Cardiac

Question 1

Overview

Answer 1

• QRS depolarization always refers to ventricular
• P wave refers to atrial
• Asystole is a lack of QRS depolarizations
• Bizarre (tachycardia)
• Chaotic (fibrillation)
• Sawtooth (flutter)

Question 2

PVC

Answer 2

• Periodic wide, bizarre QRSs
• Be concerned if:
  
  • More than 6 per minute
  • 6 in a row
  • PVC falls on T-wave of the previous beat
• Treatment
  
  • Lidocaine
  • Amiodarone

Question 3

Lethal arrhythmias

Answer 3

• Asystole
• Ventricular fibrillation

Question 4

Potentially life-threatening arrhythmias

Answer 4

• V-Tach
• A-Fib
• A-Flutter

Question 5

Adenosine

Answer 5

• Only cardiac IV drug pushed quickly
  
  • Can cause patient to go into asystole

Question 6

V-Tach

Answer 6

• Wide bizarre QRS
• Treatment
  
  • Lidocaine
  • Amiodare

Question 7

Supraventricular (Atrial) Arrhythmias

Answer 7

• Treatment
  
  • “ABCD”
    
    • Adenocard (Adenosine)
    • Beta blocker
    • Calcium channel blocker
    • Digitalis/ Digoxin (lanoxin)

Question 8

V-Fib

Answer 8

• Treatment
  
  • Defib

Question 9

Asystole

Answer 9

• Treatment
  
  • Give epi first, then atropine

Question 10

Angina vs. MI

Answer 10

• Angina
  
  • Decreased blood supply to myocardium, resulting in ischemia and pain
  • S/S
    
    • crushing substernal chest pain that may radiate
  • Treatment
    
    • Nitroglycerine (3 tablets q5 minutes)
      
      • if no relief, call MD
      • Sublingual
      • Dilates coronary arteries and reduces preload
      • S/E
        
        • htn and headache
• MI
  
  • pain not relieved by nitro and rest

Question 11

CHF

Answer 11

• Overview
  
  • When failure, compensates by
    
    • Ventricular hypertrophy
    • Dilatation
    • Tachycardia
  • Decompensation means compensatory mechanisms not working
• Left-sided
  
  • usually comes first
• Right-sided (right ventricle has decompensated)
  
  • s/s
    
    • dependent edema
    • JVD
    • Abdominal distention
    • Hepatomegaly
    • Splenomegaly
    • Anorexia and nausea
    • Weight gain
    • Nocturnal diuresis
    • Swelling of fingers/hands
    • Increased BP
• Treatment
  
  • Diuretics
  • Vasodilators
  • Digitalis
    
    • Do not give if apical pulse is below 60 in adults, 70 in children
• Interventions
  
  • Strict bed rest
  • Use TED hose
    
    • put on before getting out of bed
  • never massage calves
  • Should have a foley
  • Report weight gain of >3 lbs in a week
• Complications
  
  • PE