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110 Cards in this Set
- Front
- Back
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Leading Causes of Death in USA
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- heart disease
- cancer - trauma |
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Most Frequent Types of Trauma
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1 - MVA
2 - gun shots 3 - stab wounds 4 - burns 5 - occupational injuries |
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Trauma Peaks
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1st peak - before trauma team arrives
2nd peak - inappropriate setting of care chosen 3rd peak - one week after initial date of trauma |
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Golden Hour of Trauma
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significantly increase chance of survival if you arrive within an hour
1st 20 minutes - EMT arrive 2nd 20 minutes - "scoop and run" 3rd 20 minutes - ER staff get to work |
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Categories that Require Trauma Alert
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- multiple system injuries
- major penetrating chest/abdominal injuries - major head/neck injuries - sustained hypotension post injury - MSAT application due to lethal chest trauma |
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Airway Obstruction, Open Pneumothorax, Massive Hemothorax
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AO - fracture due to crycoid or thyroid cartilage
OP - collapsed lung and is operating outside the environment, place an inclusive dressing that will not allow the lung to expand - leave one side open MH - massive amounts of blood are lost due to penetration (2000-4000 cc) |
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Flail Chest
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- island of chest wall that is not participating in the breathing process due to fx of ribs at two sites
- results in paradoxical respiration - flail segment draws in during inspiration, out during expiration - loss of tidal volume = respiratory failure |
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Cardiac Temponade
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- occurs at the 2nd-7th intercostal space
- pericardial sac fills up with blood in which it only requires 20 cc to cause arrest - aspire the area |
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3 Sx of Pulmonary Contusion
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- involves edema, hermorrhage, atelectasis
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Aortic Disruption: Cause an Incidence of Fatality
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- 90% fatal over time
- deceleration injuries (MVA) |
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Radiological Findings of Aortic Disruption
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- deviation of the trachea to the right
- loss of space between pulmonary artery and aorta - depression of mainstem bronchus - deviation of esophagus to the right - widened paratracheal stripe |
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Best Method for Dx of Aortic Disruption
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- Aortogram (gold standard)
- expect <10% to be postive - can also use CT chest (high False -) or Transesophageal Echocardiogram |
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LETHAL CHEST TRAUMAS
Diaphragmatic Hernia Myocardial Contusion Tracheobranchial Tree Injuries |
DH -
MC - bruising of myocardium TTI - snap, crackle, pop |
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NON-LETHAL CHEST TRAUMAS
Simple Pneumothorax Simple Hemothorax RIb Fx |
SP - blunt or penetrating trauma
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Incidence of End-Stage Heart Disease
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- ischemia 45%
- cardiomyopathy 46% - congenital 2% - other 7% |
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Contraindications for Receiving Transplantation
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- psychosocial stability
- no dysfunctions - COPD, PVD, obesity, >65 years |
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Anatomy that is Affected by Transplant
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- ventricles are excised, leaving the great vessels/right and left atrium of the recipient open, donor heart is sewn to these areas
- SA nodes of the donor and recipient remain intact (ECG demonstrates 2 p waves for 3 weeks) - HR is intrinsic |
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Complications of Heart Disease
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- bleeding from the suture lines
- infection is primary concern - cardiac rejection |
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Survival Rates
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1 year = 82%
5 years = 70% |
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Longitudinal Study
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- cholesterol 4x
- HTN 3x - HTN,smoking, & cholesterol 16x |
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Ischemic Cardiac Conditions & CHF
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ICC - decrease in amount of blood coming to heart = angina/atherosclerosis
CHF - right/left ventricle fail, swelling of veins due to increased pressure and backup of blod behind sight of failure |
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Atherosclerosis (atherosis/sclerosis)
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atherosis - fatty streaks
sclerosis - fibrous component which reduces blood vessel compliance |
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Atherosis
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- lipid laden macrophages and smooth muscle cells make up fatty streaks in the media
- as they accumulate the endothelium is stretched and beings to separate, exposing the lesion to the circulation |
