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Pass_with_Pass > Myocardial Infarction > Flashcards

Myocardial Infarction Flashcards

1
Q

Subendocardial

A

The MI extends partially through the thickness of the myocardium. May or may not produce a pathological Q-waves (Q-waves > 0.04s) on future 12 lead EKGs

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2
Q

STEMI what to look for?

A

1mm or more ST segment elevation in two or more anatomically contiguous or numerically consecutive leads

Anatomically contiguous
1, aVL, V5, V6
II, III, aVF
V1, V2
V3, V4

Numerically Consecutive
V1-V2
V3-V4
V3-V4
V4-V5
V5-V6

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3
Q

Names of Myocardial Infarctions

A

1, aVL, V5, V6 = Lateral Wall MI

II, III, avF = Inferior Wall MI

V1, V2 = Septal Wall MI

V3, V4 = Anterior Wall MI

V2, V3 = Anteroseptal MI

V4, V5 = Anterolateral MI

V2, V3, V4, V5 = Extensive Anterior Wall MI

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4
Q

Right sided 12 Lead EKG

A

Inferior wall Mi = STMI = II, III, aVF = v4R

Right Coronary Artery supplies the Posterior Descending Artery and the Right marginal Artery

The posterior Descending Artery supplies the inferior wall

The right Marginal Artery Supplies The Right Ventricle

Inferior wall MI - right sided 12 lead to identify the occlusion is happening in the posterior descending artery or if proximal RCA

Right ventricle = concern with preload and nitro administration

RVI = fluid to support pre load (starling’s law), aspirin, and oxygen

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5
Q

Bundle Branch Blocks

A

Right and Left

Left - left anterior and left posterior

1) Lead V1 QRS > 0.12 (3 small boxes)

2) V1 up = righ; down = left

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6
Q

ACLS Slow HR < 60 BPM

A

*Patient must be symptomatic

  • Sinus Bradycardia
  • Junctional Escape
  • Second Degree Type 1
  • Second Degree Type 2
  • Third Degree
  • Idioventricular
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7
Q

ACLS Slow HR (Above AV)

A
  • Sinus Bradycardia
  • Junctional Escape
  • Second Degree Type 1
  1. Atropine 1mg, max of 3mg
  2. Transcutaneous Pacing 60 BPM; 50+ mA until mechanical capture (pulse) and electrical capture (captured pacer spike)
  3. Vasopressor infusion
    • Dopamine: 5-20mcg/kg/min
    • Epinephrine: 2-10mcg/min
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8
Q

ACLS Slow HR (Below AV)

A
  • Second Degree Type 2
  • Third Degree
  • Idioventricular
  1. TCP: 60 BPM; 50+mA until mechanical (pulse) and electrical (captured
  2. Vasopressor infusion
    • Dopamine: 5-20mcg/kg/min
      - Epinephrine: 2-10mcg/minute
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9
Q

Normal ACLS

A

HR: 60-150BPM

  • Normal Sinus Rhythm
  • Sinus Tachycardia
  • Atrial Fibrillation
  • Atrial Flutter
  • Accelerated Junctional
  • Junctional Tachycardia

treat underlying problem - but not going to speed or slow patient heart down

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10
Q

ACLS Fast HR ( >150 BPM)

A
  • SVT
  • Ventricular Tachycardia (w/pulse)
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11
Q

Stable SVT

A
  1. Vagal maneuvers (“bear down”)
  2. Adenosine, 6mg rapid IVP
  3. Adenosine, 12mg rapid IVP
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12
Q

Unstable SVT

A

Synchronized cardioversion (50-100J, 200J, 300J, 360J…)

May consider sedation prior to cardioversion

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13
Q

Stable VT

A

Amiodarone: 150mg over 10 minutes or
Procainamide: 25-50mg/minute
Sotalol: 100mg (1.5mg/kg) over 5 min

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14
Q

Unstable VT

A

Synchronized Cardioversion

(50-100J, 200J, 300J, 360J)

May consider sedation prior to cardioversion

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15
Q

ACLS Dead

A
  • Aystole/PEA
  • Ventricular Fibrillation
  • Pulse less Ventricular Tachycardia
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16
Q

Ventricular Fibrillation Pulse less Ventricular Tachycardia

A

SHOCKABLE

Immediately begin CPR (2 minutes/5 cycles for duration of code)

Defibrillate when it becomes available

IV/IO access

Epinephrine, 1mg, 1:10,000 (every 3-5 minutes for duration of code)

In refractory VF/pVT (rhythm sustains after two defilbrillations)

