1

Content 1 min

Cardiovascular Critical Care II Patrick M. Wieruszewski, Pharm.D., BCCCP, FCCM Mayo Clinic College of Medicine Mayo Clinic Rochester, Minnesota…

2

Content 1 min

Cardiovascular Critical Care II Cardiovascular Critical Care II Patrick M. Wieruszewski, Pharm.D., BCCCP, FCCM Mayo Clinic College of Medicine Mayo Clinic Rochester, Minnesota…

3

Learning Objectives 3 min

Cardiovascular Critical Care II Learning Objectives 1. Manage cardiac arrest from the initiation of basic life support to the use of post–cardiac arrest care. 2. List the indications and special co…

4

Content 3 min

Cardiovascular Critical Care II 4. T.B. has return of spontaneous circulation (ROSC) after 15 minutes of total resuscitation. The team is deciding whether temperature control would be appropriate…

5

Exam Content Outline 1 min

Cardiovascular Critical Care II BPS Critical Care Pharmacy Examination Content Outline This chapter covers the following sections of the Critical Care Pharmacy Examination Content Outline: 1. Domain…

6

Content 3 min

Cardiovascular Critical Care II I.  ADVANCED ADULT CARDIAC LIFE SUPPORT A. Background 1. Foundation of advanced cardiac life support (ACLS) is effective and timely basic life support (BLS). 2. Sudd…

7

Content 3 min

Cardiovascular Critical Care II iv. All patients with SCA should receive chest compressions (Acta Anaesthesiol Scand 2008; 52:914-9). v. Place patient on a hard surface, use backboard (unless it wi…

8

Data Tables 3 min

Cardiovascular Critical Care II xi. The use of extracorporeal CPR is emerging as a therapy for those who fail conventional CPR. The current data seems promising in benefiting neurologic outcomes but…

9

Content 4 min

Cardiovascular Critical Care II ii. Cricoid pressure is the technique of applying pressure to the patient’s cricoid cartilage to push the trachea posteriorly and compress the esophagus with the goal…

10

Content 3 min

Cardiovascular Critical Care II (c) Continuous chest compressions with asynchronous ventilation compared with chest compressions with interruptions for synchronous ventilation have not demonstrated…

11

Content 3 min

Cardiovascular Critical Care II Patient Case 2. L.S. is a 66-year-old woman visiting her husband at the hospital on the hospice unit. She is buying lunch in the cafeteria, and while in line to check…

12

Content 2 min

Cardiovascular Critical Care II ii. CPR should be initiated immediately, with shock delivery as soon as possible. iii. One-shock biphasic (bidirectional) shock protocols are better than or equivalen…

13

Content 3 min

Cardiovascular Critical Care II Patient Case 3. T.V. is a 72-year-old man with a history of chronic liver disease, hypoglycemia, and atrial fibrillation. He was admitted to the medical intensive car…

14

Content 3 min

Cardiovascular Critical Care II iv. During chest compressions, air is forcefully expelled from the chest, and oxygen is drawn into the chest by passive recoil. Because the ventilation requirements a…

15

Content 3 min

Cardiovascular Critical Care II (a) Physical assessments include visually inspecting chest rise bilaterally and listening to the epigastrium (breath sounds should be absent) and lung fields (should…

16

Content 1 min

Cardiovascular Critical Care II 2. Management of cardiac arrest a. Background i. Cardiac arrest can be caused by four primary “rhythms”: VF, pVT, PEA, and asystole. ii. These rhythms can also be c…

17

Data Tables 2 min

Cardiovascular Critical Care II iii. Survival requires both BLS and ACLS. Foundation of ACLS is high-quality BLS. In addition to CPR, the only proven rhythm-specific therapy that increases survival…

18

Content 3 min

Cardiovascular Critical Care II b. Medication background (rhythm independent considerations) i. Goal: Increase myocardial blood flow during CPR and help achieve ROSC ii. Drug delivery (a) Central…

19

Content 3 min

Cardiovascular Critical Care II Patient Case 5. M.G., a 58-year-old woman with a history of chronic osteoarthritis and peptic ulcer disease, is admitted to the MICU with hypovolemic shock caused by…

20

Content 3 min

Cardiovascular Critical Care II d. Medication therapy for VF/pVT i. Previous guidelines suggested medication consideration after one shock and 2 minutes of CPR (one cycle). Data from witnessed OHCA…

21

Content 1 min

Cardiovascular Critical Care II Figure 1. Adult cardiac arrest algorithm. CPR = cardiopulmonary resuscitation; IO = intraosseous(ly); IV = intravenous(ly); PEA = pulseless electrical activity; PETCO2…