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Sclerosis
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- exposure of subendothelium to blood leads to formation of fibrous components in the lesion, in part due to the release of platelet-derived growth factor
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PDGF Purpose
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- stimulates the replication of connective tissue and attracts smooth muscle cells with migrate to into the intima
- clogs up artery leading to atherosclerosis |
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Vasospasm
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- caused by artherosclerosis
- can cause angina and MI |
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Coronary Artery Disease: Occurs in 3 ways
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Occurs in 3 ways:
- sudden cardiac death - chronic stable angina - unstable angina *more likely in males |
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Sudden Cardiac Death
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- 20-25% pts with CAD experience this as initial sx
- ventricular fibrillation, leading to cessation of cardiac output is usually the cause of death - EMS within 10 mins is there only chance - this used to be the first symptom of CAD |
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Angina
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- first symptoms of CAD is Angina
- due to imbalance in supply and demand of myocardial oxygen - can cause chronic or unstable angina |
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Chronic Stable Angina
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- onset of particular rate-pressure product (HRxSBP)
- it is predictable - can decrease their activity or take nitroglycerin tablet |
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Unstable Angina
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- person has signs and symptoms of inadequate blood supply to the myocardium
- it is unpredictable - requires immediate medical attention |
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Clinical Clues Someone is Developing Unstable Angina
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- angina at rest
- patient's typical angina occurs at a lower level then normal - deterioration of a previously stable pattern, pain several times a day, several times a week |
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CHF Etiology/Cardinal Sign
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- most commonly the result of cardiac muscle dysfunction
- dysfunction may be the result of MI, HTN, aortic valve disease, pulmonary HTN, emobolus *cardinal sign is low output during rest and exertion |
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Left Sided HF May Cause...
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right sided HF - a sort of total backup of blood
fluid accumulates in the lungs, liver, abdomen, and ankles |
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CHF Sx
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- dysnpnea
- tachypnea - rales - hepatomagaly - orthopnea *lying down causes more fluid to go to the hear which increases symptoms = night pain - go to ER |
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Cardiac Muscle Dysfunction Causes
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- HTN & CAD
- cardiac arhythmias - cardiomyopathy - heart valve abnormals |
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HTN and CAD
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- most common causes are cardiac muscle dysfunction
- leads to MI and inability of the heart to pump correctly |
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Cardiac Arrhythmia & Renal Insufficiency
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- also caused by cardiac muscle dysfunction
- extreme rapid or slow cardiac arrhythmias/renal insufficiency can impair function of left, right or both ventricles |
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Cardiomyopathy
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- disease where contraction and relaxation of myocardial muscle fibers are impaired
- causes: due to inflammation, metabolic disorder, toxicity, fibrosis, genetic predisposition, and other causes - treatment: cardiac transplant |
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Dilated Cardiomyopathy,
Hypotrophic Cardiomyopathy, & Restrictive Cariomyopathy |
- D: heart chambers are enlarged but are thin/flabby walls with lots of fibrosis
- H: muscles of L ventricle are enlarged and thickened, producing a smaller chamber that diminishes the amount of blood pumped - R: myocardium is unable to expand because it is infiltrated by foreign substances causing an increase in the resistance of blood that manages to pass through the ventricles |
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Heart Valve Abnormalities:
Valvular Stenosis, Valvular Insufficiency |
- VS: blocked valves
- VI: incomplete valves, they don't close properly *both situations cause the heart the have to contract more forcefully: this produces myocardial hypertrophy which leads to less distensibility and produces myocardial dilation which regurgitated blood fills the atria or ventricle forcefully |
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Cerebral Edema & Pulmonary Edema
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- C: thrombi in left atrium
- P: leads to pulmonary failure and then death |
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What is Pericardial Effusion
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- injury to the pericardium can cause acute pericarditis: inflammation of the pericardial sac surrounding the heart
- pericarditis may progress to pericardial effusion as the fluid accumulates from the inflammation - pericardial effusion may result in cardiac compression |
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If you have 20 CCs or more in the sac then you have...
