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APA > SRNA Presentations: part 1 > Flashcards

SRNA Presentations: part 1 Flashcards

1
Q

Which lead is most useful in detecting arrhythmias since it lies so close to cardiac axis?

A

Lead II

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2
Q

What makes lead VI unique?

A
  • distinguish between left and right ventricle ectopic
  • distinguish right from left BBB
  • P waves more easily seen in right sided leads
  • differentiate SVT from V tach
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3
Q

What is Einthoven’s triangle?

A

The 3 lead configuration used in the E.R

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4
Q

What is important about Wilson’s central terminal theory?

A
  • used in 12 lead ECG

- each lead offers unique info that cannot be mathematically derived from other leads

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5
Q

What are indications for a posterior ECG?

A

Changes in V1-V3 on standard ECG (ST elevation, tall r wave, tall upright T wave)

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6
Q

Where do the coronary arteries originate?

A

In the aorta, immediately superior to aortic valve

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7
Q

When are coronary arteries perfused?

A

During diastole

- capillaries have increased resistance during systole, relax during diastole so they fill more easily

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8
Q

Which part of the heart does the left coronary artery supply?

A

Anterior left ventricle

Left lateral part of left ventricle

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9
Q

What parts of the heart does the right coronary artery supply?

A

Right atrium
Most of right ventricle
Posterior part of left ventricle (in most people)

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10
Q

The RCA divides into…..

A

The right marginal and posterior descending artery

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11
Q

The LCA divides into…….

A

The left circumflex
Left marginal and diagonal
Left anterior descending

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12
Q

How are ST elevation and ischemia defined?

A

ST elevation: > 1mm in 2 or more contiguous precordial leads

Ischemia: ST elevation or presence of new LBBB

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13
Q

Which leads will show ST elevation in a lateral wall MI?

Which coronary artery supplies this region?

A

I, aVL
V5, V6
Left circumflex artery

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14
Q

Which leads will show elevation in an inferior wall MI?

Which coronary artery supplies this region?

A

II, III, aVF

Right coronary artery

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15
Q

Which leads show elevation in a septal wall MI?

What coronary artery supplies this region?

A

V1, V2

Left anterior descending artery (LAD)

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16
Q

Which leads show elevation in an anterior wall MI?

What coronary artery supplies this region?

A

V3, V4

Left anterior descending artery (LAD)

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17
Q

In which leads will you see ST elevation and depression during a posterior wall MI?

A

ST elevation in V7, V8, V9

ST depression in V1, V2

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18
Q

What are contraindications to fibrinolytic therapy?

A
  • SBP >180, DBP >110
  • right vs left arm BP difference > 15
  • stroke >3 hours, or <3 months
  • hx structural CNS disease
  • head/Facial trauma within 3 weeks
  • major trauma/GIB/surgery within 4 weeks
  • on blood thinnners
  • pregnancy
  • hx intracranial hemorrhage
  • advanced CA
  • severe liver/renal dx
19
Q

How do you know repercussion was successful?

A

CP gone
ST segment normalized
Reperfusion dysrhythmias (2-5 beats v tach)
-never fear reperfusion is here
- release of toxic free radicals and Ca++ from ischemic cells into vascular system

20
Q

What are some causes of ST elevation intra-operatively, and how can they be managed?

A
  • tachycardia: try to keep HR<70 (beta blockers)
  • hypotension: give IVF or neo
  • hypoxia: keep sats >95%
  • anemia
  • elevated pre-load: nitro or diuretic
  • high afterload: avoid HTN, consider vasodilator
  • increased contractility: beta blocker, anesthetic gases
21
Q

What are normals for CO and CI?

A

CO: 5-6L/min
CI: 2.6-4.6L/min (CO/BSA)

22
Q

How do you calculate SVR?

What is a normal SVR?

A

[(MAP-CVP)/CO]x 80

900-1200 dynes/sec/cm^5

23
Q

What is a dyne?

A

Force required to move 1 G of weight 1 cm/sec (1/1000 newton)

24
Q

What is SVR?

A

The total peripheral resistance

The sum of resistance of all blood vessels in body (arteries, veins, capillaries etc)

25
Q

How do you calculate SVRI?

A

[(MAP-CVP)/CO] x 80

26
Q

How do you calculate PVR (pulmonary vascular resistance) and what is normal?

A

[(MPAP -PAWP)/CO)] x 80

Norm: 100-200 dynes/sec/cm^5

27
Q

What happens to PVR at different lung volumes?

A
  • At low lung volumes compression of extra alveolar vessels increases
  • at high lung volumes compression of intracellular vessels increases
  • the least resistance is at FRC *
28
Q

What is normal PRRI?

A

225-285 dynes/sec/cm^5

29
Q

What is SVO2?

A

O2 sat of blood returning to the right side of the heart

- measures the relationship of O2 consumption and delivery to the body

30
Q

How can SVO2 be calculated and what is considered normal?

A

Fick’s equation:
[(SaO2 - VO2)/(Hgb. X 1.36 x Q)]
60-80%
* most accurate when taken from PA catch

31
Q

Where is a PA cath inserted?

A

Right IJ
Left subclavian
One of femoral veins

32
Q

What are the different ports of a PA catheter used for?

A
  • proximal port: CVP
  • distal port: PAP and PAWP
  • thermistor port: continuous temperature readings
33
Q

Where is the zero point for a CVP or PA cath.?

A

Plebostatic axis: midpoint of left atrium

- 4th intercostal space, mid axillary line

34
Q

What are some complications of a PA catheter?

A
  • blood clots
  • low BP
  • irregular HR
  • cardiac tamponade
  • ** PA rupture —> 50 % mortality rate ***
  • bruising at insertion site
  • excessive bleeding
  • vein injury/tear
  • pneumothorax
35
Q

What is the norm for a CVP and when should it be read?

A

0-7 or 1-10 mmHg

Read at end of exhalation, when pleural pressures equal atmospheric pressures

36
Q

In a CVP what causes a loss of the “a” wave?

A

Atrial fibrillation or V pacing

37
Q

On a CVP what causes a large “A” wave?

A

Atria contracting against high resistance (valve or non-compliant ventricle)

38
Q

In a CVP what causes a large “V” wave?

A

Tricuspid regurgitation (c and v wave blend together)

39
Q

Most causes of volume deletion during surgery occur from:

A
  • blood loss
  • volume depletion d/t bowel prep and fasting
  • suction, vomiting, diarrhea
40
Q

What are causes of elevated CVP?

A
  • RV failure
  • tricuspid stenosis or regurgitation
  • cardiac tamponade
  • constrictive pericarditis
  • volume overload
  • pulmonary HTN
  • LV failure
  • high PEEP
    • PEEP of 10 cmH2O results in increase of CVP by 2-3 cmH2O
41
Q

Where is the optimal location for a PA catheter and what are normal PA pressures?

A

Lung zone 3

15-25/5-15 mmHg

42
Q

What does PA systolic measure and what does PA diastolic measure?

A

PA systolic: pressure in PA as blood is ejected from right ventricle
PA diastolic: pressure in PA as blood moves from artery to lungs
**INDIRECTLY measures left heart pressures

43
Q

In a PA cath what causes:
Large a waves:
Giant a waves (cannon waves):
Large v waves?

A

Large a waves: mitral valve stenosis
Cannon waves: junctional and AV dissociative rhythms
Large V waves: MITRAL REGURGITATION, ventricular failure, increased PVR or SVR, ventral/septal defect

APA (8 decks)

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