Final Flashcards
Nitroglycerin
TX - HTN, chest pain; SE - headache; dilates peripheral vessels and coronary arteries
Morphine
TX chest pain (MI, PE) - reduces anxiety, dilates; SE: resp. depression, hypotension
Atropine
Anticholinergic - TX bradycardia, heart block, asystole ; SE - increased HR, anxiety, thirst, urinary retention
Isuprel
beta-adrenergic; used to increase HR; SE - V-fib
Adenosine
antidysrhythmic ; TX PSVT (paroxysmal, supraventricular tachycardia) ; IV push fast; SE - short periods of asystole.
Verapamil
CCB; TX SVT, angina ; SE- headache
Cardizem
CCB; TX PSVT, A-fib/flutter (with increased HR) , angina
Lidocaine
fast sodium channel blocker ; TX ventricular dysrhythmias ; decreases myocardial irritability - PVC, V tach + V fib
Procainamide
fast sodium channel blocker; TX atrial. ventricular and supraventricular dysrhythmias
Epinephrine
catecholamine; improves perfusion of heart and brain in cardiac arrest - TX profound decreased HR, asystole, pulseless V-tach and V-fib; No sodium bicarb ; TX anaphylactic shock
Sodium bicarbonate
TX metabolic acidosis
Mannitol
osmotic diuretic ; TX edema of CNS ; use filter needle
Methylprednisolone
glucocorticoid; TX edema of CNS
Narcan
opiate antagonist; short duration; withdrawal symptoms
Flumazenil
reversal agent for benzodiazepine meds - Valium, Versed, Librium.
Dopamine
TX hypotension ; sympathomimetic
Norepinephrine
catecholamine ; TX hypotension
Dobutamine
no vasoconstriction - TX shock states with decreased CO ( increases BP d/t increase in CO)
Nipride
TX hypertensive crisis ; measure cyanide levels; keep wrapped with aluminum foil
Lasix
loop diuretic ; depletes Na + K
A-line
BP, blood, vasoactive meds ; radial or brachial; systolic, diastolic and MAP (min 60); dicrotic notch - closure of aortic valve; Allen’s test (patency of ulnar artery); bag pressure 300; level & calibrate transducer Q8 or position changed - Phlebostatic axis - 4th intercost. space on the right of sternum
Pulmonary artery catheter
shows pt fluid status; CVP(preload- RA pressure) ; PAP; PCWP; CO; jugular or subclavian vein ; balloon wedged 8-15 sec - risk for pulmonary infarction
CVP
1-8 mmHg
PAP
15/5 - 25/15 mmHg
PCWP
indirect left atrial pressure - 4-12 mmHg
Cardioversion
synchronized shock during QRS wave ; TX A-flutter, A-fib, V-tach (with pulse and fast rhythm); consent + sedate;
Defibrillation
asynchronous shock; pulseless V-tach + V-fib ; 2 min of CPR between shocks - Biphasic 200 joules - mono - 360.
