Emergency nursing

1. 1
CARDIAC EMERGENCIES

2. The Heart
Superior Vena Cava
Right Atrium
Aorta
Left Atrium
Left Ventricle
Right Ventricle
Tricuspid Bicuspid
Aortic valve
Pulmonary valve

3. Electrolyte effect:-
Sodium:Sodium: action potentialaction potential
Calcium:Calcium: vascular tone, myocardial contractility andvascular tone, myocardial contractility and
cardiac excitabilitycardiac excitability
Potassium:Potassium: ventricular depolarization and repolarization.ventricular depolarization and repolarization.
Magnesium:Magnesium: essential for enzyme, protein, lipid andessential for enzyme, protein, lipid and
carbohydrate functions..carbohydrate functions..

4. Conduction System
SA Node
AV Node
Left Bundle Branch
Right Bundle Branch
Purkinje Fibers

5. Preload And Afterload
Preload:Preload: degree of stretch of the cardiac muscles justdegree of stretch of the cardiac muscles just
before the contractionbefore the contraction
ContractilityContractility: The ability of mucscle tissue to contract.: The ability of mucscle tissue to contract.
Afterload:Afterload: the pressure the heart must overcome to ejectthe pressure the heart must overcome to eject
blood from the ventriclesblood from the ventricles

6. Investigation:-

7. Blood TestsBlood Tests
CT ScansCT Scans
EchocardiographyEchocardiography
Electrocardiograms (EKG)Electrocardiograms (EKG)
Holter and Event (Loop) MonitoringHolter and Event (Loop) Monitoring
Exercise Stress TestsExercise Stress Tests
MRIsMRIs

8. BLOOD TESTS
Antistreptolysin-O test – protein produced byAntistreptolysin-O test – protein produced by
streptococcal bacteriastreptococcal bacteria
Arterial blood gasesArterial blood gases
Blood fat profileBlood fat profile
Blood calcium testBlood calcium test
Complete blood countComplete blood count
ElectrolyteElectrolyte
Erythrocyte sedimentation rate (ESR)Erythrocyte sedimentation rate (ESR)
Cardiac enzyme testsCardiac enzyme tests
Glucose test.Glucose test.
Prothrombin time tests .Prothrombin time tests .
Total serum proteinTotal serum protein

9. BLOOD FAT PROFILEBLOOD FAT PROFILE
 Cholesterol
 HDL (good cholesterol)
 LDL (bad cholesterol)
 Triglycerides

10. Cholesterol Level:-
Desirable
Mg/dl
Border line
Mg/dl
High Risk
Mg/dl
Total Cholesterol < 200 200 – 240 > 240
LDL Cholesterol 100 100 – 150 > 150
HDL Cholesterol > 40 30 - 40 < 30
Triglyceride 150 150 - 200 > 200

11. CARDIAC ENZYME TESTS:-CARDIAC ENZYME TESTS:-
Creatine kinase-MBCreatine kinase-MB An elevation occurs within 4 toAn elevation occurs within 4 to
6 hours and peaks 18 to 24 hours following an acute6 hours and peaks 18 to 24 hours following an acute
ischemic attack.ischemic attack.
Lactate dehydrogenaseLactate dehydrogenase: Elevations :-24hours: Elevations :-24hours
following MI and peak in 48 to 72hours. Normallyfollowing MI and peak in 48 to 72hours. Normally
LDH 1 is more then LDH 2.LDH 1 is more then LDH 2.
Normal value :140 to 280 international units/L.Normal value :140 to 280 international units/L.
MyoglobinMyoglobin rises within 1hour after cell death, peaksrises within 1hour after cell death, peaks
in 4 to 6 hours.in 4 to 6 hours.

12. 12
Cardiac Disease
-HTN-HTN
-CAD-CAD
- MIMI
-CHF-CHF
- Valvular diseases- Valvular diseases

13. 13
Cardiac Disease Risk Factors
Non Modifiable /UncontrollableNon Modifiable /Uncontrollable
AgeAge
SexSex
RaceRace
HeredityHeredity

14. 14
Modifiable/ControllableModifiable/Controllable
SmokingSmoking
High BPHigh BP
High blood cholesterolHigh blood cholesterol
DiabetesDiabetes

15. 15
Risk Factors:-
ObesityObesity
Lack of exerciseLack of exercise
StressStress
PersonalityPersonality

16. Hypertension

17. Etiology:-
PrimaryPrimary
Family historyFamily history
StressStress
High fat dietHigh fat diet
High sodium dietHigh sodium diet
Sedentary lifestyleSedentary lifestyle
AgingAging
Tobacco useTobacco use
Oral contraceptivesOral contraceptives
Poor medicationPoor medication
compliancecompliance
SecondarySecondary
Renal diseaseRenal disease
Adrenal disorderAdrenal disorder
CV DisorderCV Disorder
CNS Disorders/injuriesCNS Disorders/injuries
Medication side effectsMedication side effects
Volume overloadVolume overload

