Vascular/Pericardial Flashcards
most common abnormality for MI
ST segment
2/3/aVF coronary artery
R CA
1/avL coronary artery
circumflex
1/avL heart
lateral LV
V3-5 coronary artery
LAD
V3-5 heart
anterolateral LV
high risk surgeries (4)
AAA
peripheral vascular
thoracotomy
major abdominal
Ischemic heart disease indicators (5)
hx of MI
current angina
positive exercise test
taking nitrates
Q wave
CHF indicators (5)
pulm edema
paroxysmal nocturnal dyspnea
Rales
S3 gallop
pulm vascular redistribution
cerebrovascular inidcators (2)
CVA
TIA
renal indicators
Cr > 2mg/dL
diabetic indicators
IDDM
avoid decreaing O2 delivery (7)
tachycardia
hypotension
hypocapnia
decr FiO2
anemia
arterial hypoxemia
L shift O2 Hb curve
avoid increasing O2 demand (6)
sympathetics
tachycardia
HTN
incr inotropy
incr SVR
incr prelaod
PMI S+S
1mm change in ST segment
PMI w/elevated SVR
give NTG
PMI w/elevated HR
give esmolol
PMI w/hypotension
give inotropes
avoid (6) in PMI
shivering
pain
hypoxemia
hypercarbia
sepsis
hemorrhage
when are aortic aneurysms operated on
> 5cm
debakey 1
60%
complete dissection
debakey 2
10-15%
ascending
debakey 3
25-30% descending
stanford A
ascending
stanford B
descending
which dissections are surgically treated?
ascending aorta
aortic arch
AAA S+S
hypotension
severe back pain
pulsatile abdominal mass
cause of anterior spinal artery syndrome
aortic cross clamp
anterior spinal artery S+S
flaccid paralysis
motor dysfunction
acute back pain
autonomic dysfunction
goal MAP above cross clamp
100 mmHg
goal MAP below cross clamp
50 mmHg
clamping causes
vasoconstriction
incr venous return
HTN
unclamping causes
blood pooling
decr venous return
hTN
how can you differentiate MI and pericarditis?
pericarditis does not impoved with NTG
cardiac tamponade S+S (8)
incr CVP
hypotension
decr ECG voltage
sympathetic activation
cardiac filling equalization
pulsus paradoxus
kussmaul’s sign
beck’s triad
what determines physiologic manifestations of tamponade
timeframe of fluid accumulation
kussmaul’s sign
jugular distension on inspiration
Beck’s triad
muffled heart sounds
incr jugular venous pressure
hypotension
pulsus paradoxus
SBP decr 10 mmHg during inspiration
cardiac tamponade managemetn
needle decompression before GETA
use ketamine
avoid PPV