Term
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Definition
<.12 sec or 3- 1mm boxes on EKG
*rapid activation of the ventricles via the normal His-Purkinje system, which in turn suggests that the arrhythmia originates above or within the atrioventricular (AV) node (ie, a supraventricular tachycardia). |
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Term
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Definition
>.12 sec
*ventricular activation is abnormally slow, most commonly because the arrhythmia originates outside of the normal conduction system (eg, ventricular tachycardia), or because of abnormalities within the His-Purkinje system (eg, supraventricular tachycardia with aberrancy). M |
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Term
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Definition
| sinus, junctional, idioventricular, atrial flutter |
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Term
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Definition
| sinus arrhythmia, multifocal atrial tachy, premature atrial contractions, atrial fib |
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Term
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Definition
| narrow QRS, normal P-R, P:QRS=1:1, regular rhythm |
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Term
| what is primary AV block? |
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Definition
| P-R >.20sec (5 little boxes or 1 big box) |
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Term
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Definition
| secondary AV block; wenkenbach-progressive prolonged P-R, then drop QRS |
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Term
| How do you differentiate between secondary and tertiary AV block? |
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Definition
| Check every P-P interval and R-R interval |
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Term
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Definition
| constant P-P, R-R can be variable or absent |
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Term
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Definition
| constant P-R interval, More P's than QRS, described by ratio (e.g. 2:1, 3:1, etc) |
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Term
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Definition
| asystole, PEA, VF, VT (puseless) |
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Term
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Definition
| non resuscitatable rhythm |
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Term
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Definition
| pulseless electrical activity, organized rhythm without a pulse |
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Term
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Definition
| istinctive form of polymorphic ventricular tachycardia (VT) characterized by a gradual change in the amplitude and twisting of the QRS complexes around the isoelectric line; prolonged QT interval; treat with Magnesium sulfate 1-2g IV |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| P's abnormal but non-variable |
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Term
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Definition
| start and stop on their own |
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Term
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Definition
| early beats=premature contractions, PAC (atrial different P waves), PJC (junctional, no P waves) |
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Term
| PVC-ventricular contractions |
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Definition
| unifocal, multifocal or couplets |
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Term
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Definition
| junctional rhythm, idioventricular |
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Term
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Definition
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Term
| how can you differentiate a fib from a flutter? |
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Definition
afib irregular rhythme
aflutter regular rhythm, sawtooth appearance, ratio |
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Term
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Definition
| 1 shock( 360 J monophasic (energy in one direction), 120-150-200 J biphasic>90% effective) |
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Term
| Protocol for witnessed collapse? |
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Definition
| (less than 5 minutes) shock first, then call 911, then CPR |
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Term
| Protocol for unwitnessed collapse? |
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Definition
| ( > 5 min), call 911, start CPR (5 cycles), then shock |
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Term
| Can you use adult pads on children? |
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Definition
| yes, children >1 yo, 2 inches between pads |
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Term
| in manual defibrillation, where are the leads placed? |
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Definition
| White to R Shoulder, Red to L Leg, Black to L shoulder, Green to R Leg |
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Term
| where are defibrillator pads placed? |
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Definition
| negative at right sternal border; positive =over left apex (i.e. 4-5th ics anterior axillary line) |
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Term
| for hand off paddles, multifunction paddles , are placed? |
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Definition
| anterior-posterior: one electrode over left sternal border, one electrode behind btwn L scapula and spine |
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Term
| what is the clinical dead box for Vfib and pulseless V tach? |
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Definition
| CPR->Shock->IV->Epi 1mg IV-> intubate prn |
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Term
| synchronized cardioversion |
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Definition
| irregular heart rhythm converted to normal heart rhythm using electricity or drugs; used to treat hemodynamically significant supraventricular (or narrow complex) tachycardias, including atrial fibrillation and atrial flutter. It is also used in the emergent treatment of wide complex tachycardias, including ventricular tachycardia, when a pulse is present. Pulseless ventricular tachycardia and ventricular fibrillation are treated with unsynchronized shocks referred to as defibrillation |
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Term
| synchronized cardioversion |
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Definition
