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Cardiovascular Emergencies Flashcards

1. Explain concept related to the care of an ED patient experiencing a cardiovascular emergency. 2. Describe various patient presentations related to cardiovascular emergencies. 3. List interventions necessary for a patient presenting with a cardiovascular emergency.

1
Q

cardiac output

A

SV x HR

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2
Q

SNS r/t HR

A

increases HR d/t:

  • stress
  • anxiety
  • acute pain
  • release of catecholamines
  • hypotension
  • drugs w/ + chronotropic effects
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3
Q

PNS r/t HR

A

decreases HR d/t:

  • vagus nerve stimulation
  • cardiac conduction abnormalities
  • drugs with (-) chronotropic effects
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4
Q

heart rhythm r/t HR

A

some dysrhythmias can impair adequate filling of heart chambers or result in loss of atrial kick which contributes to 20-40% of ventricular filling in healthy adult

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5
Q

define stroke volume

A

amount of blood ejected from each ventricle per contraction

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6
Q

stroke volume overview

A

measured in ml/beat

amount ejected / ventricle is equal in healthy patient

positively influenced by preload and contractility

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7
Q

define contractility

A

strength of each myocardial contraction

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8
Q

contractility overview

A

significantly contributes to CO

affected by preload (Frank-Starling law), afterload, electrolyte status, myocardial oxygenation, amount of functional myocardium, and drugs with inotropic effects

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9
Q

define preload

A

volume of blood that results in pressure or stretch of the ventricles during diastole

affected by amount of venous return to heart

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10
Q

what increases preload?

A

peripheral venous constriction

alpha adrenergics (epi, norepi, dopamine)

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11
Q

what decreases preload?

A

decreased intravascular volume 2/2:

  • hemorrhage
  • diuresis
  • v/d
  • third spacing
  • redistribution of blood flow

also vasodilators

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12
Q

define afterload

A

resistance to ventricular emptying during systole

negatively influences stroke volume

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13
Q

what increases afterload?

A

vasoconstriction or mechanical obstruction of ventricular outflow such as:

  • aortic or pulmonic stenosis
  • HTN
  • hypothermia
  • compensatory shock mechanisms
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14
Q

what decreases afterload?

A
  • hyperthermia
  • distributive shock
  • vasodilators
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15
Q

increasing CO: adults vs children

A

adults: HR and SV
children: tachycardia (cannot increase SV)

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16
Q

define MAP

A

average pressure over entire cardiac cycle

(DBPx2 + SBP)/3

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17
Q

define pulse pressure

A

difference between systolic and diastolic BP

calculate via systemic or pulmonary pressure

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18
Q

low systemic pulse pressure

A

narrowing pulse pressure

decreased LV SV, blood loss, low stroke volume 2/2 shock or cardiac tamponade

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19
Q

high pulse pressure

A

widening pulse pressure

may be transient and normal effect of activity

caused by chronic or acute conditions

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20
Q

chronic causes of high pulse pressure

A

atherosclerosis

aortic regurg

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21
Q

acute causes of high pulse pressure

A 
aortic aneurysm
aortic dissection
PDA
endocarditis
anxiety
fever
pregnancy
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22
Q

Cushing Triad

A

indicative of increased intracranial pressure

widening pulse pressure or HTN
bradycardia
irregular breathing pattern

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23
Q

chronotropes

A 
affect HR (generation of electrical impulse)
at SA node
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24
Q

