CEN 2 Cardiovascular Flashcards
Normal cardiac output is __ - __ L/minute
4 - 8
the normal heart rate for a neonate is
140 BPM
the normal heart rate for a toddler is
120 BPM
the normal heart rate for a school age is
100 BPM
the normal heart rate for an adult is
60 - 100
the normal respiratory rate for a neonate is
40
the normal respiratory rate for a toddler is
30
the normal respiratory rate for a school age is
20
the normal heart rate for an adult is
12-16
normal stroke volume is
60 - 130 ml/contraction
average pressure over
the entire cardiac cycle
[(2 x diastolic + systolic)/3]
mean arterial pressure
these cardiac medications affect automaticity, rate at which electricity moves through the heart.
dromotropes
these cardiac medications affect heart rate
chronotropes
these affect contractility
Inotropes
To determine the normal systolic blood pressure for
children aged 1 - 10, what do you do
add twice their age to 90 mm/Hg, to determine
systolic hypotension, add twice their age to 70 mm Hg.
what does atropine do
reverses cholinergic-mediated decreases in heart rate
what are some considerations when using atropine
Use with caution in cases of coronary ischemia and MI
Unlikely to be effective after cardiac transplantation
Not useful in Type II second-degree or third degree heart block
what is epinephrine
positive inotrope, dromotrope and chronotrope
what does dopamine do
Doses between 2 and 10 mcg/kg/minute effective to increase heart rate.
when is pacemaker therapy used
pacemakers are used when the heart’s intrinsic pacemaking system is inadequate. Most effective for bradycardia, heart block and idioventricular rhythms.
Two methods of pacing in ED:
External (transcutaneous) -Large electrodes are placed on the skin, one on the back at the midthoracic level of the spine and a second on the front at the chest lead level of V3.
Transvenous - involves threading a catheter electrode into the right atrium or ventricle via the subclavian, internal jugular, brachial, or femoral vein.
what do Calcium channel blockers (-depine) do
Vasodilators, negative inotrope, negative chronotrope, negative dromotrope.
what does Epinephrine (Adrenalin) do
Positive inotrope, dromotrope and chronotrope as well as vasoconstrictor
what does Isoproterenol, or Isuprel, do
increases alpha, beta-one and beta-two stimulation - can increase myocardial workload, can cause myocardial ischemia.
what does Dopamine, or Intropin, Dopastat do
increases alpha, beta-one and beta-two stimulation.
2 - 10 mcg/kg/minute increases cardiac output
> 10 mcg/kg/minute increases BP
what does Norepinephrine bitartrate, or Levophed do
Peripheral venous and arterial vasoconstrictor and cardiac stimulant considered in the treatment of hypotension or shock.
what does Phenylephrine, or Neo-Synephrine do
Pure alpha-agonist
Angiotensin Converter Enzymes (ACE Inhibitors). End in -_____, and do what
- pril
decrease preload and afterload through vasodilation and diuresis
what is MONA and what is it used to treat
Morphine, Oxygen, Nitroglycerin, and Aspirin.
treatments for MI
what are some contraindications for thrombolytics (8)
Recent internal bleeding (less than one month prior to arrival)
• Known bleeding diathesis
• History of cerebrovascular accident
• Recent surgery
• Intracranial arteriovenous malformations
• Uncontrolled hypertension (SBP > 180 mm Hg, DBP > 110 mm Hg)
• Trauma within the past ten days
• Recent cardiopulmonary resuscitation efforts
what is the cause of Printzmetal’s angina and what is it caused by
Variant angina, also known as variable angina, Prinzmetal’s angina or coronary artery spasms - caused by ischemia secondary to a spasm in the coronary artery.
Which of the following patients carries the highest risk of contracting endocarditis?
a. An 81-year old patient being treated for acute hypertension
b. A 39-year-old patient who had a large tattoo engraved two weeks previously
c. A 22-year old patient who has had two cases of conjunctivitis in the past three weeks
d. A 51-year old patient who had an inferior wall myocardial infarction four weeks previously
b. A 39-year-old patient who had a large tattoo engraved two weeks previously
Which of the following assessment findings is more consistent with a peripheral vascular venous occlusion?
a. A burning discomfort in an extremity
b. A fever associated with a pale, cool extremity
c. Excruciating pain which is relieved with activity
d. An aching pain localized to one area of an extremity
d. An aching pain localized to one area of an extremity
A pediatric patient weighing 12 kg is to be cardioverted. What is the appropriate initial energy level?
a. ) 3 Joules
b. ) 12 Joules
c. ) 36 Joules
d. ) 50 Joules
b.) 12 Joules
A patient presents to the ED with a blood pressure of 234/144 mm Hg. If pharmacological treatment is undertaken for this disorder, which of the following blood pressure readings would be optimal within 30 minutes of treatment initiation?
a. 120/80 mm Hg
b. 140/90 mm Hg
c. 164/100 mm Hg
d. 200/100 mm Hg
c. 164/100 mm Hg
the type of aneurysm that dilates only a portion of the artery is a ________ aneurysm.
saccular
In fusiform aneurysms, a segment of the artery is dilated around the entire circumference of the artery. A saccular aneurysm dilates only a portion of the artery. A dissecting aneurysm results in a tear in the artery.
cardiac tamponade can be clinically assessed by the presence of what
Hypotension, muffled heart tones, and distended neck veins, called Becks Triade. Distended neck veins caused by compression of the heart. Secondary symptoms may include air hunger, agitation and decreased level of consciousness.