| used to terminate unstable tachydysrhythmias with pulse; used to terminate stable, tachydysrhythmias refractory to medications |
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Term
| what is considered unstable ? |
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Definition
| hypo perfused with pulse e.g. altered mental status, signs of heart failure/pulmonary edema (i.e. rales, hypoxemia), hypotensive, chest pain, ischemic heart changes |
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Term
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Definition
| adenosine, dilitiazem, procainamide; class I agents are sodium (Na) channel blockers (which slow conduction by blocking the Na+ channel) -Class Ia slows phase 0 depolarization in the ventricles and increases the absolute refractory period. Procainamide, quinidine and disopyramide are Class Ia agents. Class 1b drugs shorten phase 3 repolarization. They include Lidocaine, Mexiletine and Phenytoin. Class Ic greatly slow phase 0 depolarization in the ventricles (however unlike 1a have no effect on the refractory period). Flecainide, moricizine and propafenone are Class Ic agents |
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Term
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Definition
| Class II agents are beta blockers which inhibit SA and AV node depolarization and slow heart rate. They also decrease cardiac oxygen demand and can prevent cardiac remodeling. Not all beta blockers are the same, some are cardio selective (affecting only beta 1 receptors) while others are non-selective (affecting beta 1 and 2 receptors). Beta blockers that target the beta-1 receptor are called cardio selective because beta-1 is responsible for increasing heart rate; hence a beta blocker will slow the heart rate. |
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Term
| MOA of Class III-potassium blockers |
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Definition
| Class III agents (prolong repolarization by blocking outward K+ current): Amiodarone and sotalol are effective Class III agents. Ibutilide is another Class III agent but has a different mechanism of action (acts to promote influx of sodium through slow-sodium channels). It has been shown to be effective in acute cardioversion of recent-onset atrial fibrillation and atrial flutter |
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Term
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Definition
| Class IV drugs are calcium (Ca) channel blockers. They work by inhibiting the action potential of the SA and AV nodes. |
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Term
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Definition
| synchronized 100J monophasic; Timing the shock to the R wave prevents the delivery of the shock during the vulnerable period (or relative refractory period) of the cardiac cycle, which could induce ventricular fibrillation |
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Term
| What pharm can be used if rate is too slow? and what is its fx |
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Definition
| pacemaker is definitive for heart block (esp Mobitz II and 3rd degree) ; atropine (.5mg every 5 min- 3mg dose=max)--> delay or failure of pacing=begin DA or Epi drip;atropine definitive in sinus bradycardia; DA infused as a bridge to pacer; epinephrine infused as a bridge to pacer |
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Term
| What are the essential drug strategies for cardiac resuscitations? |
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Definition
| oxygen, epinephrine, amidarone, adenosine, Ca blockers, magnesium sulfate, bicarb, procainamide |
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Term
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Definition
100%; class I-ischemia and infarction; goal=OaCO2=35mmHg (avoid alkalosis)
Code volume: 10cc/kg w/o O2 provider, 6-7cc/kg with O2 |
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Term
| what is normal tidal volume |
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Definition
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Term
| ACLS: vasoconstrictor of choice |
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Definition
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Term
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Definition
mixed alpha and beta
IV-1mg Q3 min
10cc of 1: 10,000IV push and flush
DOC for anaphylaxis (.01mg/kg, ususally =.3-,5mg)
alt for chronotropc support: bradycardia refractory to atropine while awaiting pacing (1mcg/min titrate to effective dose)
hypotn, esp with peripheral vasoconstriction: 2-10mcg/min infusion |
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Term
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Definition
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Term
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Definition
paroxysmal=angina, hypotn, CHF ;trt with adenosine, dig, vagal maneuvers,
sx, >150 HR=sync cardioversion starting with 100J |
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Term
| how can you determine if a wave is a T wave or P wave in SVT? |
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Definition
| if there is only one wave btw QRS complexes=Twave; p waves disappear first/ |
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Term
| IVC and SVC-->RA-->TRICUSPID VALVE-->RV-->PULM ARTERY-->PULM VALVE-->LUNGS-->PULM VEINS-->LA-->MITRAL VALVE-->LV-->AORTA-->CORONARY CIRCULATION IE ARTERIES OF HEART |
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Definition
| LEAD I, THEN AVF=DETERMINE AXIS;LEAD II=HELPS DETERMINE LEFT AXIS DEVIATION AND NML AXIS;IF LI AND AVF ARE POSITIVE THEY FALL IN THE LOWER PORTION OF THE RIGHT QUAD AND IT IS NML SO NO AXIS DEVIATION |
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Term
| Ways to deliver epinephrine |
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Definition
1mg in 500 ccD5W or NSS; 2mcg/cc; start at 30cc/hr
alt: .6x bodywt (kgs)=mg of drug to dilute to 100 cc; 1ml/hr=.1mcg/kg/min |
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Term
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Definition
vasoconstrictor
used during pulseless arrest
40 units IV one time ONLY
t1/2=10-20 min |
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Term
| Antidysrhythmic of choice |
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Definition
| Amidorone, lidocaine, procainamide |
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Term
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Definition
potassium channel blocker-prolongs effective refractory period; prolongs action potential in all cardiac tissue
indications: prophylaxis for frequent recurring VF and unstable Vtach
Code dose: 300mg IV push/20-30cc fluid (D5W); repeat in 3-5 min at 150 mg IV push
Therapeutic dose: 3 phases: 150 mg IV push over 10 min; 1.0mg/min x6hrs; .5mg/min x 18hrs
