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PHARMACOLOGY for CCCC MEDIC 2 > MEGACODE > Flashcards

MEGACODE Flashcards

1
Q

WHAT ARE THE PULSELESS ALGORITHMS

A

VFIB/Pulseless VT (shock)(epi/amio/lido) and also PEA JUST CPR AND EPI

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2
Q

What’s in the PEA cycle?

A

Check Rhythm/pulse, 2min CPR,1mg Epi every 3-5- and check H(02,CO2,VOL,TEMP,K), T(Trauma/tox, TP/CT, THROMB L/H, ACS)

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3
Q

What are H/T ?

A

H(02,CO2,VOL,TEMP,potassium), T(Trauma/tox, Tension Pneumo/Cardiac Tamponade, THROMB L/H) and ACS

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4
Q

What are the only shockable rhythms?

A

Vent Fib and pulseless VT

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5
Q

What’s in the VF/pVT cycle?

A

check rhythm/pulse, SHOCK-2minCPR-check rhthym/pulse, SHOCK-2minCPR. In between EPI 1mg/AMIO 300/EPI 1mg/AMIO 150 (or LIDO 1.5, then 0.75mg/kg)

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6
Q

What are the only CARDIOVERT rhythms?

A

UNSTABLE TACH- with ST/SVT/AT/AFLTR 50J, AFIB/MONO VT 100J, POLY VT, 200J.
CALL MEDCON FOR POLYMORPH VTACH.

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7
Q

What is the only PACE rhythm?

A

UNSTABLE BRADY

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8
Q

STABLE BRADY - what do you do?

A

O2/IV/monitor/12 lead- watch vitals and observe - 12 lead

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9
Q

STABLE TACHY - narrow/regular- - what do you do?

A

O2/IV/monitor-VAGAL - Adenosine &flush 6/12/12
BB or CCB
-METOPROLOL(bb) 5mg/1-2 min. May repeat 3X or CARDIZEM(ccb) 0.25mg/kg after 10 min mg/kg

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10
Q

STABLE TACHY - narrow/irregular- - what do you do?

A

O2/IV/monitor- Cardizem 0.25mg/kg then 0.35mg/kg - medcon

BB or CCB
-METOPROLOL(bb) 5mg/1-2 min. May repeat 3X or CARDIZEM(ccb) 0.25mg/kg after 10 min mg/kg

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11
Q

STABLE TACHY - wide/regular- - what do you do?

A

O2/IV/monitor- Adenosine &flush 6/12
then Procainimide 20/30 mg/min w/1mg/min infusion
or Amio 150 to 1mg/min,
Or LIDO 0.5mg/kg to 2-4mg/min,

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12
Q

STABLE TACHY- wide/irregular - - what do you do?

A

O2/IV/monitor- Torsades? 1-2G Mag Sulfate- medcon all others

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13
Q

UNSTABLE BRADY - what do you do?

A

O2/IV/monitor- ATROPINE 1mg (every 3-5mg) x3 [no good for second type 2 or third block] /PACE 70ppm-70mV then Dope 5-20mg/kg then EPI 2-10mcg/kg

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14
Q

UNSTABLE TACHY - narrow/regular- - what do you do?

A

O2/IV/monitor- synchronized cardioversion @50J

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15
Q

UNSTABLE TACHY - narrow/irregular- - what do you do?

A

O2/IV/monitor- synchronized cardioversion AFLTR@50J and AFIB@100J

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16
Q

UNSTABLE TACHY - wide/regular- - what do you do?

A

O2/IV/monitor- synchronized cardioversion @100J

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17
Q

UNSTABLE TACHY- wide/irregular - - what do you do?

A

O2/IV/monitor- synchronized cardioversion @200J- NO SYNC? DFIB AT 200J

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18
Q

ROSC? What do do now?

A

RELAX- YOU GOT PULSE. Get advanced airway ETT with cap @10BPM, 02-92-98%, CO2 35-45, SBP>90 or MAP>65 [temp therapy 30-32 NS, 1L bolus, Norepi 0.1-0.5mcg/g/min, or EPI 2-10cg/min or Dope 5-20 mcg/kg/min0, THE ANTI THAT BROKE IT, get 12 LEAD, check H and T

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19
Q

meds for transcutaneous pacing?

A

Fentanyl/Versed/Ketamine: Fentanyl -1mcg/kg, Versed 1mg-2mg, Ketamine 2-4mg/kg

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20
Q

meds for cardioversion?

A

Fentanyl/Versed/Ketamine: Fentanyl -1mcg/kg, Versed 1mg-2mg, Ketamine 2-4mg/kg

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21
Q

NO DRUGS UNTIL

A

MONITOR

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22
Q

TRISMUS- WHAT DO DO?

A

Try BVM with NPA first- if not. Then sedative and paralytic

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23
Q

TRISMUS-WHAT DOSES?