18. Clinical manifestation:-
Headache: especially in theHeadache: especially in the
morningmorning
EpistaxisEpistaxis
Visual disturbanceVisual disturbance
VertigoVertigo
Chest painChest pain
Shortness of breathShortness of breath
WeaknessWeakness
NauseaNausea

19. Diagnostic Testing for HTN
CBCCBC
Kidney functionsKidney functions
Elevated BUN/CreatinineElevated BUN/Creatinine
ProteinuriaProteinuria
CXRCXR
12 Lead EKG12 Lead EKG

20. Treatment of HTN
Elevate HEAD END OF BEDElevate HEAD END OF BED
Cardiac monitoringCardiac monitoring
Strict I&O’SStrict I&O’S
Frequent neuro assessmentsFrequent neuro assessments
PharmacologyPharmacology
VasodilatorsVasodilators
NitroprussideNitroprusside
Hydralazine: drug of choice for pregnancyHydralazine: drug of choice for pregnancy
NitroglycerinNitroglycerin
SympatholyticsSympatholytics
LabetololLabetolol
Nifedipine or procardiaNifedipine or procardia
DiureticsDiuretics

21. 21
Coronary Artery Disease

22. 22
Coronary Artery Disease
AtherosclerosisAtherosclerosis
Narrowing of lumenNarrowing of lumen
plaque formation - related to Risk Factorsplaque formation - related to Risk Factors
results in decreased myocardial perfusionresults in decreased myocardial perfusion
Poor tissue perfusion causes:Poor tissue perfusion causes:
tissue damage (ischemia)tissue damage (ischemia)
tissue death (infarction)tissue death (infarction)

23. 23
Atherosclerotic Plaque
Formation

24. 24
Angina Pectoris
“A choking in the chest”
Myocardial oxygenMyocardial oxygen
demand exceedsdemand exceeds
supply during periodssupply during periods
of increasedof increased
activity, exercise,activity, exercise,
or stressful eventor stressful event

25. 25
Types of Angina Pectoris
Stable AnginaStable Angina
Occurs with exerciseOccurs with exercise
PredictablePredictable
Relieved by rest or NitroglycerinRelieved by rest or Nitroglycerin

26. 26
Unstable AnginaUnstable Angina
More frequent/severeMore frequent/severe
Can occur during restCan occur during rest
May indicate impending MIMay indicate impending MI
Requires immediate treatment andRequires immediate treatment and
transport to appropriate facilitytransport to appropriate facility

27. Variable or Prinzmetal’s angina:Variable or Prinzmetal’s angina:
-Caused by coronary artery spasm,-Caused by coronary artery spasm,
-Can occur at rest and can be cyclic-Can occur at rest and can be cyclic

28. ASSESSMENT OF PAINASSESSMENT OF PAIN
OO nsetnset
PP rovocationrovocation
QQ ualityuality
RR adiationadiation
SS everityeverity
TT imeime
??

29. 29
Symptoms -Angina Pectoris
PainPain
SubsternalSubsternal
Squeezing/Crushing/HeavinessSqueezing/Crushing/Heaviness
May radiate to arms, shoulders, jaw,May radiate to arms, shoulders, jaw,
upper back, upper abdomen backupper back, upper abdomen back
May be associated with shortness ofMay be associated with shortness of
breath, nausea, sweatingbreath, nausea, sweating

30. 30
Pain usually associated with 3E’sPain usually associated with 3E’s
ExerciseExercise
EatingEating
EmotionEmotion
Pain seldom lasts > 30 minutesPain seldom lasts > 30 minutes
Pain relieved byPain relieved by
RestRest
NitroglycerinNitroglycerin

31. 31
Acute Myocardial Infarction
“Heart Attack”
Inadequate perfusionInadequate perfusion
of myocardiumof myocardium
Death of myocardiumDeath of myocardium
InfarctInfarct
Damage to myocardiumDamage to myocardium
IschemiaIschemia

32. 32
Symptoms - AMI
Chest PainChest Pain - cardinal sign of- cardinal sign of
myocardial infarctionmyocardial infarction
Occurs in 85% of MI’sOccurs in 85% of MI’s
SubsternalSubsternal
““Crushing,” “squeezing,” “tight,”Crushing,” “squeezing,” “tight,”
“heavy”“heavy”

33. Temple College EMS Program 33
Chest PainChest Pain
May radiate to arms, shoulders, jaw,May radiate to arms, shoulders, jaw,
upper back, upper abdomen backupper back, upper abdomen back
May vary in intensityMay vary in intensity
Unaffected by:Unaffected by:
swallowingswallowing
coughingcoughing
deep breathingdeep breathing
movementmovement