IABP - intra aortic balloon pump
increase CO ( by 40%); femoral artery - descending aorta ; diastole - inflates (block aorta) - blood to coronary artery; systole - deflates - vacuum effect - improves LV ejection + CO; TX HF, MI; HOB < 45; can’t flex legs
VAD - ventricular assist device
improve CO; TX end stage HF; LVHF - tube pulls blood from LV into pump - aorta
CO - blood pumped from left ventricle each minute
4-7 L/min
SV - stroke volume
amount of blood ejected with each contraction
Afterload
pressure heart must overcome to eject blood during systole
Respiratory failure
PaO2 < 60 & PaCO2 > 50
Endotracheal tube - check placement
- end-tidal CO2 ( detector)
- Breath sounds
- X-ray
CVP - central venous pressure catheter
RA pressure (preload); give fluids, blood samples; subclavian, jugular, femoral veins ( end SVC )
Paternalism
making decision for pt. ; restriction of autonomy to protect the pt from harm
Fidelity
keep promises
Veracity
tell the truth
Beneficence
prevent harm
Nonmaleficence
do no harm
PR interval
P - Q wave; total atrial activity - 0.12-0.2 sec ; * 1 small box - 0.04 ;
QRS complex
Q-S; ventricular contraction - depolarization ; < 0.12 sec
ST interval
S-T - T wave - total ventricle relaxation
QT interval
total ventricular activity
U wave
follows T wave - recovery of Purkinje fibers
Amiodarone
emergency tx A-fib, A-flutter, V-fib, V-tach, PVC; SE: AV block, hypotension, bradycardia
V-tach
HR > 100; wide, uniform, regular QRS , no P waves; TX - pulse - cardioversion, Amiodarone, Lidocaine; no pulse - CPR, defibrilation
V-fib
wavy pattern - no P or QRS waves - Cardiac arrest - CPR, defibrilation, Amiodarone or Lidocaine
Unifocal PVC vs Multifocal PVC (premature ventricular complex)
QRS is wide, T opposite to QRS; P is absent - look the same vs look different ( positive + negative PVCs) ; TX: Lidocaine, Amiodarone
A-flutter
P waves - sharp, sawtooth ; PR interval cant be measured ; TX: Amiodarone, CCB, cardioversion
A -fib
very irregular, No p waves + PR interval; normal QRS ; microemboli form ( >24 hrs) - transesophageal echocardiogram - emboli ? anticoagulation therapy ; TX- cardioversion, BB, CCB, Amiodarone, Digoxin
SVT - supraventricular tachycardia
HR > 150 ; difficult to see P waves ; TX: valsalva + vagal maneuvers , Adenosine (HR), BB + CCB, synchronized cardioversion
1st degree HB
prolonged PR interval ; TX - none - watch
2nd degree HB - Morbitz Type 1
PR interval gets gradually longer until P fails to conduct and QRS is dropped ; TX - Atropine + temporary pacemaker
2nd degree HB - Morbitz Type 2
PR intervals are the same until P wave is dropped - no QRS ; TX - Atropine + Permanent pacemaker
3rd degree HB - Complete HB
P waves unrelated to QRS - pacemaker, Atropine, Dopamine
Asystole
flat line - verify pulse - CPR - Epinephrine + Atropine - trancutaneous or tranvenous pacing - NO DEFIBRILATION
six second EKG strip - determine HR
- 300 / by number of large boxes between R intervals
- 1500/ by number of small boxes between each R interval
- least accurate - for irregular rhythm - count R waves ( don’t count first and last ) x 10
MI - ECG changes
- Inverted T waves - ischemia
- ST segment elevation - injury
- Pathological Q waves - usually permanent even after recovery
MI - chest pain + s/s
Radiates to back, abdomen, neck, jaw, left arm, shoulder.
SOB + anxiety + impending doom
MI - MONA
Morphine
Oxygen
Nitroglycerin (SBP > 90)
Aspirin (325 mg chew)
STEMI vs NSTEMI
ST elevation MI (blood clot completely blocking an artery - tx: angioplasty, stenting, clot busting meds) vs none ST elevation MI ( women, does not extend through the full depth of the heart muscle - clot-busting meds are not effective)
MI - DX - cardiac markers (enzymes)
- Troponin T + I - preferred - cardiac injury - rises 2-6 hrs
- Creatinine kinase - MB - peaks 24 hrs - heart muscle enzyme
- Myoglobin - rises 3-4 hrs - non-specific
Percutaneous Transluminal Coronary Angioplasty can be combined with stent placement
invasive but non-surgical technique - under fluoroscopic guidence in the cath lab - balloon tipped catheter - inflates - force the plaque against the vessel wall ; groin or arm;
MI - TX + SX
- Thrombolytic therapy - Streptokinase, Urokinase - first 6 hrs; Bleeding !!! - antidote - Amicar-aminocarproic acid .
- Glycoprotein inhibitors - Reopro + Integrilin - target platelet component of thrombus
- Angioplasty - with stent
- CABG - coronary artery bypass graft sx
Ace-inhibitors and MI - Captopril , Lisinopril
prevent ventricular remodeling - decreases risk of HF - SE: bradycardia, cough, hyperkalemia ;
inhibit renin-angiotensin-aldosterone mechanism - block conversion of angiotensin I to angiotensin II - prevents peripheral vasoconstriction; reduces blood volume ( inhibit aldosterone )