cardiac care flip 1

ASA

aspirin (acetylsalicylic acid)

indications: acute coronary syndrome/chest pain with cardiac features

contraindications: hypersensitivity to NSAIDs

adverse effects: bleeding, worsening of active GI ulcer

dose: 160mg chewed and swallowed

epinephrine

indications: cardiac arrest, anaphylaxis, severe asthma, croup, symptomatic bradycardia, anaphylaxis/hypotensive shock from fluid resuscitation

adverse effects: cardiac arrythmias, hypertension, N/V

dose:

• 0.5mg IM q 5-10 minutes titrate (anaphylaxis)

• 0.3-0.5mg IM/SQ q 5-15 min titrate (severe asthma)

acetaminophen

tylenol

indications: fever, pain (mild/moderate)

contraindications: acute liver disease, severe hepatic impairment

dose:

• 975mg-1000mg PO to max 4g/day (A)

• 650mg PR q 4h no repeat (A)

• 15mg/kg PO/PR q4-6h to max 75mg/kg/day or 4g/day (P)

nitroglycerin

indications: ACS and Acute Cardiogenic Pulmonary Edema

contraindications: SBP<90mmHg, HR<50bpm; sildenafil, vardenafil within 24 hours, tadalafil within 48 hours

adverse reactions: dizziness, headache, hypotension, syncope

dose: 0.4mg SL p 3-5min titrate

salbutamol

ventolin

indications: bronchospasm, hyperkalemia

contraindications: tachyarrhythmias

adverse reactions: excitement, nervousness, tremor, tachycardia

dose:

• 5mg nebulized titrate PRN (A) (2.5mg if <20kg)

• 5mg nebulized continuous (hyperkalemia)(A)

• 10 inhalations MDI PRN (A) (5 if <20kg)

  
  

Ipratropium bromide

atrovent

indications: asthma exacerbation, COPD with bronchospasm

adverse reactions: dizziness, headache, nausea

dose:

• asthma

  • 500mcg nebulized PRN to max 1500mcg

  • 5 puffs - 20mcg/puff MDI max 100mcg

  • 250-500mcg neb q 20 minutes for 1 hour than PRN (P)

  • 4 puffs MDI with spacer q 20 min prn

• COPD

  • 500mcg neb every 6-8h to max 1500mcg

  • 4-8 inhalations MDI with spacer q 20 min x 3 doses

steps to rhythm interpretation

• regularity

• rate

  • dont count PVC, PJC, PAC

• P waves

• PRI

• QRS

• interpretation

ectopic beats

premature atrial contraction (PAC): narrow,upright P wave

premature junctional contraction (PJC): narrow with absent or inverted P wave

premature ventricular contraction: wide bizarre QRS, no P wave

unifocal: all similar

multifocal: different

bigeminy: every second beat etc. (tri:3, quad:4)