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! Y6 Emergency Care - Laura Lazzari > CV emergencies > Flashcards

CV emergencies Flashcards

(54 cards)

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1
Q

What is included in Acute Coronary Syndrome ACS?

A

Unstable angina
STEMI
NSTEMI

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2
Q

How do you differentiate unstable angina from STEMI/NSTEMI

A

ECG:

  • changes: STEMI
  • no changes: NSTEMI/Unstable angina

Trop:
- elevated: STEMI/NSTEMI
- not elevated: unstable angina
STEMI/NSTEMI: high trop

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3
Q

When would you do PCI vs CABG

A

PCI: 1 or 2 vessel disease, not including LAD

CABG: 2 or 3 vessel disease, including LAD

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4
Q

What are the reversible causes of cardiac arrest?

A

4Hs and 4Ts

Hypoxia
Hypovolaemia
Hypothermia
Hypokalaemia, hyperkalaemia, hypoglycaemia

Toxins
Tamponade
Tension pneumothorax
Thrombosis

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5
Q

What are MI complications

A

DARTH VADER

Death 
Arrythmia 
Rupture 
Thrombus 
Haemorrhage 
Valvular heart disease 
Aneurysm 
Dressler / pericarditis 
Embolism 
Re-infarct
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6
Q

What is the Killip classification used for?

A

predicts risk of 30 day mortality following MI

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7
Q

What is the difference between Dressler and pericarditis

A

Dressler syndrome: 2-6 weeks after

Pericarditis: >48 hours

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8
Q

What investigation should you do if suspecting re-infarct 4-10 days after initial MI?

A

CK-MB rather than troponin

This is because troponin remains raised for up to 10 days
while CK-MB is only raised for 3-4 days

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9
Q

What ECG changes do you see in STEMI

A

ST elevation
Hyperacute T wave
LBBB

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10
Q

What ECG changes may occur in NSTEMI/unstable MI

A

ST depression

T wave inversion

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11
Q

What are sx of ACS

A

central retrosternal chest pain
heavy, crushing, tight
radiates to arms, neck, jaw, epigastrium
onset at rest

Assoc sx: SOB, sweating, nausea, vomiting

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12
Q

Who can a silent infarct occur in

A

Elderly or diabetic

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13
Q

What Ix should you get in suspected ACS

A

Full bloods - FBC, UE, CRP, Gluc, Lipid, Troponin, CK-MB, amylase (exclude pancreatitis), AST (elevated 24h post), LDH (elevated 48h post)

ECG
CXR (exclude heart failure)
Echo (LV EF)

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14
Q

What do you give for management of STEMI

A

ROMANCE

Reassure 
Oxygen if SpO2 <94
Morphine + metoclopramide 
Aspirin + ticagrelor 300mg 
Nitrite SL 
Coag resolution - PCI / thrombolysis + heparin/fondaparinux as appropriate
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15
Q

What are contraindications for beta blockers

A 
Low BP/HR
HF 
COPD/asthma 
cardiogenic shock 
heart block
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16
Q

How do you decide what type of reperfusion you should do in STEMI?

A

If pt presenting <12 hours from sx onset:

  • PCI available within 120 mins: ANGIOGRAPAHY + PCI + enoxaparin
  • PCI not available in 120 mins: THROMBOLYSIS

If pt presenting >12 hours from sx onset / low GRACE score / NSTEMI:
- FONNDAPARINUX

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17
Q

What is long term management of STEMI

A

ABCDS

ACEi 
Beta blocker 
Cardiac rehab (med diet + exercise 
DAPT 
Statin
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18
Q

What is pulmonary oedema

A

Fluid in alveolar spaces (in lung)

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19
Q

What are causes of severe pulmonary oedema

A
  • Cardiac: LVF e.g. post MI, Valvular heart disease
  • ARDS
  • Fluid overload
  • Neurogenic e.g. head injury
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20
Q

How do you manage acute pulmonary oedema

A
  1. Sit patient up
  2. High flow O2
  3. IV Morphine (reduce dyspnoea) 10mg+ IV metoclopramide 10mg
  4. IV furosemide 40-80mg
  5. GL GTN spray (or IV GTN if SBP >100)
  6. CPAP
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21
Q

How do you manage pulm oedema once stable?

A
  • daily weights
  • repeat CXR
  • manage meds (change to oral furosemide, consider thiazide, ACEi, beta blocker, spironolactone)
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22
Q

what are signs of pulm oedema on CXR

Study These Flashcards
A

Alveolar shadowing, bat-wing shadowing / kerley B lines, cardiomegaly, diverted upper lobes, pleural effusion

23
Q

What is a common side effect of GTN?

Study These Flashcards
A

It reduces blood pressure

24
Q

When do you give IV GTN compared to spray?

