-
Initial triage assessment should be done within ___ minutes.
5
-
Three level acuity system for triage?
- Emergent- go directly back
- Urgent
- nonurgent
- Urgent and nonurgent can wait safely in waiting room
-
How often should urgent and nonurgent patients waiting in the waiting room be reassessed?
- urgent - every 30 minutes
- nonurgent - every hour
-
Five-level acuity system?
- Critical - immediate Tx and constant monitoring
- Ustable/emergent: Tx and reassessment q15min
- Urgent/potentially unstable: reassess q30-60min
- Stable/nonurgent: reassess q1-2 hours
- Minor: reassessment q4h
-
Telephone triage?
assess patients and direct them to appropriate care
-
What must be established in order for a nurse to do telephone triage?
compentency assessment training and CE to demonstrate proficiency
-
Reportable occurances?
mandated by law to be reported to health department, social services, or law enforcement: abuse/neglect, animal bites, communicable diseases, suicide attempt, etc
-
Airway triage red flags?
- apnea
- choking
- drooling
- audible airway sounds
- positioning
-
Breathing triage red flags?
- grunting
- sternal retractions, increased WOB
- irregular resp patterns
- RR >60
- RR <20 in children <6yrs
- RR <15 in children <15yrs
- absence of breath sounds
- cyanosis
-
Circulation triage red flags?
- cool/clammy skin
- tachycardia/bradycardia
- HR>200 OR <60
- hypotension
- diminished or absent peripheral pulses
- decreased tearing, sunken eyes
-
Disability triage red flags
- altered LOC
- inconsolability
- sunken or bulging fontanel
-
Exposure triage red flags?
- petechiae
- pupura
- S/S of maltreatment or abuse
-
Vital signs triage red flags?
- hypothermia
- temp >100.4 in infant <3mo old
- temp >104 any age
-
Pain triage red flag?
severity
-
History triage red flags?
- chronic illness
- family crisis
- return visit to ED within 24 hours
-
What is the most common cause of airway obstruction?
tongue
-
Type of breathing with alternating period of hyperventilation and apnea?
Cheyne-Stokes
-
What do Cheyne-Stokes respirations indicate?
cerebrum injury
-
Type of respirations with 3-4 breaths of identical rate and depth followed by apnea?
Biot
-
What is indicated by biot respirations?
injury of lower pons or upper medulla
-
Type of respirations with no respiratory pattern, mostly apneic?
ataxic
-
What is indicated by ataxic respirations?
injury of medulla
-
Late sign of pneumothorax?
tracheal deviation
-
Maintain SpO2 of > ____% for patients with ineffective ventilation?
90%
-
Tx of open pneumothorax?
petroleium guaze dressing secured on 3 sides. Remove and reapply if tension pneumo develops
chest tube
-
Tx of flail chest?
stabilization with a bulky dressing
mechanical ventilation
-
Tx of tension pneumothorax?
needle decompression followed by chest tube
-
Tx of hemothorax?
chest tube
surgical exploration and repair may be required
-
Tx of impaled object?
stabilization of object
removal by surgeon
-
Normal HR in infants?
1yr old?
8-12 yr old?
infants 90-170
year old 80-160
8-12 children 70-110
-
If you can feel a brachial or radial pulse, the systolic BP is at least ___.
80
-
If you can feel a femoral pulse the systolic BP is at least ____
70
-
If you can feel a carotid pulse the systolic BP is at least ____
60
-
Bleeding that requires immediate intervention?
- uncontrolled, pulsating bleeding
- pallor of lips, skin, or nail beds
- lg amnts of blood or clots in emesis/urine/stool
- distended/rigid abd
- gross swelling of an injured extremity
-
What is minimum urine output?
1mL/kg/hr
-
What position should pt with hypoperfusion be placed in?
flat
-
What is conjugate gaze?
normal mvmt of both eyes together in same direction
disconjugate is abnormal
-
Glasgow coma scale
Eye: 4 spontaneous, 3 voice, 2 pain, 1 no
- Verbal Response: 5 oriented, 4 confused
- 3 inappropriate words
- 2 incomprehensible sounds 1 No
- Moter Response: 6 obeys commands
- 5 localizes pain, 4 withdraws from pain
- 3 abnormal flexion to pain
- 2 abnormal extension to pain 1 NO
-
Contraindication for foley in trauma pt?
blood at meatus, scrotal hematoma, or perineal ecchymosis
-
What type of exam should be done on male trauma pt before inserting foley?
rectal exam to rule out urethral injury or trauma
-
What pain scale should be used for children and nonverbal adults?
FACES
-
Infant task and fear?
develop trust
separation and strangers
-
Toddlers task and fear?
autonomy and self-control
searation and loss of control
-
Preschool-aged children task and fears?
creating a sense of initiative
bodily injury and mutilation, loss of control, the unknown, the dark, and being left alone
-
School-aged children task and fears?
developing a sense of industry
loss of control, bodily injury, and mutilation, failure to live up to expectations, death
-
Adolescents task and fears?
separation from parents, adaptation to rapidly changing body, development of sexual identity and sense of who they are, autonomous function, privacy is extremely important
loss of control, altered body image, and separation from peer group
-
Should packing be inserted into ear/nose if they are draining during an assessment?
no
-
Bruising behind the ear?
What does this indicate?
battle sign
possible basal skull fracture but may not be evident immediately after injury
-
Trismus?
inability to open mouth completely
-
What is indicated by flat jugular veins when a pt is flat?
hypovolemia
-
What is indicated by distended jugular veins when pt is elevated?
hypervolemia, R ventricular failure, cardiac tamponade, or tension pneumo
-
What is indicated by hyperresonance of chest?
hyperinflated lung or air-filled thoracic cavity
-
What is indicated by dullness of chest?
fluid-filled or consolidated lung tissue
-
Bruising in flank area is called?
What does it indicate?
Grey-Turner sign
retroperitoneal bleeding
-
Bruising of periumbilical area is called?
Suggestive of?
Cullen sign
intraperitoneal bleeding
-
How is pelvic instability tested?
push the pelvis in and press down but do not rock it
-
Equation to find normal BP for children?