inotropes

A

affect contractility

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25
dromotropes
affect automaticity (electrical impulse velocity) of heart at AV node
26
alpha beta receptors
Alpha 1 causes peripheral vascular Constriction Beta2 causes bronchial smooth muscle Dilation (AB,CD)
27
ACE inhibitors pharmacology
-angiotensin-converting enzyme, -pril -affect RAAS by blocking angiotensin I to angiotensin II -results in decreased BP (HTN) and afterload (CHF) decreased preload and -afterload via vasodilation an diuresis
28
ACE inhibitors adverse effects
dry cough angioedema, rash renal impairment category D in pregnancy
29
ARBs pharmacology
- angiotensin receptor blockers, -sartan - inhibit angiotensin II receptors - results in vasodilation, decreased aldosterone levels, increasing excretion of Na and sparing of K+ - for HTN and CHF - only oral
30
ARBs adverse effects
``` hypotension dizziness HA hyperK rarely dry cough ```
31
calcium channel blockers
-dipine | negative inotropic, chronotropic, dromotropic effects
32
beta blockers
- lol - negative inotropic, chronotropic, dromotropic effects - beta receptors - cardioselective (B1) or non cardioselective (lungs) (B2)
33
CP risk factors
``` CAD angina MI stents pacemaker age, sex, genes weight, diet, smoking, exercise, stress ```
34
sx of MI
vary by vessel - pain in chest, jaw, neck, left arm, epigastrum, scapular - N/V - hemodynamic instability (hypotension, sx decreased CO or shock, sob, dysrhythmias, anxiety, impending doom)
35
assessing MI
``` OPQRST onset provoke, precipitate, palliate quality radiate, region severity, sx timing ```
36
atypical MI presentations
women, elderly - sob, palpitations - fatigue, syncope - n/v - diaphoresis - pain/discomfort
37
assessing MI
``` labs rads (CXR, echo, doppler, stress, catheterization) ```
38
phosphodiesterase inhibitors in MI
i.e. sildenafil, etc. | can lead to profoundly decreased CO with inferior wall infarct or nitroglycerins
39
indications of pacemaker
refractory bradycardia heart block idioventricular dysrhythmias
40
transvenous pacing
catheter electrode threaded into the right atrium or ventricle via the subclavian, internal jugular, brachial, or femoral vein
41
transcutaneous pacing
pad on mid-thoracic back and front of chest at lead V3 fixed or demand, 60-80 bmp, 60-80 mA, increasing 5-10 mA until capture
42
electrical component of pacing
pacer spike precedes each: ``` QRS complex (ventricular pacing) P wave (atrial pacing) both (atrioventricular pacing) ```
43
mechanical component of pacing
palpable pulse that correlates to each paced beat
44
lack of capture on pacemaker
acidosis hypoxemia wires not connected wet/diaphoretic skin/electrodes
45
define cardioversion
synchronized defibrillation
46
cardioversion overview
with spontaneous circulation, usually hemodynamically unstable V.tach with pulse SVT refractory a.fib/flutter
47
cardioversion procedure
sync marker above R waves hold defib button until shock delivered rest sync mode for every delivery 12 lead before, during, after
48
why defibrillate?
lack of spontaneous circulation
49
most types of defibrillators
biphasic
50
joules for adult defibrillation
biphasic 120-200 | monophasic 200-300
51
joules for ped defibrillation
2/kg then 4/kg | max of 10/kg
52
define dysrhythmias
abnormal cardiac electrical activity resulting in aberrant rhythms asymptomatic or sx r/t altered CO
53
types of dysrhythmias
``` bradycardia tachycardia supraventricular arrhythmias ventricular arrhythmias heart block ```
54
define bradycardia
impaired/delayed electrical impulse SA node or CNS activation of heart is affected adults below 60 bpm peds is age specific
55
causes of bradycardia
``` CAD aging respiratory (peds) cardiac defects drugs ```
56
sx bradycardia
``` hypotension ams shock cp acute HF ```
57
interventions for stable bradycardia
correct cause atropine, IV crystalloids if asymptomatic, observation
58
interventions for unstable bradycardia
correct cause dopamine, epi infusion transcutaneous pacing
59
define tachycardia
adults > 100 bpm (unstable > 150) | peds age specific
60
causes of tachycardia
``` acute pain, fever, activity CAD cardiac defects electrolytes excessive drug use/OD ```
61
sx tachycardia
``` anxiety, diaphoresis palpitations, chest discomfort sob dizziness, syncope hypotension, shock loss of VS MS change ```
62
interventions for stable tachycardia
correct cause | amiodarone IVPB
63
interventions for unstable tachycardia
cardioversion w/ sedation regular, narrow complex: 50-100 joules, biphasic irregular, narrow complex: 120-200 joules, biphasic
