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101 Cards in this Set
- Front
- Back
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Atrial Kick |
30% of Cardiac Output not passively flowed to ventricles with opening of the AV valves, the conduction system allows an atrial contraction of the remaining 30% of blood |
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AV Valves |
Mitral (between LA and LV) bicuspid Tricuspid (between RA and RV) tricuspid S1 closure of valves |
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Semilunar Valves |
Pulmonic (between RV and Pulmonary arteries) Aortic (between LV and aorta) closure of valves S2 |
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Blood Supply to Myocardium |
AV closure allows retrograde backflow of blood onto the closed valves and the blood then flows to the myocardium to the RCA, LCA and coronary veins |
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RCA |
PDA, RA, RV and inferior LV |
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LCA (Left Main) |
LAD, Circumflex widow maker when occluded |
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Conduction System |
SA node: natural pacemaker with 60-100 intrinsic rate AV node: slows the impulse to allow the atria to contract initiating the atrial kick Bundle of His Purkinje Fibres to the ventricles to go through systole (contraction) |
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Chronotropes |
+ increase HR |
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inotropes |
+ increase contractility of the heart (increase myocardial force) |
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Dromotropes |
+ accelerate conduction speed of the AV node |
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Sympathetic Nervous System |
SNS: fight or flight adrenergics increase HR |
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Parasympathetic Nervous System |
rest and digest decrease HR cholinergics |
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Baroreceptors |
receptors sensitive to pressure changes. Stimulation allows inhibition of SNS and enhancement of PNS (and stimulation of vagus nerve) |
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Chemoreceptors |
response to O2 and CO2 and pH to allow respiratory (or metabolic) compensation |
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Diastole |
Heart resting phase ventricles relaxed and filling AV open |
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Systole |
contraction phase when the pressure increases (V > A) the semilunar valves open and the AV close and the blood is forced out in contraction and the retrograde blackflow closes the SL valves |
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CO |
amount of blood ajected from the heart per mintute HR x SV impacted by preload, afterload, and contractility |
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Systolic BP |
peak pressure during ventricular contraction |
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Diastolic BP |
residual pressure during ventricular relaxation |
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S3 |
Immediately following S2 (ventricular galllop) |
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S4 |
before S2 (atrial gallop) |
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ECG |
Electrocardiogram measures rhythm, chamber size, conduction system effectiveness, ischemia NOT EF/CO/contractility of the heart |
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Troponin |
Lab values present post MI |
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Hemodynamic Monitoring |
ongoing measurement of pressure flow, oxygenation of the cardiovascular system |
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SvO2 |
Saturation of Venous Oxygen amount of oxygen left over in the blood on the venous side (returning to the heart) 75% (tissues taking only 25%) increased: tissues aren't taking enough P2 decreased: tissues are starving and taking as much as they can get |
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Preload |
amount of blood returning to the heart |
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Afterload |
Systemic Vascular Resistance amount of resistance the ventricles have to overcome to reject the blood out increased with HTN (higher resistance) Vasodialtion decreases it |
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Cardiac Index |
CO / BMI adjustment for CO based on body size |
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Frank Starling's Law |
increasing the the preload increases the stroke volume until a plateau is reached because the heart can only fill and contract so much |
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Prelaod affected by |
vasuclar volume drugs (vasodilators: decrease preload. Vasoconstrictors: increase preload - less blood in veins) |
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Central Venous Pressure |
Right Arterial Pressure, or RV Preload venous return to the heart. |
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Left Ventricular Preload |
Wedge Pressure |
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Afterload |
vasodilation decreases afterload vasoconstriction increases it affected by volume overload and drugs |
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Right Ventricular Afterload |
Pulmonary Vascular Resistance: affected by pulmonary edema and hyternesion |
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Left Ventricular Afterload |
Systemic Vascular Resistance affected byHTN, aortic stenosis |
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Contractility |