34. Temple College EMS Program 34
Chest PainChest Pain
Unrelieved by rest/nitroglycerinUnrelieved by rest/nitroglycerin
Pain lasts longer than angina pain (upPain lasts longer than angina pain (up
to 12 hours)to 12 hours)
““Silent’ MISilent’ MI
15% of patients with MI,15% of patients with MI,
particularly common in elderly andparticularly common in elderly and
diabeticsdiabetics

35. 35
Symptoms - AMI
Shortness of breathShortness of breath
Weakness, dizziness, faintingWeakness, dizziness, fainting
Nausea, vomitingNausea, vomiting
Pallor and diaphoresis (heavy sweating)Pallor and diaphoresis (heavy sweating)
Sense of impending doomSense of impending doom
DenialDenial
50% of deaths occur in first two hours50% of deaths occur in first two hours
Average patient waits 3 hours before seeking helpAverage patient waits 3 hours before seeking help

36. AREA OF INFARCTION IN ECG?
Anterior: V1-V4 (LAD)Anterior: V1-V4 (LAD)
Septal: V1-V2 (LAD)Septal: V1-V2 (LAD)
Lateral: I, AVL, V5-V6 (Circumflex)Lateral: I, AVL, V5-V6 (Circumflex)
Inferior: II, III, AVF (RCA)Inferior: II, III, AVF (RCA)
Right Ventricular: Right V4-V6 (RCA)Right Ventricular: Right V4-V6 (RCA)
Cardiac enzymesCardiac enzymes

37. 37
Management
Early treatment is importantEarly treatment is important
Goal is to preserve myocardial tissueGoal is to preserve myocardial tissue
Position of ComfortPosition of Comfort
Patent AirwayPatent Airway
High concentration OHigh concentration O22
Reassure the patientReassure the patient
Obtain a brief history and physical examObtain a brief history and physical exam
Cardiac monitoring with 15 minutesCardiac monitoring with 15 minutes
BP in both armsBP in both arms
3 IV’S: at least 1 in the left arm3 IV’S: at least 1 in the left arm

38. 38
Nitroglycerin-Nitroglycerin- Dilates coronary arteriesDilates coronary arteries
0.4mg tablet sublingual0.4mg tablet sublingual
Patient should be sitting or lying downPatient should be sitting or lying down
Has Pt. Taken nitroglycerin in last 10Has Pt. Taken nitroglycerin in last 10
minutes? Is pain relieved? Headache?minutes? Is pain relieved? Headache?
Is BP > 90 systolic?Is BP > 90 systolic?
q 5 minutes until pain relieved or threeq 5 minutes until pain relieved or three
tablets administeredtablets administered

39. Medical Treatment
Morphine sulfate – 2-4 mg titrated for painMorphine sulfate – 2-4 mg titrated for pain
reliefrelief
decreases blood return to the heartdecreases blood return to the heart
decreases anxietydecreases anxiety
relaxes smooth muscle in the lungsrelaxes smooth muscle in the lungs
has analgesic effecthas analgesic effect
Thrombolytic therapyThrombolytic therapy ––
HeparinHeparin
Aspirin 325mg p.o.Aspirin 325mg p.o.
StreptokinaseStreptokinase
Beta blockersBeta blockers
Calcium channel blockersCalcium channel blockers

40. Temple College EMS Program 40

41. 41
Congestive Heart Failure
CHF :- Inability of the heart toCHF :- Inability of the heart to
pump sufficient blood to meet thepump sufficient blood to meet the
demands of the bodydemands of the body
ClassificationsClassifications
Left heart failureLeft heart failure: most common, results in: most common, results in
pulmonary congestionpulmonary congestion
Right heart failureRight heart failure: can result from left: can result from left
heart failure and presents with peripheralheart failure and presents with peripheral
venous congestionvenous congestion
BiventricularBiventricular

42. 42
Congestive Heart Failure
Usually begins with left-sided failure.Usually begins with left-sided failure.
Left ventricle failsLeft ventricle fails
Blood “stacks up” in lungsBlood “stacks up” in lungs
High pressure in capillary bedsHigh pressure in capillary beds
Fluid forced out of capillaries into alveoliFluid forced out of capillaries into alveoli

43. 43
Congestive Heart Failure
Right-sided failure most commonlyRight-sided failure most commonly
caused by Left-sided failure. Bloodcaused by Left-sided failure. Blood
“backs up” into systemic circulation“backs up” into systemic circulation
Distended neck veinsDistended neck veins
Fluid in abdominal cavityFluid in abdominal cavity
Pedal edemaPedal edema

