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week 2 Flashcards

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1
Q

cardiac arrest

A

unable to geenrate adequate CO to support o2 demands of tissue

four rhythms:
v fib
pulseless ventriculat rachycardia
pulseless electrical activity (PEA)
asystole

survivial depends on acs or bcls

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2
Q

only proven benefit of cardiac arrest

A

quality chest compressions

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3
Q

cardiac arrest treatments

A

1, start CPR

  1. determine rhythm
    shockable: VF and pVT

non shockable: asystole, PEA

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4
Q

VF or VT arrest

A
  1. provide shock
    work on establishing iv access,
    if still in shockable environent, give another shock….
    then can give epinephrine…
    if pt is still in shockable rhythm.. can give another shock, then give antiaryhmics like amiodarone or lidocaine
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5
Q

pea/asystole

A

non shockable

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6
Q

if asytole or pea admin epinehrine asap and perform cpr for 2 min

if pt still in nonshockable rhhtm, continue cpr

*note: EPNIPHERINE ONLY. vasopressin no longer epinephrine

A
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7
Q

cardiac arrest med admin routes

A

iv
io (intraosseous)
endotracheal (et)
NAVEL
naloxone
atropine
vasopressin
epinephrine
lidocaine

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8
Q

vasoactive agents

A

enhance organ profusion by increasing arterial and aortic diastolic pressures resulting in increases incoronary and cerebral perfusion pressures

ex: epineohrine

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9
Q

epinephrine

A

indications:
vf and pulseless vt
pea and asystole

dose: 1mg iv/ io q3-5 min

admin as soon as possible in pea/asystole

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10
Q

antiarrhythmics

A

no high quality evidence to suggest that any antiarryhtmics routinely during crdiac arrest increases survival

amiodarone
lidocaine

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11
Q

amiodarone

indications
dose
considerations

A

indications: vf and pulseless vt

dose: 300 mg iv bolus. may repeat 150mg iv bolus

considerations: caution in bradycardia and hypotension, possible qt prolongation

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12
Q

lidocaine

indications
dose
considerations

A

indications: vf an dpulseless vt

dose: 1.1.5 mg/kg IV/IO

considerations:
consider if amiodarone unavailable, risk/ hx of qt prolongation. study not suggests beenfit of lidocaine

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13
Q

magnesium

indications
dose
considerations

A

indications: vf, pvt associated with torsades des pointes. NOT TO BE USED IN VF,PVT W. NORMAL QT INTERVAL

dose: 2g iv bolus

considerations

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14
Q

reversible causes of arrest Hs

A

H
hypovolemia- give fluids

hypoxia-give 100% o2 by mask

hydrogen ions(acidosis)-bicarb not recomomended during o2 arrest

hyperkalemia:suspect in dialysis pts, renal insufficicnecy, drug induced (trt w. calcium chloride or gluconate
temporary measures: (bicarb, insulin and dextrose)
long term: diuresis, kayexalate
hypothermia

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15
Q

reversible causes of cardiac arrest

A

Toxins (opioids, TCA, etc.)
*give naloxone if suspected I

cardiac Tamponade:

Tenstion pneomothorax

thrombosis(PE and MI)

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16
Q

ischemic stroke SS

A

sudden onset of focal neurological defecit

dysphasia/dysarthria
hemianopia
weakness
ataxia
sensory
neglect

symptoms are unilateral

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17
Q

NIHSS stroke severity

A

0: no strok esymptons
1-4: minor stroke
5-15: moderate stroke
16-20: mod-sveere stroke
21-42 seevre stroke

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18
Q

treatment options for ischemic stroke

A

within 4.5 hr of symptom onset
*fibrinolysis +/- thrombectomy

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19
Q

iv fibronylitics

A

contraindications

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20
Q

iv fibrinolytics ci

A

<18
ischemic throjke w.i 3 months

intrcranial surgery w.in 3 months

gi malignancy or hib within 21 days

lmwh within 24hrs

unclear onset time >4.5

intracranial hemmorhage

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21
Q

iv fibrinolytics

A

alteplase,
tenacteplase

moa: tpa activator, dissolves fibrin

dose:
alteplase: 0.9mg/kg
short acting. can give bolus

tenacteplase: 0.25mg/kg
can give iv push, longer t/2

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22
Q

iv fibrinolytics blood pressure control

A

goal for bolus: <185/110

goal for infusion <180/105

if pt meets exclusion criteria and alteplase not given, permissive htn is allowed

