Final Flashcards
Stable angina
Worse when physically active
RELIEVED BY REST
Unstable angina
Occurs with rest
What is treatment for STEMIs
PCI is the insertion of a catheter with a ballon tip that is inflated to open a artery
Who is a PCI more reserved for
More reserved for patients with STEMIs but, non STEMI patients may also have one
Stemi
Full occlusion of the coronary vessel
Non stemi
Platelets aggregate and cause blockage of smaller vessels leading to a non stemi
ACS
Is the clinical manifestation of coronary heart disease, which includes the developement of fatty plaques in the coronary arteries
What are biochemical markers that help diagnose an infarction
Troponin
Myoglobin
CPKMB
Cardiac catherization
Is performed to determine the exact location of the myocardial injury and specific obstructions to the coronary vasculature
What is cardiac catherization most commonly used for
For the diagnosis of CAD and ACS
IT is useful in determining whether a patient would benefit from a PCI or CABG
What is the most commonly used anticoagulant for patients with ACS
Heparin
What is aftercare of PCIs
Patients with stent placement usually require anti platelet therapy with aspirin or clopidogrel for up to 6 months to reduce the risk for vessel thrombosis
What are the 3 prominent signs of cardiac tamponade
Remember BECKS TRIAD
- Distended heart sounds
- Distended jugular veins
- Decreased arterial pressure
Cardiac tamponade
Is compression of the heart resulting from fluid or blood within the pericardial sac
What is cardiac tamponade are usually the result of
Blunt or penetrating trauma to the chest
Cardiac catherization
Angiographic procedures
Pacemaker insertion
What are other signs and symptoms of cardiac tamponade
Chet pain Tachypnea Dyspnea Tachycardia in response to low CO pulsus paradoxus Hypotension
What is pulsus paradoxus
Systolic pressure that is markedly lower during inspiration
What are assessment findings of cardiac tamponade
A echocardiogram is performed to confirm the disease and quantify the amount of pericardial fluid
CXR
What is medical mgmt of cardiac tamponade
Pericardiocentesis
How is the HOB placed during a Pericardiocentesis
45-60 degrees, placing the heart in proximity to the chest wall so that the needle can be inserted directly into the pericardial sac
Pacemaker
Is a medical device designed to assist in stimulating the heart when the natural pacemaker is too slow or its impulses are blocked from reaching the ventricles
Demand pacemaker
Is synchronized with the persons HR, meaning that it fires when the HR drops below a preset amount
What are pacemakers used for
Severe bradycardia
Dysthymias
Sometimes ventricular dysthymias
What are complications of ICDs and pacemakers
Cardiac tamponade
ICDs are used in who
Used in patents who r at risk of sudden cardiac death due to VF, or those patients who have experienced one or more episodes of VTor VF unrelated to a MI
What do ICDs do
It is programmed to deliver an electric shock if the pt goes into VF
It monitors the patients HR and rhythm and is multi programmable to deliver pacing, cardioversion and or defibrillation according to the patients needs it can also pace the heart if severe bradycardia occurs
What is CABG
A procedure in which the patients diseased coronary arteries are bypassed with the patients own venous ( saphenous vein) or artery ( internal mammary or radial) vessels.
Who is CABG indicated for
Patients with ACS to relieve symptoms, improve quality of life and to hopefully prolong life
Who is CABG indicated for
Ppl who have failed medical tx
Has more than 2 diseased coronary vessels with significant blockage
May not be a candidate for PCI
has failed a PCI attempt with ongoing chest discomfort
Post op care for CABG
Apply a cardiac monitor
Monitor the volume in the circulatory system which is reflected by RAP and PCWP
Cardiogenic shock
A hemodynamic problem
A problem within the heart itself
What is cardiac tamponade are usually the result of
Blunt or penetrating trauma to the chest
Cardiac catherization
Angiographic procedures
Pacemaker insertion
What are other signs and symptoms of cardiac tamponade
Chet pain Tachypnea Dyspnea Tachycardia in response to low CO pulsus paradoxus Hypotension
What is pulsus paradoxus
Systolic pressure that is markedly lower during inspiration
What are assessment findings of cardiac tamponade
A echocardiogram is performed to confirm the disease and quantify the amount of pericardial fluid
CXR
What is medical mgmt of cardiac tamponade
Pericardiocentesis
How is the HOB placed during a Pericardiocentesis
45-60 degrees, placing the heart in proximity to the chest wall so that the needle can be inserted directly into the pericardial sac
Pacemaker
Is a medical device designed to assist in stimulating the heart when the natural pacemaker is too slow or its impulses are blocked from reaching the ventricles