64
interventions for pulseless tachycardia
defib and CPR epi q 3-5 min amiodarone VI
65
interventions for tachycardia in general
cardiac work up, EP consult cath, surgery labs AICD/pacemaker
66
where do supraventricular dysrhythmias originate?
atria
67
types of supraventricular dysrhythmias
- premature atrial contractions (PACs) - paroxysmal supraventricular tachycardia (PSVT) - Wolff-Parkinson-White - AV node re-entry tachy - a.fib - a.flutter
68
Wolff-Parkinson-White syndrome
fast HR d/t extra/abnormal pathway between atria and ventricles impulse travels via normal and extra route, causing impulse to travel rapidly presence of delta wave
69
AV node re-entry tachycardia
more than one pathway through AV node
70
a.fib
common irregular pattern many impulses in atria with complete travel thru AV node w/o coordinated electrical activity fibrillating/quivering atria RVR: > 100 bpm
71
a.flutter
1+ rapid circuits in atrium that result in organized, reg rhythm sawtooth waves AV conduction fixed or variable
72
causes of supraventricular tachycardias
``` conduction abnormalities CAD cardiac defects aging excessive drug use ```
73
sx supraventricular tachycardias
``` 100-150 bpm any bp sob, dypsnea palpitations, chest tightness MS change ```
74
interventions for stable supraventricular tachycardia
vagal maneuvers | pharm cardioversion as appropriate
75
interventions for unstable supraventricular tachycardia
synchronized cardioversion
76
interventions for supraventricular tachycardia with HR > 150 bpm
cardioversion at 50-200 joules (biphasic) amiodarone IVPB
77
define PVCs
originate in ventricles | failure of SA node or overriding of ventricle-generated impulses
78
PVC overview
"skipped' HB sensation usually benign but may be caused by specific condition and produce specific sx may be bigeminal or trigeminal 3+ PVCs = tachycardia
79
ventricular tachycardia
w/ or w/o pulse torsades - polymorphic VT - rhythm twists - QRS variable amplitude
80
v.fib
quivering ventricles no coordination for filling or ejecting of blood in chambers
81
causes of PVCs
``` blunt trauma underlying conditions (prolonged QT) heart disease hypoxic myocardium electrolytes ```
82
sx PVCs
``` HR 150-300 palpitations, chest discomfort syncope dyspnea hypotension loss of VS ```
83
interventions of PVCs with pulse
cardioversion (VT) | magnesium (torsades)
84
interventions for PVCs w/o pulse
defib, CPR, epi | correct cause
85
1st heart block
usually benign | prolonged PR interval
86
2nd degree heart block, type I
aka Wenckebach (most common) gradual increase in PR interval until dropped QRS
87
2nd degree heart block, type II
consistently long PR interval until dropped QRS
88
3rd degree heart block
no electrical coordination between atrium and ventricles P-wave intervals consistent QRS intervals consistent
89
causes of heart block
aging CAD drug OD
90
interventions for heartblock
atropine for low grade (ineffective for high grade or heart transplant) transcutaneous pacing for high degree, or heart transplant identify cause (H and Ts)
91
H and Ts in cardiac dysrhythmias
``` hypovolemia hypoxia hydrogen ion (acidosis0 hyper/hypokalemia hyper/hypoglycemia hypothermia toxins tamponade tension pneumo thrombosis (coronary, pulm) trauma ```
92
define sudden cardiac arrest
failure of cardiac electrical system NOT and MI
93
risk factors for sudden cardiac arrest
``` CAD, MI syncopal episodes exertional cp, dyspnea, syncope HF, hx MI EF < 40% modifiable CAD risk factors ```
94
interventions for sudden cardiac arrest
defib, cpr | implanted defib for future
95
causes of cardiopulmonary arrest
trauma chronic, acute illness sudden cardiac arrest
96
bls interventions
``` recognize activate response high quality CPR rescue breaths rapid defib ```
97
interventions for cardiopulmonary arrest
``` CPR airway breathing defib meds ```
98
compressions in cardiopulmonary arrest
most important to have effective, continuous compressions for cardiac perfusion and CO 100-120 bpm adequate depth and recoil minimize interruptions
99
airway in cardiopulmonary arrest
advanced airway can delay cpr or defib use bls maneuvers to ensure airway patency
100
breathing in cardiopulmonary arrest
``` rise and fall of chest bag-mask unless ineffective prevent hyperventilation 30:2 ventilate q 5-6 sec with advanced airway ```
101
hyperventilation in cardiopulmonary arrest
prevent! increases intrathoracic pressure which decreases venous return to heart
102
defib in cardiopulmonary arrest
