Cardiovascular

Question 1

Indications for Adrenaline 1:10,000?

Answer 1

Cardiac arrest.
Post-ROSC.

Question 2

Cautions for Adrenaline 1:10,000?

Answer 2

Hypertension may occur in patients on non-cardioselective beta blockers (e.g. propranolol)

Question 3

Actions of Adrenaline 1:10,000?

Answer 3

It is a sympathomimetic that stimulates alpha and beta adrenergic receptors.
Enhances myocardial and cerebral blood flow.
Increases peripheral resistance and perfusion pressure.

Question 4

Contra-indications for Adrenaline 1:10,000?

Answer 4

Do not give if core temp <30.
Between 30-35, double the dose period.

Question 5

Dose of Adrenaline 1:10,000 for cardiac arrest and post-ROSC?

Answer 5

Cardiac arrest: 1 mg in 10 ml repeated every 3-5 minutes, with no limit.
Post-ROSC: 50 mcg in 0.5 ml, and a repeat dose of 50-100 mcg in 0.5-1 ml every 3-5 minutes with no limit.

Question 6

Indications for Amiodarone?

Answer 6

Shockable rhythms. After the 3rd and 5th shock.

Question 7

Actions of Amiodarone?

Answer 7

Anti-arrhythmic. Lengthens cardiac action potential and refractory period. Prolongs QT interval.
Blocks Na and K channels in cardiac muscle, reduces electrical irritability.

Question 8

Contra-indications of Amiodarone?

Answer 8

Core temp <30.

Question 9

Side effects of Amiodarone?

Answer 9

Bradycardia.
Vasodilation - hypotension.
Bronchospasm.
Arrhythmias - Torsades de pointes.

Question 10

Dose of Amiodarone?

Answer 10

Administer into large veins, and flush with 20 ml fluid.
300 mg after 3rd shock, 150 mg after 5th shock.

Question 11

Indications of Aspirin?

Answer 11

Clinical evidence of MI or ischaemia.
Suspected TIA and: symptoms fully resolved, patient is not being conveyed, and referred to TIA pathway.

Question 12

Actions of Aspirin?

Answer 12

Anti-platelet, reduces clot formation.

Question 13

Contra-indications of Aspirin?

Answer 13

Known allergy or sensitivity.
<16 years.
Active GI bleed.
Haemophilia or clotting disorder.
Severe hepatic failure with jaundice.

Question 14

Side effects of Aspirin?

Answer 14

Increased risk of GI bleeding.
Wheezing in some asthmatics.

Question 15

Indications of Atropine?

Answer 15

Symptomatic bradycardia, to include:
Absolute bradycardia (<40 bpm).
Systolic BP below expected for age.
Paroxysmal ventricular arrhythmias.
Inadequate perfusion causing confusion, etc.
Bradycardia following ROSC.

Question 16

Contra-indications of Atropine?

Answer 16

Suspected hypothermia.
Cardiac transplant - hearts will not respond to vagal blocking.

Question 17

Actions of Atropine?

Answer 17

Blocks vagal activity and increases heart rate.

Question 18

Side effects of Atropine?

Answer 18

Dry mouth, visual blurring and pupil dilation.
Confusion and hallucinations.
Tachycardia.
No <100 mcg doses, can cause bradycardia.

Question 19

Dose for Atropine?

Answer 19

600 mcg every 3-5 minutes, to a max of 3 mg.
Administer as rapid bolus.

Question 20

Indications for Furosemide?

Answer 20

Pulmonary oedema and/or respiratory distress in acute heart failure.

Question 21

Actions of Furosemide?

Answer 21

Potent diuretic with a rapid onset and short duration.

Question 22

Contra-indications of Furosemide?

Answer 22

Reduced GCS with liver cirrhosis.
Cardiogenic shock.
Severe renal failure with anuria.
<18 years.

Question 23

Cautions of Furosemide?

Answer 23

Hypokalaemia can induce arrhythmias.
Pregnancy.
Hypotension.

Question 24

Side effects of Furosemide?

Answer 24

Hypotension.
GI disturbance.

Question 25

Dose of Furosemide?

Answer 25

40 mg in 4ml, slowly over 2 minutes.

Question 26

Indications of GTN?

Answer 26

Cardiac chest pain due to angina or MI, when systolic BP >90. Consider GTN in heart failure with ischaemia or hypertension. Chest pain and suspected cocaine toxicity.

Question 27

Actions of GTN?

Answer 27

Potent vasodilator. Dilates coronary arteries/relieves coronary spasm. Dilates systemic veins resulting in lower pre-load. Lowers BP.

Question 28

Cautions of GTN?

Answer 28

Suspected posterior MI or right-ventricular infarction.

Question 29

Contra-indications of GTN?

Answer 29

Hypotension, <90 in angina/MI, or <110 in heart failure. Hypovolaemia. Head trauma. Cerebral haemorrhage. Viagra and related drugs taken within 24 hours. Unconscious. Severe aortic or mitral stenosis.

Question 30

Side effects of GTN?

Answer 30

Headaches. Dizziness. Hypotension.

Question 31

Dose for GTN?

Answer 31

400-800 mcg, or 1-2 sprays, every 5-10 minutes with no limit.

Question 32

Indications for TXA?

Answer 32

Actual or suspected severe haemorrhage: - Time critical injury where significant internal haemorrhage is known/suspected - >18 with known/suspected head injury, GCS 12 or less, within the last 3 hours - PPH after misoprostol, if bleeding continues after 15 minutes. In trauma: - BP <90 or absent radial pulse or pulse >110 believed to be due to bleeding - Haemostatic gauze, tourniquet, chest dressing, or pressure dressing applied - Traumatic cardiac arrest

Question 33

Side effects of TXA?

Answer 33

Nausea. Vomiting. Diarrhoea. Rapid injection may cause hypotension.

Question 34

Dose of TXA?

Answer 34

500 mg in 5 ml, over 10 minutes.