44. Etiology of Heart Failure
Left HeartLeft Heart
CADCAD
MIMI
HTNHTN
Rheumatic HT DZRheumatic HT DZ
Valvular dysfunctionValvular dysfunction
Aortic stenosisAortic stenosis
Ventricular aneurysmVentricular aneurysm
Pulmonary HTNPulmonary HTN
Endocardial fibrosisEndocardial fibrosis
Myocardial fibrosisMyocardial fibrosis
Right HeartRight Heart
Left heart failureLeft heart failure
MIMI
Pulmonary HTNPulmonary HTN
DrugsDrugs
Valvular dysfunctionValvular dysfunction
Spontaneous ofSpontaneous of
unknown etiologyunknown etiology

45. SYMPTOMS of CHF
Left HeartLeft Heart
DyspneaDyspnea
Cough w/frothy sputumCough w/frothy sputum
Rales/rhonchiRales/rhonchi
HypoxiaHypoxia
Weak/fatigueWeak/fatigue
TachycardiaTachycardia
S3S3
CyanosisCyanosis
Resp AlkalosisResp Alkalosis
Right HeartRight Heart
JVDJVD
Bounding pulsesBounding pulses
OliguriaOliguria
N/V, AnorexiaN/V, Anorexia
Weight gainWeight gain
MurmurMurmur
Peripheral edemaPeripheral edema
OrganomegalyOrganomegaly

46. Diagnostic Findings
History and physicalHistory and physical
CXRCXR
Hemodynamic and cardiac monitoringHemodynamic and cardiac monitoring
LabsLabs
ABG: Respiratory alkalosisABG: Respiratory alkalosis
BNPBNP
ElectrolytesElectrolytes
Cardiac EnzymesCardiac Enzymes
CBCCBC
LFT’SLFT’S
12 lead EKG,12 lead EKG, ECHOECHO
MUGA ScanMUGA Scan
Pressure monitoring cathetersPressure monitoring catheters
PA Catheter Swan-GanzPA Catheter Swan-Ganz

47. EMERGENCY MEDICALEMERGENCY MEDICAL
CARECARE
ResponsiveResponsive
Perform initial assessmentPerform initial assessment
Focused HX and PEFocused HX and PE
Place patient in position of comfortPlace patient in position of comfort
Cardiac - c/o pain or discomfortCardiac - c/o pain or discomfort
100% oxygen100% oxygen
Assess vitalsAssess vitals

48. (ASSESSMENT OF(ASSESSMENT OF
PAIN) QUESTIONPAIN) QUESTION
OO nsetnset
PP rovocationrovocation
QQ ualityuality
RR adiationadiation
SS everityeverity
TT imeime
??

49. Nursing Intervention For CHF
Elevate HEAD END OF BEDElevate HEAD END OF BED
Oxygen therapyOxygen therapy
Cardiac and hemodynamic monitoringCardiac and hemodynamic monitoring
Strict I&O’SStrict I&O’S
Pharmacologic:Pharmacologic:
Diuretics: lasix, natrecorDiuretics: lasix, natrecor
Positive inotropics: dopamine, dobutamine, digoxinPositive inotropics: dopamine, dobutamine, digoxin
Pain/anxiety: morphinePain/anxiety: morphine
Vasodilators: NTG, Hydralazine, niprideVasodilators: NTG, Hydralazine, nipride
Potential advanced airways: BIPAP, intubationPotential advanced airways: BIPAP, intubation

50. 50
Management of CHF
Sit patient up, let feet dangleSit patient up, let feet dangle
Administer high concentration OAdminister high concentration O22
Assist ventilation as neededAssist ventilation as needed
Monitor vital signs q 5-10 minutesMonitor vital signs q 5-10 minutes
Request early ALS back-upRequest early ALS back-up

51. EMERGENCY MEDICALEMERGENCY MEDICAL
CARE PulselessCARE Pulseless
Patient > 12 yrs old - CPR with AEDPatient > 12 yrs old - CPR with AED
Patient < 12 yrs old or < 90 lbs - CPRPatient < 12 yrs old or < 90 lbs - CPR

52. 52
Pacemaker Failure/Coronary
Artery Bypass
Position of comfortPosition of comfort
Patent airwayPatent airway
High Concentration OHigh Concentration O22
Assist ventilations as neededAssist ventilations as needed
ALS InterceptALS Intercept
CPR as needed (CPR as needed (DO NOT worry aboutDO NOT worry about
damage to pacemaker)damage to pacemaker)

53. Pericarditis
inflammation of the pericardium and the frequent production ofinflammation of the pericardium and the frequent production of
exudate.exudate.
SymptomsSymptoms
Chest painChest pain
More pain laying backMore pain laying back
Pain with deep inspirationPain with deep inspiration
FeverFever
MalaiseMalaise
WeaknessWeakness
TachycardiaTachycardia
Pericardial friction rub in 30% of casesPericardial friction rub in 30% of cases
DiaphoresisDiaphoresis
DyspneaDyspnea
HypotensionHypotension