A

SUCCINYLCHOLINE (anectine), 1-2mg/KG rapid (repeat 1 if necessary/lasts 5-10 minutes), Versed(midazolam) 1-2mg, OR LORAZAPAM(ativan) 2mg IV diluted, 4mg IM (15-30min) no prego.

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24
Q

TRISMUS-WHAT OTHER DRUGS

A

BENZO (relax/pain)/PARALYTIC(stop gag)/DISSASOCIATIVE (forget)/Analgesic (discomfort)

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25
TRISMUS- doses for dissasociative and analgesia
KETAMINE- 2-4mg/kg IV (6-12mg/kg IM), Fent- 1mcg/kg
26
Antiarrhythmics list
Atropine 4 brady (stops brakes), Adenosine first line 4 ST/SVT/AT/ and MONOVT (fast/liquid dfib 6-6-12 slows AV node), Cardizem 4 Afib/fltr (slows rate/sa and av conduction), Amioderone 4 monoVtach (prolongs abs refract period), Lidocaine 4 mono vtach (decreases irritibility) , Procainamide for monoVtach (slows vent conduction)
27
Class 1 antidysrrhythmics
SODIUM - 1A- slows sodium in cells: Pronestyl/procainamide- suppress ectopic foci- can prolong Qtinterval. 1B- LIDOCAINE- Blocks Sodium in Purkinje fibers
28
Class 2 antidysrhythmics
Beta Blocker (blocks chatacholemines epi and norepi)- METAPROLOL - reduces rate during myocardial ischemia and reduces myocardial 02 demand and reduces BP.
29
Class 3 antidysrhythmics
PotassiumChannel Blocker - Increase PHASE 1/2/3- for atrial and ventricular tachycardias- prolongs absolute refractory period AMIODERONE -
30
Class 4 antidysrhythmics
Calcium Channel Blocker - reduces BP, reduces HR by slowing conduction throuth SA and AV nodes, increases O2 to myocardial cells. SLOWS AV CONDUCTION- Verapamil and Diltiazem/CARDIZEM
31
Class 5 antidysrhythmics - the unknowns
ADENOSINE - the heart stopper - liquid DFIB, and Magnesium Sulfate -
32
Action Potential Pneumonics
Summit/Plummet/Continue/Plummet (cells) vs Climb/Plummet (nodes)
33
Action potential ions
CELLS: Summit (Na+ in)/Plummet (K+OUT)/Continue (Ca+ IN)/Plummet (K+OUT) (cells). NODES: Climb (Ca+IN) /Plummet (K+OUT)
34
OD on BETA BLOCKER-
Glucagon 1-5mg
35
OD on CALCIUM CHANNEL BLOCKER?
calcium chloride 20mg/kg and Glucagon 1-5mg
36
What do beta blockers do? What drugs?
block beta- block sympathetic- block epi/norepi. Extend Phaze 4, and slow conduction. METAPROLOL(lopressor) and PROPRANOLOL (inderall)
37
What do calcium blockers do? What drugs?
Slows nodal conduction, extends phase 0 for nodes (climb/calcium).CARDIZEM(diltiazem) and VERAPAMIL
38
What do sodium channel blockers do? What drugs?
Extends phase 1, and therefore ERP, LIDOCAINE (1B), PROCAINIMIDE(1A)
39
What do potassium channel blockers do? What drugs?
extends phase 3 and therefore ERP, but also QT can initiate Torsades. AMIODERONE.
40
LIDOCAINE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
CLASS 1A SODIUM- VF/pVT- 1-1.5mg/kg (for refractory may give additional 0.5-0.75mg/kg in 5-10 min with MAX of 3mg/kg). STABLE VT -Wide 0,5-1.5 mg/kg same additional. INFUSION: 1-4mg/min. onset 1-5 minutes.
41
ADENOSINE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
(clss 5 unknown). 1st line SVT/Narrow Tach/MonoVtach just REGULAR not for AFIB/AFLTR/VF. RAPID PUSH WITH FLUSH 6/12/12mg for regular narrow, and 6/12 then amio or lido. NOT FOR DRUG INDUCED TACHY or 3rd degree block. ONSET seconds done in 12 seconds. Liquid DFIB- cans stop heart.
42
ATROPINE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
(parasympatholytic) 1st line symptomatic sinus BRADY - may help 1st or 2nd degree type 1 block. 1mg every 3-5 minutes up to 3mg. ORGANOPHOSPHATE POISONING large doses. 2mg to 4mg or more. Onset immediate up to 4-6 hours. Caustion with MI- increases O2 demand. Not for hypothermic brady or second degree type 2 or third degree block.
43
AMIODERONE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
(class 3 PCB) VF/pVT unresponsive to shock and pressor (after shock and epi) 1st 300mg, 2nd 150mg. UNSTABLE VT (caution: lasts long/many interactions/not with prolong QT/ causes hypotension). 150mg/10min rapid, 1mg/min slow, 0.5mg/min maintenance. MAX 2200MG/24hrs. Onset 2 hours peak 3-7 hours duration unknown. No prego. Also blocks sodium and calcium.
