E4 Concepts

Question 1

Depolarization

Answer 1

Causes mechanical contraction

Sodium enters the cardiac cell changing it from - to +

Question 2

Repolarization

Answer 2

Cardiac muscles relax

Potassium moves out and calcium enters the cell to change it to -

Question 3

Refractory period

Answer 3

No action potential can occur

Cells resist depolarization until full recovery

Question 4

Automaticity

Answer 4

Self-excitation

Ability of a group of cells to generate spontaneous electrical impulse (SA node)

Question 5

Excitability

Answer 5

Capability of the cardiac cell to depolarize in response to electrical stimulation

Question 6

Conductivity

Answer 6

Ability of the cardiac cells to transmit an electrical impulse

Question 7

Contractility

Answer 7

Ability of cardiac muscle to contract in response to electrical stimuli

Question 8

You are working in the ER when a patient with palpitations and shortness of breath arrives.
What are some baseline assessments you will want to do?

Answer 8

General Survey: Color, distress, fatigue?
Respiratory Assessment: Oxygenation? Rate, rhythm, effort, SOB?
Cardiovascular Assessment: Distress, Pain? Color, diaphoresis, clutching chest?
- EKG, Mental status (awake, alert, orientated), Health history, Medications

Question 9

PAC - what is it and treatment

Answer 9

Electrical impulse that comes from the atrium before the next sinus impulse from SA
Tx: reduce stimulants, limit caffeine, tabacco should also hydrate

Question 10

Treatment of a flutter

Answer 10

Anticoagulation, cardioversion, ablations, controlling the rate and rhythma

Question 11

treatment of a fib

Answer 11

beta blockers, calcium channel blockers, digoxin and class III antidysrhythmics (amiodarone, sotalol and ibutilide) prevent clots with anticoags, attempt to restore NSR with cardioversion or ablation

Question 12

PSVT

Answer 12

paroxysmal supraventricular tachycardia (PSVT) starts in part of the heart above the ventricles, does not significantly reduce cardiac output

Question 13

PVC

Answer 13

premature ventricular complexes, beat originates from site in the ventricle before the sinus beat is conducted
treatment: stop caffeine and stimulant’s, hydrate and beta blockers

Question 14

v-tach

Answer 14

repeated firing of the ventricles, always assess ABC’s if persistent cardioversion is treatment of choice
emergency treatment: amiodarone + lidocaine
if unconscious or in respiratory arrest begin CPR

Question 15

v-fib

Answer 15

rapid firing of the ventricles from multiple different ectopic places, most serious arrhythmia there is no perfusion and the patient cannot survive if it persists

Question 16

Class 1 antidysrhythmics

Answer 16

Sodium channel blockers, results in decreased conduction
Quinidine, procainamide, disopyramide phosphate (norpace)

Question 17

IV lidocaine label

Answer 17

‘lidocaine for dysrhythmias’ or ‘lidocaine without preservatives’

Question 18

Antidysrhythmic hospital teaching to patient who says: ‘they aren’t doing anything for me’

Answer 18

When giving IV medications and stabilizing pts require continuous monitoring even if it seems like
- Rise slowly and sit or lie down if feeling faint

Question 19

How do anticoagulants work?

Answer 19

Ex - heparin and warfarin
Work to prevent thrombosis in the VEINS (DVT, PE) can also work in arteries (MI, CVA, valves)
Reduces the formation of fibrins by inhibiting clotting factors

Question 20

Anticoagulants, how do they work? (Arteries)

Answer 20

Primarily prevent arterial thrombosis, prevent platelet aggregations (clumping of platelets that form a vlot)

Question 21

Thrombolytics, how do they work

Answer 21

attack and dissolve blood clots that have already formed
promotes conversion of plasminogen to plasmin which digests the fibrin to degrade the clot

Question 22

How does a clot form?

Answer 22

Decreased circulation (stasis) platelet aggregation and blood coagulation
Arterial: platelets initiate, fibrin formation occurs, RBCS are trapped in fibrin mesh
Venous: platelet aggregation and fibrin attaches to RBCS

Question 23

Antiplatelets

Answer 23

Prevents thrombosis primarily in arteries, prophylactic for use in MI/CVA and prevention for stroke (TIA) patients

Question 24

Thrombolytic indication: MI

Answer 24

Must be administered within 4 hours of symptoms (time-frame is expanding)

Question 25

Thrombolytic indication: stroke

Answer 25

Within 3 hours of symptoms (time frame is expanding)

Question 26

American heart assosiation guidelines for thrombolytics - must say YES TO ALL

Answer 26

• Symptoms not suggestive of subarachnoid hemorrhage
• Onset of symptoms less than 3 hours before beginning treatment
• no head trauma or prior stroke in past 3 months
• no MI in past 3 months
• no GI/Gu hemorrhage in previous 21 days
• no major surgery in prior 21 days
• no history of intracranial bleed
• BP <180/110
• no evidence of acute trauma/bleeding
• not taking oral anticoag or if is INR under 1.7
• if taking heparin within 48 hrs needs normal aPT
• platelet count over 100,000
• Blood glucose over 50
• no seizure with residual postictal impairments
• pt and family understand risks/benefits

Question 27

What are O2 sat readings affected by

Answer 27

Anemia, CO poisoning, shock, hypothermia, vasoconstriction

Question 28

Cardiac emergency med acronym

Answer 28

MONA
Morphine, oxygen, nitro, aspirin

Question 29

Problems with a prolonged QT

Answer 29

at risk for torsades, major SE if dizziness/fainting

Question 30

When used SQ for procedures where should EPI not be

Answer 30

fingers, nose, penis toes

Question 31

Hypovolemic shock treatment

Answer 31

correct cause - bleeding, fluid loss
results in acidosis monitor serum lactic levels

Question 32

Titration orders

Answer 32

when is the dose increased or decreased in response to patient status
Examples:
NO! – (cited in survey) – “Dobutamine start at 5mcg/kg/min and titrate to improve perfusion up to 10 mcg/kg/min” What is “improved perfusion”?
NO! – (cited) – “Propofol IV titrate for light sedation”.
YES – “Levophed IV titrate to MAP >65 starting at 2 mcg/min to a max dose of 15 mcg/min. Titrate by 0.5 mcg/min every 5 minutes as needed to achieve goal blood pressure response”

Question 33

Traditional cancer therapy vs targeted

Answer 33

systemic, generalized, cytotoxic, kills healthy cells too, multiple side effects
targeted avoids normal cells and only effects the cancer cells its after, interferes with specific molecules involved in tumor growth and progression

Question 34

what happens for cancer to occur

Answer 34

loss of the genetic control of cell growth, loss of apoptosis (programmed cell death)

Question 35

Tumor Lysis Syndrome

Answer 35

12-24 hours after infusion pts can experience electrolyte abnormalities or renal failure
Teaching: report N/V, muscle cramps, decreased urination