Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CCM > CCM wiser material > Flashcards

CCM wiser material Flashcards

1
Q

Initial evaluation and management of unstable patient

A

1) introduce yourself to the patient, if they respond, ABC intact. 2) If pt unresponsive, check for pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what if the patient is unresponsive

A

Check for pulses, if no pulse: Call for help, start CPR, or think pulseless rhythms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What if the patient is unresponsive but they do have a pulse

A

Check BP,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What if the patient is unresponsive but they do have a pulse and its low

A

begin resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What if the patient is unresponsive but they do have a pulse and its normal

A

Narcan (0.4 mg diluted in 9 ccs; start with 1 mg, 2 mg, 4 mg) given 1 amp D 50 or glucagon 1 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What if the patient is unresponsive but they do have a pulse and its normal, and you given narcan and glucose,

A

Secure airway, evaluate for other causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Unresponsive patient

A

Able to protect airway (secretions)?, breathing (spontaneously, or increased work of breathing), circulation (pulse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Increased work of breathing

A

Tachypnea, tachycardia, diaphoresis, accessory muscle use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

RR decreased, ddx

A

meds (benzos or opiates), brainstem (mid structural lesion or metabolic encephalopathy), neuromuscular, metabolic alkalosis (vomiting, meds, contractile alkalosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

RR increased? what else are you looking for (indications for BVM)

A

1) increased WOB 2) refractory hypoxia, 3) apnea, 4) inability to protect airway 5) hypoxia with bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pt fits indications for BVM, but they are still hypoxic with no chest rise

A

place oral/nasal airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pt starting on BVM, then you place ora/nasal airway

A

Direct laryngoscope and intubation (begin prep)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pt w/ increased RR but no indications for BVM

A

if the tidal volume is low (rapid, shallow breathing), beging BVM, if no, and the patient is hypoxic but responding to supplemental O2, go through ddx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ddx for hypoxic patient that does respond to supplemental O2

A

1) Low FiO2, 2) low barometric pressure 3) shunt (> 40%) 4) deat space 5) diffusion or O2 carrying abn 6) hypoventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Minute ventilation equation

A

RR x Tidal volume, normal 8L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PCO2

A

production / RR x (tidal volume - dead space)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a shunt and and % is needed for refractory hypoxia

A

perfusion of alveoli that are not ventilated; > 40% leading to refractory hypoxia; does not improve with increasing FiO2, but responds to PEEP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Etiology of shunt

A

Blood (hemorrhage), water (pulmonary edema), pus (PNA), atelectasis, ARDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is deadspace

A

Ventilation of alveoli that are not perfused; responds to FIO2, doesnt respond to PEEP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

etiology of deadspace

A

PE;

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Preparation for rapid sequence induction and intubation

A

1) evaluate airway 2) IV access 3) pre-oxygenate 4) contraindications for Succs 5) last time you ate?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Evaluating airway

A

mallampatti, thyomental distance, thyrohyoid distance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Contraindications to succynylchonile

A

kidney problems, unable to move extremities? myalgias? prior problems with anesthesia? ( burns, eye trauma, denervation, hyperkalemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

After initial preparation for intubation, what equipment do you need?

A

1) laryngoscope (mac, miller, glydoscope) 2) endotracheal tube (7.5 fem, 8 male) 3) stylet 4) syringe) 5)CO2 detector 6) cardiac, O2, BP monitor,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Meds needed for rapid sequence intubation

A

sedation: etomidate (0.3 mg/kg); ketamine 3 mg/kg; versed, propofol Paralytics: Succinylcholine, roc( 1mg per kg) Push dose: neo (20mg/D5W 250ml) give 80 mcg/cc; IVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Initial ventilator settings

A

Mode (assisst control), tidal volume ( 6cc/kg IBW), RR (target MV/tidal volume), PEEP (5 mmHg, higher for shunt physiology), FIO2 (start 100%, decrease to <60)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

MV w PCO2

A

MV PaCO2 8 40 14 30 20 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Hypotension following intubation

A

IVF if systolic is low Phenylephedrine if diastolic (20 mg into 250 cc NS) give 2 cc at a time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

VT/VF arrest witnessed

A

shock first, charge to 200

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

VT/VF arrest unwitnessed

A

2 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Arrest at 0 min

A

Help CPR IV access BVM Get defibrillator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Arrest at 1:30 min

A

Continue CPR Prep meds (epi 1 mg 1:10.000; 300 mg amio) Place pads, begin to charge for defib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Arrest at 2 min

