Respy/Cardiac Flashcards
Vital Capacity: what is the minimum for life
Maximum amount of air Exhalation
15 ml/kg
What is PA02:Fi02 indicating ARDS
Normal minute ventilation
<300 = ARDS
MV: 5-8 L/min
Pulmonary Fibrosis
Pulmonary ventilation is reduced
But cardiac output is normal so low VQ Ratio
Pa02/Fi02: low bc of shunting
CT- honeycomb appearance
Acute Hypoxic Resp Failure
Inc BP,HR,RR
Dc CO , UO
Normal Vq ratio
4L Vent / 5L Perfused - 0.8
Central Line Placement : iatrogenic pneumothorax
Thoracostomy and chest tube
Pulmonary contusion + flail chest + rib fx
Intubate
Normal tidal volume
6-8 ml/kg
Mill wheel heart murmur x tracheal perforation
Position to place them
Risk of air embolism
Trendelenburg and left decubitus tilt
Prominent v waves in pa catheter reading
Mitral insufficiency
Acute MI murmur
Mitral valve regurgitation
Papillary muscle rupture can happen after what (most common)
Where do you hear it the most
ACUTE MI *
or infective endocarditis
LOUDEST AT APEX
SURGICAL EMERGENCY
- MVR
- Pulmonary edema
- Cardiogenic shock
Unstable Angina (chest pain when)
- EKG Finding
-Trop Finding
CP @ rest
EKG:T wave inversion, ST depression
Troponin: NEGATIVE
NSTEMI
- EKG Finding
-Trop Finding
CPCPCPCPCPCP
T wave inversion, ST depression
Trop POSITIVE
STEMI
- EKG Finding
-Trop Finding
CPCPCPCPCPCPCP
ST Elevation 2+ leads
Trop POSITIVE
Variant/Prinzmetal
Transient ST elevation
Cyclic
Nicotine, cocaine, ETOH
Trop NEGATIVE
NTG relief chest pain and returns to normal ST
Do you give BB to cocaine heads
NO
Meds
ASA
AC
AP
BB
Aspirin
AC:Heparin/Enoxaparin
AP: Clopidogrel Abciximab Eptifibatide Tirofiban
BB: metope
Inferior MI
What artery is occluded
ST Elevation in what leads
AV conduction disturbance
What murmur2/t papillary muscle rupture
Heart rhythm r/t mortality
RCA occluded
v two, v three, aVF
2nd degree type1, 3rd degree, SSS, SB
MVR r/t to papillary muscle rupture
ST higher mortality
How much leads in order to diagnose for PCI and how long should the chest pain be
Door to ballon time
Door to fibrinolytic drug time
2 or more leads in ST elevation, or new LBBB. Make sure <12 hours
Door to balloon: 90m minutes
Door to Fibro: 30 minutes
PCI reocclusion s/s
Sheath removal how long to place pressure
Retroperitoneal bleed
Chest pain, ST elevation - call PHYSICIAN
Sheath removal:
s/s nausea, yawning, pallor, diaphoresis
- Give Atropine 1st, then 250 cc NS
hold pressure for 20 minutes
sudden hypotension, low back pain: blood + fluids
PCI repercussion labs and arrhythmia
PCI complication common x dangerous
STUNNING
Elevation of troponin and CKMB
VT,VF *** MOST COMMON
, AIVR
Stent thrombosis within 24 hrs
HTN Urgency vs Emergency
Greatest risk of developing _______
Meds
Nitroprusside
Labetalol
Urgency: no end organ damage
Emergency: End organ damage (brain heart kidney retina)
STROKE*
Nitroprusside: Dc Preload and Afterload
- Toxicity: Cyanide toxicity restless, lethargic, tachy, seizure, metabolic acidosis. Happens >24 hours , renal impair
Labetalol: IV intermittent push
ABI Normal
Bed position, Extremity mvmnt
> 0.90 PAD.
Reverse Trendelenburg
Do NOT elevate extremity
Carotid Artery Disease
Monocular visual disturbances Aphasia Stroke
Test: Angiography
CEA : check neuro, VS
WPW
Unstable SVT
AF
Qt Prolongation
Meds, Electrolytes
Treatment
SVT - Synchronized cardio version/Adenosine
AF- BB, Amiodarone, Procainamide
QT- Torsades des Pointes
Amiodarone, Quinidine, Haloperidol, Procainamide LOW potassium, magnum , calcium
tx: MAG
BNP
EF
released by the ventricle related to stress
BNP should be less than 100.
EF : 50-70%
Systolic HF
PMI to the left means
cannot eject, large left ventricle
high risk of dilated cardiomyopathy
positive inotrope and dilators to pump heart
pulmonary edema, S3 heart sound
PMI left means enlarged heart
NYHF Classes
CLASS 4
HF at rest, severe limitation
Dilated Cardiomypoathy
Systolic or Diastolic?
Filling or ejection problem?
SYSTOLIC / Ejecting
Thinning
LV enlarged, Left HF signs and symptoms
VAD / HEART Transplant
Hypertrophic Cardiomypoathy
Systolic or Diastolic?
Filling or ejection problem?
DIASTOLIC/Filling
Thickening
Syncope, chest pain, palpitations
**Inc risked of sudden cardiac death
Diastolic HF
Filling problem , thick walls,
S4, pulmonary edema, high BP
CCB, BB, AceARB DIuretic
Compensatory Stage
Inc HR RR
Resp Alkalosis, Met Acidosis
S3,S4
Cool Skin
Urine output dc
Pulse pressure NARROW
IABP
When does it inflate
When does it deflate
Inflate at dicrotic notch, beginning of diastole . Increase coronary artery perfusion
Deflate before beginning of systole . Decrease after load
CABG Mediastinal Chest Tube
Chest tube greater than ___ for __ hours need intervention
SEROSANGUINOUS from operation site
Chest tube lower than patient
> 100 cc for 2 hours
TAVR
Transcatheter Aortic Valve Replacement
Prosthetic valve collapsible (bovine or porcine) over the diseased valve
Via fem artery
ASA for life, Plavix for 3-6 months s/p procedure
Cardiac Tamponade
Where does the fluid accumulate
Fluid in the pericardial sac
Muffled heart sounds
Enlarged cardiac silhouette
Narrowed pulse pressure
Pulse paradoxes (SBP drops during inspiration)
What valve is most at risk for rupture due to a trauma?
AORTIC VALVE
Dresslers syndrome r/t pericarditis
happens after MI
immune response
Pericarditis
EKG ST Elevation
Viral, MI, post op
pain worse with inspiration low grade temp, Inc ESR
ST Elevation in ALL leads
watch out for cardiac tamponade
Myocardial Contusion
EKG ST Elevation
Broken vessels bleed into heart
Death can occur in 48 hours
pain worse with inspiration
ST elevation in area of injury
How much mm in aortic aneurysm should you operate
What medication to start
> 5 mm
start labetalol
Post prandial hypotension should have
Low carb meals
Post prandial hypotension should have
Low carb meals
NH pts have high risk of what virus
MRSA
AVR Replacement high risk rhythm
2nd degree type 2
Cardiac tamponade diagnosis
ECHO
Low EF and atrial dysthymia is found with which cardiomyopathy?
Dilated
Trach perf put them in trendelenburg w left decubitus tilt … this will prevent air going in where
Float to left atrium
Inc cvp + emphysema =
Cor pulmonale , inc pvr and right heart failure