An accumulation of fluid in the pericardial sac which manifest Beck’s triad is called
Pericardial tamponade
what is the treatment for blunt force cardiac injury, such as being kicked in the chest by a horse?
Ensure continuous cardiac monitoring. Echo may help determine the extent of the injury. Nitro will not help with the pain. Cardiac enzymes are not predictive of injury from blunt force.
Preload refers to what
the end diastolic volume that stretches the right of left ventricle to its greatest dimension right before systole.
A patient presents to the ED with fever, HR of 94, and pleuritic chest pain. Patient is an IV drug abuser. What is the likely diagnosis?
Endocarditis. Infections are usually caused by enterococci or staph aureus.
Also known as variant angina, episodic chest pain, usually at rest, often seen in the middle of the night and early morning. Caused by coronary vasospasm.
Prinzmetal angina
what are the characteristics of hypertensive crisis?
systolic pressure greater than 180 or diastolic of greater than 120 and have signs of acute, targeted organ damage. Encephalopathy, altered LOC, dizzyness, visual changes, renal damage, chest pain with ischemia, epistaxis.
what are Kussmaul’s respirations and what are they associated with?
Deep and rapid breathing with no pauses. Patient will gasp and be air hungry. Commonly seen with acidosis, specifically DKA
an agonist is anything that does what?
stimulates a system
bleeding between the skull and the dura mater is called what?
Epidural bleed. Usually an arterial bleed, which is most commonly caused by trauma, specifically to the temporal region of the head. Causes initial LOC, then arouses in Lucid states, then decline in LOC.
the current recommendation for magnesium sulfate for a pediatric patient in cardiac arrest includes
Torsades de pointes with suspected hypomagnesemia
intravenous fluids which contain larger insoluable molecules that do not pass easily across the vascular wall are
colloid fluids
blood, albumin, plasma
rhythmic rate and depth of respirations, appearing as a crescendo and decrescendo with brief periods of apnea. Commonly seen with increased CO2 levels in the brain.
Cheyne-Stoke respirations
anything that causes a diminished response of the system - blocks the action of the agonist
antagonist
These fluids, aqueous solutions of mineral salts or other water- soluble molecules can easily pass across the vascular wall. What are they and give two examples.
saline and lactated ringers
what are the parameters of stage I hypertension
systolic pressure of 140-159
what are the parameters of stage II hypertension?
systolic pressure of greater than 160
an accumulation of fluid in the pericardial sac which manifest Beck’s triad is known as
pericardial tamponade
When suctioning during a cardiac arrest, suctioning should be limited to which of the following?
5, 10, 20, 30 seconds
less than 10 seconds
what is a normal PETCO2 level?
Quantitative waveform capnography provides a good indication of the quality of CPR. Levels < 10 mm HG indicate either a problem with the quality of CPR or with the placement of the ETT. EtCO2 levels of ≤10 mmHg predicted death in adult patients with cardiac arrest. Measurement of EtCO2 varies directly with the cardiac output produced by chest compression . Goal is 35-45mmg HG or 5-6% CO2. The correct action would be to increase the amount of O2 being delivered.
what does PETCO2 stand for and what are the normal levels?
Percent End Tidal CO2Normal values are around 5% or 35-37mmhg. Higher than 5% would indicate low quality CPR or a need to increase O2 delivery.
Can you cardiovert V fib?
No. You can shock V fib into an organized rhythm, but you cannot cardiovert a disorganized rhythm.
what are the H’s and T’s?
The H’s and T’s include Hypovolemia, Hypothermia, Hypo/Hyperkalemia, Hydrogen Ion excess, Hypoxia, Hypoglycemia, Tamponade, Tension pneumothorax, Thrombosis, Toxins, and Trauma.
what is the best way to treat asymptomatic bradycardia?
If the bradycardic patient does not have any symptoms, the most prudent intervention is to monitor and observe the patient and attempt to determine the underlying cause of the bradycardia.
what is the first line of treatment for Hyperkalemia?
calcium
what is the second line of treatment for hyperkalemia?
insulin, folloewed by dextrose, to push K back into the cells and out of the syrum
when calcium and insulin have failed to resolve hyperkalemia, what is the next line of treatment?
hemodialysis
what are some causes of hypokalemia?
losses from vomiting and diarrhea, alcoholism with malnutrition
low potassium or hypokalemia can be detected on an EKG how
the U wave, or camel hump T wave
treatment of hypokalemia includes what
potassium supplements
hypokalemia is known to coexist with what?
magnesium imbalances
high magnesium results in what
decreased muscular irritability and activity
low magnesium results in what?
increased muscular irritability and activity