54. Endocarditis
Infection of the endothelial surface of the heart most oftenInfection of the endothelial surface of the heart most often
of the valvesof the valves
SymptomsSymptoms
Fever or chillsFever or chills
MurmurMurmur
Janeway lesions: red macules on hands/feetJaneway lesions: red macules on hands/feet
Roth spots: retinal hemorrhagesRoth spots: retinal hemorrhages
Anorexia, malaise, PetechiaeAnorexia, malaise, Petechiae
Splenomegaly or splenic infarctSplenomegaly or splenic infarct
CHF,Glomerulonephritis or infarctCHF,Glomerulonephritis or infarct
Cerebrovascular disease, or vertigoCerebrovascular disease, or vertigo

55. Nursing Considerations for Pericarditis
Position of comfortPosition of comfort
OxygenationOxygenation
Cardiac and hemodynamic monitoringCardiac and hemodynamic monitoring
Pain control: NSAIDS, Steroids, antibiotics(inPain control: NSAIDS, Steroids, antibiotics(in
pericarditis)pericarditis)
No anticoagulantsNo anticoagulants
Pericardiocentesis if necessaryPericardiocentesis if necessary
Antipyretics in endocarditisAntipyretics in endocarditis

56. Valvular Heart Disease

57. Understanding Terms
StenosiStenosiss = Constriction or narrowing of= Constriction or narrowing of
orificeorifice
RegurgitationRegurgitation = Retrograde of the flow of= Retrograde of the flow of
blood from one chamber back into anotherblood from one chamber back into another
ProlapseProlapse = valve leaflets billow back or= valve leaflets billow back or
buckle back into the atriumbuckle back into the atrium

58. Mitral Stenosis
Mitral valve becomesMitral valve becomes narrownarrow andand
constrictedconstricted
CausesCauses ↑ L. Atrial pressure and volume↑ L. Atrial pressure and volume
Most are due to Rheumatic Heart diseaseMost are due to Rheumatic Heart disease
Symptoms: murmur at 5Symptoms: murmur at 5thth
ICSICS
Extended dyspnea and fatigueExtended dyspnea and fatigue

59. Mitral Valve Prolapse
Valve billows back into L. AtriumValve billows back into L. Atrium
Cause is unknownCause is unknown
Heard as a murmurHeard as a murmur
Can be familial due to connective tissueCan be familial due to connective tissue
disorderdisorder
Most people asymptomatic, benignMost people asymptomatic, benign
Most common valve disorderMost common valve disorder
May lead to Mitral Valve RegurgitationMay lead to Mitral Valve Regurgitation
Diagnosed by ECHODiagnosed by ECHO

60. Mitral Regurgitation
Retrograde blood flow from L. VentricleRetrograde blood flow from L. Ventricle
to L. Atriumto L. Atrium
Etiology R/T: MI, Rheumatic heart disease,Etiology R/T: MI, Rheumatic heart disease,
MVPMVP
Symptoms R/T acute or chronic murmurSymptoms R/T acute or chronic murmur
Heard best at 5Heard best at 5thth
ICSICS
May feel a thrillMay feel a thrill
More common in women than menMore common in women than men

61. Valvular Regurg - picture

62. Aortic Stenosis
Blood flow restricted from L. Ventricle toBlood flow restricted from L. Ventricle to
AortaAorta
Results inResults in LVHLVH, &, & ↑myocardial oxygen↑myocardial oxygen
consumptionconsumption
Causes: congenital, Rheumatic Fever,Causes: congenital, Rheumatic Fever,
atherosclerosisatherosclerosis
Symptoms -Symptoms - ↓ S1 or S2 sound↓ S1 or S2 sound
– MurmurMurmur

63. Aortic Regurgitation
Retrograde blood flow from theRetrograde blood flow from the
Ascending Aorta into L. VentricleAscending Aorta into L. Ventricle
Results in:Results in: L. VentricleL. Ventricle dilation & LVHdilation & LVH,,
leading toleading to ↓contractility of the heart↓contractility of the heart
murmurmurmur
Soft S1, S3 or S4Soft S1, S3 or S4
Causes: Congenital, Rheumatic HeartCauses: Congenital, Rheumatic Heart
DiseaseDisease
May have Orthopnea, Exertional dyspnea,May have Orthopnea, Exertional dyspnea,
paroxysmal nocturnal dyspneaparoxysmal nocturnal dyspnea