DO NOT EXCEED 2.2 GRAMS OVER 24 HRS
SE: vasodilation, hypotension, prolong QT |
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Term
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Definition
used for resuscitation when amiodarone is not available or contraindicated
Code dose: 1.0-1.5 mg/kg IV push
Max dose: 3 mg/kg in 15 min
Infusion: 1-4mg/min
Igm in 250cc or 2gm in 500cc
15cc/hr intervals (1-4) |
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Term
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Definition
used for V fib(3rd line) and Vtach (2nd line); may be used for Afib and SVT
17mg/kg at 20-30mg/min (100mg IV over 5 min every 5); safe infusion : 1 gm in 100cc at 150cc/hr
SE: hypotn, wide QRS
ER therapeutic: mix 1 gm in 100 cc |
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Term
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Definition
1-2gm in 10cc D5W over 2 min for arrest with known hypomagnnesemia
1-2gm IV over 5-60 min/in 50-100cc D5W (.5-1gm/hr for 24hrs |
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Term
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Definition
hyperkalemia, tricyclic antidepressants, phenobarbital OD, metabolic acidosis
* given after Class I interventions
1mEq/kg repeat .5mEq/kg Q 10 min |
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Term
| Drugs for use in non-arrest states |
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Definition
| atropine, adenosine, BB (esmolol, atenolol, metoprolol) CCB(diltiazem, verapamil); digitalis |
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Term
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Definition
Class I for hypotn w/o hypovolemia
Class IIb for bradycardia, sx bradycardia
2.5-20mcg/kg/min (5-10mcg/kg/min=inotrope; 10-15mcg/kg/min=chronotrope and inotrope; 15-20 mcg/kg/min=inotrope and pressor) |
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Term
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Definition
| 6 xkg of body wt=amt of drug in mg to add to create 100cc total volume then 1 ml/hr=1.0mcg/kg/min |
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Term
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Definition
| infusion rate=wt in kg x dose (mcg/kg) x 60cc/hr/conc (mcg/ml) |
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Term
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Definition
indication: SVT , PSVT
contraindicated in carbamazepine
6-12-12 mg IV push fast (<10 sec)
t 1/2=5 sec |
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Term
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Definition
indication: DOC for rapid control of Afibb
Precautions: hypotn, re-entry phenomenon
.25mg/kg bolus over 1 min
infusion: 5-15mg/hr |
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Term
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Definition
indication: rate control of narrow complex tacky
dose: 2.5-5 mg IV over 1 min ( wait 30 sec before redo sing) |
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Term
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Definition
titrable BB used for rate control;
NOT FOR LONG TERM THERAPY
250-500 MCG/KG BOLUS over 1 min; 25-50mcg/kg/min; increase in 50 mcg/kg/min to max of 200mcg/kg
REDUCES DOUBLE PRODUCT --> MYOCARDIAL OXYGEN CONSUMPTION |
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Term
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Definition
reduces MVO2; enhances long term survival
indicated for MI w/o failure
Lopressor: 5 mg IV Q 5 min x 3
50 mg PO BID for 24 hrs
Atenolol:5 mg IV Q 5 min x2 |
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Term
| what can be used for narrow complex irregular tachy besides chemical or electrically? |
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Definition
| physical maneuvers: valsalva/cough/blow through a straw |
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Term
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Definition
more potent vasoconstrictor
indications: severe hypotension (BP <70) with low TPR
infusion: .5-1 mcg/min
reverse with phenotoalmaine |
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Term
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Definition
Class I for Hypotn w/o hypovolemia
2-20 mcg/kg/min |
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Term
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Definition
vasodilator (veno and arterial)
reduces preload (ie venous return)
low doses: 30-40 mcg/min( vneodilator)
high doses: 150-50 mcg/min arteriolar) |
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Term
| indications for nitroglycerin |
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Definition
ischemic chest pain
.3-.4 mg repeat Q 5 if BP>90
IV dose for refractory patiets ( bolus 12.5-25 mcg infuse at 10-20 mcg/min; increase Q 5-10 min
max: 500mcg/min
HOLD IF BP<90 OR HR <50 |
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Term
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Definition
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Term
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Definition
potent vasodilator
indicated for high SVR cardiogenic shock, plum edema, acute mitral regurgitation AR (reduces afterload improving MVO2), also indicated for severe hypertension
mix 50-100mg in 250 D5W
BEGIN.1MCG/KG/MIN
LIGHT SENSITIVE COVER IV BAG |
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Term
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Definition
replace the FRC w/ O2 (2 min ventilation)
10-12 breaths per min
1 ven Q 5-6 sec
8-10 BPM w/ CPR |
|
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Term
| What is effective ventilation? |
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Definition
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Term
| What are the nasal cannula flow rates |
|
Definition
| 1 LPM-->24 FiO2; 2 LPM-->28; 3 LPM-->33; 4 LPM-->38; 6 LPM-->45 |
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Term
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Definition
|
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Term
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Definition
| Rx FiO2--> desired FiO2 (24-60% with specified Orifice /entrainment) |
|
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Term
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Definition
| high liter flow: 10-15 LPM; theoretical 100% FiO2 (60-90% realistic); closed system |
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Term
| self-refilling bag valve mask |
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Definition
| flush at 10-15 LPM for 75-100% FiO2 (with reservoir); NIF=2 cm/H2O |
|
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Term
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Definition
| 3 patient fingers mouth (inter-dental); 3 under the chin (mentum to hypoid); 2 hyoid to top of thyroid |
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