Pacemaker Flashcards
Provide extrinsic electrical stimuli to–> contraction (depolarization)
Pacemaker
Pacemaker that senses low HR & fires w/in predetermined pd
Demand (Synchronous) Pacer
Require 3 wire system
2 Types of Demand Pacers
Single-chamber (most pop)
Dual-chamber
Pacer in atrium or ventricle/ sense and pace
Demand Single Chamber
Sense and pace atrium & ventricle
Demand Dual Chamber
Before applying temporary pacers
sedate the pt, wash and trim (never use a razor)
Pads of temporary pacers are placed
anterior-posteror or anterior-apex
Sedation for permanent pacemaker placement
IV conscious sedation under local anesthesia
3 functions of permanent pacemakers
- sensing (pulse generator sees intrinsic beats)
- Firing (pg delivers stimulis)
- Capturing (heart responds)
VVI
commonly used
Ventricle paced, sensed, inhibit
Pace maker fires if it doesn’t sense heart beat
DDD
commonly used for heart block/ sick sinus syndrome
Triggered by sensing AV (PR) interval expiring
DDD does not work for
A-fib
P waves unable to be paced
ECG spike occurs on time, but not followed by a QRS
Failure to capture
ECG shows spikes occurring after QRS but earlier than it should
Failure to sense
Turn off Temp Pacers
under-sensing (generator does not sense intrinsic beats aka
Failure to sense
May/ may not capture
Hits on T wave–> R on T –>V Tach
Causes of Failure to Sense
Problems with interface
Sensitivity Set too High
Pacer at fixed rate/ asynchronous
Periods of brady w/ NO SPIKES on ECG
Failure to pace
Keep Cell phones/ MP3 headphones, iPods, Ipads…etc
6 ft away
Most common cause of pulmonary edema
Left side HF
Abnormal accumulation of fluid in alveoli & interstitial spaces
Acute Pulmonary Edema
Crackles, wheezing, dullness to percussion…
pleural effusions
1st Line drug
decreases afterload & PAP
Increase CO
Limits Myocardial remodeling
ACE inhibitors
SE ACE Inhibs
Low BP, Renal insufficiency, cough
VAD can be used up to
2 years
Diet for Acute HF
DASH
2g Na+, avoid dairy and canned foods
Teach Acute HF/PE
2g+ Na+, No dairy/ canned food
Fluid restrictions <2000ml/d
No more than 2lbs/d
Rest
20% of anterior MI’s develop
Cardiogenic shock (LAD)
Preferred drug tx of Cardio Shock w/ NO hypotension
Dobutamine
Counterpulsation
inflation/deflation cycle of IABP
Most common artery used for CABG
Internal Mammary Artery
Most common vein used for CABG
Saphenous
Pre-op stop smoking
1 wk to 1 mo prior
Immediately prior to CABG
EKG, Type n X, CXR, Coag studies, CBC, UA, Lytes, BUN, Creat, Liver panel, Pulmonary Funx, ABG’s
Normal PaCO2
35-45 mmHG
Normal HCO3
22-26 mEq/L
PaO2
80-100mmHG
SaO2
> /= 96%
Increased PaCO2 > 45mmHg
(hypercapnea)
No sign of compensation
Bicarbonate WNL
PaCO2 level increased
pH decreased < 7.35
Acute respiratory acidosis
pH decreased
PaCO2 elevated
HCO3 elevated
Partially compensated respiratory acidosis
pH – low, normal level
PaCO2 - elevated
HCO3 – (Bicarbonate) - elevated to compensate
Fully compensated respiratory acidosis
Post PTCA
Bedrest 3-4h HOB flat for 30 min, then 30 degrees Leg straight (restraint/sandbag) Log Roll EKG post-procedure
D/C Teaching PTCA
No heavy lifting 1-2wks Norm activity in 1-2wks MD approval for work Medications Deit
Primary indicator for a VAD
Failure to wean patients of the heart lung machine
Contraindications for VAD
Aortic valve insufficiency
Major CVA/prolonged cardiac arrest with brain damage
Sepsis/make limiting comorbidities
Body surface area
