Review for Test 1 Flashcards
Side effects of radiation: Brain
-Fatigue
-Hair loss
-N/V
-Skin changes
-Headache
-Blurry Vision
Side effects of radiation: Breast
-fatigue
-hair loss
-skin changes
-edema
-tenderness
Side effects of radiation: Chest
-fatigue
-hair loss
-dysphagia
-cough
-SOB
Side effects of radiation: Head/Neck
-fatigue
-hair loss
-mouth changes
-taste changes
-dysphagia
-hypothyroidism
Side effects of radiation: Pelvis
-fatigue
-diarrhea
-N/V
-Sexual problems
-infertility
-urinary changes
Side effects of radiation: Rectum
-fatigue
-diarrhea
-sexual problems
-infertility
-urinary changes
Side effects of radiation: Abdomen
-fatigue
-diarrhea
-N/V
-skin changes
-urinary changes
T1:
-magnetic vector relaxes
-fat appears brighter, water appears dark
-good gray/white matter contrast-anatomy
T2:
-axial spin relaxes
-fat is darker than water
-identifies tissue edema easily-pathology
Estimation of Burn Injuries for Infants:
-head: 21%
-abdomen: 13%
-back: 13%
-each arm: 10%
-each leg: 13.5%
-buttocks: 5%
-genital area: 1%
CO “ebb state”:
-CO reduced by 60%
-hypovolemia due to permeability
-reduced response to catecholamines
-increased SVR
-myocardial ischemia d/t decreased coronary flow
-ensure appropriate fluid resuscitation
CO “Flow phase”:
-72-96 hours post-burn
-hyper-dynamic: increased CO and tachycardia
-increased myocardial O2 consumption
-increased possibility of ischemia
-decreased SVR
-this is when it’s good to give beta blockers!!
Carboxyhemoglobin levels: 1-3%:
normal nonsmoker
Carboxyhemoglobin levels: 4-9%:
smokers
Carboxyhemoglobin levels: 15-20%:
overt signs of toxicity: HA, N/V
Carboxyhemoglobin levels: 20-25%:
signs of severe toxicity: seizures, acute renal failure, myocardial ischemia
Carboxyhemoglobin levels: >25%:
unconsciousness and death
Reciprocal Changes for Inferior (2, 3, AVF):
1, AVL
Reciprocal Changes for Anterior (V3 and V4):
2, 3, AVF
Reciprocal Changes for Lateral (V5, V6, 1, AVL):
2, 3, AVF
Inferior MI:
Yes to fluids, NO to nitrates
Anterior MI:
Yes to nitrates, NO to fluid!
Right Atrial Hypertrophy:
-first part of P wave is LARGER in V1
-height of QRS >2.5mm in any limb lead
Left Atrial Hypertrophy:
-terminal part of P wave is LARGER in V1
-occurs with mitral stenosis and systemic HTN
Right Ventricular Hypertrophy:
-RV wall is VERY thick, more depolarization towards V1
-QRS in V1 are positive, R waves get smaller
Left Ventricular Hypertrophy:
-large S wave in V1, LARGER R wave in V5
-depth of V1 and height of V5= 35 mm
Ischemia:
-inverted T waves, symmetrical
Injury:
-ST elevation
Infarct:
-Q waves indicate necrosis
-1 mm wide or 1/3 QRS tall in 2 related leads
Which type of electrode setup uses less energy?
-bipolar
Pacemaker Code 1:
-chamber paced
-either O for none, Atrium, Ventricle, or dual
Pacemaker Code 2:
-chamber sensed
-either O, A, V, or D
Pacemaker Code 3:
-Response to sensing
-either O, T for triggered, I for inhibited, or D for dual
Pacemaker Code 4:
-Rate Modulation
-either O or R for rate modulation (think artifact)
Pacemaker Code 5:
-Multisite pacing
-either O, A, V, or D
What is the MOST common response to sensing (code 3)?
