Anesthesia CV Emergencies

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Author:
doza04
ID:
306876
Filename:
Anesthesia CV Emergencies
Updated:
2015-08-31 00:33:44
Tags:
Anesthesia
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Description:
CV Emergencies
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  1. Ventricular Dysrythmias
    • Lidocaine
    • Amiodarone
  2. Supraventricular Dysrythmias
    • Treat rate before rhythm
    • Esmolol: B1 Blocker (except CHF or pulmonary disease)
    • Diltiazem: Ca Channel Blocker
    • Adenosine: Adeonsine1 agonist
  3. Bradycardia
    • Atropine: Anticholinergic
    • Glycopyrrolate: Anticholinergic
  4. Tachycardia
    • Esmolol: B1 Blocker
    • Metoprolol: B1 blocker
    • Labetolol: B1, B2, a1 blocker
  5. Hypertension
    • Beta Blockers: Esmolol, Metoprolol, Labetolol
    • Vasodilating Agents: Nitroglycerin, hydralazine, nicardipine, enalaprilat
  6. Hypotension
    Ephedrine, Phenylephrine, epinephrine, Dopamine, Vasopressin
  7. CV Emergency General Principles
    • Conscious patient: Ask them how they feel. 
    • Very sedated: Make them less sedated
    • Unconscious: consider making them conscious
    • EVALUATE multiple indicators
  8. Symptomatic Bradycardia
    • Atropine: 0.5-1mg
    • Gylcopyrrolate: 0.2mg
    • Ephedrine: 5mg Low BP & HR
  9. Underlying Causes of Bradycardia (H's)
    • Hypovolemia
    • Hypoxemia
    • Hydrogen Ion (Acidosis)
    • Hypo/Hyperkalemia
    • Hypoglycemia
    • Hypothermia
  10. Underlying Causes of Bradycardia (T's)
    • Toxins
    • Tamponade
    • Tension pneumothorax
    • Thrombosis (PE, MI)
    • Trauma (ICP)
  11. Sinus Tachycardia Causes
    • Hypoxia/Hypercarbia
    • Surgical stimulation
    • IV Epi injection
    • Hypotension/Hypovolemia
    • Full Bladder
    • Medication Related
    • Decreased CO (CHF, PE, MI, tamponade)
    • Anemia
    • Hyperthyroidism/hypermetabolic/Pheochromocytoma
  12. Bradycardia Causes
    • Physiologic/reflex bradycarcia
    • Age
    • Drug induced
    • Primary conduction defect
    • Decompensation 
    • Pharyngeal and oculocardiacreflexes
    • Syncope
    • Hypothyroidism/SLE/ collagen vascular disease
  13. Premature Atrial Contraction (PACs) Causes
    • Anxiety/Caffeine
    • Excessive Alcohol
    • Sympathetic stimulation
    • Cardiac Disease
    • Mitral valve prolapse
    • Congenital
  14. Atrial Fibrillation Treatment
    • Control Rate, then rhythm
    • 1. Beta Blockers:Esmolol (0.5mg/kg) or Metoprolol (2.5mg)
    • 2. Ca Channel blockers: Diltiazem 5mg
    • 3. Antiarrhythmic: Amiodarone (150mg over 15min)
    • 4. CAUTION Cardioversion risks pulmonary embolism/stroke unless under 48 hours.
  15. Ventricular Dysrhythmia Causes
    • Myocardial Ischemia
    • Hypoxia/Hypercarbia
    • Tachycardia/HTN
    • Valvular DIsorder
    • Myocardial Infarction
    • Primary conduction abnormality
    • Bradycardia Induced
  16. Ventricular Dysrhythmia Treatment
    • Treat Underlying Cause
    • Lidocaine: 1-1.5mg/kg (3mg/kg max bolus)
    • Amiodarone (pulse): 150mg over 10min
    • Amiodarone (no pulse): 300mg IV push
  17. HTN Treatment
    • Nitroglycerin: 0.4mg SubL
    • Esmolol: 10mg/ml
    • Fentanyl and Derivatives
    • Labetalol: 5mg q 15min
    • Hydralazine 5mg q 15min
  18. Hypotension Treatment
    • Volume: 5-10ml/kg
    • Atropine: 0.5-1mg
    • Ephedrine: 5-10mg
    • Phenylephrine: 50-100mcg
    • Epinephrine: 10mcg (titrate), 500mcg (near death), 1mg (death)
  19. Chest Pain DD
    • Angina Pectoris: Usually resolves with rest or after SubL 
    • Acute MI: Chest pain at rest and no response to NTG
  20. Chest Pain Treatment (Hx of angina)
    • 1. Position patient to comfort
    • 2. Obtain Vital Signs
    • 3. NTG 0.4mg sublingual
    • 4. Supplemental O2
    • 5. If no resolution, activate EMS due to possible MI
  21. Chest Pain Treatment (No hx of angina)
    • 1. BLS, vital signs, loosen clothing
    • 2. Activate EMS (assume MI)
    • 3. Consider Trendelenberg if lower BP
    • 4. Treatment (MONA)
    • M: Morphine
    • O: Oxygen
    • N: Nitroglycerin
    • A: Aspirin
    • 5. If under GA, wake patient up.

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