64. Tricuspid Valve Disease
Stenosis & RegurgitationStenosis & Regurgitation
Tricuspid StenosisTricuspid Stenosis is uncommonis uncommon
R. Atrium enlargement &R. Atrium enlargement & ↑systemic↑systemic
venous pressurevenous pressure
Tricuspid RegurgitationTricuspid Regurgitation
Volume overload in R. Atrium andVolume overload in R. Atrium and
Ventricle occursVentricle occurs
Causes: R. Ventricular dysfunction, orCauses: R. Ventricular dysfunction, or
pulmonary HTNpulmonary HTN

65. Diagnosing Valve Disease
History and Physical ExamHistory and Physical Exam
EchocardiographyEchocardiography
Cardiac CatheterizationCardiac Catheterization
ECGECG

66. Collaborative Care for Valvular
Disease
Ask about history of Rheumatic Heart DiseaseAsk about history of Rheumatic Heart Disease
Use of antibiotic prophylaxisUse of antibiotic prophylaxis
DigitalisDigitalis
DiureticsDiuretics
Anticoagulation (ASA, Coumadin)Anticoagulation (ASA, Coumadin)
Surgical repair or replacementSurgical repair or replacement

67. Nursing Management/Goals
Maintaining normal cardiac functionMaintaining normal cardiac function
Monitoring Cardiac output, fluid volumeMonitoring Cardiac output, fluid volume
excessexcess
Improving activity toleranceImproving activity tolerance
Educating patients on the disease processEducating patients on the disease process
and preventative measuresand preventative measures

68. Mitral Valve repair

69. Valve Replacement
Mechanical/BiologicMechanical/Biologic
AntibioticsAntibiotics
Lifelong anticoagulation therapyLifelong anticoagulation therapy
mechanicalmechanical
Good oral hygieneGood oral hygiene
Prevent infectionsPrevent infections

70. V-O-M-I-T
VV= Vital Signs= Vital Signs
OO = Oxygen= Oxygen
MM = Monitor= Monitor
II = IV Access= IV Access
TT = Treatment= Treatment

71. Cardiac Drugs
Diuretics: decrease volume loadDiuretics: decrease volume load
Indications: CHF, HTN, edema, diuresisIndications: CHF, HTN, edema, diuresis
Classifications:Classifications:
ThiazideThiazide: acts on distal tubules: acts on distal tubules
• HCTZ, ZaroxolynHCTZ, Zaroxolyn
• Monitor: BP, Uric Acid, BS, Cholesterol, CNSMonitor: BP, Uric Acid, BS, Cholesterol, CNS
Potassium sparingPotassium sparing: acts on the distal loop: acts on the distal loop
• Spironolactone or AldactoneSpironolactone or Aldactone
• Monitor BP and PotassiumMonitor BP and Potassium
Loop:Loop: act on the Loop of Henleact on the Loop of Henle
• Lasix, BumexLasix, Bumex
• Monitor: BP, Lytes, BS, Uric Acid, Renal FunctionMonitor: BP, Lytes, BS, Uric Acid, Renal Function

72. Beta Blockers
Action: prevents catecholamines from binding with beta cells andAction: prevents catecholamines from binding with beta cells and
forming norephinephrine a potent vasoconstrictor.forming norephinephrine a potent vasoconstrictor.
Desired outcome: lower pulse, decrease CO, lower BP, decreaseDesired outcome: lower pulse, decrease CO, lower BP, decrease
myocardial O2 consumption, decrease contractilitymyocardial O2 consumption, decrease contractility
Monitor: BP, pulse, signs of CHF, CNS, EKG changesMonitor: BP, pulse, signs of CHF, CNS, EKG changes
Beta 1: acts on the heartBeta 1: acts on the heart
Indicated for HTN, MI, angina and CHFIndicated for HTN, MI, angina and CHF
Metoprolol or Lopressor, AtenololMetoprolol or Lopressor, Atenolol
Beta 2: acts on the lungs:Beta 2: acts on the lungs:
Indicated for HTN, angina and arrhythmiasIndicated for HTN, angina and arrhythmias
Propranolol (Inderal), LabetololPropranolol (Inderal), Labetolol

73. Calcium Channel Blockers
Action: inhibits calcium ion influx which inhibitsAction: inhibits calcium ion influx which inhibits
muscle contractionmuscle contraction
Indications: HTN, SVT, angina, MIIndications: HTN, SVT, angina, MI
Monitor: BP, signs of CHF, CNS, EKG, bowel habitsMonitor: BP, signs of CHF, CNS, EKG, bowel habits
Drugs:Drugs:
Nifedipine (Procardia)Nifedipine (Procardia)
Verapamil (Calan)Verapamil (Calan)
Diltiazem (Cardizem)Diltiazem (Cardizem)
Nicardipine (Cardene)Nicardipine (Cardene)

