Complex II Exam 1 Flashcards
What is the purpose of the mitigation phase?
planning and identifying potential hazards
What is the purpose of the preparedness phase?
to practice the plan in order to save lives
What is the purpose of the emergency response phase?
implementation and assessment of the plan
What is the purpose of the recovery phase?
assessing damage and returning everything to normal
How quickly should you assess and intervene after a trauma?
in 60 seconds or less
What do you NEED TO KNOW for a trauma patient?
- VS
- GCS
- extent of injuries
When is reverse triage used?
mass casualty (100+ people)
Who should be treated first in reverse triage?
the less injured
What are some examples of airway obstructions?
- food
- blood
- tongue
- teeth
- vomit
- foreign objects
What is the priority intervention if the airway is obstructed?
- get it out/suction
- anticipate intubation
Which airway can only be used if the patient does not have a gag reflex?
oropharyngeal
What should you do if a patient is unresponsive WITHOUT trauma to the airway?
head tilt/chin lift
When should a jaw thrust be done?
if the patient is unresponsive WITH trauma to the airway
When is a head tilt/chin lift contraindicated?
if a CSI is suspected
What should you do if you suspect blunt force trauma?
stabilize the spine and log roll
What should you LOOK for when assessing breathing?
symmetrical chest rise and fall
What should you LISTEN for when assessing breathing?
lung sounds in all 5 lobes
What should you FEEL for when assessing breathing?
chest rise and fall and broken ribs
What can having 3 broken ribs and a collapsed lung cause?
flail chest
What should you do if the patient is not breathing or is breathing inadequately?
manual ventilation by a bag valve mask with supplemental O2
How are rescue breaths given?
ambu bag
What pulses should be assessed first when assessing circulation?
central (carotid, femoral)
How should bleeding be stopped?
direct pressure
What variables are assessed for circulation?
- HR
- BP
- pulses
- cap refill
- skin color
- LOC
- urine output
How can shock be identified when assessing circulation?
increased HR and hypotension
What does disability assess?
- LOC with GCS
- AVPU
- pupillary response
What does AVPU stand for?
A: alert
V: responsive to voice
P: responsive to pain
U: unresponsive
What is the priority when assessing exposure/environment?
- maintaining body heat
- maintaining privacy and dignity
What does the trauma triad of death include?
- hypothermia
- acidosis
- coagulopathy
What do the use of warm blankets, an increased room temperature, and warmed IV fluids help with?
hypothermia
What are the five adjuncts?
- foley catheter
- full set of labs
- cardiac monitor
- NG tube
- radiology (x-ray, CT)
What does AMPLE stand for?
- allergies
- meds
- past medical hx/menstrual period
- last I&O
- exposures
What does the absence of rectal tone suggest?
SCI
What is preload, and how is it measured?
- the amount of blood going into the RA
- CVP
What is normal CVP?
2-6
What does an elevated CVP indicate, and how should it be treated?
- too much fluid
- diuretics
What does a decreased CVP indicate, and how should it be treated?
- not enough fluids, need volume
- give fluids
What does PAWP measure?
pressure generated by the left ventricle
What is a normal PAWP?
6-15
What is afterload, and how is it measured?
- pressure the ventricle has to pump to move blood out of the heart
- PVR (lungs)
- SVR (body)
What is a normal SVR?
600-1200
What is a normal systolic PA pressure?
15-28
What is a normal diastolic PA pressure?
5-16
What is a normal SV?
50-100 mL/sec
How is SV calculated?
end diastolic volume - end systolic volume
What is a normal CO?
3-6 L/min
How is CO calculated?
SV x HR
What is ejection fraction, and what is a normal EF?
- the % of blood ejected with each beat
- 55-70%
What EF % would indicate acute HF?
<40%
What does a PA catheter measure?
- RA pressure (CVP)
- PA pressure (SVR)
- LV pressure (CO)
What can a HIGH PA pressure cause?
pulmonary HTN & edema
What medication can you give to a patient with high PA pressure?
sildenafil
Which is more accurate: CVP or PAWP?
PAWP
What is the biggest risk when using a PA catheter?
clots
Where is an arterial line most commonly placed?
radial artery
If you want to get continuous BP readings, frequent ABG’s, or put your patient on vasopressors, what should you put in place?
arterial line
What can NOT be given through an arterial line?
meds or IVF
What is the biggest risk with an arterial line?
cutting off blood flow to the hand
What is Allen’s test, and what result is ideal?
- occluding arteries in the arm to examine blood flow to the hand
- POSITIVE RESULT (WANT): color returns quickly when you let go
Why should the transducer for an arterial line be level with the atrium of the heart?
accurate pressure reading
- heart and pressure = same
- transducer and pressure = opposite
What is the first major sign you should worry about with shock?
hypotension
What drops with non-progressive (compensatory) shock? What increases?
- CO and BP drop
- HR increases
Does a high CVP or low CVP indicate JVD?
