FISDAP READINESS, FISDAP Readiness
The recommended fluid resuscitation for a patient in shock with no suspected TBI is?
250mL up to 4x, maintain systolic of 80-90mmHg
A run of VTach is classified by how many sequential PVCs?
3+
Adequately perfused kidneys produce how many mLs of urine per hour?
30-50mL
The right coronary artery has how many branches and supplies blood to where?
9 Right Atrium, SA/AV node, and Right Ventricle Inferior Left Ventricle
Time frame for door-to-needle
<30mins
Time frame for door-to-balloon
<90mins
Increased rate of breathing that leads to respiratory alkalosis occurs during which stage of shock?
Compensated
What is the most important criteria for bystander CPR to meet prior to EMS arrival?
Compressions
Tendency to gather or rely on information that confirms your existing views and downplays/avoids info that does not confirm your hypothesis or field differential is what kind of bias?
Confirmation Bias
What is one of the most helpful steps to formulating a field diagnosis?
Considering and ruling out various conditions
The primary focus of running a megacode should be on?
teamwork and minimal interruptions of CPR
Hyperventilating a cardiac arrest patient reduces what?
coronary perfusion
A tachycardic pacemaker rhythm is called?
runaway pacemaker
What happens in the absence of glucose?
the cells begin to metabolize fat, which produces ketoacids (diabetic ketoacidosis [DKA]). The respiratory system attempts to eliminate ketoacids from the blood with an increased rate and depth of breathing (Kussmaul respirations) that is accompanied by a fruity or acetone breath odor.
What causes increased afterload following Alpha-1 stimulation?
Arteriolar constriction
Treatment for Beta Blocker Overdose
Glucagon: 1-5mg IV/IO (1st Line Drug) Calcium Chloride: 500mg - 1g IV/IO
AHA Guidlines for Terminating CPR efforts in field(4)
Arrest was not witnessed No bystander CPR was administered ROSC was not achieved after complete ALS care in the field No shocks were administered
What can an acute aortic dissection cause?
Acute aortic dissection can quickly cause an aneurysm, which could rupture and cause profound shock.
Indications for CPAP (5)
Alert and able to follow commands Moderate to Severe Respiratory Distress Hyperventilation SpO2 <90% Systolic >90mmHg
What type of metabolism takes over when inefficient cellular metabolism produces lactic acid?
Anaerobic
Principle symptom of Coronary Artery Disease or Acute Coronary Syndrome that occurs when supply of O2 is to the myocardium is insufficient to meet demand and cells become ischemic?
Angina Pectoris
What should you do if you are working a cardiac arrest patient and the capnography spikes from <20mmHg to >40mmHg?
Assess pulse for up to 10 seconds
The volume of the blood that enters the ventricles by atrial contraction is called?
Atrial Kick
Treatment for neurogenic shock includes IV fluids, temperature management, and possibly?
Atropine 0.5mg up to 3mg Suppress vagus nerve to increase cardiac output.
What senses decrease in blood flow and activates the vasomotor center in response?
Baroreceptors
Epinephrine MOA (4) and Dose
Beta 1 = Inotropy, Chronotropy, Dromotropy Alpha 1 = Vasoconstriction = Increased aortic diastolic pressure Beta 2 = Bronchial smooth muscle relaxation = Bronchodilation
Carvedilol (Coreg) Metropolol (Lopressor) Atenolol (Tenormin) Propranolol (Inderal) Bisoprolol (Zebeta) Acebutolol (Sectral) Comolol (Brevibloc)
Beta Blockers - used for blood pressure and cardiac problems
Which electrolyte plays a major role in depolarization of pacemaker cells to maintain depolarization and myocardial contractility?
Calcium (Ca++)
Hypotension, SOB, Lightheadedness, Chest Pain, Syncope, Palpitations, Extremity Swelling, and Muffled heart sounds are signs and symptoms of?
Cardiac Tamponade
No pulse with CPR and JVD is indicative of?
Cardiac Tamponade
Restriction of of cardiac contraction, falling cardiac output, and shock as a result of pericardial fluid accumulation are characteristics of?
Cardiac Tamponade
Tachycardia with irregular pulse, labored breathing with diffuse crackles/rales in all lung fields, pale/cool/diaphoretic skins, and low blood pressure are signs of what type of shock?
Cardiogenic
Indications for Dopamine
Cardiogenic Shock Distributive Shock after fluids Hemodynamically significant Hypotension Symptomatic Brady (2nd Line drug)
Which system is primarily responsible for tissue perfusion?
Cardiovascular
The pressure gradient that drives coronary blood pressure. The difference between aortic diastolic pressure and left ventricular end diastolic pressure that perfuses the coronary arteries.
Coronary Perfusion
Fever, chills, SOB, hx of mitral valve prolapse, and flat painless red lesions on palms of hands is indicative of?