74. Cardiac Glycoside
Action: increases contractility which improves CO andAction: increases contractility which improves CO and
blood flow to the peripheryblood flow to the periphery
Indications: CHF, cardiac arrhythmiasIndications: CHF, cardiac arrhythmias
DrugsDrugs
Digoxin (Lanoxin)Digoxin (Lanoxin)
Amrinone (Inocor)Amrinone (Inocor)
Antidote for Digoxin is DigibindAntidote for Digoxin is Digibind

75. Angiotensin Converting Enzyme Inhibitors (Ace
Inhibitors)
Inhibits conversion of Angiotensin I to Angiotensin II whichInhibits conversion of Angiotensin I to Angiotensin II which
lowers BP and dilates the arteries.lowers BP and dilates the arteries.
Indications: CHF, HTN, MIIndications: CHF, HTN, MI
Side effect: cough from bradykinin breakdown and bitter metalicSide effect: cough from bradykinin breakdown and bitter metalic
tastetaste
Monitor: BP, electrolyes, signs of CHF, renal function andMonitor: BP, electrolyes, signs of CHF, renal function and
hematologic functionhematologic function
DrugsDrugs
Captopril (Capoten)Captopril (Capoten)
Enalapril (Vasotec)Enalapril (Vasotec)
AltaceAltace
Lisinopril (Zestril)Lisinopril (Zestril)
AccuprilAccupril

76. Angiotensin II Blocker
Blocks action of Angiotensin II A potentBlocks action of Angiotensin II A potent
vasoconstrictorvasoconstrictor
Indications: HTNIndications: HTN
Monitor: BP, lytes, signs of CHFMonitor: BP, lytes, signs of CHF
Drugs:Drugs:
CozaarCozaar
DiovanDiovan
AtacandAtacand

77. Alpha 1 Blocker
Action: dilates peripheral blood vesselsAction: dilates peripheral blood vessels
Indications: HTN, CHFIndications: HTN, CHF
Monitor: BP and CNSMonitor: BP and CNS
Drugs:Drugs:
MinipressMinipress
TerazosinTerazosin
CarduraCardura

78. Peripheral Vasodilators
Action: inhibit release of NorephinephrineAction: inhibit release of Norephinephrine
Indication: HTNIndication: HTN
Monitor: BP, syncope, palpitationsMonitor: BP, syncope, palpitations
Drugs:Drugs:
HydralazineHydralazine

79. Centrally Acting Agents
Inhibits sympathetic vasomotor center inInhibits sympathetic vasomotor center in
CNSCNS
Indicated for HTN, drug withdrawlsIndicated for HTN, drug withdrawls
Monitor: BP, HR, signs of CHFMonitor: BP, HR, signs of CHF
DrugDrug
Catapres (Clonidine)Catapres (Clonidine)

80. Code Medications
Epinephrine: 1mg IVP Q3-5min, 2-2.5 x IV dose for ETTEpinephrine: 1mg IVP Q3-5min, 2-2.5 x IV dose for ETT
Medication of choice for all pulseless patientsMedication of choice for all pulseless patients
ActionAction
Makes VF more susceptible to current counter shockMakes VF more susceptible to current counter shock
Increases SVRIncreases SVR
Increases HRIncreases HR
Increases arterial BPIncreases arterial BP
Increases automaticityIncreases automaticity
Increases coronary/cerebral blood flowIncreases coronary/cerebral blood flow
Increases strength of myocardial contractionIncreases strength of myocardial contraction
Increases myocardial O2 consumptionIncreases myocardial O2 consumption

81. Vasopressin
Action: potent vasoconstrictionAction: potent vasoconstriction
Indications: V-Fib, hemodynamic shock support inIndications: V-Fib, hemodynamic shock support in
sepsissepsis
Not for patients with CADNot for patients with CAD
ExpensiveExpensive

82. LIDOCAINE
Action:Action:
Suppression of ventricular arrhythmiasSuppression of ventricular arrhythmias
Decreases automaticityDecreases automaticity
Decreases irritability of ischemic myocardiumDecreases irritability of ischemic myocardium
Indications: ventricular dysrhythmia’sIndications: ventricular dysrhythmia’s
DoseDose
Loading: 1-1.5mg/kg IV Q 5min, then 0.5-0.75mg/kg Q 5-10Loading: 1-1.5mg/kg IV Q 5min, then 0.5-0.75mg/kg Q 5-10
min, total 3 mg/kgmin, total 3 mg/kg
IV drip 1-4 mg/minIV drip 1-4 mg/min
ETT: 2-2.5 X IV doseETT: 2-2.5 X IV dose