A

Check pulse/rhythm Give meds - (epi 1 mg 1:10.000; 300 mg amio) BVM Shock if can

34
Q

Arrest at 3 min

A

Continue CPR Prep meds (epi 1 mg 1:10.000; 150 mg amio) meds for intubation Place pads, begin to charge for defib

35
Q

Arrest at 4 min

A

Check pulse/rhythm epi 1 mg 1:10.000 150 mg amio intubate Shock if can

36
Q

Arrest at 5 min

A

Continue CPR Prep meds (epi 1 mg 1:10.000; BVM q 5-6 hr Shock

37
Q

Persistent VF/VT

A

Repeat epinephrine/shock q 5 min Repeat amio/shock 150 mg IV x1 Things to consider: - Check ABG/lytes - Give Na Bicarb 1 amp IV - Give Mg sulfate 2 g IV push

38
Q

PEA ddx

A

Severe hypotension/obstructive shock 1) Massive PE (tPA, takes 24 hr) 2) Hypovolemia -> Fluids5 3) Temponade -> surgical 4) Tension pneumo 5) Hypoxia -> BVM 6) High K, 7) MI/PE

39
Q

What to do for Hyperkalemia

A

Give Ca IV, NA bicarb, Insulin IV, D50 IV

40
Q

Shock in terns of equation

A

CO = HR x SV

41
Q

Shock w/ decreased HR

A

Asystole vs bradycardia

42
Q

Shock w/ asystole

A

PEA

43
Q

Shock w/ bradycardia and hypoxic

A

Emergent BVM - treat hypoxia reverse meds, pacing,

44
Q

Etiology of bradycardia

A

1) severe hypoxia (BVM), 2) well conditioned ppl, 3) MI RCA supplying sinus node, 4) Meds (CCB, BB, digoxin (digibind), vasovagal) 5) hypothermia

45
Q

How to reverse bradycardia 2/2 BB

A

epi, glucagon, high dose insulin

46
Q

How to reverse bradycardia 2/2 CCB

A

Ca, epi, high dose insulin, lipid emulsion

47
Q

Tachycardia wide complex, NBS?

A

+ p wave, no p wave

48
Q

Tachycardia wide complex, + p wave?

A

Treat underlying cause: hyperkalemia, L or R BBB, TCA OD, WPW, pacemaker

49
Q

Tachycardia wide complex, - p wave?

A

stable vs unstable

50
Q

Tachycardia wide complex, - p wave, stable- dx and tx?

A

V tach, AVNRT w/ abberancy -> Rate and rhythm (amiodarone) cardioversion.

51
Q

Tachycardia wide complex, - p wave, unstable?

A

unstable V tach: AMS, CP, hypotensive -> electric cardioversion

52
Q

Tachycardia narrow complex, unstable?

A

AMS, CP, hypotensive -> electric cardioversion

53
Q

Tachycardia narrow complex, stable, irregular, ddx?

A

MAT Sinus tach w/ PACs or PVCs a fib

54
Q

Tachycardia narrow complex, stable, irregular, new onset?

A

Rate control/cardioversion (in < 72 hr) and correct trigger

55
Q

Tachycardia narrow complex, stable, irregular, old onset?

A

Rate control Anticoagulate and fix underlying trigger

56
Q

Causes of sinus tachycardia (triggers)

A

Hypoxia Increased WOB Shock Hypoglycemia Anemia Increased DO2 Meds and electrolytes Pain/Anxiety

57
Q

Tachycardia narrow complex thats regular, categories

A

divided based on P waves

58
Q

Tachycardia narrow complex thats regular, + P waves

A

A flutter

Sinus tachy

59
Q

Tachycardia narrow complex thats regular, no P waves

A

AVNRT

  • Reentry pathway
  • Signal comes down the AV node
  • Fast channel depolarizes
  • PAC occurs and goes down slow channel as fast channel is refractory from earlier beat
  • When PCA gets to the end of slow channel, fast channel is no longer refractory from earlier beat, re-entry rhythm starts.
60
Q

Tachycardia narrow complex thats regular, ? P waves

A

Adenosine, avoid in pt/s wiht bronchospasm (asthma, COPD)

61
Q

Rate control

A

CCB, BB

62
Q

Rhythm control

A

Amiodarone BB Digoxin

63
Q

Etiology of sinus tachycardia - decreased oxygen delivery

A

DO2 = 1.34 x Hgb x CO x SaO2

CO = HR x SV

DO2 = 1.34 x Hgb x [HR x SV] x SaO2

Examples: severe anemia, hypoxia, dereased SV from changes in preload, afterload and contractility.

