acid/base, afib, CAD, HIV Flashcards
winter’s formula and interpretation
pC02= (HCO3 x 1.5) +8 +/- 2
if CO2 higher than the range, then there’s primary resp acidosis.
if within that range, there’s a compensation.
if below, then primary resp alkalosis
5 steps for acid base problems
1) acidosis or alkalosis? look at pH. make sure pH is correct with this formula: H+= 24 (pCO2/HCO3)
2) resp or metabolic?
3) compensation
4) anion gap?
5)if anion gap, does change in AG=change in HCO3
if not, explain excess loss of HCO3
compensation rules: metabolic acidosis
winter’s formula
compensation: resp acidosis
ACUTE: pH drops by 0.08 units and HCO3 increases by 1 mEq/L per 10 mmHg increase in PaCO2 (up to a
PaCO2 of 70)
CHRONIC: pH drops by 0.03 units and HCO3 increases by 3-4 mEq/L per 10 mmHg increase in PaCO2 (up
to a PaCO2 of 70)
In general, if the HCO3 is above 30, look for a second process (chronic respiratory acidosis, concomitant
metabolic alkalosis).
do most patients with asthma attack have resp acidosis or alkalosis
resp alkalosis
when to usually get an ABG?
no history, metnal status changes
theyre on a vent
if #s in BMP dont make sense with diagnosis
CHADSVASc score
C-CHF H-HTN A- age (>65-1, >75-2) D- DM S-Stroke (2) V-vascular dz (MI, aortic atheroma, PVD) S-sex (female-1)
chadsvasc score point system
> 2- anticoagulate
1-2- consider anticoagulation or aspirin
0-aspirin or none
rate control drugs
*beta blockers
*CCB- diltiazem, verpapamil
digoxin- adjunct
amiodarone- if others failed
rhythm control drugs
class 1C (flecainamide and propafenone)
class 3- amiodarone, sotalol, dofetilide
what can you do before cardioversion to prevent someone getting stroke if they have a preformed clot?
3-4 weeks of anticoagulation
or TEE
rate or rhythm control for asymptomatic afib?
rate control drugs
management for unstable afib
synchronized cardioversion
management fot stable afib
- rate control
- evaluate need for anticoagulation (chads2vasc)
- rhythm control (pharm or pacemaker)
contraindications to cardioversion
hypokalemia
digitalis toxicity
ablation of afib is for paroxysmal or chronic afib?
paroxysmal
bruit is what?
turbulent flow from atherosclerosis
S4
atrial contraction against stiff heart at end of diastole
WHO’s definition of MI
need 2/3:
- biomarkers
- EKG changes
- clinical hx of substernal chest pain
what time frame can you get thrombolytic therapy vs angioplasty in acute MI
thrombolytic- within 30 min
angioplasty- within 90 min
indications for CABG
50% stenosis of left main artery
3 main vessels involved with reduced EF
medications to give during acute MI
beta blocker
aspirin
nitroglycerin
heparin
what meds to give someone on discharge after MI
beta blocker
aspirin
ACEI
statin
what age to test for HIV once?
13-64
