Paramedic NREMT Study Guide: Cardiology, Exams of Cardiology

Download Paramedic NREMT Study Guide: Cardiology and more Exams Cardiology in PDF only on Docsity! Paramedic NREMT Study Guide: Cardiology 1. Valve order mneu- monic Toilet Paper My A Tricuspid valve Pulmonic valve Mitral valve Aortic valve 2. Layer of Heart Mus- cle: 3 Layers of Heart Muscle: 1. Endocardium: Innermost layer 2. Myocardium: Middle layer 3. Pericardium or Epicardium: Outer layer "Peri"/"epi" mean "around" or "on top of" 3. Nodes Intrinsic Rates: Sinoatrial (SA) Node: 60-100 Atrioventricular (AV) Node: 40-60 Purkinjes: 15-40 4. Cardiac Emergen- cies Stable Angina Unstable Angina Variant Angina Left Sided Heart Failure Right Sided Heart Failure Cardiac Tamponade Myocardial Infarction 5. Angina Angina is the term for "pain in the chest". It occurs when the heart's demand for oxygen exceeds the blood's oxygen supply. It's commonly caused by atheroscle- rosis and coronary artery disease (CAD). It may also results from a spasm of the coronary arteries (Varient angina). There are 3 types of angina and they are primarily categorized by their cause and duration. 6. Stable angina Typically sudden onset Onset generally with exertion Lasts 3-5 minutes Subsides with rest and/or nitroglycerin 7. Unstable angina Typically sudden onset May initiate during rest 1 / 15 Last>20 minutes May not resolve with nitroglycerin 8. Variant angina Also called "Prinz Metal" or "Spasmotic Angina" Caused by coronary vessel vasospasm Can occur at rest, similar to unstable angina May go away spontaneously or with medication 9. Angina Manage- ment Management: Relieve anxiety/pain Place patient in a position of comfort Administer oxygen Establish IV access Obtain a 12 lead EKG Consider medication administration (MONA): oxygen, aspirin, nitroglycerin, morphine (or fentanyl) 10. Heart Failure two types of heart failure: left-sided and right-sided 11. Right sided heart failure causes left heart failure (#1 cause) Cor Pulmonale (right ventricular hypertrophy) Right Ventricular Infarct Tricuspid Valve Damage Pulmonic Valve Damage Pulmonary Embolism 12. Left Sided Heart Failure Causes Pulmonary edema Hypertension Left Ventricle Infarct Mitral Valve Damage Aortic Valve Damage Cardiomyopathy Myocardial Infarction (#1 cause) 13. Right sided heart failure signs & symptoms JVD Peripheral Edema Ascites (abdominal swelling) Sacral(Scrotal Edema) Orthopnea Hepato-Jugular Reflex 2 / 15 27. Dissecting Aortic Aneurysms Man- agement Rapid transport to hospital with emergency surgery capabilites 28. 12 Lead EKG Leads 29. Elevation in inferior leads= Check for RVI, Right Sided 12 Lead 30. What leads repre- sent what arteries? Lateral Leads (I, aVL, V5, V6): left circumflex Inferior leads (II, III, aVF): posterior descending artery- right coronary artery Septal Leads (V1, V2)- left anterior descending Anterior Leads (V3, V4)- left anterior descending 31. Remember only ______% of MIs are STEMIs and _____% of MI's are NSTEMIs. 50 50 32. Types of MI: Subendocardial: The MI extends partially through the thickness of the myocardium. May or may not produce a pathological Q wave on future 12 lead EKGs. Transmural: The MI extends completely through the thickness of the myocardium. Will leave pathological Q-waves (Q-waves>.04s) on future 12 lead EKGs 33. STEMI: what to look for? 1 mm (or more) of ST segment elevation in two or more anatomically contiguous or numerically consec- utive leads. 