Cardio/Resp Flashcards
Dissecting Aortic Aneurysm
Sudden severe chest pain radiating to the back, ripping or tearing pain. hypertension, unequal peripheral pulses.
Lower B/P to 120/80 below,
Metoprolol 5mg IV, 50-100mg PO.
MEDEVAC
Pericarditis
fever, friction rub, substernal chest pain, sharp pleuritic (when inhaling and exhaling), radiated to neck, shoulder, and arm. worsen when supine, relieved by sitting up and learning forward.
Aspirin 325-650 Q6h. NSAID (indomethacin, Motrin, naproxen) for 3 week.
Myocarditis
Fever, sinus tachycardia not proportion to temperature. retrosternal chest pain, in severe case signs of CHF.
S3, S4.
AVOID NSAIDS
Treatment: rest, fluids, pain control with morphine 4-8mg IV, treatment CHF sign with diuretics.
MEDEVAC
Endocarditis
Fever, new onset heart murmur (any new heart murmur with a fever is endocarditis until proven otherwise).
peripheral lesions:
petechia on palate, conjunctiva or beneath fingernail.
splinter hemorrhage
janeway lesions: painless lesions on palm and soles.
osler’s nodes: painful
orth spots: exudative lesion in the retina.
Initial: ABC, monitor, IV, O2 < 94%.
* 3 blood cultures
* Septic embolization to brain, extremities, eye, spleen, kidney, PE or AMI.
Ceftriaxone 2g IV daily plus doxy (IV drug user, off Lable, contact MO)
MEDEVAC
Pericardial Tamponade
Beck Triad: Muffled heart sounds, Jugular venous distension, hypotension unresponsive to fluid.
Tachycardia, Pulsus Paradoxus.
Echocardiogram: Gold standard
IV fluid bolus
Pericardiocentesis, Para-xiphoid, 18g, 10cm spinal needle, 20ml, aspirate as advanced.
MEDEVAC ASAP
Cardiac Contusion
Chest wall pain, tachycardia disproportionate to the degree of trauma, severe anterior chest injury (broken ribs, chest wall contusion).
Looking for possible life-threatening arrhythmias
ABC, IV, O2, Monitor
Analgesics for pain control,
Monitor for 4-6 hours, if no hemodynamic instability apparent, repeat EKG in 24 hour.
Dx and treatment any cardiac arrhythmias accordingly.
MEDEVAC
Deep Vein Thrombosis (Venous clots)
Least one of Virchow’s triads
Venous stasis (not moving, venous insufficiency old age)
Hypercoaguable state (Hormones)
Injury to vessel wall (surgery, smoking) Pain, redness, swelling, warmth, tenderness, leg circumference and compare to unaffected leg, Homan’s sign.
prevent PE is the primary Goal,
D-dimer/Ultrasound
Lovenox (Enoxaparin) 1mg/kg SC q 12 hours OR Heparin 80 units/kg
Pain control with Tylenol, Morphine 4-8mg
Patient’s will need long term anticoagulation 3-6 months minimum.prevent PE is the primary Goal,
Stable Angina: Chest pain with exertion and relieved by rest.
Unstable Angina: Chest pain while resting.
Prinzmetal’s Angina: Rare, caused by coronary vasospasm often without any CAD.
Substernal chest pain (#1 symptoms).
Chest pain commonly described as pressure on chest (like an elephant is sitting on their chest).
Chest pain can radiate to left shoulder, left arm, neck or jaw.
Occurs at rest, commonly in the morning.
Diaphoresis
Intense feeling like they are going to die
Can hear a new heart murmur
ABCs
O: Oxygen 4L NC
N: Nitroglycerine 0.4 mg SQ Q5M as needed for chest pain, max dose 3 doses in 15 minutes
A: Aspirin: 160-325 mg daily
M: Morphine 4-8 mg IV for chest pain unresponsive to Nitroglycerine.
Lovenox (Enoxaparin):
Metoprolol: STEMI
Hypertensive Urgency Hypertensive Emergency
SBP >220 mm HG or DBP >125 mm HG.