Demand pacemaker
Is synchronized with the persons HR, meaning that it fires when the HR drops below a preset amount
Cardiogenic shock
A hemodynamic problem
What are signs and symptoms of cardiogenic shock
Decreased CO
Decreased BP
increased SVR
What is hypovolemic shock
A fluid deficit problem
Decreased fluid in the intravascular space
What are causes of hypovolemic shock
Decreased CO
Decreased BP
increased HR
What are causes of hypovolemic shock
Dehydration
Trauma
What is distributive shock
ADEQUATE BLOOD AND FLUIDS THAT ARE DISTRIBUTED ABNORMALLY, the patient will still have decreased CO, but not bc of decreased fluid
What is treatment for distributive shock
Fluid won’t help, you must correct the u deflating cause
What is obstructive shock
It is related to the heart
The ventricles don’t fill or empty adequately
It’s a ventricular problem
Cardiac tamponade causes which type of shock
Obstructive shock
What is anaphylactic shock
A hypersensitivity reaction to drugs or food
It affects CO bc of massive vasodilation
How do you treat anaphylactic shock
Treat the cause, epinephrine l, iv steroids and Benadryl won’t help
What is spinal shock
Shock resulting from SCI
There is adequate volume, nothing is wrong with the heart
It is a type of distributive shock
What are the stages of shock
Mild- reversible
Moderate- reversible
Severe- body can’t compensate
Causes of obstructive shock
Pulmonary embolism
Cardiac tamponade
Tension pneumothorax
Pericarditis
What are causes of distributive shock
SCI
anaphylaxis
Severe sepsis
What are causes of cardiogenic shock
Cardiac ischemia/ infarction
Valve dysfunction
Dysthymias
Blunt cardiac trauma
What are causes of hypovolemic shock
Hemmorhage
Burns
Third spacing
DI
What is collaborative care of a patient experiencing hypovolemic shock
Fluid resuscitation with colloids such as blood products
Or isotonic solutions such as 0.9% ns
What is treatment of cardiogenic shock
Dopamine
Norepinephrine
* if pulmonary edema exists, provide diuretics or preload reducers such as nitroglycerin
Name a preload reducer drug
Nitroglycerin
What is treatment for spinal shock aka neurogenic shock
Crystalloids first
Dopamine, norepinephrine or phenylephrine… If necessary atropine for bradycardia
What is treatment of anaphylactic shock
Epinephrine
Diphenhydramine
Ranitidine or famotidine
What is treatment of septic shock
Norepinephrine
Dopamine
Phenylephrine
Vasopressin
Prolapsed valve
The valve is weakened
It doesn’t shut completely
What are the main valves that can be diseased
Aortic, mitral or both
Regurgitation can occur ( blood flows back up into the valves)
Mitral valve prolapse is more common in who
Females
Signs and symptoms of valve disease
Palpitations
Bruit which is best heard when the pt. is laying on the left side
What diagnostic can detect valve disease
Echocardiogram can show regurgitation
What is surgical repair of a diseased valve
A commissurotomy or surgical repair which is either a porseine or St. Jude’s valve
What is a porseine
A pig valve
What are advantages of porseine valves
No need for anticoagulants for life
The patient may be on Coumadin or clopidogrel to decreased the risk for clots but, it won’t be for life
What are disadvantages of the porseine valve
Lasts from 10-15 years
Seems to have a high rate of failure
What are advantages of the St. Jude’s valve
It can last 20 yrs or more
What are disadvantages of the St. Jude’s valve
Increased risk for clots
The patient will need to be on Coumadin or clopidogrel for life
What is repair of a diseased valve
A valvuloplasty
In general, valves that undergo valvuloplasty function longer than prosthetic valve replacements and patients do not require continuous anticoagulation therapy
Complications of CABG
Cardiogenic shock
If cardiogenic shock is left untreated, what will occur
S3 heart sounds ( gallop) a xtra sound that shouldn’t be there
Pulmonary edema
What does the cerebrum control
Intelligence
Sensory function
Motor control
What does the cerebellum control
Posture
Balance
Motor movements
What does the brain stem control
Respiratory rate ( medulla) Vomiting, coughing reflexes,
What does the pons control
Cranial nerves
What is a definitive dx for stroke
MRI
Before tx of a stroke, what info must be known
Is it hemmorhagic or ischemic
If it is hemmorhagic DO NOT GIVE ANTICOAGULANTS
What’s a basilar skull fracture
Fracture at base of skull. A change is facial characteristics
What’s a coup injury
Injury to the front of the head
What’s a counter coup injury
Injury to the back of the head
What is the criteria that must be met for a TBI
Severe loss of consciousness for more than 6 hours
What is a extradural hematoma
The person bleeds a lot it is very dangerous
What is helpful to reduce inflammation in a TBI
Steroids watch for hyperglycemia
What are seizures a complication of
Increased ICP
stoke
ICH is considered what type of stroke
