Cardiac interventions

CPAP indications and Contraindications

Indications

• Acute pulmonary oedema

Contraindications

• Patients <16 years

• GCS 8 or less

• Facial trauma (face)

• Epistaxis (nose)

• Inadequate ventilatory drive (mouth)

• Hypotension (SBP <90 mmHg) (heart)

• Pneumothorax (chest)

GTN Indications and Containdcations

Indication

Suspect ACS with pain

Acute Cardiac APO

Autonomic dysreflexia

Contraindications

HR <50 OR > 150

Sys < 100

Actue CVA

Head trauma

PDE5 medications (Viagra, Vedafil, Tadalis, Levitra, and Spedra 24 hrs) (Tadalafil/Cialis 48 hrs)

CPAP procedure

give Oxygen, GTN and aspirin first if indicated

explain procedure to patient “its gonna be loud”

Red (small) Blue (large)

start @ 8lmp

check to see if air is escaping (run finger around seal)

Increase to 15lmp is needed

CPAP pressures

O₂ L/min	cm H₂O

8

5

10

8

12

10

15

15

PEEP def

CPAP def

Positive End Expiratory Pressure, at the end of expiration alveoli pressure is above atmospheric pressure.

Continuous Positive Airway Pressure, constant level of positive pressure during inhalation and exhalation.

PEEP benefits

• Improving oxygenation in patients with acute respiratory distress syndrome and hypoxemic respiratory failure

• Reducing gas trapping in patients with expiratory airflow limitations by increasing lung compliance

• Minimising lung injury by preventing alveolar collapse and re-inflation

• Reducing ventilation/perfusion mismatch by increasing alveolar volume

• Enabling decreased workload of breathing

PEEP indications and contraindications

Indications

• Pulmonary oedema (cardiogenic and non-cardiogenic)

• Asthma and COPD

• Profound hypoxaemia associated with flail segments, pulmonary contusions, aspiration

• Newborn resuscitation

Contraindications

• Absolute: Hypotension

• Relative: Pneumothorax, uni-lateral lung disease, broncho-pleural fistula, hypovolaemia

PEEP procedure

1. If PEEP is indicated, take the patient’s blood pressure to confirm no contraindications

2. Attach the PEEP valve to the BVM expiratory flow diverter

3. Adjust the PEEP valve to 5 cm H₂O

4. Commence Positive Pressure Ventilations, ensuring neither tidal volume nor ventilatory drive rate are too high

5. Continuously monitor the patient’s:

   • SPO₂

   • Blood pressure

   • EtCO₂

*PEEP can be increased to 10 cm H₂O in acute pulmonary oedema if after 10 minutes the oxygen saturations do not increase above 90%.

Valsalva Indications, Contra.

Indications

• Hemodynamically stable SVT

Contraindications

• Requirement for immediate cardioversion

• Hypotension (SBP <90 mmHg)

• Atrial fibrillation / atrial flutter

• Aortic stenosis (aortic valve in the heart becomes narrowed,)

• Recent myocardial infarction (within 3 months)

• Glaucoma (pressure in eye, vison loss)

• Retinopathy (damaged blood vessels in eye)

• Third trimester pregnancy (last 3 months, 28-40 weeks)

Valsalva complications

Syncope

Prolonged hypotensive state

Aspirin Indications and Contraindications

Indication

Suspected ACS

Acute Cardiac Pulmonary Oedema

Contraindications

KAR

Bleeding or clotting disorders

Current GI Bleeding

<18yo

Fentanyl indication and Contraindications

Indications

Significant pain

Sedation

Autonomic Dysreflexia

Contraindications

KAR

When to use Fent over Morphine

KAR to morphine

Hemodynamically unstable

known or suspected kidney disease

Nasal admistration

ACS

Adrenaline indications and Contraindications

Indications

Cardiac arrest

Anaphylaxis

Life threatening bronchispasam

Shock Unresponsive to Flinders resus

Bradycardia with poor perfusion unresponsive to atropine or pacing

Croup (moderate to severe)

Contraindications

Nill

Amioderone indications and Contraindications

Indication

Cardiac arrest (VT or VF) after 3 shocks

Sustained conscious VT (hemodynamically stable)

Contraindications

For arrest - tricyclic antidepressants OD

For sustained VT - KAR

-conduction disorders

-tricyclic OD

Amioderone therapy

-current anti arithmetic therapy that prolongs QT

Pregnancy/lactation

APO S&S

APO

SOB sudden onset with is worse when lying flat, often during night

Felling of suffocation/drowning

Hypoxic (cyanosis when bad)

Hypertension (usually over 170) will be low in late stage

Tachy

Cough with Pink frothy sputum

Crackers (sometimes wheeze)

on duretics

JVD

Peripheral Oedema, in chronic re

ECG

LVH

LBBB

LAE (broad noitched p wave)

AF

Ishemia if MI triggered APO ST depression, T wave inversions in lateral leads

RVS right ventricular strain, R>S progression backwards, RAD

6 H