HIGH
What DECREASES with hypovolemic shock?
- BP
- CO
- CVP
What INCREASES with hypovolemic shock?
- HR
- SVR
What is the PRIORITY intervention for hypovolemic shock?
replace fluids (NS or blood)
What are the only fluids that can be given bolus?
LR and NS
What do digoxin and dobutamine (positive inotropes) do when used for hypovolemic shock?
- DO NOT treat shock
- increase contractility
- slow and strengthen, making pumping more efficient
What vasopressors can be used for hypovolemic shock?
- norephinephrine
- dopamine
- epinephrine
- vasopressin
What is the BEST med for hypovolemic shock? Why?
norepinephrine because it does not increase HR
What has to be present for vasopressors to work?
FLUIDS (CVP >2)
What should you give if extravasation occurs after administering vasopressors?
phentolamine
What vasodilators can you give for hypovolemic shock?
nitroglycerine and nitroprusside
In what situation would you transfuse whole blood?
if a patient has lost a large amount of blood
How quickly after collection does whole blood need to be transfused and why?
within 24 hours to avoid deterioration of coagulation factors
What type of blood is used to raise Hgb and Hct levels?
packed red blood cells
What do packed RBC’s restore/maintain?
oxygenation and circulating blood volume
What type of blood is used to treat active bleeding, coagulation disorders, burns, and shock?
fresh frozen plasma
What can platelets be used to treat?
- thrombocytopenia
- aplastic anemia
- chemo-induced bone marrow suppression
What does albumin do?
expands blood volume and increases BP
When should you check vitals during a blood transfusion?
@ 15 mins, 30 mins, 1 hr, immediately after, and 1 hr after
How often should you do vital signs for older adults during a blood transfusion?
q 15 mins
What should you withhold during a blood transfusion for older adults?
IVF
What meds should you give to older adults after a blood transfusion?
diuretics
What causes an acute hemolytic reaction?
blood type/Rh factor incompatibility
What is the onset of an acute hemolytic reaction?
immediate or during subsequent transfusions
What is the onset of a febrile reaction?
within 2 hours
What should you give for a febrile reaction and why?
antipyretics because an increase in temperature can occur
What is the onset of an allergic/anaphylactic reaction?
up to 24 hours after
What should you do if the patient has an allergic reaction?
restart at a slower rate or admin an antihistamine
What type of reaction requires epinephrine, oxygen, and possibly CPR?
anaphylactic
What is the onset of a bacterial reaction?
during or several hours after
What med should you give for a bacterial reaction?
antibiotics
How should you position someone having a circulatory overload reaction?
upright with feet lower than heart
When does a circulatory overload reaction occur?
any time during transfusion
What problem occurs with the atria?
clots
What problem occurs with the ventricles?
contraction
What does the QRS look like if the current originates in the atria?
narrow
What does the QRS look like if the current originates in the ventricles?
wide
What meds should you give for sinus tachycardia?
adenosine or beta blockers
What is the rate of sinus tachycardia?
101-160 bpm
Is the rhythm regular or irregular in sinus tachycardia?
regular
What med should you give to a stable patient experiencing SVT?
adenosine 6 mg IV slam (can be repeated twice)
What should you do for an unstable patient experiencing SVT?
synchronized cardioversion (50-100 joules)
What is the rate of SVT?
> 160 bpm
What does SVT look like?
narwhals (no p wave, inverted t waves, narrow)
How long should a carotid pulse be assessed?
5-10 seconds
What steps should you take if a patient is in v-tach or v-fib and has no pulse?
- call code
- start CPR
- early defibrillation
- give epi
- give amiodarone
In what rhythm is it important to assess electrolytes (K, Mg, Na)?
Torsades de pointes
What med should you give for torsades de pointes?
magnesium 2 mg IVP
What is the rate of v-tach?
> 100 bpm (no p wave, wide QRS)
What does v-tach look like?
tombstones
What does torsades look like?
voice memo
What does v-fib look like?
quivering, no p waves
What do you document for abnormal heart rhythms?
- pre-procedure rhythm
- # of defibrillation/cardioversion attempts with the setting, time, and response
- pt’s condition and LOC (pre and post)
- post-procedure rhythm
- skin condition under electrodes
What should you NOT do for PEA? What SHOULD you do?
- NO shock
- YES CPR
How can you treat PEA?
fluids/blood, amiodarone
If a patient has a complete 3rd-degree heart block, what will end up being done?
they will get a pacemaker
What will the QRS look like with a 3rd-degree heart block?
wide with no relationship to the p wave
What meds can you give for a-fib?
- amiodarone
- CCB
- heparin/enoxaparin, warfarin
What can you do for a-fib if the HR increases?
synchronized cardioversion
What does a-fib put the patient at high risk for?
CLOTS
- DVT, PE
Does a-fib have a regular or irregular rhythm?
irregular with no p wave
What meds can you give for a-flutter?
