Module 3

Question 1

ACS management

Answer 1

ASA
Clopidigrel
Heparin
Nitroglycerin
IV opiods
TNK

Question 2

ASA/Clopidogrel

Answer 2

Antiplatelet ( stops aggregation)

Stops the clot from getting bigger

Question 3

Heparin

Answer 3

Anticoagulation
Works on Thrombin (which acts like plastic wrap)
stops thrombin from sticking to platelets

Question 4

Nitroglycerin

Answer 4

Reduces preload and afterload
DO NOT GIVE TO RT SIDED (Inferior) MI
because it drops the preload

Question 5

IV opiods

Answer 5

decrease preload and stop SNS activations

Question 6

TNK

Answer 6

fibrinolytic

clot buster

Question 7

NSTEMI

Answer 7

ischemia/tissue damage but not death

Question 8

STEMI

Answer 8

STevelvation MI- cell death/Infarct

Needs- fibrinolytic, PCI and maybe Defib

Question 9

Key features of successful thrombolysis

Answer 9

Resolution of CP
Resolution of ST-segment elevations
Reperfusion arrhythmias

Question 10

Cardiogenic shock

Answer 10

Pump problem

Question 11

Causes of cardiogenic shock

Answer 11

MI
coronary artery dissection
chest trauma
Infection ( pericarditis)
tamponade
arrhythmia
pharmacological OD
Mechanical valve

Question 12

Cardiogenic shock symptoms

Answer 12

CP

Decreased cardiac output
decreased BP
Decreased LOC
Cool extremities
decreased urinary output

Pulmonary edema
Pulmonary crackles
Increased JVD

Question 13

cardiogenic shock- Preload

Answer 13

INCREASED
compensation/consequence

Treatment:
Vasodilation- Nitro,
Diuretics- lasix
Opiods-morphine

Question 14

cardiogenic shock- Afterload

Answer 14

INCREASED- increased SVR
this is compensation- the body feels the decreased cardiac output so it constructs vessels causing an increase in afterload

Treatment: Vasodilation- Nitroglycerine or Nitroprusside

Question 15

cardiogenic shock- Contractility

Answer 15

DECREASES
This is the cause of cardiogenic shock

Treatment:
Increase contractility with positive inoptropes
Dobutamine, Milinone and Dopamine

Question 16

cardiogenic shock- HR

Answer 16

INCREASED
this is compensation for decreased cardiac output

Treatment if needed - negative inotropes to decrease cardiac oxygen demand

Question 17

Cardiogenic shock- Cardiac output

Answer 17

DECREASES
as a consequence

treatment: Intra aortic balloon pump

Question 18

ST segment

Answer 18

reploarization of teh ventricles
J point (measure 1.5 boxes over) to T wave

Question 19

PR

Answer 19

< 0.2 seconds

Question 20

Brady rhythms

Answer 20

> 50 bpm

decreased cardiac output

Question 21

Pacemakers

Answer 21

SA node
AV node
Ventricles

Question 22

SA node rate

Answer 22

60-100

AV node

Question 23

AV node rate

Answer 23

40 -60

Question 24

Ventricular rate

Answer 24

20-40

Question 25

Ventricular rate

Answer 25

20-40

Question 26

Things that slow the heart

Answer 26

Beta blockers Vagus nerve MI hypoxia

Question 27

Symptoms of brady cardia

Answer 27

``` Heart failure symptoms Decreased LOC hypotension/poor perfusion CP weakness/fatigue ```

Question 28

Why do we give EPI

Answer 28

Alpha 1- vasoconstriction Beta1- contractility Beat 2 Bronchodilation

Question 29

EPI dose

Answer 29

1mg Q 3-5 mins IV

Question 30

Drug for brady rhythms

Answer 30

Atropine

Question 31

Atropine

Answer 31

``` anticholinergic stops parasympathetic stops vagus nerve only works at atria 0.5-1mg Q3-5 mins ( max 3 mg) ```

Question 32

Hs

Answer 32

``` Hypothermis Hypoxia Hydrogen Hypo/Hyperkalemia Hypovolemia ```

Question 33

Ts

Answer 33

``` Tension pneumo Tamponade Toxins Thrombosis (pulm) Thrombosis (cardiac) ```

Question 34

Reasons for PEA

Answer 34

No mechanical activity caused by hypoxia- heart can contract Hypovolemia- no preload

Question 35

unstable tachycardia symptoms

Answer 35

CP >20 mins SOB or new or worsening CHF Low BP Signs of shock

Question 36

Synchronized cardioversion

Answer 36

For persistent unstable tachyarrhythmia Shock on R Consider sedation

Question 37

Adenosine

Answer 37

Pauses conduction through the AV node Only treats irritability/reentry near the AV node (party close to the border) Does not work on Atrial irritability (doesn't treat afib or flutter)

Question 38

Antiarrhythmics

Answer 38

Procainamide (works on Na/CL) | Amioodarone (works on all channels)

Question 39

1st 4 steps in a PEA arrest

Answer 39

CPR while putting pads on/monitor rhythm check asap (if its shockable we need to know so we can intervene asap) CPR x 2 mins- give epi 1mg while doing CPR Rhythm check CPRx2mins

Question 40

ROSC - what to do next

Answer 40

Airway- intubate Breathing-oxygenate Circulation- BP low (pt has no vascular tone) give fluid bolus 1-2. start vasopressors. ECG Differential diagnosis. labs, cath lab, SX, CXR Disability (34-36 C) targeted temperature management Keep afebrile x24h b/c we want to decrease O2 demand aggressive ROC infusion