83. Amiodarone (Cordarone)
Action: suppression of atrial/ventricularAction: suppression of atrial/ventricular
arrythmias, useful with LVF w/EF <40%, CHFarrythmias, useful with LVF w/EF <40%, CHF
Dose: V-Tach with pulse 150mg/10minDose: V-Tach with pulse 150mg/10min
VFIB/VTACH no pulse: 300mg IVP andVFIB/VTACH no pulse: 300mg IVP and
may repeat 150mg Q 3-5 min not to exceedmay repeat 150mg Q 3-5 min not to exceed
2.2mg/kg in 24 hrs2.2mg/kg in 24 hrs
IV drip: 1mg/min and titrate to ordersIV drip: 1mg/min and titrate to orders
Caution: renal failure, half-life 40 daysCaution: renal failure, half-life 40 days

84. Procainamide
Action: decreases ventricular ectopy, decreased activityAction: decreases ventricular ectopy, decreased activity
of all pacemakers, slows intraventricular conductionof all pacemakers, slows intraventricular conduction
Dose: 20-30 mg/min until suppression of arrhythmiaDose: 20-30 mg/min until suppression of arrhythmia
and then start dripand then start drip
Maximum dose 17mg/kgMaximum dose 17mg/kg
Monitor: BP, heart blocks, lytes, arrhythmiasMonitor: BP, heart blocks, lytes, arrhythmias

85. Adenosine
Action: interupts re-entry pathways through the AVAction: interupts re-entry pathways through the AV
node to restore a sinus rhythmnode to restore a sinus rhythm
Indications: SVT, junctional arrhythmias, WPWIndications: SVT, junctional arrhythmias, WPW
Dose: 6mg rapid IVP, if no conversion in 1-2 minutesDose: 6mg rapid IVP, if no conversion in 1-2 minutes
12 mg rapid IVP, if no conversion in 1-2 minutes12 mg rapid IVP, if no conversion in 1-2 minutes
12 mg rapid IVP12 mg rapid IVP
Caution: periods of asystole, asthmatics can developCaution: periods of asystole, asthmatics can develop
bronchconstriction, blurred vision, facial flushingbronchconstriction, blurred vision, facial flushing

86. Atropine
Action: initiates electrical activity , restores normalAction: initiates electrical activity , restores normal
AV node conduction , increases SA node activityAV node conduction , increases SA node activity
Indications: asystole, PEA, SymptomaticIndications: asystole, PEA, Symptomatic
Bradycardia, Last Resort in 2Bradycardia, Last Resort in 2ndnd
and 3and 3rdrd
Heart BlocksHeart Blocks
Dose: 1mg IVP Q3-5 minDose: 1mg IVP Q3-5 min
ETT: 2-2.5 X IV doseETT: 2-2.5 X IV dose
Bradycardia: 0.5-1mg IVP Q 3-5 minBradycardia: 0.5-1mg IVP Q 3-5 min
Maximum dose 0.3-0.4mg/kgMaximum dose 0.3-0.4mg/kg

87. Dopamine
Action: precursor of norephinephrine,Action: precursor of norephinephrine,
vasoconstrictor, inotropic supportvasoconstrictor, inotropic support
Dose: 5-20 mcg/kg/min and titrate to BPDose: 5-20 mcg/kg/min and titrate to BP
Caution: may cause tachyarrhythmias andCaution: may cause tachyarrhythmias and
tissue necrosis for infiltrationtissue necrosis for infiltration

88. Norepinephrine/levophed
Action: vasoconstriction, increases contractionAction: vasoconstriction, increases contraction
Indications: shock statesIndications: shock states
Dose: 0.5-1 mcg/min IV drip and titrate to BPDose: 0.5-1 mcg/min IV drip and titrate to BP
Caution: increases myocardial O2 consumption,Caution: increases myocardial O2 consumption,
increases risk of arrhythmias, tissue necrosis withincreases risk of arrhythmias, tissue necrosis with
infiltrationinfiltration

89. Calcium Chloride
Action: increases calcium levels which improvesAction: increases calcium levels which improves
contractility. Decreases potassium and magnesiumcontractility. Decreases potassium and magnesium
levels.levels.
Indications: calcium channel blocker toxicityIndications: calcium channel blocker toxicity
Dose: 2-4mg/kg of 10% solution for arrestsDose: 2-4mg/kg of 10% solution for arrests
8-16 mg/kg of 10% solution for severe elevation in8-16 mg/kg of 10% solution for severe elevation in
potassium and calcium channel blocker ODpotassium and calcium channel blocker OD

90. Sodium Bicarbonate
Action: buffers acidosisAction: buffers acidosis
Indications: counters increased potassium,Indications: counters increased potassium,
counters tricyclic and phenobarbital overdosescounters tricyclic and phenobarbital overdoses
Dose: 1meq/kg IVP according to ABGDose: 1meq/kg IVP according to ABG
Half the dose if ABG is not availableHalf the dose if ABG is not available