22

Content 3 min

Cardiovascular Critical Care II (e) Prehospital methylprednisolone in primarily shockable rhythms was studied in a phase II study and demonstrated significant reductions in inflammatory markers asso…

23

Data Tables 3 min

Cardiovascular Critical Care II Table 3. Medications Used During Sudden Cardiac Arrest Medication Primary Mechanism of Action in Cardiac Arrest Dosage, Route, Frequency Clinical Benefits Epinephrin…

24

Content 3 min

Cardiovascular Critical Care II (2) Recommended for all non-shockable rhythms to administer epinephrine as soon as feasible (Circulation 2015;132(suppl 2):S315-S367). Data analyses suggest that prom…

25

Content 3 min

Cardiovascular Critical Care II (4) Producing excess CO2 through rapid dissociation, which can freely diffuse intracellularly (e.g., myocardial and cerebral cells) and cause intracellular acidosis…

26

Content 3 min

Cardiovascular Critical Care II (b) Human retrospective data from IHCA demonstrated that dextrose administration during resuscitation was associated with a significantly decreased chance of survival…

27

Content 3 min

Cardiovascular Critical Care II ii. Early evidence suggested significant benefit for primarily shockable (VF/pVT) OHCA (N Engl J Med 2002;346:549-56; N Engl J Med 2002;346:557-63; Circulation 2010;1…

28

Data Tables 3 min

Cardiovascular Critical Care II (e) Axillary or oral temperature monitoring is inadequate for temperature control (Acta Anaesthesiol Scand 1998;42:1222-6; J Cardiothorac Vasc Anesth 1996;10:336-41),…

29

Data Tables 2 min

Cardiovascular Critical Care II Neurologic (Circulation 2010;122:S729-767; Circulation 2008;118:2452-83; Pharmacotherapy 2008;28:102-11; Ther Hypothermia Temp Manag 2016;6:189-93) Sedation and A…

30

Data Tables 3 min

Cardiovascular Critical Care II Endocrinologic (N Engl J Med 2002;346:557-63; Endocrinology 1970;87:750-5) Hyperglycemia caused by decreased insulin production and effect in periphery, increased g…

31

Data Tables 2 min

Cardiovascular Critical Care II iii. Emergent coronary angiography is no longer recommended over a delayed/selective strategy in patients with ROSC after cardiac arrest. Exceptions exist for patient…

32

Data Tables 3 min

Cardiovascular Critical Care II Medication Typical Dosing Range (mcg/kg/min) Clinical Pearls Dopamine 2–20 In general, dose-related receptor activity: 2–5 mcg/kg/min dopamine receptor, 5–10 mcg/kg/mi…

33

Content 2 min

Cardiovascular Critical Care II (c) For patients with ictal-interictal continuum patterns on electroencephalography can be given nonsedating antiseizure medications (i.e., non-benzodiazepine). iv.…

34

Data Tables 3 min

Cardiovascular Critical Care II Patient Case 6. K.G., a 71-year-old woman with a history of atrial fibrillation, coronary artery disease status post three-vessel coronary bypass artery grafting 6 ye…

35

Data Tables 2 min

Cardiovascular Critical Care II 3. Withdrawal syndromes (e.g., clonidine or β-antagonists) 4. Drug-drug/drug-food interactions (e.g., monoamine oxidase inhibitors and tricyclic antidepressants, ant…

36

Data Tables 3 min

Cardiovascular Critical Care II (c) Treatment should occur only if (1) thrombolytic therapy is required (goal SBP less than 185 mm Hg and DBP less than 110 mm Hg before thrombolysis initiation - has…

37

Data Tables 2 min

Cardiovascular Critical Care II Table 9. Medications Used in Hypertensive Emergencies Medication Usual Dosing Range Onset Duration Preload Afterload Cardiac Output Nitroprusside IV 0.25–10 mcg/kg/min…

38

Data Tables 2 min

Cardiovascular Critical Care II Table 10. Indications and Special Considerations for Medications Used for Hypertensive Emergencies Medication Indication Special Consideration Nitroprusside Most indica…

39

Data Tables 2 min

Cardiovascular Critical Care II Medication Indication Special Consideration Enalaprilat Acute left ventricular failure Contraindicated in pregnancy acute myocardial infarction, unstented bilateral r…

40

Content 3 min

Cardiovascular Critical Care II (6) Eclampsia: new-onset tonic-clonic, focal, or multifocal seizures in the absence of other causative conditions often associated (but not required) with hypertensio…