{70+(2 X age in years)}
-
What age group are prone to hypothermia?
seniors
-
Infants are obligate ____ breathers
nose
-
What type of breathing occurs in pt until age 6-7?
abd breathing
-
Considerations for children airways and respiratory system?
more susceptible to resp infections
airway smaller and more easily occluded
-
When is visual acuity of 20/20 attained?
age 7
-
When is ability to control urination gained?
between 2-3 years old
-
What happens to renal function after age 40?
renal function decreases and incomplete bladder emptying occurs
-
What endocrine issue may occur in children?
growth hormone abnormalities
-
What occurs in children due to increased flexibility of bones?
greenstick fractures, subluxation is common
-
What type of endocrine disorder is likely to occur in geriatric patients?
thyroid disorders
-
What must be done before a patient is transferred to another facility?
pt must be stabilized
-
Why do different cultures and illegals delay seeking medical attention?
language, cost, and cultural barriers
-
Does culture affect a patient's pain?
patient's reactions to pain are culturally driven
-
Does genetics affect a person's drug metabolism?
drug metabolism is genetically determined
-
Environmental factors that can affect drug metabolism?
diet, alcohol, smoking, malnutrition, vitamin deficiencies, stress, fever, and physiologic rhythms
-
What type of HTN med is ineffective in African Americans?
ACE inhibitors
-
What type of BP meds are used for African Americans?
- calcium-channel blocker: diovan/valsartan
- Beta-blocker
r/t decreased response to ACE
-
Cultural variation for Native Americans?
eye contact is considered a sign of disrespect
-
Cultural variation for Appalachians?
eye contact is impolite or sign of hostility
-
Cultural variation for American Eskimos?
seldom disagrees publicly with others
-
Cultural variation for Jewish Americans?
excess touching is offensive
-
Cultural variation for Chinese Americans?
- Excessive eye contact is rude
- Excessive touch is offensive
-
What cultures consider eye contact to be rude/offensive?
- Native Americans
- Chinese Americans
- Appalachians
- Vietnamese Americans
-
Cultural variation for Filipino Americans?
offending people is to be avoided at all cost
-
Cultural variation for Haitian Americans?
- Touch is used in conversation
- Direct eye contact is used to gain attention & respect
-
Cultural variation for East Indian Hindu Americans?
Women avoid eye contact as a sign of respect
-
Cultural variation for Vietnamese Americans?
- Avoidance of eye contact = respect
- The head is considered sacred - not polite to pat the head
- Upturned palm is offensive in communication
-
Cultural variation for Christian Scientist?
Disease and illness are delusions of the nonspiritual mind and can be overcome with prayer
may refuse medical care
-
Cultural variation for Hinduism?
- Illness may be r/t misuse of the body or from the sins of a previous life
- Females cannon be left in the presence of unfamiliar males
-
Cultural variation for Islam (Muslim)?
- Prayer and washing are required 5X/day
- The L hand is considered unclean- will not handle food with L hand
-
Cultural variation for Jehovah's Witnesses?
Opposed to transfusions - source of soul is in the blood
Do not celebrate national holidays or birthdays and do not salute flags
-
Cultural variation in Judaism?
Sabbath begins at sundown on Friday and ends at sundown on Saturday - no work: includes driving & using the phone
Must stay with a critically ill or dying family member until death so the soul will not feel alone
-
Cultural variation with Seventh-Day Adventist?
Sabbath begins at dusk on Friday and ends at dusk on Saturday
-
Omnibus Reconcilation Act of 1986?
requires hospitals that receive Medicare and Medicaid reimbursement to make patients and families aware of organ and tissue donation options
-
What will improve a patient with lung transplant prognosis?
if they receive a heart too
-
Exclusions for organ/tissue donation?
suspected or Hx of IV drug use in past year, sepsis, transmissible disease, metastatic cancer (except for primary brain tumor)
-
PaCO2 that indicates brain death?
PaCO2 of >60 X3-5 minutes with absence of spontaneous ventilation
-
EEG indication of brain death?
no electrical activity X at least 30 minutes
-
Cerebral angiography indication of brain death?
no intracerebral filling in circle of Willis or at carotid bifurcation
-
What is required for determination of brain death?
signature of 2 physicians: one not being involved in the care of the patient
-
Who must be called for chemical terrorism if the chemical is a military agent?
army
-
Pharmacy consideration in chemical terrorism with organophosphate?
may need large amounts of atropine and pralidoxime (2-PAM)
-
What part of a debriefing is the only part that is required?
Fact phase: individuals discuss their role in the incident and what they experienced through their five senses
-
What should be included when labeling photo that is collected for evidence?
patient's name and photographer's name, date and time
-
Chain of custody documentation that is included on evidence?
- How evidence was collected
- Who collected
- How transferred to law enforcement
- Date and time
- Person who took evidence and affilation with date and time
The fewer ppl who handle evidence the better
-
2 limitations to autonomy?
Rights of 1 person interfere with another individual's rights
High probability that a person may injure himself or others
-
Positive euthanasia?
- life support is withdrawn or med/Tx/procedure
- is used to cause death
-
Negative euthanasia?
no extraordinary or heroic life-support measures are used to save a person's life
DNR
-
Law that spells out nursing responsibilities and scope of practice?
Nurse Practice Act
-
Civil?
one individual sues another
-
Tort?
- legal wrong committed against a person or property - direct invasion of someone's legal rights
- (assault, battery, false imprisonment, invasion of privacy, defamation, slander
-
Administrative issues?
charges filed by a state or federal government agency
-
Malpractice?
unintentional tort: omission to do something that a reasonable and prudent professional would do or doing something reasonable person wouldn't do
-
Common problems made in documentation?
- omissions without explanation
- vague and ambiguous language
- unapproved abbreaviations
- error correction
- spelling and grammar errors
- illegibility
-
What treatment exceptions are made for minors?
- 1. pregnancy
- 2. Tx of STD
- 3. drug/alcohol Tx
- 4. birth control
-
Can person in custody of law enforcement consent/refuse treatment?
How can they be treated if they refuse?
may consent/refuse
need court order to collect forensic evidence
-
What law states patients must be given info regarding advance directives if the do no already have one?
Patient Self-Determination Act of 1991
-
Independent variable?
the variable that is being observed, introduced or manipulated in research study
-
Dependent variable?
variable that is being observed for a change after the intervention
-
Extraneous variables?
not being studied but may or may not be relevant to the results of the study
-
Quantitative research?
tests hypotheses and examines cause and effect of relationships: emphasizes facts and data
-
Ex post facto (correlational)?
describes relationships between variables
-
Qualitative?
emphasizes development of new insight, theory, and knowledge
nursing strategies, interpersonal communication techniques, intuition, and collaboration
-
Ethical responsibilities r/t nursing research studies?
- 1. Protect rights of subjects
- 2. Benefits outweigh potential risk
- 3. submit proposed study for review by investigational review committee
- 4. Obtain informed consent from each subject
-
TJC regulations for risk assessments?
