INC CARDIAC OUTPUT
36
special considerations for dobutamine
- inactivated in alkaline solution
| - extravasation = tissue ischemia and necrosis
37
indications for norepinephrine
hypotensive shock (low svr and unresponsive to fluid resuscitation)
38
actions of ne
- inotrope, vasopressor, catecholamine
- activates a-adrenergic receptors (inc smooth muscle tone)
- activates myocardial b1 adrenergic receptors (inc contractility and hr)
39
special considerations for ne
- inactivated in alkaline solns
| - iv infiltrations = tissue ischemia and necrosis
40
the 4 serious side effects of dobutamine
- premature ventricular contractions
- myelosuppression
- neutropenia
- anemia
41
actions of sodium bicarbonate
- alkalinizing agent, electrolyte
| - increases plasma bicarbonate = forms co2
42
drugs that sodium bicarbonate inactivates
catecholamines: dopamine, epinephrine, ne, dobutamine
43
special considerations for sodium bicarbonate
- ensure adequate ventilation due to co2 production
| - can form insoluble caco salts
44
actions of furosemide
- loop diuretic
- ascending loop of henle: inhibits resorption of na and cl; excretion of na, cl, ca, mg, and water
- inc potassium excretion
45
3 adverse effects of sodium bicarbonate
- respiratory depression
- calculi
- hypernatremia
46
indications for intubation
- rapid progression of oxygen requirement over hours
- lack of improvement on >50 L/min of high flow o2 and fio2 50%
- evolving hypercapnia (abg), increasing work of breathing, increasing tidal volume, worsening mental status
- hemodynamic instability or multiorgan failure
47
pre-treatment intubation drugs
oxygen, fentanyl, lidocaine
48
induction/sedation drugs for intubation
etonamide, ketamine, propofol, midalozam
49
paralysis drugs for intubation
succinylcholine, rocuronium, sugammadex
50
2 physiologic events that happen during intubation
- pressor response: inc bp and hr due to upper airway manipulation
- intracranial hypertension: gag and cough reflex
51
actions of fentanyl
- suppress cough reflex
| - decrease catecholamine discharge
52
lidocaine
read
53
etomidate
read
54
ketamine
read
55
propofol
read
56
midalozam
read
57
t/f sedation is a must prior to paralysis
true
58
the only depolarizing neuromuscular blocking agent
succinylcholine
59
rocuronium
read
60
sugammadex
read --off switch to rocuronium
17 Acute Care
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