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57 Cards in this Set
- Front
- Back
Tx for Symptomatic bradycardia
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atropine
cardiac pacing |
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Tx for PAC
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No specific Tx. Monitor for A flutter, A fib, PSVT
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differentiates PSVT from sinus tach
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PSVT
1) rate 150-250 2) ends/begins abruptly (often with PAC i.e. irregular) 3) converts to NSR with vagal |
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Why is DCCV usually TOC for a flutter
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Rx generally not effective
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When is DCCV indicated in a flutter
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Unstable
-Sx and/or dec CO (usually with rapid ventric response rate i.e. <4:1) |
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Rx that increases HR by inhib of ACh
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atropine
used in brady's and heart block |
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initial TOC for Afib in absence of hemodynamic compromise
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Slow HR
-BB, CCB, Dig |
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BB, CCB, Dig did not decrease vent response in stable Afib.
Then what? |
-At this point its probably been greater then 48 h thus pt at risk for thrombi so
-Anticoagulate for 3-4wks and DCCV |
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DCCV did not work to restore NSR in stable Afib. Now what?
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Ablation
MAZE |
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TOC in hemodynamically unstable Afib
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DCCV
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atropine did not increase bradycardia enough, what next
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pacer
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why might psvt pt be unstable
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hr 150-250
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key feature of Afib rhythm
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irregular
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key features of jxnal rhythm
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p wave inverted or absent
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whats the main diff between all the jxnal rhythms
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rate
brady <40 reg 40-60 DDx with reg brady? (inverted p wave) accel 60-100 tachy 100-150 |
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NSR, all of a sudden you see an ivnerted, premature p wave
What rhythm do you suspect |
Premature jxnal contraction
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NSR and all of a sudden a wide bizarre QRS pops up
You think |
PVC
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AKA for non-sustained V tach
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PVC run
-trigeminy |
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Action/Tx when you see PVC on monitor
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If isolated, nothing. Check lytes (K, Mg-replacement) and monitor. Can lead to Vtach, Vfib
You would however Tx PVC runs(same as stable Vtach i.e. amiodarone) |
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Mg is always kept ??
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>2
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AKA short and non sustained V Tach
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Run of PVC's
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Diff between trigeminy (PVC)and non sustained V Tach
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Non ustained v tach is defined as <30 sec's
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When do you definately call a Cond C for V Tach
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Unstable with a pulse
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TOC for stable VT with a pulse
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amiodarone
if doesn't work-DCCV |
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After call Cond C for unstable VT with a pulse, then what
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DCCV
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torsades Tx
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Mg Sulfate
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When does atropine Tx jxnal rhythms
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jxnal brady and jxnal rhythm
-C/I in jxnal accel -vagal/adenosine in jxanl tach |
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Tx reg jxnal
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Asympt (just monitor)
Sympt-atropine and underlying cause (dig/BB/CCB tox??) |
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Tx jxnal brady
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usually pretty sympomatic
-atropine -possibly external pacer |
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rate in reg jxnal
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40-60
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rate in jxnal accel
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60-100
-often asympt, just monitor |
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rate in jxnal tachy
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100-150
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Tx jxnal accel
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often asympt (just monitor)
-treat underlying cause -atropine C/I |
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atropine C/I
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jxnal accel
Mobitz 2 |
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Which jxnal rhythm might be Tx'd with adenosine/DCCV
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jxnal tach
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Tx jxnal tach
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Same as PAC
vagal adenosine DCCV |
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Rhythms often assoc with Dig tox
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Jxnal
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Which two rhythms req immed pacing
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Mobitz 2
#rd degree/complete heart block |
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Difference in pathologic cause of jxnal and HB
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jxnal=AV node tajes over d/t failure of SA node
aV block=disturbance in some portion of AV conduction system. SA is sending out regular signals but none or only some make it to ventricles. |
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Monitor rings out VT. You assess your pt. v.s. 120, 26, 110/80. C/o no chest pain. Your suggest
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Amiodarone
If that doesn't work, DCCV |
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Monitor rings out VT. You assess your pt. v.s. 175, 32, 100/65. C/o SOB and lightheadedness. You suggest
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Cond C
DCCV |
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Monitor rings out VT. You assess your pt. v.s. 250, 32, 90/30 and unresponsive. You suggest
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SCREAM
Cond A Defib (360 joules) CPR (30:2 q2min) Epi Amiodarone Lidocaine/Mg |
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During a code/SCREAM how often must you reassess
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q 2 minutes after every 30:2 CPR
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PAC's may be precursor to?
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PSVT, A flutter, AF (usually moreso in pt's who have decompensated). Just monitor. No Tx needed excpet for underlying cndx's.
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Most common sustained dysrhythmia?
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AF
anticoag-cardiovert ablate/maze |
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2 or mote episodes of AF that resolve spontaneously
recurrent/persist/chronic |
recurrent
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AF sustained>7d. Also describes AF>1y in which cardiversion has failed
recurrent/persist/chronic |
persistant
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Where is shock timed to occur in DCCV
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R wave
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procedure where AV node is destroyed and pacemaker takes over
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Ablation, usually reserved for AF pt's in 60-70's
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Procedure that uses incisional scars to block abnormal conductin
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MAZE
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Tx for PVC runs
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amiodarone (same as VT)
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Tx isolated PVC's
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Monitor for progression to VT/VF
Check lytes |
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Therapeutic INR in AF
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2.5-3.0
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Cndx's that may cause torsades
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R on T phenom (PVC, Defib)
amiodarone infusions Lyte imbalances |
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Common reperfusion arrhythmia
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Accelerated idioventric, requires no Tx
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PEA Tx called for in these cndx
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idioventric
Asystole PEA (rhythm present but no pulse) |
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Why might atropine be indic in Mobitz 1
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Slow vent rt
Not used in (both really need pacing) Mobitz 2 (paradoc fx) 3rd degree (may be fx'ive in temp 3rd degree block) |