early defib has better outcomes CPR while charging resume immediately after shock no pulse checks w/o organized rhythm
103
meds in cardiopulmonary arrest
circulate with CPR epi q3-5 min amiodarone or lidocaine
104
benefits of family presence during cardiopulmonary arrest
more likely to understand grieving process medical hx reduce fear/anxiety/isolation
105
concerns for family presence during cardiopulmonary arrest
interference misinterpret efforts, litigation traumatic grief response may be violent
106
procedure for family presence during cardiopulmonary arrest
one staff member to remain with family and explain procedure in clear, simple terms allow for interaction with patient if possible
107
trauma considerations for cardiopulmonary arrest
poor survival rates (0-3.7%), especially with hypovolemia
108
thoracotamy in trauma cardiopulmonary arrest
high mortality rate maybe for penetrating injury with quick transport and objective signs of life upon arrival also for massive intrathoracic hemorrhage, tamponade, internal cardiac massage
109
causes of pediatric cardipulmonary arrest
usually resp failure or shock apparent life threatening event SIDS
110
pediatric apparent life threatening event
ALTE cause of cardiopulm arrest color change, marked change in muscle tone, choking, gagging
111
SIDS
cause of cardiopulm arrest unknown cause accidental suffocation <1 year, most 2-3 mo
112
interventions for pediatric cardiopulm arrest
high quality BLS PALS family presence
113
causes of maternal cardiac arrest
BEAU-CHOPS ``` bleeding/DIC embolism anesthesia uterine atony cardiac disease HTN/preeclampsia Others: H/Ts placentae abruptio/previa sepsis ```
114
interventions for maternal cardiopulm arrest
- ACLS - higher chest compressions - displace uterus to left to prevent vena cava syndrome - PIV above diaphragm - remove fetal monitoring device prior to defib - remove cause - emergency C section if no ROSC within 4 min
115
PCI in cardiopulm arrest
early PCI is gold standard thrombolytics if no PCI transfer to PCI hospital
116
therapeutic hypothermia in cardiopulm arrest
only therapy shown to improve neuro recovery after ROSC with persisting neuro deficits initiate immediately after ROSC when pt comatose
117
procedure for therapeutic hypothermia
``` 32-34 C for 12-24 hrs continuous core temp control shivering sedation, analgesia, neurmusc block baseline electrolytes hourly glucose IUC with temp monitor ```
118
consistent findings in at least two contiguous EKG leads indicates what?
ischemia, injury, or infarct
119
opposite changes from contiguous EKG leads that may be found in reciprocal leads indicates what?
confirm interpretation
120
EKG alteration for ischemia
tall or inverted T waves | ST depression
121
EKG alteration for heart injury
elevated ST with reciprocal changes T-wave may invert in some leads
122
EKG alteration for infarction (acute)
ST elevation T-wave may be inerted
123
EKG alteration for infarction (old)
abnormal Q wave | normalized baseline
124
indications for Right Sided EKG
acute MI of R ventricle or posterior wall adult and geriatric
125
ACS
s/sx of MI caused by imbalance of myocardial oxygen supply and demand
126
four stages of MI
stable angina unstable angina NSTEMI STEMI
127
stable angina overview
cp with exertion, short duration relieved by rest or meds
128
unstable angina overview
cp with no exertion/at rest, lasts longer than stable indicates unstable atherosclerotic plaque, may lead to acute MI
129
NSTEMI overview
MI with ischemic cp rupture of unstable plaque that resulting in intermittent coronary occlusion
130
STEMI overview
MI with complete obstruction of 1+ coronary arteries with thrombosis
131
anterior left ventricle infarct
sx LV failure crackles, S3, resp distress d/t pulm edema
132
right ventricle infarct
sx RV failure hypotension, increased CVP, jugular venous distention, no crackles
133
pain, EKG, trop in stable angina
relieved by rest or nitro transient ST depression normal
134
pain, EKG, trop in unstable angina
> 20 min, unrelieved by rest, nitro transient ST depression T wave inversion normal
135
pain, EKG, trop in NSTEMI
continuous cp ST segment depression T wave abnormal elevated
136
pain, EKG, trop in STEMI
pain worse than angina ST elevation > 2mm in V1-3 and > 1 mm in other leads elevated
137
trop and CK-MB trends during infarct
trop: 3-12 hours peak 10-24 hrs CK-MB: 4-12 hrs peak 10-24 hrs
138
moNA
morphine oxygen nitro aspirin
139
morphine during ACS
decrease pain, anxiety for persistent cardiac pain unrelieved by nitro
140
oxygen during ACS
