Exam hints given by Peter or if he says something is important Flashcards
Serial ECGs to monitor changes over time are given at:
• STAT • 2 hours • 4 hours
What are the shockable rhythms:
- Ventricular fibrillation
- Pulseless ventricular tachycardia
- Atrial fibrillation
What are the non-shockable rhythms:
• Asystole • Pulseless electrical activity
Definitive sign of MI
Sudden chest pain unrelieved by drugs or rest.
Cardiac enzyme markers reliably diagnostic of MI
- Troponins I & T (proteins found in the myocardium)
- Creatine kinase are enzymes where the amount released correlates with degree of infarction.
- Myoglobin is a protein found in muscle. Increases are not specific but a neg. result rules out MI.
NSTEMI (non ST elevation MI) means:
Partially occluded MI leading to smaller areas of myocardial infarction.
STEMI (ST elevation MI) means:
Fully occluded artery leading to more extensive areas of myocardial infarction.
ABG’s
Normal pH:
7.35 - 7.45
Normal Hydrogen concentration
ABG’s
Normal PaCO2
41-51 mmHg
Normal carbon dioxide concentration
ABG’s
Normal PaO2
80-100 mmHg
Normal Oxygen concentration
ABG’s
Normal HCO3
22-26 mmol/L
Normal Bicarbonate concentration
ABG’s
Base excess
+2.0 to -2.0 mmol/L
A measure of buffering capacity
ABG’s
Normal SaO2
98%
Normal Oxygen concentration
Metabolic acidosis is characterised by a
Renal based
• Low pH <22 mmol/L
Most commonly due to renal failure.
Manifestations may be headache, confusion and drowsiness.
Metabolic alkalosis is characterised by a
Renal based
• High pH >7.45
• High bicarbonate >26 mmol/L
Most common cause is vomiting or gastric suction.
May be due to meds especially long-term diuretics.
Manifestations may be respiratory depression, tachycardia.
Respiratory acidosis is characterised by a
Respiratory based
• Low pH 42 mmHg
Always due to respiratory problem with inadequate excretion of CO2.
Manifestations may be increased pulse, respiratory rate and BP, mental changes (COPD, hypercapnic).
Respiratory alkalosis is characterised by a
Respiratory based
• High pH >7.45
• PaCO2 <35 mmHg
Always due to hyperventilation.
Manifestations may be light-headedness and inability to concentrate.
ROME
Respiratory, Opposite; Metabolic, Equal
pH ⬇️ and CO2 ⬇️ = Metabolic Acidosis
pH ⬆️ and CO2 ⬆️ = Metabolic Alkalosis
pH ⬇️ and CO2 ⬆️ = Respiratory Acidosis
pH ⬆️ and CO2 ⬇️ = Respiratory Alkalosis
Intermittent claudication is when
supply does not equal demand. It is only caused by arterial supply failure.
There is • muscular cramping (ischaemic) type pain which is precipitated by exercise. It resolves within 10 minutes of rest. IT HAS TO BE REPRODUCIBLE. The area is dependent on which vessel is affected.
