ECMO Flashcards
what is ecmo
provides prolonged cardiac and respiratory support to sustain life and give gas exchange/perfusion
what does veno venous support
lung
what does veno arterial do
heart, but also lung
does single lumen or bi caval allow mobility
bi caval
where does a patient need to be on RASS as a screen to mobilize on ECMO
-1 to 1 , conscious, orientated, responsive
what is considered a major adverse event
cannula movement
bleeding
fall
what is considered a minor event
hypotension
arthrymia
persistent drops in flow
difference analgesia anesethetic
analgesia - pain relief
anesthetic - blocking sensation (including pain)
Acetaminophen
onset
peak
duration
onset: 30-1 hr
peak : 1-2 hrs
duration: 4-6 hr
NSAIDS
onset
peak
duration
onset: 30min-1 hr
peak : 1-2 hrs
duration: 4-6 hours
Gabapentin
onset
peak
duration
onset: 1 hr
peak : 2-4 hrs
duration: 6-8 hrs
morphine
onset
peak
duration
onset 5-10 mins
peak 30 mins
duration 4 hrs
Hydromorphine
onset
peak
duration
onset 5-15 mins
peak 30-60 mins
duration 4-5 hrs
Fentanyl
onset
peak
duration
onset 1-2 mins
peak 15 mins
duration 1 hr
opioid side effects
decreased LC, respiration, gut mobility, rash, decreased cardiac status
if someone has prior substance abuse do you give them sedative
yes its a pre disposing factor
if someone has severe hypoexemia and shock do you give them sedative
yes
benzodiazepines, propofol ,and dexmedetomidine are examples of
sedatives
sedative side effects
decreased LOC, decreased respiration, decreased cardiac status
RASS -5/-4 what do you do
PROM
RASS -3/-2 what do you do
PROM sit
RASS -1/0/1 what do you do
AROM
active exercise
sit stand walk
ADL
when are paralytics used
endotracheal intubation
decrease shock state
manage ICP
do paralytics have analgesics
no so they better be sedated properly
which drug can cause renal failure
NSAIDS
iontropes do what
increase CO
vasopressors do what
increase vasoconstriction, increase MAP
why treat low BP or hypotension
blood to vital organs
restore tissue perfusion
reduce mortality
dopamine is a vasopressor or inotrope
mixed but primary increases inotrophy
whats dobutamine do
increase CO (inotropic), vasodilator
whats milrinone do
inotrophy and vasodilator, but longer therapeutic effect than dobutamine
name three vasopressors
norepinephrine
epinephrine
midodrine
what are vasopressors and iodtropes used for
hypotension
side effects of vasopressors and iodtropes
hypo perfusion (blood to vital organs, you could amputate digits)
cardiac dysrhymias
myocardial ischemia
activity mobility guidelines
no increased dose of vasopressor for 2 hours
no evidence of MI 24 hours
no new artiarthymic agent 24 hours
HR <75% predicted max HR at rest
less than 20% variability of BP
on low dose of inotrope support <10
heparin is an example of what kind of drug
anticoag
is heparin brief onset brief duration
yes
T/f heparin is used over the counter
hospital only
difference warfarin and heparin
slower onset, longer duration
physio considerations for anticoags
they could bleed or clot
could be on specific bed rest
with low INR they __ with high INR they
clot
bleed
how to assess for delrium
confusion assessment method
common anti psychotics
haloperidol
methotrime
loxapine
quetiapine
can transplant patients be on EMCO
yes
signs symptoms of transplant rejection
pain at site of transplant ill, flu like symptoms fever weight change swelling decreased urine output
side effects of immunsuppression
mm weakness, tremors
peripheral neuropathy, myopathy
increased likelihood of CAD
t/f early post transplant failure has high mortality rate
true
heart transplant peak HR
only 80% of normal
do heart transplant patients get angina
no
difference transplant heart ECG
2 p waves
first P wave not followed by QRS
Pt considerations in heart transplant
there tacky all the time
longer warm up cool down
heart can’t respond quickly (orthostatic hypotension)
lung transplant consideration for PT
decreased mucus clearance
ineffective cough
decreased strength
increased reliance on anaerobic metabolism
considerations for liver transplant
hemorrhage
mm weakness
tacky