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ventricular fibrillation
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Pericardial Effusion Causes Compression on the Heart Which Causes:
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- cardiac tamponade
- characterized by elevated intra-cardiac pressures, limited ventricular diastolic filling, & reduced stroke volume - results in gradual production of cardiac muscle dysfunction |
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Spinal Cord Injury and CMD
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- cervical SCI can cause CMD
- transection prevents sympathetic driven changes to maintain cardiac performance - results in CMD with pulmonary edema |
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Aging/Congenital Abnormalities and CMD
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- aging gradually decreases cardiac output which results in a mild but progressive CMD
- congenital abnormalities may be manageable for years without surgery because children are adaptable |
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Classification of Heart Disease: Class I & Class II
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- Class I - pt has cardiac disease but without limitations on physical activity. Ordinary activity does not cause fatigue, palpation, dyspnea, or anginal pain
- Class II - pt with cardiac disease that results in slight limitations of physical activity. Pts are comfortable at rest but ordinary activity results in fatigue, palpitations, dyspnea, or anginal pain *stable angina for Class I-III |
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Classification of Heart Disease: Class III & Class IV
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- Class III - pt with cardiac disease results in marked limitation of physical activity. Pt comfortable at rest but less than ordinary activity causes fatigue, palpitations, dyspnea, or anginal pain
- Class IV - Pt with cardiac disease resulting in inability to carry on any physical activity without discomfort. Fatigue, palpitations, dyspnea, or anginal pain may be present even at rest. If any physical activity is undertaken, symptoms increase (Unstable Angina) |
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Signs of CHF
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elevated blood-urea-nitrogen (BUN) level, increased amount of protein in their urine (proteinurea), increase in creaptinine levels
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CPK Tests
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test that shows up to tell if there are skeletal muscle cells in the blood - suggesting a breakdown of muscle tissue - it is an inaccurate measure that is used to look at an cardiac episode, doesn’t tell you that something is specifically going on at the heart = it does tell you that something is wrong
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Troponin 1 & Troponin T
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Troponin 1 & Tropinin T - if elevated then you know that the heart is messed up
- normally ordered when people have had a heart attack or other damage by the heart - used to diagnose a heart attack and to seperate it from chest pains/other causes |
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Cardiac Catheterization
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- catheter is threaded through the vein in arm or groin and is directed to the coronary arteries
- dye is injected while x-rays are taken |
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What is the #1 cause of Right HF
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- CAD
- HTN use to be #1 - not the case now because of new meds that are available |
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Widow Maker
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right coronary artery
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Common Site of Blockage is...
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left anterior descending artery (LAD)
- stints are installed which will give you 10 years - bypass (more expensive/invasive) |
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Percutaneous Transluminal Coronary Angioplasty / Stent
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- PTCA is called balloon angioplasty
- the angioplasty or stent placement may be done at he time of diagnostic catherization *make sure the stint is coated with Sirolimus to prevent the invasion of muscle into the artery |
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PTCA
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balloon that inflates to squash out blockage
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PTCA with Stent
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- stent used to help keep the artery open
- stent placed after the balloon is done - stents can be coated with meds to increase the amount of time they are effective |
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Xience Everolimus Drug Coated Stent
Absorb Stent Genous Coated Stent CoStar Stent Endeavor Stent |
X: drug coated that discourages scar tissue formation
A: holds artery open for 6 months and dissolve over the next 2 years G: attracts stem cells to help the intima heal C: tiny wells that release anti-clotting meds E: less likely to cause artery inflammation |
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Coronary Artery Bypass Graft
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- when several vessels are blocked they are bypasssed using other vessels
- saphenous vein or internal mammary artery (best choice because vein doesn't have 3 layers like arteries) |
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Traditional CABG
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- requires sternotomy
- requires that the patient's heart is stopped and the patient is on the heart/lung machine - complications of pulmonary inflammation due to heart/lung machine |
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Minimally Invasive Coronary Artery Bypass (MID CAB)
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- blockage is usually in LAD
- no sternotomy - small incision between the ribs - no heart/lung machine - surgery is done on a beating heart! - can only do anterior arteries - recovery is quicker with fewer complications _ 85% have successful recovery with 5% having later damage - 90% success rate at 10 years out versus only 66% of stints still functioning the same time period |
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Off-Pump Coronary Artery Bypass (OPCAB)