Study These Flashcards
A

When SBP >100

25
What must you do if BP drops after giving GTN?
Stop giving GTN Wait 10 mins then reassess As GTN has very short half life!
26
What do you do once pull oedema patient is stable=
Daily weights Repeat CXR Manage medications: Oral Furosemiide, consider thiazide if on high Furosemide dose, start ARB / beta blocker, spironolactone
27
What investigations must you get if suspecting pulmonary oedema
ECG to exclude MI ABG, BNP immediately CXR (portable if pt unwell)
28
What are causes of severe pulmonary oedema?
CV (left ventricular failure - commonly post MI or post ventricular heart disease) ARDS Fluid overload
29
What is cardiogenic shock?
Shock caused by insufficient cardiac contractility
30
What are causes of cardiogenic shock
``` MI Arrythmia Cardiac Tamponade PE Myocarditis Valve destruction Aortic dissection ```
31
How do you manage cardiogenic shock?
MOVE TO ITU ASAP 1. Oxygen 2. Diamorphine 3. Underfilled: plasma expander // Overfilled: Inotrope e.g. dobutamine
32
What must you insert for cardiogenic shock, and why?
Insert Swan-Gantz catheter (insert into pulmonary artery via RA) - Measure pulmonary wedge pressure and monitor left and right ventricular funciton - Purely diagnostic - Other indications: complicated MI, measure inotrope effects, thrombolysis for PE
33
What are causes of bradycardia
- physiological - cardiac (e.g. Post-MI, third degree heart block, mobitz T2, sick sinus syndrome, aortic valve disease, cardiomyopathy) - non-cardiac (vasovagal, hypercalaemia, hypothermia, Cushings triad, hypothyroid) - Drug induced
34
How do you manage bradycardia
ABC If either low GCS or low SBP <90 call for SENIOR HELP / CARDIAC ARREST TEAM IV cannula + bloods Check ECG Tx: Atropine 0.5mg IV (anticholinergic) If unsatisfactory response: repeat every 3-5 mins Transcutaenous pacing > transvenous pacing
35
what is GRACE score used for
To estimate 6 month mortality of patient with ACS
36
What must you define when you see a tachycardia?
Broad complex / narrow complex tachy
37
What are causes of broad complex tachy
VT (incl TdP) SVT Pre-excited tachycatdia with underlying WPW (e.g. AF, atrial flutter)
38
What do you see on ECG to define a broad complex tachy?
ECG rate >100 | QRS >120 ms (more than 3 small squares)
39
What is the first thing you give in a broad complex tachy with a pulse?
High flow O2 IV access 12 lead ECG
40
What adverse signs are eyou looking out for in a broad complex tachy
Shock CHest pain /ischaemia on ECG HF Syncope
41
What do you do if no adverse signs present in pt with broad complex tachy
1. Correct electtrolyte problems | 2. Assess rhythm: if regular, indicates VT >
42
What do you give for pulse VT
Amiodarone 300mg IV over 20 mins Then 900mg over 24h Sedate and cardiovert if unsuccessful
43
What do you do if adverse signs present in pt with broad complex tachy
``` 1. Get expert help 2- Sedate 3- 3 synchronised DC shocks 4- Check and correct electrolyes 5. Amiodarone 300mg IV / 20 mins > 900mg IV / 24y 6. Further cardioversin ```
44
what is sick sinus syndrome
Sinus node fibrosis typically in elderly Sinus node becomes dysfuncitonal can cause sinus bradycardia / tachyarrhythmia
45
what are sx of sick sinus syndrome
Syncope Light headed Palpitations SOB
46
What is a narrow complex tachy
ECG shows HR >100, QRS <120ms (3 small squares)
47
What do you do if patient with narrow complex tachy has advere signs
``` Expert help Sedate 3 synchronised DC shocks Check and correct electrollyte Amiodarone ```
48
What do you do in patient with narrow complex tachy without adverse signs, with regular rythm
1. Vagal maneuvres | 2. IV adenosine bolus (6mg, 12mg, 12mg)
49
What do you classify a narrow complex tachy with irregular rhythm
AF
50
what bloods do you NEED TO GET if thinking PE (thinkthat you will need to start anticoag!)
FBC, U&E, renal, LFT, PT, APTT
51
What DOAC do you give for PE
Rivaroxaban / Apixaban
52
Management of ruptured AAA
volume resus, analgesia, VTE prophylaxis | EVAR
53
what is a type 2 MI
Ischaemia of myocardium occurring due to insufficient perfusion (NOT due to atherothrombosis)
54
How do you manage an NSTEMI
DAPT Anticoag: SC Fondaparinux 2.5 mg OD Morphine + metoclopr Beta blocker + assess risk and need of angiography with GRACE score

! Y6 Emergency Care - Laura Lazzari (9 decks)

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