cardiac Flashcards
equation for cardiac output
CO = HR x SV
How often is GTN tablets administered?
5/60, unless the onset of side effects or titrated to pain
outline Management of Acute coronary syndrome
12 Lead ECG - Transmit if STEMI (mica if STEMI)
300mg aspirin
if have pain SBP >110mmHg 600mcg (prev. admin) 300mcg (no prev. admin) repeat 5/60, titrating to pain/side effects
SBP >90mmHg
GTN patch 50mg (0.4mg per hour)
IV access
Pain relief
antiemetic
Define acute coronary syndrome (ACS
ACS is a broad term, used to cover a spectrum of conditions such as STEMI, NSTEMI, unstable angina, leading to the narrowing and occlusion of coronary arteries
risk factors of Acute coronary syndrome
- Age
- Gender
- Ethnicity
- Hypertension
- High cholesterol
- Diabetes
- Family History
- Sedentary lifestyle
- Obesity
- Smoking
Signs & symptoms of Acute coronary syndrome
- Pain - chest, back, shoulder, jaw, epigastric
- Shortness of Breath
- Diaphoresis
- Anxiety
- Lightheaded
- Fatigue
- Near/fainting
- ECG changes
- Nausea
- Vomiting
- Dizziness
Define Atherosclerosis
Atherosclerosis is defined as the thickening/ hardening of vessel walls, with the accumulation of lipid laden layer, impeding blood flow
contraindications for CPAP
GCS <13 Facial trauma Pt requiring airway management Actively vomiting Hypoventilation Life threatening arrhythmias Pneumothorax
Management of SVT
Reassurance
12 lead ECG
Stable: Valsalva/modified 3 times 2/60, max 2 attempts
Unstable: adenosine/cardioversion
IV access
Pain relief, antiemetic, fluid Mx if hypotensive
IV should be placed as far up the arm as possible.
Signs of deteriorating SVT
Less than adequate perfusion/shock
APO
Ischaemic chest pain
ACS/collapse
Bradycardia criteria
Heart rate less than 40BPM & APO
Heart rate <20Bpm
Runs of PVCs or VT
less than adequate perfusion
Mx of bradycardia
Reassurance 12 lead ECG Request mica IV access symptomatic relief - hypotensive/pain/antiemetic
Criteria for SVT
Rate: >100bpm Rhythm: Regular P wave: not discernible P-R interval: not discernible QRS: present, upright, less than 0.12secs
management of Pulmonary oedema
Reassure
Position; upright
Oxygen if SPo2 less than 92%
SOB with crackles
SBP >110mmHg GTN 300 or 600mcg repeat 5/60 titrate to side effects/symptoms
SBP >90mmHg GTN patch 50mg (0.4mg/hr)
Full field crackles/no improvement
CPAP
cardiogenic VS non-cardiogenic Pulmonary oedema
cardiogenic is cause secondary to LVF or CCF or other cardiac cause
non-cardiogenic is cause by altered permeability
Smoke inhalation
toxic gases
anaphylaxis
sepsis
near drowning/aspiration
What some differential diagnosises for chest pain?
Pe Percarditis Chest infection Cardiac tampons Arotic aneurysms Endocarditis Pericardial effusion Anxiety GORD Asthma Trauma Oesophageal rupture
If a cardiac muscle cells dies, what does it release?
Myosin
Actin which has tropinon on it and around it creating CK-Mb which are essential for engery transfer
When cells dies, it release tropinon and CKMB into the bloodstream, measured to see if necrosis has occurred
Trops rise rapidly, lasting up to 8 days, peaks day 2
Ckmb, rises but drops faster
What are the cardiac markers looked for in MI?
Myoglobin - peaks 4-6 hrs, found in both heart and skeletal muscles, can be unreliable
Ck-MB (creatine kinaesthetic MB isoenzyme)- primarily occurs after myocardial necrosis, usually show after 4hrs after 4 hours unreliable as if pt having a stemi, most damage has already occurred
Troponin, remains elevate 5-14days, myocardial specific, 3 subunits, but troponin T and 1 helps clearly indicate whether skeletal or myocardial tissue is involved
Order of peak myoglobin, combined, trops
What ECG changes are common in STEMi?
St elevation Greater than 1square or 0.1mv, above j point, peaked T waves in 2 or more contiguous leads
What ECG changes are common in NStemi?
St depression of 0.1mv below j point or biphasic/ inverted T waves in 2 or more leads
