Medical Emergencies Lab Flashcards
• Device used for patients with bradydysrhythmias & heart blocks.
Cardiac Pacemakers
Used for emergency pacing; large pacing pads placed on chest;
generator set to deliver impulses at set rate, voltage.
External (temporary)
Inserted during cardiac surgery (temporary); lead wires on epicardial surface )
epicardial (temporary)
Lead wires threaded into atrium & ventricle(s) via subclavian vein & battery implanted in sub-q pocket surgically
Implanted (permanent)
Pacer is “seeing” the pt’s own rhythm & not pacing over it. (Failure: pacer spikes falling in random places & close to pt complexes)
Sensing
Pacer spikes followed by complexes @ regular intervals. (Failure: Long pauses w/ no pacer spikes)
Pacing
Pacer spike causes vent. to contract as evidenced by QRS complex immediately after the spike. (Failure: Presence of pacer spikes that are not followed by QRS complexes).
Capture
• Purpose: Prevention of sudden cardiac death.
- Can deliver high-energy electrical impulses to restore heart’s rhythm (shocks are painful).
- Used for patient’s having recurrent V-fibrillation, V-tachycardia episodes
- Implanted like pacemaker
- Can be programmed to serve as pacemakers
ICD or AICD
• Post-implantation Care:
- bedrest ~ 6 hrs
- telemetry monitoring
- VS q 1-4 hrs
- prophylactic antibiotic prn
- assess incision.
Teaching ICD or IACD
1) Don’t put stress on incision site/leads (immobilize arm for 24 hr in sling).
2) Don’t raise arm over head or lift anything for 4-6 months
3) See MD for CP, SOB, swelling sudden weight gain
4) Assess wound for infection
5) Keep ID card & Medic-alert jewelry with you.
6) No contact sports
7) Prevent interference w/ device: avoid cell phones on side of device; welding equip.; high-current industrial equip.; TENS units; lithotripsy;
MRIs;
(airport scanners; dept store scanning devices; microwaves & other household appliances are OK)
Description:
• Temporary (days), implanted device used to augment failing ventricular function.
• Inserted via femoral artery & threaded into position in the descending aorta.
• Balloon set to inflate during diastole (augments CA filling; pushes blood into CA) & deflate during systole (reduces afterload; creates a vacuum).
IABP
Uses for AIBP
- Post-cardiac surgery
- Refractory CHF
- Cardiogenic shock (i.e. MI)
- Refractory unstable angina
- Septic shock
- Non-cardiac surgery w/ altered CO
Placement of a catheter into the vascular system to monitor progress and therapy of critically patients.
cardiac cath - hemodynamic monitoring
Progression of Catheter in hemodynamic monitoring throgh the heart
- peripheral artery or central vein
- Rt Atrium
- Rt Ventricle
- Pulmonary artery
- sutured in place
Normal Arterial B/P (lt heart afterload/SVR)
MAP at least 65mmHg
Normal Right Atrial/CVP (rt heart preload)
0-8mmHg
Normal Pulmonary artery pressure/PAP (rt. heart afterload/PVR)
Normal = 15 mmHg mean (15-25 systolic. & 6-12 diastolic)
Normal PAWP (PAOP/PWP) (lt. heart preload)
Normal = 4-12 mmHg
Normal Cardiac ouput
4-8 L/min
Indications for Hemodynamic Monitoring
MI
CHF
shock states
trauma
cardiac surgery
non-cardiac surgery in high risk pts.
for injection of air (~ 1.5 ml) to inflate balloon at distal tip of catheter for obtaining PAWP
balloon inflation port
has a temperature-sensitive wire near proximal end of catheter for CO readings after saline injection
CO thermister port
CPR compressions:breaths ratio
30:2, 15:2 (before puberty)
how fast do you perform compressions in CPR
100bpm (stayin alive)
