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Adult Critical Care > Test 2 > Flashcards

Test 2 Flashcards

1
Q

H’s and T’s

A 
Hypovalemia 
Hypoxia
Hydrogen Ion (acidosis)
Hyper/Hypokalemia
Hypothermia
Tablets
Tamponade
Tension Pneumothorax
Thrombosis-coronary (MI)
Thrombosis-Pulmonary (PE)
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2
Q

Hypovalemia

A

Low blood vol-fixed by fluids

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3
Q

Hydrogen Ion

A

Check if its acidosis/ or metabolic… fix with bicarb when acidosis

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4
Q

Hyper/Hypokalemia

A

Hyperkalemia-fixed with albuterol

Hypokalemia- fixed with potassium

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5
Q

Tablets-overdose

A

Find antidote and fix with Narcan

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6
Q

Tamponade

A

Cardiac, Relieve pressure around heart (squeeze)

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7
Q

Tension Pneumothorax

A

fix with chest tube/ needle

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8
Q

Thrombosis-coronary

A

MI- clut buster

PCI-Stent-relieve block, angioplasty-open up, see block

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9
Q

Thrombosis-Pulmonary

A

PE- Clot buster

Remove clot

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10
Q

PVC

A

Premature Ventricular Contraction- Normal Irritability of the heart that starts in ventricle, outside of the normal path of conduction and bounces through ventricle= wide QRS, no Pwave

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11
Q

PVC rate, Rhythm, P wave, QRS

A

Rate- dependent upon underlying rhythm
Rhythm- irregular because of PVC
P wave- No p wave is associated with the PVC
QRS- Greater than 0.12 seconds that is wide and bizarre

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12
Q

When is PVC a problem

A

When it is frequent and is symptomatic

PVC is caused by stress

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13
Q

Run of 3

A

Run of v. tach: loses C.O.
Happens every 2? Bigemity
Every 3? Trigemity

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14
Q

Ventricular Tachycardia

A

-Three Consecutive PVC’s is considered a “run” of ventricular tachycardia
-Ventricular Rate= 100-250 bpm
-Ventricular rhythm essentially regular
-QRS > 0.12 seconds
-Ventricular tach without a pulse is an emergent situation. BLS should be initiated as soon as possible and the pt defibrillated
DONT DELAY SHOCKING

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15
Q

Vent. Tach. shocking

A

Can have with or without pulse
With pulse-Can cardiovert
Without pulse- Defib/ CPR 2 min then check/ push meds= restore CO

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16
Q

Monomorphic V. tach.

A

All coming through the same ventirucle

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17
Q

Polymorphic V. tach.

A

Twisting of points

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18
Q

V. tach common causes/ problems

A
  • MI
  • Myocardial Ischemia
  • Pt may become severely hypotensive to the point of syncope
  • Cardiac output may deteriorate significantly causing the pt to become unresponsive
  • Serious arrhythmia, often leading to ventricle fibrillation
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19
Q

Treatment of V. tach.

A

Follow pulseless ventricular tachycardia/ Ventricular fibrillation ACLS algorithm
Goal: return spontanious, then look at causes

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20
Q

Torsade De Pointes

A

Polymorphic Ventricular Tachycardia (PVC)
“twisting of points”
Caused by multiple things
-Drugs including: antidepressants, antidysrhythmics, eating disorders, and electrolyte imbalances
-Treated with mg sulfate (in crash cart)

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21
Q

Torsade De Pointes think

A

Magnesium!! important in muscle contraction

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22
Q

Ventricular Fibrillation

A
  • Quivering of the ventricles with no beat producing rhythm
  • Rhythm is chaotic with no pattern or regularity
  • There is no CO or BP!!
  • Pt becomes unconscious, no pulse
  • Without tx the pt will die in minutes
  • Nothing can be identified
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23
Q

Vent. Fibrillation tx

A

Follow pulseless ventricular tachycardia/ ventricular fibrillation ACLS algorithm
Compare asystole and PEA, SHOCK ASAP

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24
Q

Asystole

A
  • Complete absense of electrical and mech activity
  • no cardiac output
  • Flatline: used to determine clinical death
  • must confirm in two leads

Tx: Follow asystole/ PEA ACLS algorithm
Remove monitors

Can only do CPR and EPI

25
Q

PEA

A

Pulseless Electrical Activity
Connected to Asystole
-Electrical Pattern that is seen on EKG or rhythm strip, bud does not produce a pulse

26
Q

CAB

A

Circulation- most important
Airway
Breathing
check PETCO

27
Q

Compressions should be performed at a rate of

A

at least 100bpm and atleast two inches deep on an adult. It is recommended to rotate the compressor every two min while heart rhythm is checked.