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does not need to use a heart lung machine
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Robotic Assisted Coronary Artery Bypass (RACAB)
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surgeon sits at a computer console and maneuvers robotic arms to complete the procedure
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Two Major Complications of Cardiac Transplantation
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infection and rejection
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Heart Failure
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- significant inability of the heart to pump blood through the body
- slow process of deterioration - problems may be hidden by compensation > frequency of contractions enlargement to allow > flow hypertrophy for >force of contractions |
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Symptoms of Heart Failure
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- dyspnea in supine or during exercise
- fatigue due to less O2 and nutrients carried in blood - accumulation of fluid in LEs and abdominal area - productive and persistent coughing - sometimes wheezing *TQ - angina is not the first symptoms - dyspnea is |
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Medications for Treatment
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- Digitalis
- Diuretics - Vasodilators - ACE inhibitors |
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Triglycerides
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if over 160-180 then you need to be on meds
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Statuns
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used to process the cholesterol
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Rhambdomyolysis
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- break down of actual muscle fibers
- makes you feel like you have the fule and have been hit by a truck since your muscles start to dissolve |
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Digitalis
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- increases force contraction
- slow HR - improves cardiac performance -Two preparations: *digitoxin *digoxin |
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Digotoxin
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- complete absorption with tablets
- half life of 7 days - metabolized in liver - longer duration of action (3-6 hours) |
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Digoxin
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- absorption rate of nearly woo% when envapsulated
- half life of 1 1/2 days - metabolized in kidney - shorter duration of 1 1/2 hours |
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Adverse Effects of Digitalis
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- toxicity
- nausea and vomiting - neurological pain in the lower 1/3 of the face - muscle weakness - easy to fatigue - irregular heartbeats |
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Diuretics
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- increases cardiac contractile forces
- reduces fluid = reduces plasma volume, promotes salt and water excretion, early stages of HF |
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Classification of Diuretics
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- Thiazide = moderate efficacy, mild to moderate failure
- Loop = greater efficacy, severe failure - potassium - sparing |
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Study on Tolvaptan (Diuretic)
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no difference within a 10 month period but did promote high amounts of water loss
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Adverse Effects of Diuretics
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- sodium depletion (hyponatremia)
- potassium depletion (hypokalemia) = muscle weakness/cramps & joint pain - orthostatic hypotension - mental confusion & mood changes |
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Vasodilators
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- relaxes arteriolar smooth muscle
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Angiotensin Converting Enzyme Inhibitors (ACE)
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- mild to moderate HF
- decrease venous and arteriolar constriction This causes: - decrease pressure within blood vessels - reduces problems associated with pumping - increases survival rates |
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Adverse Effects of ACE Inhibitors
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- skin rashes
- too much K+ - loss or altered taste |
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PT Rx for:
Acute HF Medically Stable |
AHF: bed rest
MS: exercise protocols - always get in upright position due to orthostatic hypotension - muscle fatigue and weakness - monitor SOB |
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Beta Blockers
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- block epinepherine and NE
- decrease HR and contractility - reduce cardiac output - used in patients with HTN and angina, CAD and arrhythmias |
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Side Effects of Beta Blockers
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- cold extremities
- reduced tolerance to exercise - muscular weakness - CNS: nausea, hallucinations, dizzy - Cautionary use: respiratory problems |
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Cerebral Ischemia
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commonly caused by blockage of cerebral blood vessel
- causes of blockage (will occur in the coroidal branch of the MCA) - cerebral embolism - thrombus |
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Management of Ischemic Strokes: Anticoagulants
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- aspirin - prevents 2nd stroke but not sure about 1st
- thienopyridenes - ticlid and plavix (thin the blood out) |
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Heparin
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- increase effects of circulating protein
- intravenous administration (heparin locks) - decline in use clinically since the 1980s - adverse effects such as intracranial bleeds |
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Study of Heparin
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- used following Coumadin for DVTs
- inhibits Vitamin K regeneration in the liver - decreases synthesis of clotting mechanism |
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Throbolytics
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?