-Dual (triggered and inhibited)
A wave:
-atrial contraction, occurs after P wave
-increases atrial pressure
-provides atrial kick
C wave:
-interrupts decreasing atrial pressure, end of atrial involvement
-isovolumetric contraction of the ventricle
-tricupsid valve closed and ventricle bulges toward the atria
-follows the R wave
X descent:
-decrease in atrial pressure from the A wave through ventricular systole
-called systolic collapse
-sometimes called X and X^1
V wave:
-venous filling of the atrium
-during late systole, tricuspid valve remains closed
-peaks just after the T wave
Y descent:
-tricuspid valve opens, initial blood flow into the ventricle
-called diastolic collapse
Abnormal CVP waveforms-atrial fibrillation:
-absence of A wave
-longer C wave
Abnormal CVP waveforms- tricuspid regurg:
-no X descent b/c of incompetent valve
Abnormal CVP waveforms-tricuspid stenosis:
-tall A wave b/c of back pressure and inability to contract
-y descent is masked
Guidelines for PAC depth:
-110 cm length, marked at 10 cm intervals
-RA: 20-25 cm
-RV: 30-35 cm
-PA: 40-45 mm
-Wedge: 45-55 cm
Abnormal PAC Waveform- Mitral Regurg:
-Tall V wave
-C wave fused with V wave
-no X descent
-no specificity or sensitivity to severity of MR due to LA compliance changes and volume change
Abnormal PAC Waveform- Mitral Stenosis:
-slurred, early y descent
-A wave may be absent due to frequent association with a fib
-with mitral valve surgery, often have to cardiovert
Abnormal PAC Waveform- Acute LV MI:
-Tall A waves due to noncompliant LV
-LV systolic dysfunction increases LVEDV and LVEDP
-PAWP increases
Mixed Venous Oximetry Equation:
SvO2= SaO2-VO2/(Q x 1.34 x Hgb)
-SVO2: mixed venous Hgb saturation
-SaO2: arterial Hgb saturation
-VO2: oxygen consumption
-Q: CO
-1.34: oxygen carrying capacity of hgb
What is true if hgb, arterial saturation, and oxygen consumption stay the same?
-Mixed venous oximetry is an indirect indicator of CO
-so if CO falls, mixed venous value will fall too
Average mixed venous sat:
75
Average PVR and SVR:
-PVR: 80
-SVR: 1200
With bolus thermodilution, what does it mean if the temp changes alot?
-the CO is probably low
-change of 13% in temp is significant
Thermodilution inaccuracies:
(measured at right heart, assumed left heart)
-intracardiac shunts
-tricuspid/pulmonic regurg
-mishandling of injectate
-fluctuations in temperature (following bypass)
-rapid fluid infusion-cool meds or blood?
Pulse Contour Inaccuracies:
-atrial fibrillation
-site of arterial puncture
-quality of arterial trace-affected by pressors
-requires frequent re-calibration-ideally calibrated initially with a known CO
Echo-M mode:
-narrow beams to measure tissue planes
-ex: ventricular wall mass
Echo-2D:
-real time motion, shows function
Echo-Doppler:
-can determine speed and direction, color!
Focus Method with Echo:
-5 key views
-anterior structure is at top of image, closest to transducer
-windows: parasternal (3-5 ICS), apical @ PMI, Subcostal (below xiphoid)
Parasternal long axis:
-great overall view, measures LA, LV, and Ao root
Parasternal short axis:
-LV function and volume assessment
Apical 4 chamber:
-RV and LV size, TV and MV function, and descending Ao
Subcostal 4 chamber:
-4 chambers, pericardial effusion often next to right heart
Subcostal IVC:
-diameter, collapsibility
(especially in spontaneous respiration)
TEE: what’s it good for?
-rescue tool
-assessment of valve function
-posterior structures are now closer to transducer, at top of image! opposite of TTE setup
Contraindications to TEE:
-esophageal varices
-laparoscopic banding of the esophagus