A hemmorhagic stroke
ICH usually derives from what
Bleeding of small arteries or arterioles directly into the brain
What are common causes of ICH
HTN
TRAUMA
ILLICIT DRUG USE
What is a subarachnoid hemorrhage
Rupture of an aneurysm that releases blood directly into the CSF under arterial pressure. The blood spreads rapidly within the CNS immediately increasing ICP
If bleeding continues deep coma or death may occur
What’s a thrombotic stroke
Occlusions promote thrombus formation in the arteries
Atherosclerosis is the most common cause
What is a embolic stroke
It is caused by particles that arise from another part of the body resulting in blockage of arterial blood flow to a area of the brain
Are the onset of symptoms for a embolic stroke fast or slow
A embolic stokes onset of symptoms is a brunt and rapid as a sudden blockage has occurred
What’s a embolic stroke
From emboli like in a fib
What will the patient complain of with a ruptured cerebral aneurysm
Severe headache
What’s the clinical profile of a acute ischemic stroke
The person I’d sedentary when the symptoms arise
What’s the clinical profile of a embolic stroke
Sudden onset
Occurs when the pt is awake and active
Maximin deficit within minutes
What r causes of a embolic stroke
Cardiogenic embolism
A fib
Valvular disease
MCA most often affected
What are risk factors for a hemmorhagic stroke
HTN AVM TRAUMA DRUGS TUMOR, ENDOCARDITIS
What are symptoms of a anterior stroke
Affects one side of the body
Both motor and sensory
Left side of brain causes aphasia
Usually not conscience
What are symptoms of a posterior stroke
THE 4 Ds
Diplopia, dysarthria, dysphagia, dizziness (vertigo)
What’s medical treatment of a stroke
Anti platelet and antithrombotic therapy
Treat HTN
Neuroprotectives such as CCB nimodipine
THROMBECTOMY
CEA
Lab findings of Addison’s disease
Decrease cortisol
Decreased glucose
Decreased Na
Increased K+
Lab findings of cushings disease
Increased Na
Increased glucose
K+ increased
Ca decreased
S&S of pheochromocytoma
Intermittent symptoms like HTN, headaches, tachycardia, vertigo, vision changes,postural hypotension, tremors, ringing of ears
What are the 5 Hs of pheochromocytoma
HTN HEADACHE HYPERMETABOLISM HYPERGLYCEMIC HYPER HYDROSIS ( Diaphoresis)
What is pheochromocytoma
Benign tumors
Usually dx in the 50-60s
If undiagnosed potentially fatal,
INTERMITTENT SYMPTOMS
What is surgical tx for pheochromocytoma
Surgery to resect tumor
What are medications for pheochromocytoma
Regitine Doxazosin Prazosin to decrease spiked BP CCB, BETA BLOCKERS Glucocorticoids pre and post op.
What’s the clonidine suppression test
If catecholamines are not suppressed, it is positive for pheochromocytoma
Neurological patients are on what kind of drip
Drips to control glucose because blood glucose increases in brain damage/ tissue/ hypoxia.
What are V tach medications
IV lidocaine
CCB
BETA BLOCKERS
IV ADENOSINE IF UNRESPONSIVE TO BETA BLOCKERS
Patho of pulmonary HTN
If the pulmonary vascular bed is damaged, or obstructed as in PH the ability to handle whatever flow or volume of blood it receives and is impaired the increased blood flow increases pulmonary artery pressure… the increased workload deceases right ventricular function, the myocardium cannot handle this increased workload.
Signs and symptoms of pulmonary HTN
Dyspnea is the main symptom, it occurs with exertion and eventually with rest
Substernal chest pain
Weakness, fatigue, syncope, ocassional hemoptysis, signs of fight sided HF ( edema, ascites, Distended jugular veins,liver engorgement, crackles, heart murmurs) anorexia and pain in RUQ
Indications of mechanical ventilation
Evidence of respiratory failure or compromised airway, decreased o2 and increased CO2
Signs and symptoms of DIC
Cyanosis and or gangrene especially of the digits
Diminished pulses
Inadequate perfusion to the brain result in altered LOC
inadequate renal perfusion leading to decrease in urine output, increased Cr and or
costovertenral angle pain
Abdominal tenderness, diminished or absent bowel sounds
A platelet count of what is suggestive of DIC
A value less than 50,000
Elevated PT
PTT greater than 70 is critical
Most common cause of ARDS
SEPSIS in the setting of pneumonia
Early symptoms of ARDS
Dyspnea, tachypnea,
Rapid. Shallow breaths, use of accessory muscles, mottling or cyanosis of skin,abnormal breath sounds, dry cough, change in level of consciousness, restlessness, retrosternal discomfort, tachycardia, fever
Dx of ARDS
ABGs will demonstrate hypoxia despite o2 delivered
CXR
CT
P/F ratio is important in dx
What’s the key tx for ARDS
Mechanical ventilation with positive pressure and high peep to increase oxygenation
What is ARDS characterized by
Non cardiogenic pulmonary edema
What is ventilator Mgmt goals in ARDS
Tidal volume between 4-8
Fio2 less than or equal to 60
Judicious use of peep at 5-15 cm h2o
Maintain sao2 between 88-95%