bp not treated unless >220/110 in effort to perfuse brain

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23
Q

ischemic stroke htn treatment

A

1st line: labetalol
nicardipine

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24
Q

fibrinolytic complications

A

systomatic ICH:
d/c alteplas einfusion
treat w. cryocepitate 10u

angioedema
-miantaine airway, hold acei-

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25
post fibrinolytic care
neuro and bp monitoing for 24 hrs dysphagia and aspiration risk high dose statin all apts anti platelets dvt prophylaxis >24hr post alteplase anticoags if cardioembolic stroke or hx of a fib
26
secondary strok erevention
lifestyle and nutrition smoking cessation limit alcohol consumption ocunsel on substance abuse
27
risk factor for breakthorugh seizures
provoked: intoxication withdrawal, etoh, benzos trauma meningitis psychiatric metabolic derangements unprovoked *difficultto determine
28
1st line agents to stop seizures
benzos (lorazepan, diazepam, midazolam)
29
antiepileptics for seizures
not first lines do not stop seizures prevent more seizures from occuring
30
treatment of seizures
stage 1(0-10 min): lorazepam or midazolam stage2: 10-30 min phenytoin, foshenytoin stage 3: 30-90 min midazolam or propofol stage 4 (90 min-many hours to days): pentobarbitokl
31
benzos for seizures
1st line: lorazepam 4mg second line: diazepam 5-20 mg moa: bind to gaba receptor ae: impaired conciousness hypotension resp depression
32
antiepileptics for seizures
second seizure indicates epileptic if on epileptic, can give small dose of at home antiepileptic phenytoin fosphenytoin
33
pneumonic for phenytoin adr
PHENYTOIN p-450 reactin hirsutism enalarged gums nystahmus yellow borwning of skin hepaptiis teratogenecity osteomalaciaa inteferance w. metabolsm neuropathies cardio: hypotension, bradycardia, qt prolongation saturable pk monitinrg: goal 10-20. if seizing, goal 15-25 must correct for low for albumin
34
levetiracetam
dose: 60mg/kg for status epilepticus levels do not correlate w. efficacy AE: agitation, drowsiness
35
valproic acid
LD: 50 mg/kg goal levels 50-100 AE: hyperamonemia thrombocytopenia DDI: phenytoin and valproic acid both strongly protein bound
36
lacosamide
dose: 100-200 mg adr: dizziness, abnormal vision
37
refractory status epilepticus
no response to inticial anticonvulsants seizure lasting>2 hrs OR occuring at 2 more incidences per hour high dose benzos: ex.midazolam2mg iv bolus propofol infusion phenobabrb and pentobarb coma (only use dif intubated because causes severe respiratory supression
38
post intubation treatment
paralytic used during intubation
39
goal of status epilepticus
to attai n burst supression
40
super refactory status epilepticus
treatment: ketamine infusion.
41
how to wean off antiepileptics for seizures
wean off meds tht have high risk AE
42
status epilepticus outcomes
repeat full neuro examinations
43
shock
sbp<90 mmhg decrease by 40 mmhg from baseline
44
end organ dysfunctions in shock
cns cardiac pulmonary (acute resp failure) renal(AKI, ATN GI(erosive gastritis) hepatic hematologic metabolic immune system
45
hemodynamic parametes
BP=COxSVR(systemic vascular resistance) CO: HR x SV stroke volume: preload, instrinsic contractility, afterload mean arterial pressure(MAP) calculation= 1//3SBP+2/3DBP
46
mean arterial pressure calculation
1/3 SBP+2/3 DBP
47
goals for shochk mgt
determien etiology (hypovolemic, cardiogenic, distributive, obstructive maintian adequate perfusion (assess preload, restore mean artieral pressure (GOALMAP normalize lactate: goal<2
48
devices used in recognizing and magaing shock states
central venous catheyer *measures central venous o2 sat admin of fluids pulmonary artery catheters *measures pulmonary pressure, CO, mixed venous sat not commonly used due to severe complications
49
Shocks hypovolemic what is it cause treatment
Shocks what is it: low and sudden loss of iv volume cause: hemorrhage, gi loss, severe dehydration, burns #1 cause of death<45y.o preload:decrease CO: decrease SVR increase o2 sat decreases treatment REPLACE blood loss(PRBCS) aniticoag reversal etc.
50
Shocks CARDIOGENIC SHOCK what is it cause treatment
Shocks what is it: failure of left ventricle cause: ACUTE MI arrythimas, etc. treatment. preload increase CO: decreaseSVR: increase treatment: treat underlying cause (mi:recatheterization)
51
Shocks disitributive shock what is it cause treatment
Shocks what is it: septic shock classic. pronounced vasodilation cause: septic shock most common cause preload: low aterload: decrease decreased or increased CO decreased or increased tissue perfusion treatment
52
Shocks obstructive what is it cause treatment
Shocks what is itdecrease din lv stroke volume cause PE pulmonary hypertension tension pneumothorax treatment preload: high CO:decrease svr: increase tissue perfusion: decreased
53
shock therapy
fluid challenge(generlly w. sepsis): crystalloid 30ml/kg over 25 min-30 min
54
pharm theraoy of shock
initiation of vasoactive agents when map remains <65 despite fluid admin vasopressors: norepinehpine epinehorine dopamine phenylephrine vasopressin
55
NE for shock theraopy
alpha adrenergic agonist: causes peripheral vasoconstriction
56
epinephrine
b2 agonists may increase aerobic lactate production also useful in anaphylactic shock
57
dopamine in use for shock
dose dependent pharm most effective in hypotensive ots w. depressed function
58
phenylephrine
reflex bradycardia CO is hih and bp is low
59
dobutamine:
inotrope
60
vasopressin
goal: reduce concurrent vasopressor doses o.3-0.4 u/min
61
septic shock mgt
correction of underliying cause (abx, source control) abx timing: sepsis is deifnite: admin abx immediately sepsis is possible: if present, give abx w.in an hour, if not present, reassess, admin abx w.in 3 hrs if ocncern of infeciton persisst fluid resucitation: crystalloid 30ml/kg bolus (fluid of choice for initial recussiatiairon 1L of crystallid gives ~250ml o fintravascular volume vasopressors inotropes corticosteroids
62
what is sepsis
lifethreartening organ dysfunction caused by a dysregulated host response to infection
63
SIRS criteria for spetic shock
atleast 2 of following 1. temp >38 C or < 36 C hr: > 90 bpm Rr: >20 wbc>12 or <4
64
pharm of septic shock
initiate when map <65 despite fluid amdin 1dt line: norepinehprine vasopressin: an be added if pt has inadequate map while on norepinephrine glucocorticoids( hydrocortisone) improves ohysiologic response to sepsis, regulation of proinflammatory state improve time to shock resolution added when pt is still hypotensice despite increasing norepinephrine and assing

Critical Care/Hematology/Oncology (4 decks)

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