Master recap: the cardiac card, the ten-minute drill, and where to go next

THE CARDIAC CARD

Band one · The three levers

• ☐ Preload the volume that arrives. Lose it and pressure falls in the patient who depends on filling.
• ☐ Afterload the resistance to push against. Raise it and demand climbs while forward flow does not.
• ☐ Contractility and time the squeeze and the diastolic window. Beat too fast and the heart fills poorly and feeds itself poorly.

Band two · Sixteen rhythms, three-word priority

• ☐ Sinus tachycardia — treat the cause
• ☐ Atrial fibrillation with rapid response — assess perfusion, onset
• ☐ Atrial flutter — count ventricular rate
• ☐ Supraventricular tachycardia — vagal if stable
• ☐ Premature ventricular contractions — check potassium, magnesium
• ☐ Monomorphic ventricular tachycardia — check the pulse
• ☐ Torsades de pointes — magnesium, review medications
• ☐ Ventricular fibrillation — compressions, then shock
• ☐ Pulseless ventricular tachycardia — compressions, then shock
• ☐ Pulseless electrical activity — compressions, no shock
• ☐ Asystole — confirm, compressions, no shock
• ☐ Sinus bradycardia — treat the symptoms
• ☐ Junctional rhythm — review the digoxin
• ☐ First-degree block — monitor and document
• ☐ Mobitz type I — monitor, usually benign
• ☐ Mobitz type II and complete block — pads on, pace

Band three · Four valve lesions

• ☐ Aortic stenosis — systolic, right second space to the carotids; angina, syncope, dyspnea.
• ☐ Mitral regurgitation — holosystolic at the apex to the axilla; fatigue and pulmonary congestion.
• ☐ Mitral stenosis — diastolic rumble at the apex; atrial fibrillation and hemoptysis.
• ☐ Aortic regurgitation — early diastolic at the left sternal border; wide pulse pressure, bounding pulses.

Band four · Four post-procedure watches

• ☐ Catheterization site, distal pulses, back or flank pain with a falling pressure.
• ☐ Bypass chest tube output and sudden cessation, new atrial fibrillation, sternal precautions.
• ☐ Pacemaker arm restriction, hiccups or chest twitching, spike answered by a complex.
• ☐ Implanted defibrillator one shock is a call, more than one is an ambulance.

THE TEN-MINUTE DRILL

• ☐ 2 minutes · levers. Say each lever and one clinical consequence. Self-score: ___ / 3
• ☐ 4 minutes · rhythms. Cover band two and say the priority from the name alone. Self-score: ___ / 16
• ☐ 2 minutes · traps. State all three without looking. Self-score: ___ / 3
• ☐ 2 minutes · limbs. Arterial versus venous position and prohibition. Self-score: ___ / 4

THE THREE TRAPS

• ☐ Nitrate given in right ventricular infarction drops filling.
• ☐ Compression applied to an arterial limb worsens ischemia.
• ☐ Paced screen accepted without a wrist pulse check.

Watch outeach of the three traps above is a reasonable-looking action that harms the patient. Reasonableness is the disguise.

Cross-links: → BOOK 07 · P4 values · → BOOK 06 · P6 infusion math · → BOOK 05 · P3 drug classes · → BOOK 09 · P9 shock · → BOOK 03 · P5 priority frameworks · → BOOK 16 · P3 countdown

Margin noteif you only get one page, get this one.

Takeawayevery rhythm on this card resolves into one action, and if you cannot name the action you do not yet know the rhythm.