28
Q

Advanced airways are important because

A

providing ventilation and compressions becomes simultaneous

29
Q

Breathing- avoid

A 
excessive ventilation (one breath every  6 seconds after an advanced airway has been placed) 
Excessive= increase pressure in chest
30
Q

Cardioversion vs. Defibrillation

A

Both deliver an electrical shock to the heart, in joules, in hopes of restoring adequately perfused conduction

31
Q

External Defibrillator

A

Can also perform cardioversion, external heart pacing-transcutaneously shocking or pacing(capture to see NRG is strong enough), synchronizing

32
Q

Defibrillation

A

Delivery of a uniform current of sufficient intensity to depolarize ventricular cells and terminate the abnormal heart rhythm

  • Momentary asystole provides opportunity for SA node to regain control
  • Also called unsynchronized counter shock
  • Monophasic 360 or biphasic 200
33
Q

Rhythms that we defibrillate

A

Pulseless V. tach and V. Fib

34
Q

AED

A

Automated External Defibrillation

  • Voice prompted
  • Looks at rhythm, QRS width, rate, and amplitude
  • Safety checks for false signals: poor/ loose electrode contact, radio transmissions
35
Q

Cardioversion

A
  • Synchronized to deliver a shock during ventricular depolarization or on the “R” wave.
  • MUST HAVE A QRS
  • Shock attempts to restore normal sinus rhythm
  • Can also give drugs to reduce symptoms, otherwise shock
36
Q

Cardioversion rhythms

A

SVT! Unstable tachycardia, Unstable A. flutter or A. Fib, High ventricular rate= 150bpm or more

  • No CPR , patient is awake and having symptoms
    goal: restore ventricular rate
37
Q

Routes of Delivery

A

IV= Intravenous
IO= Intra-osseous
Endotracheal

38
Q

IO

A
  • Infusing medication, fluids, and blood products into the bone marrow cavity which intern enters venous circulation
  • Any medication that can be administered IV can be administered IO (same dose)
39
Q

Endotracheal meds

A

Medication is absorbed by the lungs and carried into circulation

  • Unreliable
  • Double dose and bag for circulation (optimal dose unknown)
40
Q

Approved ETT drugs

A 
NAVEL
N: Naloxone/ narcan- reverse opiates
A: Atropine- Symptomatic Brady
V: Vasopressing- Potent vasoconstrictor
E: Epinephrine- Given Q 2-3 min, PRN
L: Lidocaine- Antiarrythmia

(plus mycomyst, combivent, duo, ect)

41
Q

Drugs that have dose changes as increased

A

Amiodarone and Adenosine

42
Q

RES Q-POD

A

Improves cardiac output by improving venous return during chest recoil- creates a vacuum like effect in chest

  • also has a light that flashes to guide ventilation: keeps from hyperventilating
  • If pt is resuscitated successful, the Res Q POD must be removed (immediately after ROSC)
  • Aka impedence threshhold device
  • Can be used with ETT and BVM
43
Q

How does hyperventilating impede resuscitation efforts

A

reduces cardiac output inhibit

44
Q

PETCO

A

End Tidal CO2

  • Reflects perfusion efforts during CPR- circulation not ventilation
  • If end tidal CO2 drops below 10mmhg, improve compressions or switch compressors
  • At 40mmhg; ROSC
  • Keep at 10-20 during CPR atleast
  • Measured during exhalation
45
Q

STEMI

A

ST elevated myocardial infarction

  • PROTOCOL; EKG within 10 minutes of ED admission
  • TX: Fibrolytics or percutaneous coronary intervention (PCI) (angioplasty, stenting): 90 minutes
  • MONA
46
Q

Fibrolytic Tx of STEMI

A

-No catheterization lab within distance
-break down of fibrin clots
-tx with fibrolytics increases risk of bleeding out
ex.
Retavase, Streptokinase, Tissue Plasminogen activator (tPA)

They break of clots, risk of bleeding out

47
Q

TX for suspected MI

A

MONA
M: Morphine- Helps pain, reduces stress
O: Oxygen- Treat hypoxemia, low dose 1-4lpm, maintain SpO2 (too much=coronary vasoconstriction)
N: Nitroglycerin- tx angina (chest pain), cause vaso coronary dilation be careful of low BP
A: Aspirin- doesnt bust clots, helps stop continue of formation

48
Q

STROKE

A

Cerebral Vascular Accident (CVA)
-You must find out if it is caused by a clot or hemorrhage
-treatment with fibrolytics
-timely tx extremely important: within 3 hours- stroke fibrolytic check list
Signs and symptoms? CT right away rule out head bleed
STEMI= 90 min

49
Q

Clot

A

Occlusion of vessel

50
Q

Hemorrhage

A

burst of vessel

51
Q

Cardiovert at

A

50Joules- any tach

52
Q

Adenosin

A 
SVT
IV Access
6mg followed by rapid flush of saline 
12 mg rapid flush
No compressions
53
Q

Epinephrine

A

1mg every 3-5 minutes followed by CPR

PEA, Pulseless vtach,

54
Q

Amiodarone

A

300mg
150mg ETT
Pulseless Vtach
Continue CPR

55
Q

TPA

A

Fibrolytic

given within 3 hrs of CVA: stroke, busts clot not blood thinner

56
Q

Atropine

A

Bradycardia
0.5mg every 3-5 minutes, Max 3mg
no compressions

57
Q

Chewable Aspirin

A

STEMI

160-320 mg

58
Q

STEMI Intervention and outcome

A

Repurfusion- 90 minutes

Adult Critical Care (5 decks)

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