Critical care final

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Terms in this set (90)
SA nodeprimary pacemaker of the heart 60-100 bpmAV node and bundle of His40-60 bpmPurkinje fibers20-40 bpmp waveatrial depolarization should be no more than 0.12 secondsQRS complexventricular depolarization should be between 0.8 and 0.12 secondst waveventricular repolarizationNormal PR interval0.12-0.20ST elevation is indicative of what?MI (STEMI)ST depression indicatesischemia dig toxicity hypokalemiaSodium causes ____ changes on EKGno significantu waveindicative of hypokalemiasinus bradycardiaonly treat if symptomatic use atropine,then pacing or epi/dopamine if neededSinus Tachycardiatreat underlying causea fibno definite p wave tx- O2,anticoagulants,cardiac meds then cardiovertPVCsidentify and treat cause skip QRS complexa fluttersawtooth tx cardioversionV-tachtreat with defibrillation if no pulse pulse:O2,meds,defibV fibCPR,defibrilate, and alternate epi and amiodarone per ACLS protocolVFib/Pulseless VTachdefibrillate then epi/vasopressin amiodaronePEA/Asystoledetermine and treat underlying causeaystoletreat cause,pacing,epiUnstable Tachycardiacardiovert and reassesnonshockable rhythmsPEA and asystoleCardiovert fora fib,a flutter synch to r wave to avoid vulnerable t wavedefibpulseless v tach v fibatropinetreats bradycardia (symptomatic)amiodaroneAntidysrhythmic used to treat v fib and v tachLidocaineAntiarrhythmic alternative to amiodaroneadenoiseused to treat SV dysrhythmiasMagnesiumtorsades de pointesdopaminesymptomatic hypotension increases BPepigiven in v fib, pulseless v tach,asystole and PEAvasopressionalternative to epiFirst degree heart blockIf R is far from the P then you have first degree tx none just monitorWenkebach heart blocklong long drop then you have wenkebachMobitz Type II heart blockif some ps dont get through then you have mobitz 2Third degree heart blockIf Ps and Qs don't agree, then you have Third degreeIndications for pacingbradyarrhytmias,tachyarrhytmias,permanent pacemaker failure,suppport of CO post surgery,dx studies or when heart is unresponsive to med treatmentcapturewhat you want to happen spikes are seen in front of waveformAsynchronous/inhibiteddelivers an impulse no matter whatDualpaces both atrium and ventricle DDD most common method of pacingMethods of implantationtransthoracic,transvenous,epicardial,trancutaneous transvenous-most common methodICD are used inpts who are at risk for sudden cardiac deathcardiac tamponadepressure on the heart caused by fluid in the pericardial space S/S becks triad: distended neck veins,hypotension,muffled/distant heart sounds tx:pericardialcentesisPA waveformssquare wave test to ensure accurate bedside monitoringpeak systolic pressurepressure on arteries during systoledicrotic notchclosure of the aortic valve beginning of diastole end of systoleIABPgoal:balance O2 supply and demand by increasing coronary blood flow and reducing afterloadOnly use IABP ifthere is a potential for recoveryMost common complicationthrombocytopenia limb ischemia-weak or absent distal pulses tx angioplasty or stentCompression of renal artery by IABP would lead todecreased kidney perfusion and UOP blood tinged urine confirm with x rayHTN crisisany clinical condition requiring immediate reduction in BP S/S extreme HTN: Diastolic BP>110/BP pressure of 220/150,headache,drowsiness/confusion,blurred vision,seizure Tx:IV antihypertensives,HOB 45 degrees,monitor I/Os decrease with vasodilator (nitro) or stroke will occurMIsevere and abrupt O2 deprivation Can be STEMI/NSTEMI S/S chest pain that radiates down left arm,dyspnea,dysrhymtimas,SOB TX:MONA;if ineffective cath labthrombolytic therapyuse within 3-6 hrs of MI,arterial thrombosis,DVTS,occluded shunts/catathers and PEsCABGused in left main dx,multi vessel dx and significant symptomatic blockages bypasses occluded coronary arteriesCommon veins used for CABGsaphenous vein internal mammary arteryconcerns after CABGhypotension cardiac tamponade f/e imbalanceStroke (brain attack)manifest as a sudden neuro focal dysfunction can be ischemic(thrombosis/emboli) or hemorrhagicstroke is dx byCT scan electroencephalography cerebral arteriography MRIstroke s/sagnosia,apraxia,heminoposia,unilateral neglect, homonymous hemianopsia and proception alterationsstroke assessment findingsweakness or numbness on one side of the body,slurred speech/inability to comphrend,visual disturbances,dizziness,sudden onset headachesStroke interventionsmaintain airway suction monitor for ICP monitor LOCMeds for strokeanticoagulants antiplatelet diuretics antihypertensive antiseizure (depending upon cause) tpa within 90 minscentral spinal cord injuryoccurs in central portion of spinal cord loss of function in upper extremities s/s weakness in upper extremites,lack of sensation/difficulty urinating tx-neck immobilization,rehab,and surgeryanterior spinal cord injurydamage to anterior portion function loss below level of injury s/s loss in motor,pain,and temp sensations tx: treat underlying causeLateral (brown-sequard)ipsilateral and contralateral damagespinal cord injury interventions-do not move if spinal cord injury is suspected!! -log rollNormal platelet count150,000-400,000Normal WBC count5,000-10,000Normal RBC count4-6 millionNormal Hgb levels11-18Normal Hct values36-52AIDSprogresses when CD4 count is less than 200Normal CD4 count500-1600 c/mm3S/s of AIDSconfusion,memory loss,malaise,fever,diarhhea,leukopenia,night sweats,fungal infection precaution-treat symptoms and put on infection precautionsKaposi sarcoma (KS)type of skin cancer often seen in patients with AIDS; consists of brownish-purple papules that begin in skin and spread to internal organsCancerabnormal cell growth that can occur anywhere in the body typically dx via bioposyHodgkin's lymphomaoriginates in a single nodeNon-Hodgkin's Lymphomaoriginates from any node in the body