Cardiac Emergencies 3 Flashcards
treatment of junctional and heart block
- atropine for junctional and first degree only
- pacemkaer if no response to meds
- dopamine or epi IV if 2nd or 3rd degree for symptomatic brady
what are the doses for atropine if brady
3 doses at 3-5 min apart, then pacemaker, then dopamine
treatment for V fib
- CPR, ACLS protocol
- DEFIB
- ICD
early signs of HF
- dyspnea
- orthopnea
- fatigue
- nonproductive cough
describe right sided HF
- diastolic HF
- r/t rest of body, ascites
- r/t fluid
- increase in preload (amount that stays in R side of heart, end diastolic volume)
- affected by back flow of heart into R side
signs of R sided HF
-JVD
-hepatomegaly
-RUQ pain
-anorexia
-nausea
-nocturia
-pitting edema
-ascites
S3
EF is lower in….
L sided HF
how is R sided HF treated
-diuretics (lasix and bumex)
(bumetatide works on abdomen)
(useful as tend to hold fluid in abdomen)
describe L sided HF
- systolic HF
- pulmonary (LUNGS)
- low ejection fraction (normal is 60-70%)
- EF becomes 20-30% with L HF (once < 20%, very serious signs)
signs of L sided HF
- crackles
- hemophysis
- displaced PMI
- tachycardia
- S3 and S4
- confusion
- cyanosis
- SOB
diagnostics for HF
- CXR
- EKG for dysrhythmias
- labs: liver enzyme, BUN, CR, BNP
- ECHO (EF and wall size)
- ABGs
once EF is <20%…
you have BOTH systolic and diastolic BP
treatment of both L and R HF
1) ACE inhibitors/ARB, aldosterone (work on renin, blockes angio tensin 2, vasoconstrict)
2) CCB (amlodipine)-vasodilate
BB (Carrvedolol, COrreg): decrease workload, good for A Fib and decrease HR
HF progression
1) L sided starts t/t chronic HTN (narrow vessels) or MI
2) L ventricle has to push harder to get blood out
3) afterload increases (systolic BP)
4) L ventricle enlarges, compensates for push needed to get blood out (eventually muscle cannot stretch anymore)
5) blood starts to backflow into L atrium and pulmonary veins
6) fluid backs up in lungs (pulmonary s/s)
7) lungs then put pressure on R ventricle (pulmonary arteries)
8) R side fills up with fluid, increase pressure and affects preload (diastolic BP)
what is BNP
- brain naturetic peptide
- elevated when heart is enlarged
- normal is < 100
- may be in 1000s
- as EF decreases, brain thinks needs more Na and H2O so increases BNP
treatment for HF
- sit upright, give O2, monitor HR and pulse Ox
- diuretics: lasix or bumex IV
- ACE inhibitors, BB, digoxin if needed
- NOAC: non vitamin K, oral anticoagulants
- Natrector
what are NOACs
- dabigatron (pradaxa)
- rivaroxaban (xaralto)
- apixaban (eliquis)
what is natrector for
for elevated BNP or Milrione inotrope increases push
if pulmonary edema fills up quickly give..
diuretics
nitrates
morphine
O2
describe HTN crisis
- BP too high (ie/ 200/100)
- causes: not taking meds, CVA, autonomic dysreflexia, cushings
signs of HTN crisis
- throbbing headache
- V
- irritability
- confusion
- blurred vision
- SOB
- angina
- S4
- *retinopathy with retinal hemorrhages
what is important to remember about HTN crisis
- need to bring BP down but not too dramatically
- will become unconscious if too much fluid is pulled from the brain too fast
if retinopathy with retinal hemorrhages..
go go ER!
will strok or MI
what to do for HTN crisis:
- decrease BP with IV meds
- monitor HR and ABGs
- transfer to acute unit, initiate an arterial line for BP monitoring
- reduce BP by no more than 25% of MAP over the first 2 hrs (drop NP slowly over 4 hrs, once systolic is 130 stop)
signs of aortic aneurysm
- severe substernal pain, radiates to neck, back, andomen, or shoulder
- hoarseness/cough
- difficulty swallowing
- difficulty breathing
- unequal BP in both arms
- aortic murmur
meds for HTN crisis
- Nitroprusside IV, titrate slowly or Nitro
- Labetalol
- Hydralazine
aortic aneurysm if ruptures…
- monitor BP, rhythm, pulse Ox
- get ABGs, labs for CBC and coag
- need 2 large IV sites
- give IV fluid bolus and blood replacement
- initiate art line, foley, and get pt to surgery
- IV nitro to keep BP down and decrease chest pain
- IV BB to decrease workload on heart
aortic aneurysm diagnosis
- ECHO
- angiogram
if aortic aneurysm ruptures..
need help immediately, may have rapid decrease in BP (need surgery)
