Class 11 Flashcards
Metabolic syndrome
is the result of insulin resistance. MetS presents with
impaired glucose tolerance, compensatory hyperinsulinemia, raised triglycerides,
reduced HDL and increased abdominal adiposity. The most important site of insulin resistance is muscle. In muscle, insulin resistance reduces the insertion of the glucose transporter into the membrane and thus reduces
entry of glucose into muscle. Hyperinsulinemia causes sodium retention and hypertension, and if energy intake exceeds expenditure, promotes triglyceride synthesis in adipose tissue.
Trx Metabolic syndrome
Mediterranean diet, low Na Exercise Stress reduction Smoking cessation Weight loss • Obesity causes increased cardiac output, increased muscle strain, insulin resistance • Sleep apnea secondary to obesity Medication ROH reduction
Rx metabolic syndrome
Metformin ACEI (Ramipril, Perindopril): vasodilation . Side effects: • Hypotension • Reduction in GFR • Hyperkalemia • Cough • Angioedema and anaphylaxis Lipitor, Crestor s/e: increased risk for db, muscle cx
LDL target
< 3.5 mmol/L
Typical chest pain features
- Sqeezing, heavy sensation
- Indigestion or heart burn
- Short of breath/ can’t catch your breath
- Radiates to Left arm/ shoulder/ jaw/ back
- Fatigue
- Diaphoretic
- Loss of consciousness if concomitant arrhythmia
STEMI
- Presence of criteria:
- retrosternal chest pain
- increased cardiac markers
- ECG changes
- ECG changes: Increased ST > 0.1mm in 2 adjacent leads or new LBBB
- Emergency
NSTEMI
Presence of retrosternal chest pain and an increase in cardiac markers (troponin)
without ECG changes
RESPIRATORY ASSESSMENT:
HEAD TO TOE inspection
Head and neck • Presence of cyanosis of lips • Purse lipped breathing • Prominent sternocleidomastoid muscle Chest • Shape of thorax: barrel chest • Posture Peripheral • Cyanosis • Clubbing of fingers • Pedal edema
Assesment pulmonary
- Inspection
- Observation is key
- You can gain a multitude of information from inspection alone
- Palpation
- Intercostal spaces
- Auscultation
- Normal vs abnormal sounds
- Percussion
- Lung fields to assess for fluid or masses
ABDOMINAL ASSESSMENT
Skin: Observe color, scars, striae, dilated
veins, petichia, masses and nodules.
Umbilicus: Observe the umbilicus, its position, signs of herniation.
Contour and symmetry: Observe the abdominal contour
from the costal margin to the symphysis pubis (flat, globular) for symmetry.
Peristalsis Pulsation
Auscultation: Bowel sounds (30s), Vascular sounds, Friction rubs
General percussion: tympanic vs dullness
Liver span
Costovertebral angle tenderness
Light palpation, deep
Neuro assessment
smile, stick out tongue, scrunch up face, squeeze hands, pup reflexes
pulse over what isn’t normal
150
look at normal wave PQRST
-
darker mark on ecg
3 sec
normal qtc
450
