Resus During RHC

Question 1

Indications for adenosine

Answer 1

Adenosine

-stable (or even unstable if also have pads on) narrow-complex monomorphic tachycardia
-AVRT/AVNRT (SVTs)

Question 2

Adenosine dosing for stable narrow-complex regular tachycardia

(a) Peripheral line
(b) Central line

Answer 2

(a) Adenosine
6mg over 1-2 seconds via peripheral line, immediately flushed with 20cc NS

(b) Initial dose 3mg if centrally or heart transplant pt

If dose ineffective in 1-2 minutes, 12mg second dose (6mg centrally)

Question 3

AFib with RVR in PH patient

Answer 3

Depends on RV function- careful with beta-blockade in RV dysfunction

Question 4

Adenosine mechanism of action

Answer 4

Anti-arrhythmic- slows conduction through AV node, interupting re-entry pathways that use the AV node in hopes of restoring sinus rhythm

Question 5

Adenosine

(a) Onset of action
(b) Half-life

Answer 5

Adenosine

(a) Seconds
(b) Half life under 10 seconds

Question 6

How to push adenosine (flush)

Answer 6

• Push then flush with 20cc saline
  Half-dose if using central access

-Have pads on for synchronized DC cardioversion

Question 7

Cardioversion vs. defib

Answer 7

Cardioversion = delivery of energy synchronized to QRS complex

Defib = asynchronous delivery of shock randomly during cardiac cycle

Question 8

Initial parts of adult tachycardia algorithm- with a pulse

Answer 8

Hypotension (cycle BP), check mental status, ?chest pain

If signs of shock- consider synchronized cardioversion with or without sedation immediately

Question 9

What is cardiac power output?

Answer 9

Indicator of LV output, higher CPO associated with better survival
-way to look at heart function (so can give pressors to improve SVR and therefore MAP, but that won’t improve the CPO)

CPO = MAPxCO / 451

Question 10

Cutoff for low cardiac power output

Answer 10

CPO = MAPxCO / 451

Low under 0.6

Question 11

What is PAPi?

(a) Clinical utility

Answer 11

PA pressure index
(a) Consider degree of RV contribution in cardiogenic shock

Question 12

Utility of cardiac power output?

Answer 12

CPO = (MAPxCO) / 451, low if < 0.6
-predict cardiogenic shock
-can give pressors to improve SVR/MAP, but that won’t improve CPO as much

Question 13

What narrow vs. wide pulse pressure may tell you

Answer 13

Pulse pressure used as surrogate for stroke volume (difference between diastole and systole)