impacted by inotropes Decreases Ca decreases contractility drugs O2/Co2 levels |
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Arterial Pressure Monitoring |
direct, continuous BP monitoring cath placed directly in artery (brachial or radial) Connected to transducer (placed in level with heart @ 4th ICS mid axillar line) to convey pressure into a graph for the monitor test with Allen Test |
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Allen's Test |
tell pt to make a fist and occlude the radial and ulnar. release the ulnar and the pt hand will turn red. if not that radial artery shoudl not be pricked as the ulnar does not have enough blood flow |
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Pulmonary Artery Catheter |
Invasive hemodynamic monitoring in cardiac catheterization, in the pulmonary arteries cath not inflated for more than 10 s tol allow blood flow |
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Vilegio |
minimally invasive of continuous central venous O2 |
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Dicrotic Notch |
on a graph of hemodynamic monitoring, represents the backlflow of blood of the closure of the SL valves. |
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Phelbostatic Axis |
head of bed @ 60o 4th ICS mid anterior posterior diameter is the Right Atrium (where the catherer for CVP monitoring would lay) |
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Zero the Transducer |
equalize the pressure to eliminate atmospheric and hydrostatic pressures (@ level of heart). flush pressure bad with 3-5 cc / hour to prevent clotting |
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Passive Leg Raising |
mimics fluid bolus Pt sitting up, quickly lay head down while lifting legs up to mimic 250 mL bolus. an increase of SV implies the pt is on the ascending part of Frank Starlings Law) a negative response means they would not repsond to fluid treatment - it would not increase the CO |
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Hypotnesion |
decreased preload (venous return) decreased contractility decreased afterload (artirial vasodilation or decreased resitance) |
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Potassium |
works in nerve conduction (conduction system of the herat) hypokalemia more concerning than hyperkalemia for heart arrythmias |
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P Wave |
indicates SA node initiates atrial depolarization |
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QRS Complex |
Ventricular Depolarization, atrial repoalrionzaiton hidden here |
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T wave |
ventricular Repolarization |
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Isoelectric Line |
in line with the P wave end point, depressed ST segment indicated NSTEMI, increased indicated STEMI |
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PR Interval |
0.12 - 0.20 |
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Absolute Refractory Period |
heart cannot be re-stimulation (initated anotehr eelctrical condution systme) regardless of the impulse or how strong it is PQRS |
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Relative Refractory Period |
T wave segment a strong enough stimulus (focci) can stimmulate anoter action potential |
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Steps to ECG Assessmemnt |
1. Rhythm: R wave for every P wave, no variatio in their shapes 2. HR 3. P Waves present or not 4. PR Interval: 0.12 - 0.2 5. QRS Complex 0.04 - 0.1 6. ST segment (with isoelectric line) 7. T wave inflection/inverted |
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Bradycardia |
<60 bpm Atropine to increase HR temporary pacing epinephrine or dopaine infusion to increase HR |
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Tachycardai |
>100 bpm treatemnt: OLOL: beta adregnergic blockers |
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Supraventricular Tachycardi |
NO P WAVES atrial focci HR ~ 150 Stable pt: adeosine (pharmacologic cardioversion) Unstable pt: synchronized cardioversion |
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Synchronized Carioversion |
low energy shock using a sensor to deliver the shock in synchornization with the peak of the QRS complex (sync option on the defib) to avoid an R on T phenomena |
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Atrial Flutter |
saw-toothed shaped flutter waves one focci firing at 300 bpm no atrial kick high risk o fclots stable pt: amiodarone (antiarrhythmia) unstable pt: synchronized cardioversion |
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Atrial fibrilation |
multiple focci at 400bpm no P waves treatment: amiodarone treatment 2: antiocooagulatns before cardioversion (to prevent thrombosis) |
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PVCs |
Premature VEntricular Contractions PR Interval not measurable QRS for PVC are WIDE AND BIZARRE Amiodarone |
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Unifocal |
ONE foci in the ventricle |
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Multifocal |
multiple focci with PVCs all looking different |
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Bigeminy |
QRS PVC QRS PVC |
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Trigeminy |
QRS QRS PVC |
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Couplet |
PVC PVC QRS |
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Triplet |
PVC PVC PVC QRS |
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Monomorphic Ventricular Tachycardia |
No P wave Rate > 140 QRS wide and bizarra same throughout SStable: amiodarone Unstable: synchronized cardioversion Pulseless: Defib |
