General Final Review (Diebel, Christenson, Ect.) Flashcards
Where are S1 and S2 heard loudest?
- S1 loudest at apex
- S2 loudest at base
Why can you hear a split S2 over the aortic and pulmonic valves?
with inspiration there is an increase in venous return due to decreased pressure - leads to more blood and delayed closure of pulmonic valve
When do you most commonly hear S3, and where is it heard best?
- hear with CHF
- heard best over mitral area
- hear after S2
What heart sound do you hear with stiff wall hypertension and when is it heard?
Hear S4 (last little push of blood from atria against fluid)
Hear before S1
When do you best hear aortic regurg?
with expiratory breath due to increased intrathoracic pressure pushing against valve
Definition of SHOCK
hypoperfusion of vital organs
not defined as low BP
What is the marker of severity of oxygen supply and demand imbalance?
lactic acid production
5 typical findings seen in shock
- Hyperkalemia
- hyponatremia
- metabolic acidosis
- hyperglycemia
- lactic acidosis
SIRS (systemic inflammatory response syndrome) requriements
- temp < 36 C or >38
- pulse > 90
- respirations > 20
- PaCO2 < 32
- WBC < 4000 or > 12,000
clinical findings in shock
- hypotension MAP < 65
- cool, clammy skin (except warm w/distributive)
- altered mental status
- urine output <20 cc/hr
- metabolic acidosis - lactate > 4
Causes of cardiogenic shock
- acute MI
- arrhythmia
- outflow obstrucation
- mitral regurg, VSD
- endocrine
Causes of distributive/dissociative shock
- decreased SVR
- septic shock
- spinal cord injury
- anaphylaxis
- cyanide
- carbon monoxide
- adrenal insufficiency
Causes of extracardiac shock
- pulmonary emboli
- pericardial tamponade
- constrictive pericarditis
- pulmonary hypertension
may see distended neck veins
Normal Pressure for Wiggers
- Right atria = <5
- Right ventricle = 25/5
- Pulmonary artery = 25/10
- Left atria = <12
- Left ventricle = 130/10
- Aorta = 130/90
Staph aureus
- gram positive
- catalase +, coagulase +
- protein A
- FnbpA binding proteins (elastin, collagen, fibronectin)
- commonly infects surgical wounds
- IV drug endocarditis
- 20% of articficial vavles
- catheter infections
- within 2 weeks for pacemakers