Amiodarone, 300mg IVP

Remains Refractory…

Amiodarone, 150mg IVP

H & T’s throughout cardiac arrest

17
Q

Dead - Asystole/PEA

A

NONSHOCKABLE

Immediately begin CPR (2 minutes/5 cycles for duration of code)

IV/IO access

Epinephrine, 1mg, 1:10,000 (Every 3-5 minutes for duration of code)

H & T’s through

18
Q

ACLS Medication Adenosine

A

Anti dysrhymthmic: delays conduction through the atrioventricular (AV) node

Used in stable SVT 6mg, 12mg -> 18mg total (may consider second dose of 12mg for a maximum of 30mg)

Rapid IV push, peripheral IV site, followed by 10-20 mL saline flush

**Adenosine has a 10-second half life

19
Q

ACLS Medications Amiodarone (Cordarone)

A

Class III Anti dysrhythmic: blocks potassium channels, which increases the effective refractory period. Also blocks sodium channel and has some calcium channel blocking properties

Indications: Recurrent Ventricular Fibrillation and Pulseless Ventricular Tachycardia 300mg IVp (first dose), 150mg IVP (second dose)

Stable Ventricular Tachycardia (with a pulse) 150mg infused over 10 minutes (minimal)

20
Q

ACLS Medications Aspirin

A

Antipyretic, Antiplatlet Aggregator: Blocks platelet aggregation (prevents from stick together, thus, reduces risk of clot formation)

Indication: Chest pain, acute coronary syndrome

Contraindications: children, known hypersensitivity, active ulcer disease, signs of or history of stroke

Dose: 81 - 324mg (1 baby aspirin tablet = 81mg)

If patient has taken aspirin in lat 24 hours, give remaining tablets to total 325mg

21
Q

ACLS Medication Atropine

A

Parasympatholytic & Anticholinergic: inhibits parasympatholytic nervous system; acts on the vagus nerve (CN X - Cranial Nerve 10)

Used in:
Symptomatic Bradycardia
- 1mg (max of 3mg cumulative dose)
- Push rapid, too slow of administration can cause refractory bradycardia

Organophosphate posioning
- 1mg every 3-5 minutes to control secretions (Sludge)

22
Q

ACLS Medications Dopamine (Intropin)

A

Endogenous Catecholamine

0.5-2mcg/kg/min -> dopaminergic dose -> dilates renal and mesenteric arteries

2-10mcg/kg/min -> beta receptor stimulation -> positive inotropy, chronotropy, dromotropy

10-20mcg/kg/min -> alpha dose -> alpha receptor stimulation -> vasoconstriction

23
Q

ACLS Epinephrine (Adrenalin)

A

Endogenous Catecholamine & Sympathomimetic

Cardiac Arrest dose -> used every 3-5 minutes for the duration of the cardiac arrest

1mg IV/IO, 1:10,000

Used in shockable and non-shockable cardiac arrest rhythms

24
Q

ACLS Medication Lidocaine (Xylocaine)

A

Antidysrhythmic

Ventricular Fibrillation or Pulseless Ventricular Tachycardia
1-1.5mg/kg IV/IO (first dose)
0.5-0.75mg/kg IV/IO (second dose
IF conversion -> give 0.5mg/kg IV/IO, in 10 minute increments (two times)

25
Q

ACLS Medication Nitroglycerin

A

Potent Vasodilator

Indications: Chest Pain: obtain 12 lead first and establish IV access

Pulmonary edema: Administer with CPAP to help with evacuating fluid from the alveoli

Dose: 0.4 SL (3 times, every 3-5 minutes as needed, 1.2mg maximum total dose) Monitor blood pressure with each dose -> do not administer with systolic blood pressure under 100mmHG (some protocols may vary)

*Obtain IV access prior to administration when possible, always obtain 12 lead prior to administration to rule in/out RVI

Nitro-Bid is the paste form of nitroglycerin and is applied in a 1* circle (!5mg TD) to upper left chest area

26
Q

ACLS Medication Procainamide (Pronestyl)

A

Antidysrhythmic: Blocks influx of sodium, slows conduction (decrease both atrial and ventricular rates)

Consider in stable tachycardic rhythms (>150bpm; SVT/VT/A-Fib)
25-50mg/minute

27
Q

ACLS Medications Sodium Bicarbonate

A

Alkalizing agent

Cardiac arrest for known dialysis patients or prolonged down time 1mEq/kg IV/IO

May cause transient increase in capnography

28
Q

ACLS Medications Sotalol (BetaPace)

A

Antidysrhythmic

Considered in stable tachycardic rhythms (>150bpm; SVT/VT/A-Fib)

100mg (1.5mg/kg) over 5 minutes

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