TJC requires hospitals to perform risk assessments for at least one high-risk process each year
-
What must be included in a physician's order for restraints?
- date and time
- type of restraint
- purpose of restraint
- time limit
-
Observation required during first hour of restraint?
continuous face-to-face observation
-
How often must restrained pt be offered food, toileting, and hydration?
q3h
-
What must be documented about restrained patient's condition?
- General condition and response to treatment
- condition of restrained limb before restraint
-
When should restraints be loosened?
at regular intervals
-
What not to do if a patient is in denial?
confront with the truth
-
What should be done if family is allowed to be present during CPR?
designate staff person to be the facilitator for the family
-
How do pediatric patients compensate for decreased cardiac output? Why?
tachycardia
decreased vascular tone -> decreased venous return-> limits ability to increase stroke volume to raise CO
-
What may be indicated in a child with a new murmur with a fever?
Rheumatic fever
-
What is the primary cause of bradycardia and cardiac arrest in peds?
respiratory issues
-
What complication may occur r/t rheumatic fever?
valvular disease
-
What may be cause of tachycardia in peds?
underlying conduction system anomalies: Wolff-Parkinson White syndrome, Lown-Ganong_Levine syndrome
-
What may be cause of cardiac s/s in pediatric patient?
congenital cardiac issue
accidental drug ingestion
-
Why are older adults less able to adapt to cardiac stressors?
cardiac output at rest decreases and cardiac reserve is limited
-
Vascular changes with aging result in?
increase in diastolic BP
-
Consideration for s/s of MI in older adult?
more likely to have a silent MI than younger patients
-
Consideration for aging of liver and kidneys?
altered drug metabolism
-
Why are older adults predisposed to adverse effects of drugs?
polypharmacy
-
Where is apex of heart located?
normally at the fifth L intercostal space at the midclavicular line
-
Where is the base of the heart located?
second intercostal space
-
4 layers of the cardiac wall?
- pericardium
- epicardium
- myocardium
- endocardium
-
How much serous fluid is in pericardial space?
10-30 mL
-
What is included in myocardium?
conduction fibers and cardiac muscle
-
Endocardium?
smooth surface for blood contact and the deterrence of clot formation
- continues with lining of great vessels
- lines heart chambers and valves
-
Inflow tracts to R atria?
superior vena cava, inferior vena cava, coronary sinus, and Thebesian veins?
-
Outflow tract for R atria?
through tricuspid valve to R ventricle
-
L atria inflow tracts?
4 pulmonary veins - only veins that carry oxygenated blood
-
L atria outflow tract?
through the mitral valve to L ventricle
-
R ventricle outflow tract?
pulmonary artery - only case of artery carrying deoxygenated blood
-
L ventricle outflow tract?
aorta
-
Stenosis?
narrowing of the valvular orifice to prevent normal antegrade flow
-
AV valves?
mitral and tricuspid
-
What is the cause of the first heart sound S1?
closing of AV valves: mitral and tricuspid
-
Semilunar valves?
aortic and pulmonic
-
Where are aortic and pulmonic valves located?
- aortic - b/t L ventricle and aorta
- pulmonic - b/t R ventricle and pulmonary artery
-
What is the cause of S2 second heart sound?
closing of semilunar valves
-
Pathway of blood through the heart and vascular system?
vena cava->R atrium->tricuspid valve->R ventricle->pulmonic valve->PA->pulmonary capillary bed->pulmonary veins->L atrium->mitral valve->L ventricle->aortic valve->aorta->arteries->arterioles->capillaries->venules->veins->vena cavae
-
Where are coronary arteries located?
first branch off of the aorta immediately outside of the aortic valve
-
When is the L ventricle primarily perfused?
DIASTOLE
-
When is R ventricle perfused?
throughout cardiac cycle - greater during diastole
-
Preload?
stretch of heart muscle: affected by ventricular volume
-
Afterload?
pressure against which the ventricle must pump to open the semilunar valve: affected by vascular resistance, ventricular diameter, and the mass and viscosity of blood
-
Contractility?
the contractile force of the heart
-
Determinants of myocardial oxygen supply?
- 1. patent arteries
- 2. diastolic pressure
- 3. diastolic time
- 4. oxygen extraction: hemoglobin, O2 sat
-
L coronary artery before bifurcation?
Divides into what arteries?
L main coronary artery
L anterior descending artery and L circumflex artery
-
What areas are supplied by the L anterior descending coronary artery?
- 1. anterior L ventricle
- 2. Anterior 2/3 of interventricular septum
- 3. apex of L ventricle
- 4. Bundle of His and bundle branches
-
What areas are supplied by the L circumflex coronary artery?
- 1. L atrium
- 2. sinoatrial node in 45% of hearts
- 3. AV node in 10% of hearts
- 4. obtuse marginal branch ->lateral L ventricle, posterior L ventricle
-
What areas are supplied by the marginal branch?
lateral R ventricle and inferior R ventricle
-
Factors that foster development of collateral flow?
- 1. anemia
- 2. hypoxemia
- 3. gradual occlusion (arteriosclerosis)
-
Most coronary veins empty into the __ which empties into the ___.
-
Natural pacemaker?
sinoatrial node
-
Where is SA node located?
R atrial wall near the opening of superior vena cava
-
Bachmann bundle?
takes impulse from the R atrium to the L atrium
-
AV node?
accounts for 0.08-0.12 second delay to allow atria to completely depolarize, contract, and finish filling ventricles before the ventricles are stimulated
-
What is primary function of AV node?
delay impulse - contains no pacemaker
-
Secondary pacemaker?
HR?
AV junction
40-60BPM
-
Function of R bundle branch?
takes impulse to R ventricle myocardium
-
Hemiblock?
blockage of either of 2 major branches of L bundle branch
-
Final tertiary pacemaker?
HR?
Purkinje fiber system
20-40
-
What occurs during systole?
- Contraction increases pressure in ventricles - no change in volume
- AV valves are closed
- Ventricular pressures must exceed the pressure in great vessels to open semilunar valves
- Blood ejected->when pressure in vessels > pressure in ventricles ->semilunar valves close
-
What happens during diastole?
AV valves open -> blood rushes into ventricles->atrial anv ventricular pressures decrease and ventricular volumes increase
-
What may cause atrial contraction to account for more ventricular filling than the normal 15to30%?
L ventricular filling is impeded (mitral stenosis)
-
What occurs at end of diastole?
AV valves close
-
4 determinates of CO?