34. Anatomically Con- tiguous I, aVL, V5, V6 II, III, aVF V1, V2 V3, V4 35. 5 / 15 Numerically Con- secutive V1-V2 V2-V3 V3-V4 V4-V5 V5-V6 36. Names of MIs: I, aVL, V5, V6= Lateral Wall MI II, III, aVF= Inferior Wall MI V1, V2= Septal Wall MI V3, V4=Anterior Wall MI V2, V3= Anteroseptal MI V4, V5= Anterolateral MI V2, V3, V4, V5= Extensive Anterior Wall MI 37. When the new 12 lead prints when moving V4 to the right side, look specifically in V4 for an ST segment el- evation of greater than 1mm. If there is elevation, this is in- dicative of a right ventricular infarction (RVI) When an inferior wall MI is identified, a right-sided 12 lead occurs in an attempt to identify if the occlusion is happening in the posterior descending artery alone or if it is happening in the proximal RCA which would cause infarctions of both the inferior wall and the right ventricle. 38. When the right ven- tricle is involved in an MI, we are con- cerned with preload and nitroglycerin adminstration 39. RVI Management When a RVI is found, use caution with nitroglycerin. Instead, consider a fluid bolus to support preload (Star- ling's law), aspirin, and oxygen. 40. Bundle Branch Block Identification Steps 1. In lead V1, look to see if the QRS is wider than 0.12 (3 small boxes). If it is not, then you can stop. If it is, then proceed to step 2. 2. With a wide QRS in V1, you now need to determine if the QRS complex is deflected up or down. 3. Picture yourself holding a steering wheel. you are 6 / 15 going to make a right turn so you hit the turn signal leel "up". A QRS that is wide and deflected up is a right bundle branch block. 41. LBBB vs RBBB in- terpretation LBBB= 12 lead interpretation is a LBBB and then treat your patient's clinical presentation. RBBB= 12 lead interpretation is whatever you find "with a RBBB". Treat your patient's clinical presentation and 12 lead findings.` 42. Brady ACLS Algo- rithm Slow HR<60 bpm "Patient must be symptomatic" Sinus Bradycardia Junctional Escape Second Degree Type I Second Degree Type II Third Degree Idioventricular 43. Brady ACLS Algo- rithm: HR<60 and "pt must be sympto- matic" Sinus Brady Junctional Escape Second Degree Type I Management 1. Atropine: 1 mg, up to a max of 3 mg 2. Transcutaneous Pacing: 60 bpm (AHA recommend increase as needed), 50+ mA until mechanical (pulse) and electrical (captured pacer spike) is achieved. 3. Vasopressor infusion Dopamine: 5-20 mcg/kg/min Epi: 2-10 mcg/min 44. Brady ACLS Algo- rithm: HR<60 and "pt must be sympto- matic" Second Degree Type II Third Degree Idioventricular Management 1. Trancutaneous Pacing: 60 bpm (AHA recommend increase as needed), 50+ mA until mechanical (pulse) and electrical (captured pacer spike) is achieved. 2. Vasopressor infusion Dopamine: 5-20 mcg/kg/min Epi: 2-10 mcg/min 7 / 15 57. ACLS Medications: Amiodarone (Cor- darone): indications Recurrent Ventricular Fibrillation and Pulseless Ven- tricular Tachycardia 300 mg IVP (first dose), 150 mg (second dose) Stable Ventricular Tachycardia (with a pulse) 150 mg infused over 10 minutes (minimal) 58. ACLS Medications: Aspirin: what does it do? Antipyretic, Antiplatelet Aggregator-> Blocks platelet aggregation (prevents platelets from stick together, thus, reduces risk of clot formation) 59. ACLS Medications: Aspirin: indications Indications-> chest pain, ACS 60. ACLS Medications: Aspirin: contraindi- cations