if SpO2 below 94% or severe resp sx or shock
141
initial nitro during ACS
sublingual - reduce myocardial oxygen demand - coronary artery dilation - improve collateral blood flow to ischemic myocardial tissue - dilate peripheral vasculature - reduce preload
142
additional nitro during ACS
transdermal or IV if necessary
143
contraindications for nitro during ACS
hypotension bradycardia phosphodiesterase inhibitors inferior wall infarcts
144
aspirin during ACS
greatest benefit if taken asap 160-324 mg ``` few contraindications class D pregnancy ```
145
stemi interventions
early reperfusion PCI gold standard (less than 90 min) fibrinolytic therapy if PCI unavailable
146
pharm interventions post-infarct
beta blockers (for all ACS) ACE inhibitors or ARBs to reduce infarct size and improve ventricular remodeling
147
define heart failure
inadequate CO and oxygen delivery to tissues LV EF < 40%
148
types of HF
systolic: inability to pump effectively diastolic: inability to fill adequately
149
sx R side HF
``` peripheral edema JVD ascites hepatomegaly increased CVP ```
150
sx L side HF
``` SOB dyspnea crackles S3 pulm edema ```
151
interventions for HF
``` ABCs cardiac monitor oxygen > 90% BiPap IV fluids with caution loop diuretics, vasodilators ``` + inotropes if cardiogenic shock
152
define aortic dissection
tear in intimal layer of aorta that exposes medial layer to forces of blood pressure results in dissection of two layers of arterial wall
153
risk factors for aortic dissection
``` HTN atherosclerosis 60 + years cardiovascular surgery connective tissue disease cocaine trauma ```
154
sx aortic dissection in general
sudden pain to chest, back, flank, shoulders tearing, ripping, sharp, stabbing not relieved by analgesia 20 mmHg BP difference
155
sx ascending aortic dissection
MS change | sx stroke, MI, cardiac tamponade, aortic valve insufficiency
156
sx descending aortic dissection
renal failure paraplegia loss of distal pulses
157
interventions for aortic dissection
ABCs O2 two large bore IVs SBP > 100-120 IV nitroprusside, nitroglycerin, beta blockers analgesics prn surgical repair
158
define hypertensive urgency
substantial elevation in bp that should be treated w.in 24 hours
159
define hypertensive emergency/crisis
SBP > 180 DBP > 120 evidence of end organ damage
160
sx hypertensive emergency/ crisis
``` AMS cp, dizziness epistaxis, HA HF hematura, oliguria S3, S4 SZs, visual disturbance ```
161
interventions for hypertensive emergency/crisis
``` O2 IV continuous BP (art line) nitro/nitroprusside IV labetalol if other meds contradinicated ``` ICU
162
define endocarditis
inflammation of endocardium, including valves
163
sx endocarditis
sx infection pleuritic cp abd or back pain signs of embolization - stroke like sx - hemoptysis - conjunctival petechiae
164
complications of endocarditis
``` MI pericarditis cardiac arrhythmias valvular insufficiency CHF stroke arthritis aneurysm abscesses ```
165
define pericarditis
acute or chronic inflammation of pericardial sac
166
causes of pericarditis
``` virus, bacterial infection acute MI aortic dissection cancer, radiation renal failure mediastinal injury connective tissue disorder ```
167
sx pericarditis
sudden onset cp worse with inspiration, activity, supine and relieved by leaning forward pericardial friction rub tachycardia sx infection
168
EKG changes in pericarditis
-ST elevation -absent reciprocal changes tall, peaked T waves in all leads except aVR, V2 -PR segment depression in lead II
169
pharm management of pericarditis
anti-inflammatory meds corticosteroids if refractory to tx if with HF: - high dose NSAIDs - colchicine - abx/antifungals - corticosteroids or diuretics
170
define blunt cardiac injury
blunt force to chest that may result in damage to myocardium, coronary arteries, or other heart structures
171
causes of blunt cardiac injury
MVCs with thorax on steering wheel falls, crush injuries, violence, sports
172
mechanism of injury for blunt cardiac injury
rapid deceleration shearing forces compression
173
areas of injury during blunt cardiac trauma
RV and RA coronary arteries pericardium thoracic aorta
174
sx blunt cardiac trauma
varies, maybe asymptomatic cp dysrhythmias and ectopy sx of: - cardiac tamponade - great vessel rupture - shock - thorax, thoracic spine fx - pulse changes - cardiac failure
175
define pericardial tamponade
potentially life threatening condition in which pericardial sac, which normally holds 20-50ml fluid, accumulates additional fluid, resulting in pericardial or cardiac effusion increase pressure compresses heart and affects ability to pump
