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Flashcards in Final Deck (66):
1


Nitroglycerin

TX - HTN, chest pain; SE - headache; dilates peripheral vessels and coronary arteries

2

Morphine

TX chest pain (MI, PE) - reduces anxiety, dilates; SE: resp. depression, hypotension

3

Atropine

Anticholinergic - TX bradycardia, heart block, asystole ; SE - increased HR, anxiety, thirst, urinary retention

4

Isuprel

beta-adrenergic; used to increase HR; SE - V-fib

5

Adenosine

antidysrhythmic ; TX PSVT (paroxysmal, supraventricular tachycardia) ; IV push fast; SE - short periods of asystole.

6

Verapamil

CCB; TX SVT, angina ; SE- headache

7

Cardizem

CCB; TX PSVT, A-fib/flutter (with increased HR) , angina

8

Lidocaine

fast sodium channel blocker ; TX ventricular dysrhythmias ; decreases myocardial irritability - PVC, V tach + V fib

9

Procainamide

fast sodium channel blocker; TX atrial. ventricular and supraventricular dysrhythmias

10

Epinephrine

catecholamine; improves perfusion of heart and brain in cardiac arrest - TX profound decreased HR, asystole, pulseless V-tach and V-fib; No sodium bicarb ; TX anaphylactic shock

11

Sodium bicarbonate

TX metabolic acidosis

12

Mannitol

osmotic diuretic ; TX edema of CNS ; use filter needle

13

Methylprednisolone

glucocorticoid; TX edema of CNS

14

Narcan

opiate antagonist; short duration; withdrawal symptoms

15

Flumazenil

reversal agent for benzodiazepine meds - Valium, Versed, Librium.

16

Dopamine

TX hypotension ; sympathomimetic

17

Norepinephrine

catecholamine ; TX hypotension

18

Dobutamine

no vasoconstriction - TX shock states with decreased CO ( increases BP d/t increase in CO)

19

Nipride

TX hypertensive crisis ; measure cyanide levels; keep wrapped with aluminum foil

20

Lasix

loop diuretic ; depletes Na + K

21

A-line

BP, blood, vasoactive meds ; radial or brachial; systolic, diastolic and MAP (min 60); dicrotic notch - closure of aortic valve; Allen's test (patency of ulnar artery); bag pressure 300; level & calibrate transducer Q8 or position changed - Phlebostatic axis - 4th intercost. space on the right of sternum

22

Pulmonary artery catheter

shows pt fluid status; CVP(preload- RA pressure) ; PAP; PCWP; CO; jugular or subclavian vein ; balloon wedged 8-15 sec - risk for pulmonary infarction

23

CVP

1-8 mmHg

24

PAP

15/5 - 25/15 mmHg

25

PCWP

indirect left atrial pressure - 4-12 mmHg

26

Cardioversion

synchronized shock during QRS wave ; TX A-flutter, A-fib, V-tach (with pulse and fast rhythm); consent + sedate;

27

Defibrillation

asynchronous shock; pulseless V-tach + V-fib ; 2 min of CPR between shocks - Biphasic 200 joules - mono - 360.

28

IABP - intra aortic balloon pump

increase CO ( by 40%); femoral artery - descending aorta ; diastole - inflates (block aorta) - blood to coronary artery; systole - deflates - vacuum effect - improves LV ejection + CO; TX HF, MI; HOB < 45; can't flex legs

29

VAD - ventricular assist device

improve CO; TX end stage HF; LVHF - tube pulls blood from LV into pump - aorta

30

CO - blood pumped from left ventricle each minute

4-7 L/min

31

SV - stroke volume

amount of blood ejected with each contraction

32

Afterload

pressure heart must overcome to eject blood during systole

33

Respiratory failure

PaO2 < 60 & PaCO2 > 50

34

Endotracheal tube - check placement

1. end-tidal CO2 ( detector)
2. Breath sounds
3. X-ray

35

CVP - central venous pressure catheter

RA pressure (preload); give fluids, blood samples; subclavian, jugular, femoral veins ( end SVC )

36

Paternalism

making decision for pt. ; restriction of autonomy to protect the pt from harm

37

Fidelity

keep promises

38

Veracity

tell the truth

39

Beneficence

prevent harm

40

Nonmaleficence

do no harm

41

PR interval

P - Q wave; total atrial activity - 0.12-0.2 sec ; * 1 small box - 0.04 ;

42

QRS complex

Q-S; ventricular contraction - depolarization ; < 0.12 sec

43

ST interval

S-T - T wave - total ventricle relaxation

44

QT interval

total ventricular activity

45

U wave

follows T wave - recovery of Purkinje fibers

46

Amiodarone

emergency tx A-fib, A-flutter, V-fib, V-tach, PVC; SE: AV block, hypotension, bradycardia

47

V-tach

HR > 100; wide, uniform, regular QRS , no P waves; TX - pulse - cardioversion, Amiodarone, Lidocaine; no pulse - CPR, defibrilation

48

V-fib

wavy pattern - no P or QRS waves - Cardiac arrest - CPR, defibrilation, Amiodarone or Lidocaine

49

Unifocal PVC vs Multifocal PVC (premature ventricular complex)

QRS is wide, T opposite to QRS; P is absent - look the same vs look different ( positive + negative PVCs) ; TX: Lidocaine, Amiodarone

50

A-flutter

P waves - sharp, sawtooth ; PR interval cant be measured ; TX: Amiodarone, CCB, cardioversion

51

A -fib

very irregular, No p waves + PR interval; normal QRS ; microemboli form ( >24 hrs) - transesophageal echocardiogram - emboli ? anticoagulation therapy ; TX- cardioversion, BB, CCB, Amiodarone, Digoxin

52

SVT - supraventricular tachycardia

HR > 150 ; difficult to see P waves ; TX: valsalva + vagal maneuvers , Adenosine (HR), BB + CCB, synchronized cardioversion

53

1st degree HB

prolonged PR interval ; TX - none - watch

54

2nd degree HB - Morbitz Type 1

PR interval gets gradually longer until P fails to conduct and QRS is dropped ; TX - Atropine + temporary pacemaker

55

2nd degree HB - Morbitz Type 2

PR intervals are the same until P wave is dropped - no QRS ; TX - Atropine + Permanent pacemaker

56

3rd degree HB - Complete HB

P waves unrelated to QRS - pacemaker, Atropine, Dopamine

57

Asystole

flat line - verify pulse - CPR - Epinephrine + Atropine - trancutaneous or tranvenous pacing - NO DEFIBRILATION

58

six second EKG strip - determine HR

1. 300 / by number of large boxes between R intervals
2. 1500/ by number of small boxes between each R interval
3. least accurate - for irregular rhythm - count R waves ( don't count first and last ) x 10

59

MI - ECG changes

1. Inverted T waves - ischemia
2. ST segment elevation - injury
3. Pathological Q waves - usually permanent even after recovery

60

MI - chest pain + s/s

Radiates to back, abdomen, neck, jaw, left arm, shoulder.
SOB + anxiety + impending doom

61

MI - MONA

Morphine
Oxygen
Nitroglycerin (SBP > 90)
Aspirin (325 mg chew)

62

STEMI vs NSTEMI

ST elevation MI (blood clot completely blocking an artery - tx: angioplasty, stenting, clot busting meds) vs none ST elevation MI ( women, does not extend through the full depth of the heart muscle - clot-busting meds are not effective)

63

MI - DX - cardiac markers (enzymes)

1. Troponin T + I - preferred - cardiac injury - rises 2-6 hrs
2. Creatinine kinase - MB - peaks 24 hrs - heart muscle enzyme
3. Myoglobin - rises 3-4 hrs - non-specific

64

Percutaneous Transluminal Coronary Angioplasty can be combined with stent placement

invasive but non-surgical technique - under fluoroscopic guidence in the cath lab - balloon tipped catheter - inflates - force the plaque against the vessel wall ; groin or arm;

65

MI - TX + SX

1. Thrombolytic therapy - Streptokinase, Urokinase - first 6 hrs; Bleeding !!! - antidote - Amicar-aminocarproic acid .
2. Glycoprotein inhibitors - Reopro + Integrilin - target platelet component of thrombus
3. Angioplasty - with stent
4. CABG - coronary artery bypass graft sx

66

Ace-inhibitors and MI - Captopril , Lisinopril

prevent ventricular remodeling - decreases risk of HF - SE: bradycardia, cough, hyperkalemia ;
inhibit renin-angiotensin-aldosterone mechanism - block conversion of angiotensin I to angiotensin II - prevents peripheral vasoconstriction; reduces blood volume ( inhibit aldosterone )