121- Exam 3 Flashcards
What are 6 Treatments for Sleep Apnea?
Whats the #1 Treatment
1= CPAP
- Weight Reduction
- Sleep Position
- O2 Therapy
- Drug Therapy
- Protriptyline Hydrochloride to reduce REM sleep
- CPAP or BiPAP
What are the 3 Types of Sleep Apnea and their characteristics?
- Obstructive= Most Common. Obstruction of the airway. Pt appears to hold breath
- Central= No Airflow or Chest movement. Brain stops sending signal to Resp. Muscles. Brain Spinal injuries, Neuromuscular disorders
- Mixed= Combination of both. Presents as Central followed by Obstructive
8 Respiratory Events watched in a sleep study (polysomnography)
- Apneas
- Apnea Index
- Hypopneas
- Hypopnea Index
- Hypopnea + Apnea
- AHI (Apnea+Hypopnea Index)
- MEAN SPO2
- Irregular Breathing pattern
8 Indications for a Sleep Study (polysomnography)
- COPD with awake PAO2 <55
- Pulmonary Hypertension
- Right Heart Failure
- Polycythemia
- Excessive Daytime sleepiness
- Disturbances in Resp Control PACO2 <45
- Disturbed Sleep
- Morning Headaches
10 Things monitored during a sleep study (polysomnography)
- EEG= Brain Activity
- EOG= Eye Movement
- EMG= Muscle Movement
- ECG= Heart Rhythm/Rate
- Airflow in/out of lungs
- Ventilatory rate/effort
- Oximetry
- Breathing Effort
- Chest/Abdomen movement
- Audio/Video recording
What are the 5 stages of Sleep and how are they split?
Non-REM Sleep 1-4
1. Falling Asleep (easily awakened)
2. Deeper than 1 (N1 2-5% sleep)
3. Deeper than 2 Most sleep (N2 45-55%)
4. Deepest (N3 15-20%)
REM Sleep Stage 5
5. REM= Muscles can’t move, dreaming (REM 20-25%)
What is a doppler Echo detecting?
Speed and direction of blood flow in the heart
Echocardiogram TTE vs TEE
TTE= Transthoracic (Most common) (Through the Thorax, non invasive)
TEE= Transesophageal (through esophagus, invasive)
What is an echocardiogram?
Ultrasound of the heart
What does an echocardiogram examine?
Structures and functions of the heart
7 reasons we do echocardiograms?
- Look for blood clots
- Fluid around the heart
- Aorta Issues
- Cardiomyopathy
- Pulmonary Hypertension
- Septal Defects (ASD vs VSD
- Valve issues
5 Types of echocardiograms?
- TTE
- TEE
- Stress
- Doppler
- Bubble
Pulseless Electrical Activity (PEA)
What does it look like on EKG Strip?
Is it Shockable?
Has Normal Rhythm but there is no Pulse. It is electrical activity in the heart with no functioning muscle
NOT Shockable as there is no electricity to shock. DO CPR
Asystole
What does it look like on an EKG Strip?
Is it Schockable?
Flatline
NOT Shockable as there is no electricity in the heart. DO CPR
Atrial Flutter (A-Flutter)
Rate?
Rhythm?
CLUE to detect?
Atrial Rate 250-300 bpm
P-wave is irregular
CLUE= Saw Tooth P Waves
Atrial Fibrillation (A-FIB)
Rate?
Rhythm?
CLUE to detect?
> 400 atrial bpm (uncountable)
Wavy, erratic baseline (squiggles)
CLUE= QRS complex is irregular timing
Ventricular Fibrillation (V-FIB)
What does it look like on EKG?
Rhythm?
Shockable?
No solid looking QRS Complex. Fluttering or quivering of the ventricles. Bunch of short unorganized squiggly lines
YES Shockable= Emergent
Ventricular Tachycardia (V-TACH)
What does it look like on EKG?
Rhythm?
Shockable?
tall, regular rhythm, no QRS complexes, looks like even hills
YES Shockable=Emergent
Premature Ventricule Complex (PVC)
Multifocal Vs. Unifocal
What do they look like?
Impulses sent from somewhere other than SA Node (Atria). NO P Wave. Starts in the ventricles.
Multifocal= QRS do no match, they can be up or down, are irregular meaning the signal is coming from multi locations in ventricles
Unifocal= QRS do match, so signal is coming from the same spot
Sinus Tachycardia
Rate?
Rhythm?
Fast HR
>100 BPM
Regular Rhythm
Sinus Bradycardia
Rate?
Rhythm?
Slow HR
<60 BPM
Regular Rhythm
What is an EKG artifact?
irregular squiggles close together on EKG strip due to movement, shivering, loose electrodes or warn out leads
What does QT Interval Include and what is it?
Begins at the START of Q ends at the end of T
Measure depolarization & Repolarization of ventricles
What does the ST segment include and what is it?
Begins at END of S to Beginning of T
Ventricles preparing to repolarize