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Defibrilization |
Monomorphic V Tach V fib (+ epinephrine) Pulseless electrical activity (no CO) |
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Polymorphic V Tach |
Tosade de Pointe (Twisty) Rate >150 No P waves Treatment: Mg |
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Ventricular Fibrilation |
Straight Squiggly line No rate, regularity, identifiable regular activity NO CO - NO PULSE treament: de fib |
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Amiodaronew |
stable v tach, PVC, a fib, stable A flutter |
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Synchromized cardioversion |
untable v tach supraventricular tachy unstable a flutter unstable a fin (+anticoagulation) |
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Fized PAcemaker |
very selcetive fires regarless of pt's intrinsic rate (could have an R on T phenomennon) |
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Demand Pacemaker |
snesing mechanism (in chamber(s)) to onlny fire when pt intrinsic rate falls below set point |
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Shock |
inadequate perfusion (to tissues or organs) leading to impaired cellular metabolism - leading to irreversible cell damage |
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Cardiogenic Shock |
caused by MI or cardia injury leading to ischemia Tachycardia, hypotension, increased LV afterload, pulmonary congestion, Treatment: hemodynamic monitoring, intra-aortic balloon pump or ventricular assit decvice |
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Hypovolemic Shock |
decreased circulating volume decreaseds strovke volume (preload) therfore CO so there is decreased tissue perfusion. Treamnet: 3 mL of isotonic crystalloid for every 1 mL of estimated loss |
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Absolute Hypovoemia |
fluid loss (bleedign out) |
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Relative Hypovolemia |
shunting, albbumin is low and fluid shifts out of vascular space |
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Neurogenic Shock |
only shock with bradycardia (due to loss of sympathetic response) hypotension treatment: atropine, monitor hypotension and treat, monitor hypothermia |
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Anaphylactic Shock |
massive vasodialtion: hypersensitivity reaction epinephrine and maintain patent airway |
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Septic Shock |
life threatening organ dysfunction to infection (not a normal response) - SIRS (systemic Inflammatory Response Syndrome) Treatmnet: take cultures, fludis and antiobiotics Warm Phase (vasodilation) Cold Pse (vasoconstriction) |
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Stages of any Shock |
Compensatory Progressive Recovery |
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Compensatory Stage |
body shifts fluid from non essential organs vasoconstriction cool and clammy skin (except septic pt) |
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Progressiv eStage |
compenssatory mechanisms fail MODS: multi organ dysfunction syndrome low CO, pulmonary eedema |
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Refractory Stage |
accumulation of lactic acid MODSS DIC unlikely recovery |
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Classification of Burn |
superficial partial thickness burn epidermis Deep Partiral thickness burn dermis Full Thickness Burn dwn to fat, muslce or bone |
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Rule of Nines |
head: 4.5 arms: 9 total trunk: 18 perineum: 1 legs: 18 total |
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Admission to Burn Unit |
10% partial thickness to children and seniors 20% partial thickness to anyone burns to severe locations (face, joints, perineum) electrcal burns full thickness burns chemical burns inhalation injury |
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Compartment Syndrome |
circmferential urns impeding flow and increasing pressure released with eschartomoty to relieve the pressure: lateral/medial cuts along extremities to allow expansion of tissues: otherwise ichemia or suffication |
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eschar |
tough leathery tisse of full thinckness burns |
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chemical burns |
rinse and remove clthins usually chemical burn when below the glottis |
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electrical burns |
will continue to burn up to 72 hours afterward |
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CO poisoning of smoke inhalation injury |
skin cherry red O2 sat normal |
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Cyanide pposiing of inhalation injury |
;actic acid buidlup |
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Ulcers |
Curlings ulcer for burns: give PPI (azole durgs) |
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Parkland Formula of fluid resucitation |
4 mL x % BSA (rule of nines) x weight (kg) / 2 first half given in the first 8 hours second half of fluid gien over next 16 hours |
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Medications for dressing Changes |
morhpine for pain haloperidol for sedation lorazepam for anziety midiazola, VERSED for anesteao and consicous sedation |
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CEA |
Cultured Epithelial Autographs clients own skin taken and grown |
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Skin Grafts |
from cadavers, self or xygivers (animals) purpose is to protect underlying skin until tissue can granulate |