- amiodarone
- CCB
- beta blockers
- digoxin
What should you do when a patient with a-flutter is unstable?
synchronized cardioversion
What is the rate of a-flutter?
240-350
What does a-flutter look like?
saw-tooth, wings (butterfly), mountains
What can a peaked t-wave indicate?
hyperkalemia
How should you treat someone with peaked t-waves?
- obtain BMP
- D50
- insulin
- calcium gluconate
- diuretics
- sodium polystyrene sulfonate
What can U waves indicate?
hypokalemia
What does ST elevation suggest?
irreversible cardiac injury (finding of acute MI)
What is the most common single chamber pacing code?
VVI
What is the most common dual chamber pacing code?
DDD
Why should you get a chest x-ray after the insertion of a pacemaker?
to assess for lead placement, pneumo/hemothorax, and pleural effusion
What should the patient wear after pacemaker insertion to avoid wire dislodgment?
a sling
When should you watch for bleeding, hematoma formation, and infection?
after the insertion of a pacemaker
What lab is the earliest marker of acute MI?
myoglobin (gone after 24 hrs)
What is a normal creatine kinase-MB level? What indicates cardiac muscle damage?
0.1-4.9, elevation = damage
What is a normal troponin I or T level?
0.01-0.03
When will you see troponin I elevation? When will you see troponin T elevation?
I: 2-4 hours
T: 4-6 hours
What artery is used for cardiac catheterization?
femoral (most common) or brachial
What allergies are important to know for an angiogram?
shellfish and iodine
What labs should you monitor for an angiogram?
BUN and creatinine
What do dysrhythmias, hypotension, and increased chest pain indicate with an acute MI?
deterioration
What does ONAM stand for?
- Oxygen
- Nitroglycerine
- Aspirin
- Morphine
How should aspirin be taken?
chew only
Why would metoprolol be given for an AMI?
to decrease afterload and BP
Why would anticoagulants be given for an AMI?
to keep the clot from worsening
Why would thrombolytics be given for an AMI? What is the risk?
to break up the clot, but there is a high risk for bleeding
What is the point of an angioplasty?
to place a stent to keep an artery open
How long must the extremity remain straight after an angioplasty?
4-6 hours
What is the earliest sign of cardiac tamponade?
dyspnea
What is the latest sign of cardiac tamponade?
cardiac arrest (too late)
What are cardiac tamponade, hemorrhage at the insertion site, AKI, and restenosis complications of?
angioplasty
What is restenosis of a vessel?
if a blockage comes back after an angioplasty
Why can AKI occur after an angioplasty?
secondary to the IV contrast dye
When would you do a CABG?
- PCI could not open the CA
- 3 vessel blockage
- 50% occlusion of the left main CA
What type of shock can occur from a CABG?
hypovolemic
How is cardiac tamponade treated?
pericardiocentesis (UNLESS following CABG)
What do you do for pericardiocentesis?
insert a needle into the pericardial sac and drain blood to relieve pressure on the heart
What electrolytes might be depleted after a CABG?
K and Mg
What characterizes cardiac muscle with cardiomyopathy?
enlarged, thick, rigid
What does cardiomyopathy lead to?
HF
What is starling’s law?
the cardiac muscle loses the ability to stretch and contract
What are family hx, sudden cardiac arrest, endocrine/metabolic diseases, alcoholism, and HTN risk factors for?
cardiomyopathy
What does LHF affect?
lungs
What does RHF affect?
body
What are diagnostic tests done for HF?
- Echo
- BNP
- chest x-ray
- ECG
- cardiac enzymes
- ABG’s (respiratory acidosis)
- electrolytes (decreased - dilution)
What med can be given to reduce preload?
diuretics
What med can be given to reduce afterload?
ACE, CCB
What med can be given to increase cardiac output?
digoxin, dobutamine, dopamine
What med can be given to reduce cardiac workload?
beta blockers, nitrates, natriuretic
What med can you give if acute HF is due to MI?
aspirin
When do you use cardioversion?
with a pulse
When do you use defibrillation?
without a pulse
What increases with cardiogenic shock?
HR, CVP, SVR
What decreases with cardiogenic shock?
BP, CO
What is the priority intervention for cardiogenic shock?
oxygen
What meds can you give for cardiogenic shock?
diuretics and morphine
What should you avoid giving for cardiogenic shock?
fluids
What is the systolic BP level in hypertensive crisis?
> 180-240
What is the diastolic BP level in hypertensive crisis?
> 120
What med is given for hypertensive crisis?
nitroprusside (low dose initially)
Who is at the most risk for aortic aneurysm?
- male
- uncontrolled HTN
- atherosclerosis
- old age
What might you see with an abdominal aortic aneurysm?
bruit
What should you NOT do if there is a pulsating abdominal mass?
palpate
How can you tell if the aneurysm has been dissected?
loss of pulses
How can aortic aneurysms be treated?
- AAA resection: surgical repair
- endothelial stent: strengthens the wall
- thoracic aneurysm repair
