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Emergency Med > Cardio > Flashcards

Cardio Flashcards

(50 cards)

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1
Q

What pathway does electrical activity travel in parts of the heart?

A

Endocardium to epicardium

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2
Q

What pathway does vascularization travel in parts of the heart?

A

Epicardium to endocardium

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3
Q

How does a pacemaker work?

A

Leads go in RV and left subclavian vein

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4
Q

At what HR do the ventricles receive no benefit?

A

> 140 bpm

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5
Q

What are the signs of an unstable pt?

A 
Diaphoresis
CP
Hypotension
AMS
Pulmonary edema
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6
Q

What is considered hypotension?

A

SBP <90 mm Hg

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7
Q

What are drugs used to sedate a pt?

A

Etomidate

Propofol

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8
Q

What is the first step in treatment strategies?

A 
Monitor
IV
Oxygen
Crash cart
Defibrillator
Nurse/techs
Prepare to run full resuscitation every time
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9
Q

What does a saw tooth pattern on EKG indicate?

A

Atrial flutter

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10
Q

What does a chaotic p wave pattern on EKG indicate?

A

A fib

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11
Q

What does variable p wave morphology on EKG indicate?

A

Multifocal atrial tachycardia

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12
Q

What are the narrow regular tachycardias?

A

SVT
Atrial flutter
Wolff-Parkinson-White

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13
Q

What is a common cause of SVT?

A

Illegal drugs

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14
Q

Revert procedure

A

For SVT
Put the head of the bed at a 45 degree angle
Tell the pt to blow the plunger out of a 10cc syringe as long and hard as they can
Once pt is fatigued, lay head of bed flat, raise legs 45 degrees

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15
Q

What are vagal maneuvers to perform for SVT?

A

Plunging face into basin of ice water
Carotid massage
Valsalva maneuver
These only work 17-20% of the time, whereas revert maneuver has a 40-60% efficacy

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16
Q

How should one treat SVT if vagal maneuvers don’t work

A 
Adenosine
-Ultra short AV blocker. Rapid administration.
-Severe chest discomfort, asystole.
-Unmask atrial flutter
CCBs
-Diltiazem/verapamil
-Long-acting AV blockers
-Slows A. flutter, does not convert
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17
Q

Tx for unstable SVT

A

Cardiovert at a rate of 25-75 J

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18
Q

Atrial flutter

A

Circular rhythm in the SA node, may eventually go to AV node

Atrial rate is 300, ventricular rate is 150

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19
Q

Tx for atrial flutter

A

BBs
CCBs
-Nondihydropyradines will slow atrial flutter but will not convert it, will slow ventricular response

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20
Q

Wolff-Parkinson-White

A

Circus movement arrhythmia that goes to the AV node but also goes to an ectopic node

  • Orthodromic: clockwise direction- goes to AV node first
  • Antidromic: counterclockwise direction- goes to ectopic node first
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21
Q

Tx for Wolff-Parkinson-White

Study These Flashcards
A

AV nodal blocker
Cardizem
Metoprolol

22
Q

What are the narrow and irregular tachycardias?

Study These Flashcards
A

A fib
MAT- multiple atrial tachycardia
Atrial flutter with variable block

23
Q

What are the atrial and ventricular rates for A fib?

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A

Atrial: 600+
Ventricular: 170-180

24
Q

Tx for A fib

Study These Flashcards
A

Rate or rhythm control
-Rhythm: cardioversion/ drugs
-Rate control: Long-acting AV nodal blockers, CCBs, BBs (esmolol, metoprolol), digoxin
Cardioversion (200J) for unstable pts

25
Atrial flutter with variable block
Grouping of the saw tooth varies in terms of ratio | Treat with AV nodal blockers to control rate
26
Multifocal atrial tachycardia
Irregular but distinct P waves but different morphologies Associated with COPD Treat hypoxia
27
What are the tachycardias associated with a wide complex and regular rhythm?
V Tach SVT with BBB Antidromic Wolff-Parkinson-White
28
Tx of stable VTach
``` Amiodarone Procainamide Lidocaine Mg Adenosine ```
29
Tx of unstable VTach
Cardiovert (200J)
30
SVT with BBB
An atrial tachycardia with a BBB | May stop with adenosine
31
Antidromic Wolff-Parkinson-White tx
AV nodal blockers
32
What are the irregular wide tachycardias?
A fib with BBB Torsades de Pointes WPW + A fib
33
A fib with BBB
Most common cause of wide irregular rhythm Treat with long-acting AV nodal blockers Cardiovert if unstable
34
Torsades de Pointes tx
Mg | Cardioversion (200J)
35
WPW + A fib
Very rapid chaotic appearance rate may approach 300
36
Tx for WPW + A fib
CARDIOVERSION AV blockers are dangerous Procainamide only OK agent
37
HR general principles
The more abnl the heart rate, the more likely it is that it is responsible for the pt's sx The more extreme the heart rate, the more aggressive the tx will be Whether the rate is very slow or very fast, tx decisions should be based on the appearance of the pt, not their actual hR
38
First step in bradycardia management
``` Monitor Airway equipment Defibrillator Pacemaker Crash cart ```
39
Ischemia as a cause of bradycardia
Think ACS
40
Electrolytes as a cause of bradycardia
Think potassium
41
Drug-induced causes of bradycardia
BBs | Others
42
Endocrine causes of bradycardia
Hypothyroid
43
General tx options for bradycardia
Cardioactive drugs -Atropine 0.5 mg increments -Epi 2-10 mcg increments Pacing (transcutaneous/transvenous)
44
Bradycardia + CP/dyspnea
Ischemia may cause tachycardia or bradycardia | Large MI with CHF, PE, adrenergic tone
45
Bradycardia + acute coronary syndrome/MI
Bradycardia d/t ischemia of the conduction system or vagal response Bradycardia with inferior MI usually narrow complex, transient, caused by vagal stimulation. Responds to atropine. Bradycardia with anterior MI usually wide complex, caused by ischemia of the conduction system. Does not respond to atropine Nitro may cause a reflex tachycardia (drop in preload/afterload). Contraindicated in severe bradycardia
46
Bradycardia + syncope
3rd degree AV block (Stokes-Adams attack) | Sick sinus syndromes
47
Bradycardia + overdose
Digoxin- ventricular arrhythmias BBs- hypoglycemia CCBs- hyperglycemia Clonidine: Opioid like syndrome
48
Bradycardia + AMS
Consider overdose vs. increased ICP
49
Bradycardia + renal failure
Hyperkalemia
50
Bradycardia + myxedema
Tx is thyroid replacement

Emergency Med (11 decks)

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