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T-PA (Activase)
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only administered if you have had a stroke within 3 hours
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Calcium Channel Blockers
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- used to diminish neurological problems that accompany stroke
- within 6 hours of stroke - Nimodipine most commonly used |
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Adverse Effects of Calcium Channel Blocking (Ticlid)
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- hemorrhaging
- GI related - nausea - vomiting - neuropenia - GI pain |
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How Often to administer CCB and Mechanism?
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- administered 3-4 times daily following stroke
- stops entry of calcium into cells - intereferes with AV node conduction - reduces coronary vascular resistance - side effects include constipation, pedal edema, HA, and tachycardia |
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Angina Pectoris
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- primary symptom is dyspnea!!
- pain in substernal/left shoulder/left arm - induced by exercise, eating, and emotions *ST depression on ECG |
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Primary Cause of Angina Pectoris
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- increase oxygen demand
- decrease in oxygen supply |
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Use of Nitrates for Angina
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- dilates vascular smooth muscle to help coronary arteries
- reduces afterload and preload - decrease oxygen demand - reduces work on heart |
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Nitrate Side Effects
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- HA
- hypotension in veins |
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Cancer: Adjuvant Treatment
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treatment that is done alongside the primary cancer treatment, aim is to kill cancer cell that may have broke away from primary lesion site
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The TNF Staging System
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1 small tumor
4 large tumor N = node: 0 = no positive lymph nodes 3 = positive lymph nodes M = metastasis: 0 = no spread 1 = spread |
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Four Stages of Cancer
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Stage 1 = a cancer that is relatively small and contained with the organ
Stage 2 = the cancer is localized, but the tumor is larger than stage 1. Sometimes Stage 2 means there are nearby that have cancer cells in them Stage 3 = means that the cancer is larger and that there are cancer cells in the lymph nodes Stage 4 = means that the cancer has spread from where it started to another body organ such as the liver, bones or lungs |
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Carciongenesis
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- process by which normal cells are transformed into cancer cells
- two step process: *infiltration - first the cancer cells initiate the reproduction *proliferation - the cancer cells then spread |
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Anatomical Alterations Due to Cancer
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- abnormal cell size
- abnormal mitosis - enlarged nuclei *aneuploidy - abnormal number of chromosomes *abnormal chromosome arrangements |
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Alterations in Cellular Differentiations Due to Cancer
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- cancer cells will also have a different differentiation process (loss of contact inhibitions where muscle cells keep growing when they bump against the fascia)
- dediferentiation cells - process by which cells loose their characteristics of normal cells - results in cell immortality, loss of contact inhibition, alterations in antigen expression |
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Early Warning Signs
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- Changes in bowel or bladder habits
- A sore that does not heal in 6 weeks - Unusual bleeding or discharge - Thickening or lump in breast or elsewhere - Indigestion or difficulty in swallowing - Obvious change in a wart or mole - Nagging cough or hoarseness *proximal muscle weakness *changes in deep tendon reflexes |
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Invasion and Metastasis
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- invasion - capacity of neoplasm that attacks and destroys normal tissue
- metastasis - are tumor implants that are discontinues with parent tumor (hematogenous spread, lymphatic spread, seeding) |
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Cancer Incidence
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- #1 leading cause of death now for people <85 years old
- rank variations by sex and age - historical rank variations are changing |
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10 Leading Sites by Sex
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Males:
- prostate - 29% - lung and bronchus - 15% - colon 10% Females: - breast - 29% - lung and bronchus - 13% - colon - 10% |
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10 Leading Cancer Deaths by Site
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Males:
- lung & bronchus - 31% - prostate - 13% - colon - 10% Females: - lung & bronchus - 25% - breast - 16% - colon - 11% |
