Perfusion 5 Flashcards
side effects of Green Tea
has caffeine but labelled as not having
HIbiscus tea
lower BP, a potent diuretic and ACE inhibitor
Licorice
Increases BP, interferes at the renal level of neg feedback of cortisone (cortisone needs to be converted to its inactive form to not interfere with BP) licorice stops this conversion
Coconut Oil
is a saturated fat, advertised as not
Garlic
is an anti-inflammatory
Ginger
anti-platelet
Vit K rich foods would counter the ____ (which drug?)
warfarin
Clotting antidotes
for heparins: ise protamin sulfate
coumadin - use vit k or FFP
effect of diuretics
decrease preload, heart can pump more efficiently
tx of A-fib
calcium channel blockers, beta blockers and anti coagulant/platelet
tx of angina
nitro:
if it responds its stable angina.
unstable angina may end in MI
tx of HF
ACE inhibitors. or ARBs which are less potent. likely will also be on diuretics or beta 1 blockers (atenolol)
drugs to decrease HR
Calcium channel blockers, beta blockers.
How soon can we give a thrombolytic for an MI?
within 6 hours.
How soon can we give a thrombolytic for a stroke?
3 hours
SE of Thrombolytics
risk of bleeding as it is plasminogen.
When a atherosclerotic plaque begins to travel it is called a what?
a thrombus
Risk factors for a thrombus/thromboembolism
- blood stasis
- high estrogen
- smoking
- blood clotting disorders
- injury to the vessel or embolus (why we treat prophylactically with warfarin during surgery)
DVT
diagnosis made with ultrasound.
- pain in the affected area, redness, swelling and edema.
Always assess for symmetry
place pt on thrombolytics or anticoagulants.
PE
Caused by DVT
S&S: low o2, compensatory mechanisms, chest pain
diagnosis made with a CT scan
tx: prevention: early mobilication post sx, anticoagulation pre/post/during sx (heparin, LMWH)
- thrombolytics - break the clot before it goes cerebral
injury in the brain is a risk of
cerebral edema, increased ICP and brain damage
Earliest symptom of increased ICP
LOC changes, can be as subtle as a headache or confusion
Cushings Triad
- increased BP
- Decreased HR
- irregular BP
widening pulse pressure in resp to intracranial pressure increasing
Vasogenic cerebral edema
BBB compromise
head injury, hematoma, hemorrhage, CNS infection leads to inflammation and increased permeability
Cytotoxic cerebral edema
increased intracellular fluid shift, hypoosmotic states, ischemia leading to increased h20 shift into cells. increased ICP
tx of cerebral edema
treat the underlying cause ex. fever, dehydration, do they need electrolytes
Hypo-osmotic situation
someone sweating but only replacing with water. The blood will be high in water but not electrolytes. The cells will be high in electrolytes but the blood won’t. water will move into the cells to balance causing intracellular fluid shift. When this happens in the brain this caused increased ICP.
CVA: CT to confirm ischemic vs hemorrhagic
ischemic: 80% of all CVAs
Risk factors for CVA
risk factors: htn, artherosclerosis, smoking, dyslipidemia, stenosis, diabetes, atrial fib, meds, age…..
TIA
angina of the brain, often a warning sign of CVA risk.
often seen as a brief LOC change, may trip and fall w/o remembering
FAST acronym for stroke
Facial Droop
Arm Drift
Speech slurring
Time (call for help)
Dysarrythria
weal muscle control (slurred speech)
Aphasia
impairment of language (production or comprehension. wernickes or brocas area affected)
tx of CVA
- Sx
- antiplatelets, anticoagulants
- tx htn, dyslipidemia
Carotid endarterectomy
cut into carotid and take out the clot
Endovascular tx.
following angiogram, the clot is then removed.
Area most often affected by CVA
middle cerebral artery, upper limbs and face are the area supplied by this vessel. often affects motor and broca’s area.
hemorrhagic CVA
more often fatal.
risks include htn, meds, age, arterial deficits, bleeding disorders.
sudden onset of headache, vomiting.
tx: stabilize and reverse anticoagulation. osmotic diuretics, hypertonic NS,
Lab work for the CVA pt often includes…
Thrombocytopenia (low platlet count)
Osmosis for tx
hypertonic NS (3% NaCl IV solution) osmotic diuretic: mannitol
the solution has so much solute in it that it will draw water out of the cell. make sure we do this slow or we kill the cells
AVM: arteriovenous malformation
congenital defect: a bundle or arteries and veins lacking capillary network and lacking normal wall structure.
- high pressure arterial flow enters veins with no capillaries and the vessels rupture.
AVM will steal blood flow from surrounding area, causes slow onset neuro deficits, headaches and seizures.
Sx tx of AVM
surgical removal or clipping of AVM, gamma knife radiation, embolization
Aneurysms
80% of cerebral aneurysms are in the circle of willis which is an area of high pressure in the brain
AAA (aortic abdominal aneurysm) causes systemic bleed. NEEDS SURGERY ASAP
Risk factors for aneurysms
congentially malformed vessels, htn, atherosclerosis, age
sx tx of aneurysms
coiling or flow diversion (similar to angioplasty but in the brain)
meds for aneurysms
often started 3 months pre sx and continues 3 months post sx.
- ASA, Clopidogrel (plavix)
- if the pt is high risk for clotting then heparin immediately post and antiplatelets. MRI followup
Why is aortic aneurysm more common in elderly
elastin is not synthesized in the elderly. after menopause with estrogen deficiency comes decreased elastin and collagen (vessels are less strong and flexible)
Cardiac Tamponade
Blood in the heart muscle builds up and puts pressure on the heart. decreased CO, heart failure.
tx” pericardiocentesis
Intracerebral hemorrhage
can be caused by a ruptures aneurysm, AVM, stroke. if this is epidural burrholes may be appropriate.
Epidural hematoma
caused by skull fx injury
Subdural hematoma
Most common with accel/decel injuries leading to venous tearing.