64
Q

Etiology of sinus tachycardia - decreased resistance

A

BP = CO x Resistance

HR will rise to provide compensatory increase in CO

Examples: Sepsis, anaphylaxis, medications-vasodilator, adrenal insufficiency

65
Q

Etiology of sinus tachycardia - increased WOB

A

Increased catecholamines as pt struggles to breath

66
Q

meds

A

Beta agonists, withdrawal - EtOH, BB

67
Q
A
68
Q

Multifocal Atrial Tachycardia

A

3 or more distinct P wave morphologies

Irregular PR interval

Common to chronic lung

69
Q

Determining if SVT is stable vs unstable

A

SOB

CP

Hypotension

  • IF UNSTABLE, CARDIOVERSION (sedate, intubate, cardiovert, set on synchronized cerdioverstion start at 100J)
70
Q

If stable SVT, how to dx

A
  • if P waves visible, tben based on EKG
  • If no p waves, need to use adenosine toslow rhythm down enough to make dx
  • Adenosine IV - block AV node for 5 seconds
71
Q

Adenosine IV to dx SVT

A
  • Adenosine IV - block AV node for 5 seconds
  • need pt to be monitored, be prepared for rare complications of asystole
  • Give adenosine IV
    • peripheral: 6 mg repeat at 12 mg
    • central: 3 mg repeat at 6 mg
  • AVNRT - converts to NSR
  • A flutter - converts to flutter waves
  • Sinus tach - converts to 3rd degree AV block
72
Q

How to do rate control of SVT

A
  • Increase level of care to place where you can manage possible hypotension or arrhythmia
  • Beta Blocker – IV metoprolol or esmolol drip
  • Calcium Channel Blockers- diltiazem IV or drip
  • Side Effect of Rate control could be hypotension
    • Reverse hypotension of Calcium Channel Blockers with IV calcium
    • Reverse hypotension with Neosynephrine IV
73
Q

How to do rhythm control of SVT

A
  • Amiodarone IV
    • Loading Dose 150mg IV over 10 minutes
    • Drip: 1mg/hour x 8 hours then 0.5mg/hour x 16 hours
    • Start PO after drip completed
74
Q

Hypotension categories

A
  • low pulse pressure (preserved diastolic)
    • Cardiogenic (HF, ACS) -> Ionotropes, pressors
    • Obx (PE, tamponade, tx) -> reverse
    • Hypovolemia (hemorrhage, dehydration)
  • wide pulse pressure (decreased diastolic)
    • Distributive (sepsis, AI, anaphylaxis, meds)
    • Neurogenic (usually with bradycardia)
      • Sepsis tx, IVF, pressors
      • Adrenal Insuff: steroids
      • Anaphylaxis: IVF, epi, H1 and 2, steroids
      • Neurogenic: ionotropic and pressors
        *
75
Q

Narrow Pulse Pressure Hypotension

  • Example: 120/80 decreases to 100/70
  • Change more in systolic blood pressure
  • Systolic Blood Pressure related to _____
A
  • Stroke Volume and Aortic Compliance
    *
76
Q

Stroke Volume is dependent on 3 main factors

A
  • Preload (loss of intravascular volume)
  • Afterload (blood not leaving heart)
  • Contractility (decreased L ventricular function)
77
Q

Hypovolemia- loss of intravascular volume

A
  • Dry Mucous Membrane, Jugular Veins flat
  • Non-Hemorrhagic - vomiting, third spacing, diuresis
  • Hemorrhagic- Trauma, acute GI bleed
  • Treatment- Volume Resuscitation- IV fluid 2L wide open
78
Q

Obstruction- prevents return of fluid to the heart

A
  • JVD, Clear lungs
  • Massive Pulmonary Embolism – vascular blockage
  • Cardiac Tamponade- pericardial pressure preventing ventricular filling
  • Tension pneumothorax- intrathoracic pressure preventing blood return
  • RV Infarct
  • Treatment- Volume Resuscitation and relieve underlying condition
79
Q

Afterload- Prevents blood from leaving heart

A
  • Severe valvular stenosis
  • Treatment- Decrease afterload
80
Q

Contractlity- Decreased Left ventricular function

A
  • Myocardial Infarction
  • Arrhythmia
  • Cardiomyopathy
  • Infiltrative Disease
  • Treatment- Inotropic Agents
81
Q
A

CCM (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions