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Adult Critical Care > Test 2 > Flashcards

Test 2 Flashcards

(58 cards)

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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

Study These Flashcards
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
PEA
Pulseless Electrical Activity Connected to Asystole -Electrical Pattern that is seen on EKG or rhythm strip, bud does not produce a pulse
26
CAB
Circulation- most important Airway Breathing check PETCO
27
Compressions should be performed at a rate of
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
Advanced airways are important because
providing ventilation and compressions becomes simultaneous
29
Breathing- avoid
``` excessive ventilation (one breath every 6 seconds after an advanced airway has been placed) Excessive= increase pressure in chest ```
30
Cardioversion vs. Defibrillation
Both deliver an electrical shock to the heart, in joules, in hopes of restoring adequately perfused conduction
31
External Defibrillator
Can also perform cardioversion, external heart pacing-transcutaneously shocking or pacing(capture to see NRG is strong enough), synchronizing
32
Defibrillation
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
Rhythms that we defibrillate
Pulseless V. tach and V. Fib
34
AED
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
Cardioversion
- 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
Cardioversion rhythms
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
Routes of Delivery
IV= Intravenous IO= Intra-osseous Endotracheal
38
IO
- 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
Endotracheal meds
Medication is absorbed by the lungs and carried into circulation - Unreliable - Double dose and bag for circulation (optimal dose unknown)
40
Approved ETT drugs
``` 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
Drugs that have dose changes as increased
Amiodarone and Adenosine
42
RES Q-POD
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
How does hyperventilating impede resuscitation efforts
reduces cardiac output inhibit
44
PETCO
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
STEMI
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
Fibrolytic Tx of STEMI
-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
TX for suspected MI
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
STROKE
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
Clot
Occlusion of vessel
50
Hemorrhage
burst of vessel
51
Cardiovert at
50Joules- any tach
52
Adenosin
``` SVT IV Access 6mg followed by rapid flush of saline 12 mg rapid flush No compressions ```
53
Epinephrine
1mg every 3-5 minutes followed by CPR | PEA, Pulseless vtach,
54
Amiodarone
300mg 150mg ETT Pulseless Vtach Continue CPR
55
TPA
Fibrolytic | given within 3 hrs of CVA: stroke, busts clot not blood thinner
56
Atropine
Bradycardia 0.5mg every 3-5 minutes, Max 3mg no compressions
57
Chewable Aspirin
STEMI | 160-320 mg
58
STEMI Intervention and outcome
Repurfusion- 90 minutes

Adult Critical Care (5 decks)

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