Endocarditis (Janeway lesions)
Swelling of affected limb, pain and tenderness, inflammation/redness, warm to touch on affected limb, pain on dorsiflexion (Homan Sign) are all signs of?
DVT
Slurring in the upstroke of the first part of QRS complex is called a?
Delta wave
When cardiac cell wall permeability changes and sodium rushes into the cell, it initiates?
Depolarization
Your FIRST action in managing a patient with an altered mental status should be to:
Determine if the patient is breathing adequately. -When treating a patient with an altered mental status, you must first ensure a patent airway and determine if the patient is breathing adequately. If the patient is breathing adequately, administer supplemental oxygen and continue your assessment. If the patient is not breathing adequately (ie, fast or slow rate, shallow breathing [reduced tidal volume]), assist his or her ventilations.
During what phase of circulation do coronary arteries receive blood?
Diastolic
Time from patient entering ED to catheter passing through lesion of coronary vessel.
Door-to-balloon-time
Time from patient entering ED to fibrinolytic therapy administration.
Door-to-needle-time
Time frame that starts at the patient contact by EMS and ends with definitive therapy of catheter passing through lesion of coronary vessel.
EMS-to-Balloon-Time
What intervention is indicated for a ROSC patient who remains comatose besides vitals, 12-lead, and temperature regulation?
ET Intubation
Four properties of the Cardiac Conduction System
Excitability - cells respond to electrical impulse Conductivity - cells pass impulse to one another Automaticity - hearts ability to generate its own electrical impulse Contractility - hearts ability to contract when stimulated
What causes hypovolemia in septic shock patients?
Fluid leaks out of vascular space
When insulin levels in the blood remain high:
Glucose is rapidly taken out of the blood to fuel the cells -Insulin is a hormone that promotes the cellular uptake of glucose from the bloodstream. If insulin levels remain high, such as when a diabetic inadvertently takes too much insulin, glucose is rapidly taken out of the blood to fuel the cells. This leads to low circulating blood glucose levels (hypoglycemia) and a condition called insulin shock
If someone has a syncopal episode and then complains of headache and inability to walk without feeling dizzy, you should suspect?
Head Injury
An S3 heart sound in older adults signifies?
Heart Failure
Where are Beta 1 receptors found?
Heart and Kidneys
Stimulation of Beta 1 receptors result in an increase of what?
Heart: Inotropy, Chronotropy, Dromotropy Kidneys: Renin-Angiotensin-Aldosterone System = Vasoconstriction = Increase blood pressure
A 72-year-old woman is found unresponsive in her poorly ventilated home. Her skin is flushed, hot, and dry, and her respirations are rapid and shallow. She is wearing a medical alert bracelet that states she is a diabetic and is allergic to sulfa drugs. You should be MOST suspicious for:
Heat stroke. -classic heat stroke commonly affects children and older adults, and typically occurs when the patient is in a hot, poorly ventilated space for a prolonged period of time.
What is a diabetic coma?
Hyperglycemic crisis, typically presents with warm, dry skin and a slow onset, sometimes over a period of days
Which of the following structures is responsible for regulating body temperature?
Hypothalamus. -The hypothalamus, which is located within the brain stem, regulates body temperature by acting as the body's thermostat. During a heat-related emergency, the hypothalamus can "reset" the body's normal temperature to a much higher temperature in response to the environment and the body's inability to eliminate heat.
What is insulin shock?
If insulin levels remain high, such as when a diabetic inadvertently takes too much insulin, glucose is rapidly taken out of the blood to fuel the cells. This leads to low circulating blood glucose levels (hypoglycemia) and a condition called insulin shock
Hypercalcemia results in?
Increased contractility
S/S of methamphetamine overdose
Increased heart rate and blood pressure, pupillary dilation, agitation and hyperthermia.
Criteria for Unstable Dysrhythmia
Ischemic Chest Pain ALOC Hypotension/Hypovolemia Signs of Shock Acute Heart Failure
What does hyperglycemia cause?
It causes the patient to eliminate excess water from the body through urination *(diuresis)*, resulting in dehydration
Crushing chest pain with ST-Elevation in V1-V4 would indicate an infarct in which artery?
Left Anterior Descending
Left Coronary Artery is the largest and shortest coronary vessel. It divides into what and supplies blood to where?
Left Anterior Descending and Circumflex Coronary arteries. Left Ventricle, Septum, and at times the AV node and atria.
Point of maximal impulse is anatomically located where?
Left anterior chest Midclavicular 5th ICS
What are the signs of CNS depressants?
Like benzos (sedative-hypnotic) they include a decreased level of consciousness, hypoventilation, bradycardia, and hypotension.
Which electrolyte stabilizes cell membrane and acts in concert with K+ and opposes actions of Ca++?
Magnesium (Mg++)
Allowing full recoil of the chest in CPR enhances blood return to the heart by what mechanism?