176
precipitating factors for pericardial tamponade
``` dissecting aortic aneurysm end stage lung CA and other CA MI cardiac surgery pericarditis trauma ```
177
complications of pericardial tamponade
pulm edema shock rapidly fatal w/o tx
178
sx pericardial tamponade
beck triad kussmaul sign obstructive shock
179
Beck triad
3 D's distant (muffled) heart sounds distended jugular veins (JVD) decreased BP
180
Kussmaul sign
paradoxical increase in JVD and jugular venous pressure on inspiration
181
interventions for pericardial tamponade
pericardiocentesis or pericardial window fluids with caution (consider vasopressors) advanced airway with caution
182
define peripheral vascular disease
slow and progressive circulation disorder that may affect arteries, veins, or lymphatic system 2ndary affects on organs
183
primary cause of peripheral vascular disease
atherosclerosis
184
types of peripheral vascular disease
artrial venous lymphatic
185
define atherosclerosis
"hardening" of arteries that results from plaque accumulation on arterial wall
186
atherosclerosis overview
arterial wall becomes narrow and stiff leg muscles work harder to get oxygenated blood since they are most distal and most commonly affected
187
define peripheral artery disease
narrowing or hardening of arteries outside of heart in which blood flow is compromised d/t compromised vessels
188
complications of peripheral artery disease
organs supplied by these arteries damaged d/t decreased blood flow, oxygenation, nutrients
189
sx peripheral artery disease
``` might be asymptomatic weakness/numbness sores w/ delayed healing shiny skin decreased pedal pulses hair loss intermittent claudication ```
190
define peripheral venous disease
chronic venous insufficiency where one or more veins do not adequately return blood flow from lower extremities to heart d/t damaged venous valves
191
complications and sx of peripheral venous disease
``` PE dilated veins, varicose veins edema leg pain skin fibrosis, venous ulcers venous claudication cellulitis, hair loss, redness, bruising delayed wound healing ```
192
define DVT
thromboembolic disease where blood clots develop in deep peripheral veins
193
risk factors for DVT
``` injuries to LE veins slow blood flow 2/2 decreased mobility increased estrogen chronic conditions genetics, age obesity ```
194
complications and sx of DVT
``` venous stasis ulcers delayed healing clot traveling, PE skin color changes edema ```
195
define thrombophlebitis
blood clot in superficial or deep vein that is inflamed, usually in legs
196
risk factors for thrombophlebitis
varicose veins recent surgery or trauma prolonged inactivity
197
complications of thrombophlebitis
limb ischemia PE varicose veins
198
sx thrombophlebitis
edema erythema persistent pain, heaviness
199
define lymphedema
most common peripheral lymphatic disease edema 2/2 blockage to normal drinage pattern of lymph nodes
200
causes of lymphedema
``` surgery CA radiation lymph node infection inherited conditions ```
201
sx lymphedema
asymmetry of affected extremity progressive, painless swelling leg heaviness
202
define thromboembolic disease
blood clots that travel through blood stream and lodge in end organs, causing significant damage
203
thromboembolic disease overview
typically in legs, but also arms DVT type of thromboembolic disease
204
improve/worsen pain in PVD
arterial: -constant, worse with movement venous: -w. standing, better with elevation, rest
205
quality of pain in PVD
arterial: burning venous: aching, throbbing
206
region of pain in PVD
arterial: distal to occlusion venous: local to occlusion
207
severity of pain in PVD
arterial: excruciating venous: aching, throbbing
208
timing of pain in PVD
arterial: as occlusion develops, not easily relieved venous: pain evolves
209
objective findings of PVD
arterial: cold extremity, decreased pulses progressing to paralysis venous: extremity swelling with deep muscle tenderness, darkened skin, fever
210
interventions for PVD
arterial: elevate HOB, not extremity venous: elevate extremity
211
activitity for PVD
arterial: encourage activity venous: absolute bed rest
212
complications of PVD
arterial: emboli, CAD, MI, stroke, ulcers, gangrene, limb ischemia venous: emboli, PE, stroke
213
tx of PVD
arterial: thrombolytics, embolectomy, balloon catheter extraction or bypass graft, surgery for ischemia venous: anticoags or thrombolytics, vena cava filter, compression socks

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