- heart rate
- preload
- afterload
- contractility
-
What occurs with increased preload?
greater force of contraction: increased stretch -> increased contraction force
-
Chronotropic?
effect on heart rate
-
Inotropic?
effect on contractility
-
Dromotropic?
effect on conductivity
-
SNS effects on heart?
positive chronotropic, inotropic, and dromotropic effects
-
What type of drugs counteract SNS effects?
sympathomimetic/adrenergic drugs
-
Parasympathetic nervous system effects on heart?
negative chronotropic, inotropic, and dromotropic effects
-
Is PNS stimulation generally desirable in critically ill patients?
How might it help?
no
decreases myocardial oxygen consumption by up to 50%
-
What drugs block the effects of PNS?
parasympatholytic/vagolytic agents: atropine
-
Where are chemoreceptors located?
carotid and aortic bodies
-
Function of chemoreceptors?
sensitive to changes in PaO2, PaCO2, and pH
cause changes in HR and RR
-
Baroreceptor reflex location and function?
in carotid sinus and aortic arch
sensitive to arterial pressure
increased BP causes vagal stimulation ->decrease in HR and contractility
-
Bainbridge reflex location and function?
- R atrium
- sensitive to R atrial pressure
- increased R atrial pressure ->increase in HR
-
Respiratory reflex?
inspiration -> decreased intrathoracic pressure -> increases venous return to R side of heart ->Bainbridge reflex -> LV cardiac output increases -> increases arterial BP and decreases HR through stimulation of baroreceptors
-
What dysrhythmia is respiratory reflex partly responsible for?
What else contributes?
sinus dysrhythmia
interaction b/t respiratory and cardiac centers in the medulla
-
Alpha receptor location and function?
vessels
vasoconstriction of most vessels, especially arterioles
-
Beta 1 receptors location and function?
heart
chronotropic, inotropic, and dromotropic effects
-
Beta 2 receptor location and function?
Bronchial and vascular smooth muscle
bronchodilation and vasodilation
-
Dopaminergic receptor location and function?
renal and mesenteric artery bed
dilation of renal and mesenteric arteries
-
Sympathomimetic agents?
- phenylephrine/Neo-Synephrine
- norepinephrine
- epinephrine
- dopamine
- dobutamine
- isoproterenol/Suprel
-
Phenylephrine/Neo-Synephrine receptor stimulation?
alpha ++++
-
Norepinephrine/Levophed receptor stimulation?
-
Epinephrine/Adrenalin receptor stimulation?
- alpha ++++
- beta 1 ++++
- beta 2 ++
-
Dopamine/Intropin receptor stimulation?
- alpha ++ >5mcg/kg/min
- beta 1 ++++ >10 mcg/kg/min
- beta 2 +
-
Dobutamine/Dobutrex receptor stimulation?
- alpha +
- beta 1 ++++
- beta 2 ++
-
Isoproterenol/Isuprel receptor stimulation?
-
3 layers of arterial wall?
intima, media, adventitia
-
Intima layer of arterial wall?
thin lining of endothelium & small amnt of elastic tissue
decreases resistance to flow and minimizes chance of platelet aggregation
-
Media layer of arterial wall?
smooth muscle and elastic tissue
changes lumen diameter as needed
-
Adventitia layer of arterial wall?
connective tissue
strengthens and shapes the vessels
-
What is the cause of edema?
imbalance in pressures or increase in capillary permeability
-
Cause of edema in HF?
peripheral edema caused by venous congestion and excessive hydrostatic pressure a the venous end
-
Cause of edema in liver disease?
decrease in plasma proteins->decreases capillary colloidal oncotic pressure ->fluid leak out of capillary
-
What is the purpose of the venous pump?
sends blood back to R side of heart
skeletal muscles contract->compress veins -> propel blood toward the heart
-
What prevents retrograde blood flow in veins?
valves
-
4 regulators of BP?
- 1. autonomic nervous system
- 2. Renin-angiotensin-aldosterone system
- 3. capillary fluid shifts
- 4. local control mechanisms
-
Renin-angiotensin-aldosterone system?
Renin secreted by kidney in response to decreased BP, SNS stimulation, hyponatremia ->stimulates conversion of angiotensinogen to angiotensin I->angiotensin I converted to angiotensin II by ACE -> angiotensin II stimulates vasoconstriction and release of aldosterone->vasoconstriction and Na+/water retention increase BP and decrease renin secretion
-
Pulse pressure?
difference between systolic and diastolic pressures
-
Normal pulse pressure?
40mmHG
-
2 factors that affect pulse pressure?
stroke volume and arterial elasticity
-
Mean arterial pressure?
average pressure in the aorta and its major branches during the cardiac cycle
-
Formulas for MAP?
(systolic BP + [diastolic BP X2]) /3
diastolic BP + 1/3 pulse pressure
-
-
2 factors that affect MAP?
CO and systemic vascular resistance
-
Oxygen delivery to tissues is a product of ___ ____ and ___ ____ ___.
cardiac output and arterial oxygen content
-
VO2?
volume of oxygen consumed by tissues each minute
determined by comparing O2 content in arterial blood with venous blood
-
Therapeutic methods to decrease VO2?
hypothermia, sedation, analgesia
-
What is indicated by lactic acidosis?
tissue oxygen deficit
-
Characteristics of cardiac cough?
- usually occurs at night
- precipitated by supine position, exertion, or turning to one side
-
Possible cardiac cause of hemoptysis?
pulmonary edema
-
Cardiac cause of ascites?
RV failure
-
Cardiac cause of abd pain?
RV failure
-
Cardiac cause of edema or weight gain?
frequently r/t RV failure
-
Cardiac cause of nocturia?
HF
-
Cardiac cause of unexplained joint pain?
may be r/t rheumatic fever
-
Angina pectoris provocation, palliation, and timing
provocation: exercise, exertion, exposure to cold, emotional stress, eating, smoking
palliation: rest, oxygen, nitro, Ca channel blockers
gradual or sudden onset, duration usually 1-4 min
-
When do most MI's occur?
within 3 hours of awakening
-
Is MI pain relieved with rest or nitroglycerin?
no
-
Dissecting aortic aneurysm provocation, palliation, and duration
provocation: peripheral vascular disease, Marfan syndrome, aortitis, htn, hypertensive crisis, chest trauma
palliation: no relief with rest or nitro
sudden onset, worse at onset, hours to days
-
Pericarditis predisposing factors?
MI, cardiac surgery, trauma, infections, uremia, lupus erythematosus
-
Palliation for pericarditis?
NSAIDS, sitting up and leaning forward
-
Quality of pain with pericarditis?
sharp, stabbing, knifelike, worsened by inspiration, coughing movement, recumbent position
-
S/S of pericarditis?