Negative intrathoracic pressure
Atrial depolarization characterized by smooth, round, upright deflection less than 0.11 secs long and less than 2.5mm tall is referred to as what on the ECG?
P wave
Pain in legs while walking that is relieved after sitting down for a little while is indicative of?
Peripheral arterial disease
Which electrolyte flows out of cardiac cells to to initiate repolarization?
Potassium (K+)
Which electrolyte is responsible for repolarization?
Potassium outflow
What accompanies insulin shock (hypoglycemic crisis)
Presents with cool, clammy skin and a rapid onset.
Chest pain that occurs at rest and is caused by coronary artery vasospasm? Risk for Dysrhythmia, MI, Heart Block and Death
Prinzmetal Angina (PA)
A heart experiencing an extended refractory period would reflect what on an ECG?
Prolonged QT
Propoxyphene (Darvon) is categorized as which type of drug?
Propoxyphene (Darvon) is in the narcotic (opiate) class of drugs. Other narcotics include heroin, morphine, codeine, and meperidine (Demerol).
A sudden nervous system reaction that causes temporary generalized vasodilation leading to syncope describes what type of shock?
Psychogenic
What is a procedure that would require a sterile cockpit approach?
RSI
The middle of phase 3 to beginning of phase 4 in the cardiac cycle where cardiac cells are partially refractory and partially repolarized and certain cells can be depolarized in response to electrical stimulus.
Relative Refractory Period (Partial flush of the toilet)
Contraindications for CPAP (8)
Respiratory Arrest Hypoventilation ALOC Chest Trauma/Pneumo Tracheostomy GI bleed or Vomiting Inability to fit CPAP Excessive Facial Hair/Dysmorphic features
Pedal edema, enlarged abdomen, and JVD are associated with failure of which ventricle?
Right
The right atrium, right ventricle and part of the left ventricle are supplied by that artery?
Right Coronary Artery
Coronary circulation begins from aorta at the?
Right and Left Coronary Arteries
Which node is located at the junction of the superior vena cava and the right atrium, is typically supplied by the Right Coronary artery, and fires at a rate of 60-100 bpm.
SA Node
Affects of RCA occlusion in terms of the SA node ischemia?
SA node becomes ischemic = slower firing rate (<60-100) or cease fire completely causing another automaticity foci to take over such as AV (40-60) or Purkinje (20-40).
Which electrolyte flows into cardiac cells to initiate depolarization?
Sodium (Na+)
Which electrolytes are responsible for depolarization?
Sodium and Calcium influx
Decreased cardiac output with a HR >150 is caused by decreases in?
Stroke volume and ventricular filling
Treatment of DVT
Supportive Care, Position of Comfort, Establish IV, Cardiac Monitor, Pulse Ox, O2, Monitor vitals for embolism. Do not massage affected limb.
Tachycardia, Difficulty Breathing, Diminished Lung Sound, Pulse Quality Changes, and unequal chest rise are early signs and symptoms of?
Tension Pneumothorax Air is entering the pleural space but cannot escape. Positive pressure ventilation can make it worse.
What are sympathomimetic drugs?
They mimic the effects of the sympathetic (fight or flight) nervous system; therefore, restlessness or hyperactivity, hypertension, tachycardia, and pupillary dilation.
A 60-year-old male complains of a tearing sensation in his abdomen. He tells you the pain began suddenly and feels like someone is sticking a knife into his abdomen. He is conscious and alert with a blood pressure of 148/88 mm Hg, a pulse of 120 beats/min, and respirations of 22 breaths/min. In addition to administering high-flow oxygen, you should:
Transport at once and be prepared to treat him for shock. -Given the onset and nature of the patient's pain (eg, sudden onset, tearing sensation), you should suspect that he has an acute dissection of the abdominal aorta. Administer high-flow oxygen and transport him at once.
What type of angina is characterized by awaking a person at rest/sleep?
Unstable (Prinzmetal)
Epinephrine Norepinephrine Vasopressin Dopamine Phenylephrine Dobutamine
Vasopressors
Signs of narcotic (opiate) overdose
altered mental status; slow, shallow breathing; pupillary constriction (miosis), hypotension; and bradycardia. -Narcotics are central nervous system depressants that, when taken in excess, suppress the vital functions necessary for life, such as breathing, heart rate, and blood pressure.
Hyperkalemia results in?
decreased automaticity/conduction
Hypomagnesemia results in?
decreased conduction
Hypocalcemia results in?
decreased contractility and increased irritability
Accumulation of lactic acid and other waste products in the blood inhibits what interaction?
hemoglobin from binding with and carrying oxygen
What happens when insulin levels are too low?
if insulin levels are too low, such as when a diabetic forgets to take his or her insulin, glucose cannot enter the cells and pools in the bloodstream (hyperglycemia)
Hypermagnesemia results in?
increased myocardial irritability
Hypokalemia results in?
increased myocardial irritability
