Cardiac Emergencies 4 Flashcards
1
Q
what is cardiac tamponade and the signs
A
- post OHS, blood accumulates in pericardial sac
- heart stops pumping and blood backs up
- *beck’s triad
1) elevated CVP with JVD
2) muffled heart sounds
3) decrease in systolic BP
2
Q
treatment of cardiac tamponade
A
- monitor rhythm, initiate PA and art line
- get ABGs, give O2, possible intubation
- fluid bolus, IV dobutamine (watch for decrease in BP and increase in dyspnea)
- surgery for pericardiocentesis or pericardial window
3
Q
describe pericarditis
A
- inflammation of pericardium
- r/t infectious process, bacterial, viral, fungal, cancers, radiation to chest, uremia and autoimmunity
4
Q
signs of pericarditis
A
- sharp sudden chest pain
- radiates to neck, shoulders, back and arms
- increases with inspiration and decreases when sit up or lean forward
5
Q
treatment of pericarditis
A
- if conductive problems or BP decreases, need immediate treatment
- sit pt upright, give O2, monitor HR and BP
- keep on bedrest and prepare for pericardiocentesis
- give NSAIDS and antibiotics and fluids
6
Q
describe cardiogenic shock
A
- complication of 15% of pt with MI
- affects pt whose infarction involves more than 40% of LV
- heart is so damaged from MI, goes into shock
7
Q
causes of cardiogenic shock
A
MI, ischemia, cardiomyopathy, HF, acidosis, myocarditis, arrest, prolonged cardiac surgery
8
Q
signs of cardiogenic shock
A
- decrease in BP (systolic below 30)
- cyanotic, cold, clammy
- tachycardia
- rapid respirations, anxiety
- oliguria
- confusion
- crackles
- narrow PP
- faint heart sounds
9
Q
treatment of cardiogenic shock
A
- maintina patent airway
- ABGs, O2, prepare intubate and ventilate
- continuous cardiac monitoring, art line, PA line
- transfer to ICU
- initiate 2 IV sites or central lines
- IV fluid bolus, colloids, or blood
10
Q
what meds should be given for cardiogenic shock
A
- IV dopamine, norepi, *dobutamine, vasopressin, nitro to balance BP
- IABP (intra aortic balloon pump)
11
Q
important mediation for cardiogenic shock
A
- put them on balloon pump (VAD)
- may take them in for OHS (CABG)- cannot graft an artery to dead tissue, must be viable
- balloon pump helps perfuse CA
12
Q
other procedures for cardiogenic shock
A
- external pacemaker
- transvenous pacemaker
- VAD (ventricular assist device)
- ICD life vest
- esophageal pressure monitoring
- ECMO (high flow to heart)
13
Q
describe VAD
A
- used as end stage destination therapy or bridge to heart transplant
- battery replacement needs to be sterile
- hand pump themselves if run out of electricity and no batter
14
Q
what to rememeber about external pacemaker
A
- can be hooked to epicardial wires or transvenous lines
- always monitor BP, HR and rhythm, not pulses and LOC
- wire that’s inserted into R ventricle to make it beat more effectively
15
Q
what is the most common pacemaker
A
ventricular pacing
atrial pacing done if chronic a fib or chronic SVT (can be put in atrium)