- tachycardia/tachypnea
- FEVER
- dyspnea
- pericardial friction rub
- diffuse concave ST segment
-
Pulmonary embolism provocation?
- venous stasis (immobility, pelvic surgery)
- hypercoagulability (contraceptives)
- injury to vessel (IV, vascular surgery)
-
Pulmonary embolism palliation?
- narcotics
- high fowler's position
- splinting of chest
-
S/S of PE?
- PALLOR/CYANOSIS
- COUGH
- ATRIAL DYSRHYTHMIAS
- ACCENTUATED P2
- IF RVF -> JVD
- IF PULMONARY INFARCTION: pleural friction rub, hemoptysis, fever
- tachycardia/tachypnea
- dyspnea
-
Medications that may cause dysrhythmias?
tricyclic antidepressants, Dilantin, pheothiazines, lithium, theophylline,
-
Cardiac effects of phenothiazines?
dysrhythmias or hypotension
-
Cardiac effect of doxorubincin/Adriamycin?
may cause cardiomyopathy
-
Consideration with corticosteroids and HF?
cause Na and fluid retention
-
Cardiac effects of theophylline?
dysrhythmias, tachycardia
-
Cardiac effect of erectile dysfunction meds?
hypotension
-
Normal of BP that is normal when standing?
up to 15 systolic and 5 diastolic
-
How to assess for orthostatic changes?
stand pt-> wait 2-3 min and recheck
-
Variation of BP up to ___mmHg b/t arms is normal.
15mmHg
-
How does BP in lower extremities compare to upper extremities?
expected to be 10mmHg higher than in upper
-
What is indicated by narrowed pulse pressure?
Causes?
vasoconstriction
innervation of SNS (hypovolemic shock), vasopressor use
-
What is indicated by widened pulse pressure?
Cause?
vosodilation
septic shock, vasodilators
-
Central cyanosis is seen where?
Indicates __g of deoxygenated HgB
lips, tongue, and mucous membranes
5
-
What does cyanosis look like on dark-skinned ppl?
ashen
-
What cardiac issues can ruddiness indicate?
polycythemia or hypercapnia
-
What does edema indicate?
increase in interstitial fluid of 30% above normal
-
3 causes of facial edema?
- 1. allergies- anaphylaxis
- 2. steroids - exogenous/endogenous
- 3. renal disease
-
Endogenous cause of facial edema?
Exogenous?
Cushing syndrome
prednisone
-
Degree of pitting assessment?
- 1+ = 0-4inch
- 2+ = 1/4=1/2 inch
- 3+ = 1/2 to 1 inch
- 4+ = > 1 inch
-
What may be indicated by episodic facial flushing?
pheochromocytoma - tumor of the adrenal medulla that produces large amnts of catecholamines
-
What is head bobbing up and down with each heartbeat referred to as?
What does it indicate?
de Musset sign
indicates aortic aneurysm or regurgitation
-
Positioning of patient for JVD assessment?
45 degree angle
-
Normal height of neck vein distention?
1-2 cm above sternal notch
-
What may be indicated if neck vein distention is >2cm above the sternal angle?
- 1. RVF
- 2. hypervolemia
- 3. tension pneumothorax
- 4. cardiac tamponade
-
Estimage central venous pressure CVP using height of neck vein?
add 5 cm to the height of the neck vein distention
-
What may happen to aortic pulsation with aneurysm?
lateral expansion my be felt
-
Pulsus alternans?
alternating pulse waves with every other beat being weaker than the preceding one
-
Pulsus alternans in characteristic of what condition?
LVF
-
Pulsus paradoxus?
an exaggeration of the normal physiologic response to inspiration
- normal BP decrease 10
- pulsus paradoxus: drop >10
-
What happens to BP during inspiration?
normal decrease in BP during inspiration is 10mmHg
-
Pulsus paradoxus may be characteristic of what conditions?
- pericardial effusion
- constrictive pericarditis
- cardiac tamponade
- severe lung disease
- advanced HF
- hemorrhagic shock
-
S3?
low-pitched sound that occurs early during diastole after S2 ken-tuc-ky
-
Cause of S3?
rapid rush of blood into a dilated ventricle
-
S3 abnormal in what patients?
patients >30
-
S3 primarily associated with what condition?
What other conditions may cause it?
HF
fluid overload, cardiomyopathy, ventricular septal defect or patent ductus arteriosus, mitral and tricuspid regurgitation
-
S4
dull, low-pitched sound that occurs late during diastole before S1
-
Cause of S4?
atrial contraction of blood into a noncompliant ventricle
-
When is S4 abnormal
in adults
-
S4 associated with what conditions?
- myocardial ischemia or infarction
- hypertension
- ventricular hypertrophy
- AV blocks
- severe aortic or pulmonic stenosis
-
Pericardial friction rub?
Where is it best heard?
scratchy sound
at 4th and 5th intercostal space at lower L sternal blocker with patient leaning forward
-
Differentiate between pericardial and pleural friction rub?
have pt hold breath
-
Cause of pericardial friction rub?
When is is commonly heard?
inflammation of pericardium
after MI or cardiac surgery
-
Bruit is associated with what 2 conditions?
plaque or aneurysm
-
-
-
-
-
Ionized calcium normal?
4.5-5.6
-
phosphorus normal
3.0-4.5
-
Mg normal
- adults 1.3-2.1
- children 1.4-1.7
- infants 1.4-2
-
-
-
-
Total creatine kinase normal
-
Creatine kinase myocardial bound normal?
0% of total creatine kinase
-
Lactate dehydrogenase normal
90-200
-
Lactate dehydrogenase-1 normal?
17 to 25% of total Lactate dehydrogenase
-
-
Troponin I normal?
1.5 g/ml
-
-
Cholesterol normal
150-200
-
triglycerides normal
40-150
-
-
-
-
-
-
BNP with HF
- mild: 100-300
- moderate: 300-700
- severe: >700
-
-
-
ESR normal?
- men </= 15 mm/h
- women </= 20mm/h
-
Prothromibin normal?
12-15 seconds
-
Therapeutic prothrombin time?
1.5-2.5X normal
-
PTT normal?
60-90 seconds
-
PTT therapeutic?
1.5-2.5 X normal
-
-
Platelets normal
150,000 to 400,000
-
specific gravity serum normal?
1.005-1.030
-
Osmolality serum normal?