44
CARDIZEM- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
(class 4 CCB) STABLE/NARROW/IRREGULAR TACH Afib/Afltr: 0.25mg/kg after 10 min 0.35mg/kg. (infuse at 10mg/hr)
45
PROCAINAMIDE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
(1A sodium)- Stable monomorphic VT (or re-entry sVT after adenosine and vagal, or with stable wide complex tach of unknown origin). NOT WITH TORSADES or second or third heart block. 20-30mg/min up to 17mg/kg OR dysrhythmia ends, or HYPOT, or QRS widens >50%.
46
METAPROLOL- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
BETA 1 BLOCKER- stops epi and norepi - Stable monomorphic Tachy - after adenosine and vagal. 5mg/1-2 minutes up to 3X onset 1-2minute up to 3-4 hours. No breastfeed/NOT WITH DILTIAXEM or VERAPAMIL - don't block calcium and beta
47
GLUCAGON- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
OVERDOSE on Beta blockers or Calcium Channel Blockers - 0.05 to 0.15 mg/kg IV/IO/3-5 minutes. 0.05 to 0.10mg/min infusion. Onset 1 minute up to 1.5hours.
48
CALCIUM CHLORIDE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
OVERDOSE on Beta blockers or Calcium Channel Blockers (also hyperkalemia, hypocalcemia, hypermagnesemia)- BETA OD: 20MG/KG max 1G. CALCIUM OD: 500mg to 1000mg. Onset 1-3 minutes. Up to 30 minutes or even 4 hours. IV preferred
49
SUCCINYLCHOLINE_ WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
TRISMUS - a PARALYTIC - SUCCINYLCHOLINE (anectine), 1-2mg/KG rapid (repeat 1 if necessary/lasts 5-10 minutes), warn patient
50
MIDAZOLAM- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
TRISMUS or PACE or CARDIOVERSION 1-2MG. Onset 1-3 minutes for 4-6 hours (no prego- monitor- reduce by 50% for geriatric).
51
KETAMINE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
dissasociative TRISMUS or PACE or CARDIOVERSION 2-4mg/kg IV/IO 6-12mg/kg IM - 30second onset for 5-10 minutes (could cause hypertension and resp depression)
52
MAGNESIUM SULFATE- WHEN/HOW MUCH/WHAT/ HOW LONG/WARNING
CARDIAC ARREST - due to hypomagnesemia or Torsades de Pointes: 1-2 g (2-4 ml of 50% solution into 10ml NS). TORSADES W/PULSE or AMI with HYPO: 1-2G mixed in 50-100ml NS over 5-60 minutes. Follow with 500-1000mg/hour infusion. Onset IMMEDIATE with IV/IO- up to 30 minutes. NOT WITH HEART BLOCK! drop in BP
53
Dopamine- WHEN/HOW MUCH/WHAT/HOW LONG/WARNING
SECOND for symptomatic BRADY after atropine. Also for hypotension. 5-20 mcg/kg/min TITRATE. Don't mix with sodium bicarb. VOLUME before squeeze. Not with CHF. Onset 1-4 minutes stops when infusion stops.
54
EPINEPHRINE- WHEN/HOW MUCH/WHAT/HOW LONG/WARNING
VF/pulselessVT/Asystole/PEA- Symptomatic Brady after atropine (and dope). Severe Hypotension when pacing and atropine fail. Or when brady and hypor- or with phosphodiesterase enzyme inhibitor. Anaphylaxis (combine with fluid volume/corticosteroids and antihistamines). DOSE - 1mg every 3-5 minutes WITH FLUSH. infusion of 0.1-0.5 mcg/kg/min. TITRATE. ETT route- 2-2.5mg in 10mlNS. PROFOUND BRADY: 2-10mcg/min titrate.
55
50J - WHEN?
Sinus Tach. A Flutter. SVT
56
100J- WHEN?
A Fib. Mono VTACH
57
200J- WHEN?
Poly VTACH or vfib
58
LVAD triangle- initial
Skin Color and Temp- Cap refill- Check LOC
59
LVAD perfusion ok? LOC check
Hypoxia/BGL/OD/STROKE (aeioutipps)
60
LVAD- perfusion not ok? What next?
Look listen alarms and hum
61
LVAD IS FUNCTIONING - now what?
Check MAP>50 and or petCO2>20
62
LVAD functioning and MAP>50 and PETCO2>20mmHg what next
DO NOT PERFORM CPT- follow local protocols contact medcon
63
Goal MAP and CO2 for LVAD
MAP>50 and PETCO2>20mmHg
64
LVAD not functioning- now what?
Attempt to restart- power- ask people- call number
65
Can't get LVAD to start--
MEDCON- Perform compressions (upper)

PHARMACOLOGY for CCCC MEDIC 2 (11 decks)

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