Contraindications-> children, known hypersensitivity, active ulcer disease, signs of or history of stroke 61. ACLS Medications: Aspirin: dosage Dose-> 81-324 mg (1 baby aspirin table= 81 mg) 1 adult table= 325 mg If patient has taken aspirin in last 24 hours, give remain- ing tablets to total 324 mg 62. ACLS Medications: Atropine: what does it do? Parasympatholytic & Anticholinergic-> inhibits parasympatholytic nervous system; acts on teh vagus nerve (CN X- Cranial Nerve 10) 63. ACLS Medications: Atropine: used in: Symptomatic Bradycardia: 1 mg (max of 3 mg cumulative dose) Push rapid, too slow administration can cause refrac- tory bradycardia Organophosphate poisoning 1 mg every 3-5 minutes to control secretions (SLUDGE) 64. ACLS Medications: Dopamine (Intropin) Endogenous Catecholamine 0.5-2mcg/kg/min-> dopaminergic dose-> dilates renal and mesenteric arteries 10 / 15 2-10 mcg/kg/min-> beta dose-> beta receptor stimula- tion-> positive inotropy, chronotropy, dromotropy 10-20 mcg/kg/min-> alpha dose> alpha receptor stim- ulation-> vasoconstriction 65. ACLS Medications: Epinephrine (Adren- alin): what it dose and dosaging Endogenous Catecholamine & Sympathomimetic Provides vasoconstriction, chronototropy, inotropy, dro- motropy and bronchodilation Cardiac arrest dose-> used every 3-5 minutes 1 mg IV/IO 1:10,000 concentration 66. ACLS Medications: Lidocaine (Xylo- caine) Classifica- tion Anitdysrhythmic 67. ACLS Medications: Lidocaine (Xy- locaine) Ventricu- lar Fibrillation or Pulseless Ventricu- lar Tach Dosage 1-1.5 mg/kg, IV/IO (first dose) 0.5-0.75 mg/kg, IV/IO (second dose-if needed, max dose 3 mg/kg) If no conversion-> start infusion at 2-4 mg/minute (1 mg higher than converting dose) 68. ACLS Medications: Lidocaine (Xylo- caine) Stable Ven- tricular Tachycardia with Pulse Dosage 1-1.5 mg/kg, IV/IO (first dose) 0.5-0.75 mg/kg, IV/IO (second dose-if needed, max dose 3 mg/kg) If no conversion-> give 0.5 mg/kg, IV/IO, in 10 minute increments (two times) 69. ACLS Medications: Nitroglycerin Clas- sification Potent Vasodilator 70. 11 / 15 ACLS Medications: Nitroglycerin Indica- tions CP-> obtain 12 lead first and establish IV access PE-> administer CPAP to help with evacuating fluid from the alveoli 71. ACLS Medica- tions: Nitroglycerin Dosage 0.4 mg SL (3 times, every 3-5 minutes as needed, 1.2 mg max total dose) *Monitor BP with each dose-> do not administer with systolic BP under 100 mmHg *Obtain IV access proper to administration when pos- sible, always obtain 12 lead prior to administration to rule in/out RVI 72. How to apply Ni- tro-Bid? Nitro-Bid is the paste form of nitroglycerin and is ap- plied in a 1" circle (15 mg TD) to upper left chest area. 73. ACLS Medica- tions: Procainamide (Pronestyl): what it does, indications, and dosage Antidysrhythmic-> blocks influx of sodium, slows con- duction (decreases both atrial and ventricular rates) Considered in stable tachycardic rhythms (>150 bpm; SVT/VT/A-Fib) 15-50 mg/min 74. ACLS Medications: Sodium Bicarb: classification, indi- cations, and dosag- ing Alkalinizing agent Cardiac arrest for known dialysis patients or prolonged down time: 1 mEq/kg Tricyclic Antidepressant (TCA) overdoses: 1 mEq/kg, IV/IO **May cause transient increase in capnography 75. ALS Medications: Sotalol (BetaPace) Antidysrhythmic Considered in stable tachycardic rhythms (>150 bpm; SVT/VT/A-Fib) 100 mg (1.5 mg/kg) over 5 minutes 12 / 15