50-1200
-
Considerations with cardiac catheterization and coronary angiography?
check for allergy to iodine, shellfish, or dye
hydration (contrast used)
cath extremity immobilized in straight position for 6-12 hours
Note complaints of back pain & vital sigh changes: may indicate retroperitoneal hemorrhage
-
Contraindications for MRI?
implanted metallic devices: pacemakers, defibrillators, metallic heart valves, intracranial aneurysm clips
-
Stress electrocardiography?
for ppl know to have CAD or postsurgical pt for ischemia
exercise or pharmacological agent (adenosine, dipyridamole, dobutamine)
-
Positive stress electrocardiography for CAD?
>/= 1 mm of transient ST segment depression
-
Monitoring during stress electrocardiography?
monitor for exercise-induced hypotension or ventricular dysrhythmias
-
Thallium stress elctrocardiography?
ischemic areas show a decreased uptake of radioactivity
-
What can arterial catheter measure?
systemic arterial BP and mean
-
CVP catheter measurement?
CVP measured as a mean
-
PA catheter measurement?
R atrial pressure measured as a mean
-
PA catheter 2 types?
- R atrial (proximal port)
- PA (distal port) - cannot use for fluid and drug admin - heparinized flush only to ensure patency
-
What can specialized PA catheters do?
- perform intracardiac pacing
- measure SvO2
- measure continuous CO
-
When would diastolic pressure be expected to be higher and pulse pressure to be narrowed?
endogenous catecholamine release or if receiving sympathomimetic agents
-
When is diastolic pressure expected to lower and pulse pressure widened?
excessive vasodilatory mediators (septic shock, anaphylactic shock) or if patient is taking vasodilators
-
What MAP is necessary to perfuse vital organs?
60
-
Normal adult systolic, diastolic and MAP?
- systolic: 90-130
- diastolic: 60-90
- MAP: 70-105
-
How is R atrial pressure measured?
catheter in superior vena cava (CVP) or at the proximal port of the PA catheter (RAP)
-
R atrial pressure normal values?
-
Normal pulmonary artery pressure?
- systolic: 15-30
- diastolic: 5-15
- Mean: 10-20
-
Pulmonary artery occlusive pressure normal?
8-12
-
-
Cardiac index normal?
2.5-4 L/min
-
-
-
Where is PA pressure measured?
from distal tip of the PA catheter with the balloon deflated
-
Pulmonary artery occlusive pressure (pulmonary capillary wedge pressure & PA wedge pressure)
pressure in the PA with the balloon inflated - indicates pressure in L atrium in absence of pulmonary htn
-
Where is pulmonary artery occlusive pressure/pulmonary wedge pressure measured?
from dital tip of the PA catheter with balloon inflated
-
Mixed venous oxygen saturation? (SvO2)
oxygen saturation of the blood as it returns to the lung for reoxygenstion
-
What does SvO2 represent?
average of the venous oxygen saturation of all organs and tissues
-
-
Central venous oxygen saturation? (ScvO2)
oxygen saturation of the blood in the superior vena cava
-
When is ScvO2 used?
serves as a surrogate for SvO2 before PA cath is performed or when PA cath placement is not possible
-
What happens to SvcO2 readings with shock conditions?
consistently overestimates SvO2 by around 5-15%
-
-
When should art line transducer be leveled and balanced to 0?
with each position change of HOB and at least q12h
-
Phlebostatic axis?
correlates with R atrium and is at 4th intercostal space midway b/t sternum anterior and spine posterior
-
What happens if transducer is too high?
readings too low
-
Positioning of patient for hemodynamic monitoring?
supine with HOB no more than 60 degrees and air-fluid interface is level with phlebostatic axis
-
Confirming placement of CVP or PA catheter?
CXR
-
Pressure readings obtained at the end of expiration?
minimize the effects of intrathoracic pressure changes
-
Difference in hemodynamic pressure in spontaneously and mechanically ventilated pt?
- spontaneous: expiration is positive - high point of fluctuation
- mechanically ventilated: expiration is neutral- low point of fluctuation
ventilator valley patient peak
-
Usual heparin concentration ?
0.5-1 unit/ 1mL of flush
-
When is heparin contraindicated for art line?
Hx of HITT
-
Why should hemodynamic values by correlated with clinical presentation?
hemodynamic parameter changes may precede clinical presentation changes
-
What occurs during P wave?
P wave is no more than ___mm tall and no more than ___ sec wide.
atrial depolarization
2.5mm 0.11 seconds
-
What occurs during PR segment?
What is PR segment?
delay in the AV node
line b/t P wave and QRS
-
What occurs during PR interval?
How is PR interval measured?
atrial depolarization and delay in AV node
beginning of the P wave to the beginning of the QRS
-
Normal PR interval time?
0.12-0.20
-
What occurs during QRS complex?
Measuring QRS?
Normal QRS interval?
ventricular depolarization
from beginning of first wave of complex to the end of last wave of complex
0.06-0.11
-
Normal QRS amplitude?
<30mm
-
What occurs during ST segment?
ventricles have completely depolarized and the beginning of repolarization
normally isoelectric at baseline
-
J point?
When does J point deviate from isoelectric line?
angle at which the QRS complex ends and ST segment begins
ST segment is elevated or depressed
-
What occurs during T wave?
ventricular repolarization
-
Cardiogenic shock s/s?
- tachycardia, tachypnea, hypotension
- S3
- crackles, dyspnea
- JVD
- hepatomegaly
- peripheral edema
- oliguria
-
Hemodynamic presentation of cardiogenic shock?
- CVP, PAP, & PAOP elevated
- CO & CI decreased
- SaO2, SvO2 & ScvO2 decreased
-
Hypovolemic shock s/s?
- flat neck veins
- tachycardia, hypotension, tachypnea
- oliguria
-
Hemodynamic presentation in hypovolemic shock?
- CVP, PAP, PAOP decreased
- CO & CI decreased
- SvO2 and ScvO2 decreased
-
Anaphylactic shock s/s?
- hypotension, tachypnea, tachycardia
- angioedema
- warmth, erythema, pruritus, and hives
- wheezing & stridor
-
Anaphylactic shock hemodynamic presentation?
- CVP, PAPA, & PAOP decreased
- CO & CI decreased
- SvO2 & ScvO2 decreased
-
Neurogenic shock s/s?
- hypotension, tachypnea
- bradycardia
- warm, dry, flushed skin
- hypothermia
- neurologic deficit
-
Neurogenic shock hemodynamic monitoring?
- CVP, PAP, PAOP decreased
- CO & CI decreased
- SvO2 & ScvO2 decreased
-
Septic shock s/s?
- hypotension, tachycardia, tachypnea
- hyperthermia
- irritability and confusion
- warm, moist, flushed skin
-
S/S of cardiogenic shock?