41

Content 3 min

Cardiovascular Critical Care II (c) In the intracerebral hemorrhage population, decreased BPV has been correlated with improved early neurological function (Eur J Neurol 2013;20:1277-83), favorable…

42

Content 3 min

Cardiovascular Critical Care II REFERENCES Abazi L, Awad A, Nordberg P, et al. Long-term survival in out-of-hospital cardiac arrest patients treated with tar- geted temperature control at 33°C or 36…

43

Content 3 min

Cardiovascular Critical Care II Arpino PA, Greer DM. Practical pharmacologic aspects of therapeutic hypothermia after cardiac arrest.  Pharmacotherapy. 2008;28(1):102-111. https:// doi.org/10.1592/p…

44

Content 3 min

Cardiovascular Critical Care II Bougouin W, Dumas F, Karam N, et al. Should we per- form an immediate coronary angiogram in all patients after cardiac arrest?: insights from a large French regis- try…

45

Content 3 min

Cardiovascular Critical Care II Dörges V, Ocker H, Hagelberg S, Wenzel V, Schmucker P. Optimisation of tidal volumes given with self-inflatable bags without additional oxygen.  Resuscitation. 2000…

46

Content 3 min

Cardiovascular Critical Care II controlled trials.  Crit Care Med. 2024;52(2):e89-e99. https://doi.org/10.1097/ccm.0000000000006112 Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenan…

47

Content 3 min

Cardiovascular Critical Care II arrest patients in Sweden. Resuscitation. 2000;47(1):59- 70. https://doi.org/10.1016/s0300-9572(00)00199-4 Holmberg MJ, Issa MS, Moskowitz A, et al. Vasopressors durin…

48

Content 3 min

Cardiovascular Critical Care II Med. 2016;34(2):225-229. https://doi.org/10.1016/j. ajem.2015.10.037 Kim YM, Youn CS, Kim SH, et al. Adverse events asso- ciated with poor neurological outcome durin…

49

Content 3 min

Cardiovascular Critical Care II volunteers. Anesthesiology. 2009;111(1):110-115. https:// doi.org/10.1097/aln.0b013e3181a979a3 Levy DE, Caronna JJ, Singer BH, Lapinski RH, Frydman H, Plum F. Predict…

50

Content 3 min

Cardiovascular Critical Care II postcardiac arrest patients.  Ther Hypothermia Temp Manag. 2016;6(4):189-193. https://doi.org/10.1089/ ther.2016.0009 Nakakimura K, Fleischer JE, Drummond JC, et al…

51

Content 3 min

Cardiovascular Critical Care II cardiopulmonary resuscitation and emergency cardio- vascular care.  Circulation. 2019;140(24):e881-e894. https://doi.org/10.1161/cir.0000000000000732 Paradis NA, Mart…

52

Content 3 min

Cardiovascular Critical Care II Rea TD, Helbock M, Perry S, et al. Increasing use of cardiopulmonary resuscitation during out-of-hospital ventricular fibrillation arrest: survival implications of g…

53

Content 3 min

Cardiovascular Critical Care II Spindelboeck W, Schindler O, Moser A, et al. Increasing arterial oxygen partial pressure during cardiopulmonary resuscitation is associated with improved rates of hos…

54

Content 3 min

Cardiovascular Critical Care II interventions: a logistic regression survival model.  Circulation. 1997;96(10):3308-3313. https://doi. org/10.1161/01.cir.96.10.3308 Vallentin MF, Granfeldt A, Meil…

55

Content 1 min

Cardiovascular Critical Care II outcome.  Arch Intern Med. 2001;161(16):2007-2012. https://doi.org/10.1001/archinte.161.16.2007 Zeiner A, Sunder-Plassmann G, Sterz F, et al. The effect of mild ther…

56

Answers & Explanations 4 min

Cardiovascular Critical Care II ANSWERS AND EXPLANATIONS TO PATIENT CASES 1. Answer: B Because rescuer fatigue is common and may lead to inadequate compression quality, it is recommended to change…

57

Content 4 min

Cardiovascular Critical Care II patients for whom the information is unknown, clinical evaluation and attainment of information should occur, when possible. This retrieval of information, together…

58

Self-Assessment 4 min

Cardiovascular Critical Care II ANSWERS AND EXPLANATIONS TO SELF-ASSESSMENT QUESTIONS 1. Answer: C The largest portion of adult cardiac arrests are caused by cardiovascular, not respiratory, events…

59

Content 2 min

Cardiovascular Critical Care II B is incorrect). This patient’s D-dimer is normal as well, but even if it were elevated, this is not a specific marker of target organ damage (Answer D is incorrect).…

No pages match your search