Hypertensive Urgency:
PO med, goal reducing DBP < 100 over 24 hours.
Hypertensive Emergency:
IV, O2 sat 94%. Goal reduces 25% at 1 to 2 hours, then 160/100 in the next 24 hours.
Labetalol 20 mg IV
Once stable, Metoprolol 20-50 mg PO BID.
Closely monitor for END ORGAN DAMAGED.
Acute Arterial Occlusion of a Limb:
S/S: sudden onset of extremity pain with loss or reduction of pulses, numbness or paralysis,
6 Ps: Pain, Pallor, Poikilothermic, Pulselessness, Paresthesia, Paralysis.
Enoxaparin (Lovenox): 1 mg/kg SC q 12h,
* Heparin IV STAT.
* Initial care: Heparin immediately, MEDEVAC.
Asthma
wheezing, dyspnea, or cough. worse at night or in the early morning.Prolonged expiration and diffuse wheezes. Occur spontaneously or be precipitated or exacerbated by many different triggers, Hunched shoulders Allergic asthma: Eczema, atopic dermatitis, or other allergic skin
Fluticasone (Flovent)
Systemic corticosteroids: Prednisone 40 mg PO daily for 5 days Mild/Moderate exacerbations: SABA albuterol with inhaled corticosteroid, not
improving after 48 hours, a 5- to 7-day course of oral corticosteroids. Severe Exacerbations:oxygen, high doses of an inhaled SABA, and systemic corticosteroids
Reactive Airway Disease (RAD).
Sudden onset of asthma-like symptoms following high-level exposure to a corrosive gas, vapor, orfumes. Onset of symptoms within 24 hours after exposure with persistence for at least 3 months. Symptoms that simulate asthma with cough, wheeze, and dyspnea
Oxygen if O2 Sats <95%, SABA Oral corticosteroids and bronchodilators commenced within the first 3 months have had the most favorable outcomes
Pulmonary Edema
Acute Onset, worsening of dyspnea at rest. 9-10 pain, arterial hypoxemia,
Tachycardia, diaphoresis, cyanosis, rales/crackle all lung fields,. Rhonchi, expiratory wheezing.
Production of pink, frothy sputum.
*O2, In full-blown pulmonary edema, the patient should be placed in a sitting position with legs dangling over the side of the bed.,
*Intravenous diuretic therapy is usually indicated even if the patient has not exhibited prior fluid retention. Furosemide (Lasix) 20 - 80mg IV/IM/PO, increase by 20 - 40 mg q6- 8h until desired response is achieved, max 600mg/day. Bumetanide (Bumex), 1 mg IV/PO.
*Morphine: 2-8 mg IV repeated after 2-4 hours PRN.
*Nitrate therapy: improvement by reducing both BP and LV filling pressures. nitroglycerin CHF.
Pulmonary Embolism
Low grade fever, hypotension, cyanosis, DVT signs, and pleural friction rub may be present.
Virchow’s Truad: Venous stasis, Injury to the vessel wall, Hypercoagulability.
- Oxygen to correct hypoxemia, monitor pulse oximetry.
- Enoxaparin (Lovenox) LMWH (low molecular weight heparin) as effective as Heparin. mg/kg SubQ Q12h,
- Streptokinase, urokinase, and recombinant tissue plasminogen activator “clot busters”
Upper Respiratory infection
Common cold: Clear rhinorrhea (runny nose), hyposmia (decreased sense of smell), and nasal congestion, malaise, headache, cough, low grade fever (99.5 – 100.3 F), a dry or “scratchy throat”
- Acetaminophen (Tylenol): 325-1000 mg PO Q4-6h, max 4g/24hours.
- Pseudoephedrine (Sudafed, Zephrex-D): 60mg every 4 to 6 hours.
- Oxymetazoline (Afrin) Nasal: 2-3 sprays BID for 3 days. Contraindications: HTN, cardiovascular disease, hyperthyroidism, and benign prostatic Hyperplasia. Don’t use more than 3 days for rebound stuffy nose (rhinitis medicamentosa).