- S/S of shock: hypotension, tachycardia, tachypnea
- S/S of fluid overload: crackles, dyspnea, JVD,
- S3, peripheral edema
- oliguria
- hepatomegaly
-
S/S of hypovolemic shock?
- S/S of shock: hypotension, tachycardia, tachypnea
- S/S of decreased fluid volume: flat neck veins, oliguria
-
S/S of anaphylactic shock?
- S/S of shock: hypotension, tachycardia, tachypnea
- S/S of allergic reaction: warmth, erythema, pruritis, hives, wheezing, stridor, angioedema
-
S/S of neurogenic shock?
- S/S of shock: hypotension, tachypnea, but with BRADYCARDIA in stead of tachycardia
- warm/dry/flushed skin
- hypothermia
- neurologic deficit
-
S/S of septic shock?
- S/S of shock: hypotension, tachycardia, and tachypnea
- fever
- irritability and confusion
- warm/moist/flushed skin
-
Pulmonary hypertension S/S?
tachycardia, JVD, dyspnea
-
Cardiac pulmonary edema S/S?
tachycardia, dyspnea, crackles, S3
-
Cardiac tamponade s/s?
- S/S of shock: hypotension, tachycardia, and tachypnea
- feeling of fullness in the chest
- muffled heart sounds
- JVD
- electrical alternans
-
Hemodynamic presentation with cardiogenic shock?
- CVP, PAP, PAOP elevated
- CO, CI decreased
- SaO2, SvO2, ScvO2 decreased
-
Hemopdynamic presentation with hypovolemic shock?
- CVP, PAP, PAOP decreased
- CO & CI decreased
- SvO2 & ScvO2 decreased
-
Hemodynamic presentation with anaphylactic shock?
- CVP, PAP, & PAOP decreased
- CO & CI decreased
- SvO2 & ScvO2 decreased
-
Hemodynamic presentation with neurogenic shock?
- CVP, PAP, & PAOP decreased
- CO & CI decreased
- SvO2 & ScvO2 decreased
-
Hemodynamic presentation with septic shock?
- CVP, PAP, & PAOP decreased
- CO & CI increased
- SvO2 & ScvO2 increased as a result of decreased O2 extraction at the tissues
-
Hemodynamic presentation with pulmonary htn?
- CVP may be elevated
- PAP elevated
- SaO2, SvO2, & ScvO2 decreased
-
Hemodynamic presentation with cardiac tamponade?
- CVP, PAP, & PAOP elevated
- pulsus paradoxis: drop in BP of 10 during inspiration
- CO & CI decreased
- SvO2 & ScvO2 decreased
-
S4 at apex may indicate what type of infarction?
left ventricular infarction
-
S4 at apex may indicate what type of infarction?
R ventricular infarction
-
New holosystolic murmur at lower L sternal border may indicate what condition?
rupture of ventricular septum
-
Positioning of patient for insertion of deep vein catheters?
trendelendburg
-
What should you have patient during deep vein catheter-tubind disconnections?
hold their breath
-
Intervention if suspect air embolus in deep vein catheter?
Durant maneuver: turn pt to L side with his or her head down
-
How long should pressure be held on an arterial puncture?
- 5-10 min
- longer if on anticoagulants
-
How long should catheter for hemodynamic monitoring be in place?
ideally no longer than 72 hours
-
When should you stop injecting air into balloon of hemodynamic monitoring catheter?
when PAOP waveform is seen
-
Indications that balloon has ruptured on hemodynamic monitoring catheter?
inability to obtain the PAOP and absence of resistance during inflation
-
What equipment should be available during insertion of hemodynamic monitoring device?
emergency equipment and transcutaneous pacemaker
-
What patient position may assist hemodynamic monitoring device to migrate back into the pulmonary artery?
L side
-
Intervention for art line clot?
- aspirate rather than flush
- use only luer-lock connections
- alarms on
-
How often should flush solution, tubing, and dressing be changed on art line?
every 72-96 hours
-
Indications of pulmonary artery rupture with art line?
hemptysis, dyspnea, and hypotension
-
Prevent pulmonary artery rupture with art line?
- only enough air to cause the PAOP waveform
- do not overinflate balloon
- limit inflation time to a max of 15 seconds
-
Indications of pulmonary infarction with art line?
chest pain, dyspnea, and decreased SaO2
-
Prevention of thrombosis with art line?
maintain heparinized NS drip with intermittent flush device
keep pressure bag at 300
neurovascular checks every hour
-
QT interval?
ventricular depolarization and repolarization
first wave of QRS to end of T wave
slower the HR, the longer the normal QT interval
-
ECG changes with hypokalemia?
flat T with prominent U wave - U wave taller than T wave as K decreases
T wave and U wave same amplitude or U wave taller
ST segment flattening or depression
prolongation of QT interval
if <1 U wave fuses with T wave
-
Hyperkalemia ECG changes?
- tall, narrow, peaked T waves
- QRS widens - can merge with T wave
- Pwave widens/shallow
-
ECG changes with hypocalcemia?
- prolonged QT
- prolonged ST segment
-
Hypercalcemia ECG changes?
- shortened QT
- shortened ST segment
-
Hypomagnesemia ECG changes?
- prolonged QT
- broad, flattened T wave
-
Hypermagnesemia ECG changes?
- prolonged PR and QT
- prolonged QRS
-
What is caused by a block of either bundle branches?
delay in conduction through ventricles and a prolongation of QRS interval
-
ECG indication of L BBB?
- QRS >/= 0.12 seconds
- QRS positive in V6 and negative in V1
-
ECG indication of R BBB?
- QRS >/= 0.12 seconds
- QRS positive in V1 and negative in V6
-
Junctional escape rhythm?
- 40-60 BPM
- P wave, if visible, will be inverted - may be in front of, in, or after the QRS complex
-
Accelerated junctional rhythm?
- 60-100 BPM
- P wave, if visible, will be inverted - may be in front of, in, or after QRS complex
-
Idioventricular and accelerated idioventricular rhythm?
ventricular rhythm usually regular - no atrial activity
20-40 BPM and 40-100BPM
-
What ECG changes indicate ischemia?
T wave changes
-
What T wave changes indicate ischemia?
symmetrically inverted T waves in the leads that face the ischemic area
-
What is an ECG reciprocal change?
tall T waves in the leads opposite the ischemic area
-
What ECG changes indicate injury?
- ST segment changes:
- ST segment elvation in leads that face the injured area
reciprocal change: ST segment depression in the leads opposite the injured area
-
What leads indicate an anterior MI?
What artery is affected?
V2, V3, V4
LAD
-
What leads indicate a septal MI?
What artery is affected?
V1 and V2
LAD
-
What leads indicate an anteroseptal MI?
What artery is affected?
V1, V2, V3, and V4
LAD
-
What leads indicate a lateral MI?
What artery is affected?
- I and aVL indicate high lateral
- V5 and V6 indicate low lateral
LCA
-
Lead I axis and view?
R shoulder to L shoulder
shows lateral surface of L ventricle
good for looking at atrial rhythms
-
Lead II axis and view?
R arm to L leg axis
views inferior surface of L ventricle
position mirrors normal current flow of heart
useful with atrial dysrhythmias and sinus node problems
-
Lead III axis and view?
L arm to L leg axis
inferior surface of L ventricles
-
Where is V1 placed?
View?
4th intercostal space to R of sternum
views septum of heart
monitors ectopic beats, ventricular arrhythmias, ST changes, and BBB's
-
Where is V2 placed?
View?
4th intercostal space to L of sternum
views septum
shows ST segment elevation
-
What does V3 show?
anterior surface of heart
detects ST elevation
-
Where is V4 placed?
View?
5th intercostal space at midclavicular line
anterior surface of heart
shows changes in ST segment and T wave
-
Where is V5 placed?
View?
fifth intercostal space at anterior axillary line
lateral surface of heart
shows changes in ST segment or T wave
-
Where is V6 placed?
view?
5th intercostal space at midaxillary line
lateral surface of heart
-
aVR axis and view?
R arm to heart
view of atria and great vessels but no view of heart walls
-
aVL axis and view?
L arm to heart
lateral wall of L ventricle
-
aVF axis and view?
L leg to heart
inferior wall
-
What leads indicate an anterolateral MI?
What artery is affected?
V3, V4, V5, V6 (may be I and aVL)
LCA
-
What leads indicate an inferior MI?
II, III, and aVF
RCA
-
What leads indicate a RV MI?\
What artery is affected?
V4R, V5R, V6R may be transient
RCA
-
What leads indicate a posterior MI?
What artery is affected?
V7, V8, V9 or reciprocal in V1, V2, and V3
RCA, LCA, or both
-
Where are posterior chest leads placed?
What do these show?
- V7 on L side of back at midaxillary line
- V8 on L side midclavicular
- V9 on L side near spine
posterior surface of heart
-
What leads show reciprocal changes in posterior MI?
V1, V2, V3
-
Wellens syndrome?
group of signs associated with the occlusion of the proximal L anterior descending artery and a high risk of sudden cardiac death in a patient with unstable angina
-
ECG changes with Wellens syndrome?
symmetric and deeply inverted T waves in V2 and V3 that persist even when patient is pain free
little or no ST elevation
little or no enzyme elevation
-
Tx of Wellens syndrome?
cardiac catheterization
-
ST elevation in leads II, III, and aVF indicate what type of MI?
What type of reciprocal changes might occur?
inferior
Leads I and aVL
-
ST elevation in leads I and aVL indicate what type of MI?
What type of reciprocal changes might occur?
high lateral MI
II, III, aVF
-
ST elevation in leads VI, V2, V3, & V4 indicate what type of MI?
What type of reciprocal changes occur?
anterior
none
-
What indicates posterior MI?
ST depression in V1, V2, and V3
ST elevation in V7, V8, and V9 with posterior EKG
-
ECG changes in pt with pericarditis?
normal in V1 and aVR but all other leads show ST segment elevation
depression of PR interval in limb leads and L chest leads V5 and V6
Decrease in QRS voltage if pericardial effusion is present
-
ECG changes in pt with trauma?
high risk for dysrhythmias and AV nodal blocks
-
What cardiac dysfunction may be caused by binge drinking?
acute dysrhythmias especially SVT
-
Wolff-Parkinson White syndrome?
AV node is bypassed: short PR, wide QRS with slurring of the first portion of the QRS (delta wave)
tachydysrrhythmias
-
Second degree type I heart block?
Wencke-bach
-
Junctional escape rhythm?
protects pt from asystole, do not suppress
treat by accelerating sinus node: atropine, pacemaker
discontinue digoxin if it is cause: common cause of this rhythm
-
What SpO2 should be maintained for all patients unless ordered otherwise?
SpO2 for COPD patients?
95%
90%
-
What type of fluid is contraindicated for liver patients?
LR
-
Contraindications for cardioversion?
tachydysrhythmias that result from digoxin toxicity
nonsustained tachydysrhythmias
longstaniding Afib
Afib with normal or slow ventricular rate in the absence of AV nodal blocking drugs
Multifocal atrial tachycardia
-
Elective procedures should be preceded by at least a ____ hour fast.
6
-
What electrode placement is preferable for the cardioversion of Afib?
anteroposterior
-
What type of shock is used for cardioversion?
how much voltage is used?
synchronized
25 to 200 joules
-
Indications for pacemakers?
- 1. symptomatic bradydysrhythmias
- 2. sinus block or sinus arrest with ventricular asystole
- 3. alternating tachycardia and bradicardia
-
Asynchronous and synchronous pacemakers?
asynchronous: fixed rate regardless of heart's intrinsic activity
synchronous: pacing stimulus only when the heart's intrinsic pacemaker fails to function at predetermined rate (demand)
-
Atrial pacemaker requires what?
intact AV node
-
How are pacing leads placed?
percutaneously via the internal jugular or subclavian vein and advanced into the R atria, the R ventricle or both
-
Presence of T wave confirms what?
ventricular depolarization
-
Complications that can occur with pacemaker placement?
infection, pneumothorax, myocardial perforation, hematoma, frozen shoulder, dysrhythmias, electrical malfunction
-
What setting is pacemaker initially set on?
between 3 and 5 mA depending on pacing threshold
-
Defibrillating with pacemaker?
do not place defibrillator paddles within 5 to 10 cm of the generator
anteroposterior may be more effective
-
How is the automatic implantable cardioverter-defibrillator deactivated?
with a magnet
-
During ACLS if a patient is adequately breathing what is the preferred position?
L side
-
Ventilator rate for rescue breathing for adults and children?
10-12 BPM for adults and 12-20 for infants and children
-
Depth of compressions in adults and children?
Compression rate?
- 1.5 - 2 inches in adults
- 1/3 to 1/2 depth of chest for children
- \
- 100 compressions/minute
-
CPR that is expertly performed provides ___% of normal cardiac output.
20
-
Why is prompt defibrillation critical to survival?
resistance of ventricular dysrhythmias to defibrillation occurs over time
-
What rhythm is is especially important to ID and treat cause of cardiac arrest?
PEA
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