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29 Cards in this Set

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PRECIPITATING FACTORS OF MI:
OCCURS AT REST OW WITH MODERATE ACTIVITY
-LOW ACTIVITY IS A RISK FACTOR
-PEAK INCIDENCE 6AM-NOON, MONDAYS
S/S OF MI
1.CHEST PAIN DESPITE REST & MEDS (FOR 30 MINS)
2.ANXIETY & RESTLESSNESS
3.INCREASED HR & RR
4.SHORTNESS OF BREATH
5.NAUSEA
WHAT ARE THE 3 I'S OF CORONARY ARTERY EVENTS?
1.ISCHEMIA
2.INJURY
3.INFARCTION
ECHOCARDIOGRAM
USED TO EVALUATE CARDIAC FCN,SPEC VENTRICULAR FCN
-CAN DETERMINE EJECTION FRACTION
ISCHEMIA
CHEST PAIN/ANGINA
CAN BE REDUCED BY:BETA-BLOCKERS (SLOW RATE) OR VASODILATION W/NITROGLYCERIN
-FIRST SEE LARGE & SYMMETRIC T WAVES FOR 24 HRS & THEN T WAVE INVERSION ON THE EKG W/IN 1-3 DAYS.LASTS 1-2 WKS
INFARCTION
ACTUAL DEATH OF THE INJURED MYOCARDIAL CELLS
-CPK,TROPONINS,MYOGLOBLIN LEAK INTO BLD
-BEGINS W/IN 40-2 HRS (90%COMPLETE IN 6 HRS)
-SIGNIFICANT Q WAVES DEV IN 1-3 DAYS
DIAGNOSIS OF MI BASED ON:
**ST ELEVATION**,T WAVE INVERSION
HISTORY,ECG,LAB TESTS
WHICH LAB TEST (SERUM MARKERS) IS BEST FOR DETERMINING A MI?
CK-MB HEART MUSCLE
-INCREASES WHEN A MI
-STARTS TO INCREASE 3-6 HRS & PEAKS WITHIN 24 HRS OF AN MI
RETURNS TO NORMAL IN 3 DAYS
MY0CARDIAL INFARCTION
PROCESS BY WHICH MYOCARDIAL CELLS IN THE HEART ARE PERMANENTLY DESTROYED
NORMALLY LDH-1 IS LESS THAN LDH-2,AFTER AN MI...
LDH-1 > LDH-2
LDH RISES IN 24-48 HRS,PEAKS IN 48-72 HRS,AND RETURNS TO NORMAL IN 5-10 DAYS
INJURY
OCCURS IF ISCHEMIA LASTS > FEW MINS
OCCURS W/IN 20-40 MINS AFTER BLOCKAGE
PAIN IS SEVERE
-ST SEGMENT ELEVATION>1MM OVER BASELINE SEEN IN THE LEADS OVER OR FACING MI.RETURNS TO NORMAL IN 1-6 WKS
WHEN SHOULD AN ECG BE DONE?
WHAT DOES IT SHOW?
1.WITHIN 10 MIN OF ENTERING ED
2.LOCATION,EVOLUTION,RESOLUTION OF MI
CAUSES OF MI:
1.REDUCED BLD FLOW
2.VASOSPASM
3.DECREASED OXYGEN SUPPLY (ANEMIA,LOW BP)
4.INCREASED DEMAND FOR OXYGEN (RAPID HR,THYROTOXICOSIS,COCAINE)
MYOGLOBIN
A HEME PROTEIN
INCREASES IN 1-2 HRS & PEAKS 6 HRS AFTER ONSET
***NO SPECIFIC TO INDICATE AN MI****
TROPONIN
HAS 3 ISOMERS:C,I,T-T OR I IS USED FOR CARDIAC
-INCREASES IN 4-6 HRS,PEAKS 10-24 HRS
-REMAINS ELEVATED FOR 5-7 DAYS
WHICH LOCATION OF AN MI HAS THE HIGHEST MORTALITY RATE?
ANTERIOR LAD (LEFT ANTERIOR DESCENDING)
-TACHYCARDIA
-CHF,CARDIOGENIC SHOCK,V.ANEURYSM,A FIB
WHICH LOCATION OF AN MI IS TREATED W/ GIVING FLUID?
RIGHT VENTRICULAR (RCA)
-DYSRHYTHMIAS,SINUS BRADY
-RIGHT VENTRICULAR FAILURE,PAPILLARY MUSCLE RUPTURE
GOAL OF MED MANAGEMENT OF MI
MINIMIZE MYOCARDIAL DAMAGE
PRESERVE MYOCARDIAL FCN
PREVENT COMPLICATIONS
WHAT IS TO BE DONE FOR A PT COMING INTO ED FOR MI?
1ST 10 MINS-IMMEDIATE ASSESSMENT
2."MONA"
WHAT DOES "MONA" GREETS ALL PTS STAND FOR?
1.MORPHINE
2.OXYGEN
3.NITROGLYCERIN
4.ASPIRIN
OXYGEN IS TO BE GIVEN AT__ L/MIN
YOU WANT PULSE OX TO BE GREATER THAN__
O2 AT 4 L/MIN
PULSE OX >93%
NITOGLYCERIN IS GIVEN___
WHAT DOES IT DO?
SL OR IV
.04 MG..MAY REPEAT TWICE AT 5 MIN INTERVAL (TOTAL OF 3 TABS)
-DILATES PRIMARILY THE VEINS (DECREASED PRELOAD)BUT ALSO ARTERIES(DECREASED AFTERLOAD)
-REDUCES MYOCARDIAL
ASPIRIN IS TO BE GIVEN AT ___
WHAT DOES IT DO?
160-325 MG
PREVENTS PLATELET AGGREGATION
SHOULD BE CHEWABLE
MORPHINE SHOULD BE GIVEN __
WHAT DOES IT DO?
WHAT ARE S/S OF OVERDOSE?
IV 1-3 MG DOSES REPEATED AT 5 MIN INTERVALS AS NEEDED (SOME PTS MAY NEED 30 MG)
-REDUCES PAIN & ANXIETY
-REDUCES PRELOAD
**OVERDOSE=RESP DEPRESSION AND LOW BP**
THROMBOYTIC THERAPY
DISSOLVE & LYSE THE THROMBUS IN THE CORONARY ARTERY ALLOWING BLD TO FLOW THROUGH THE CORONARY ARTERY AGAIN
-MINIMIZES THE SIZE OF INFARCTION & PRESERVES VENTRICULAR FCN
IN ORDER FOR THROMBOLYTIC THERAPY TO BE EFFECTIVE,IT MUST BE ADMINISTERED..
AS EARLY AS POSSIBLE
DOOR TO NEEDLE TIME SHOULD BE LESS THAN 30 MIN
GIVE WITHIN 6 HRS
WHAT ARE THE 2 TYPES OF THROMBOYLYTIC AGENTS USED?
1.STREPTOKINASE-MADE FROM STREP BACTERIA **RISK OF ALLERGIC RXN**
1ST GIVE ANTIHISTAMINE
2.TPA-TISSUE PLASMINOGEN ACTIVATOR
**MORE CLOT SPECIFIC & SHORTER HALF LIFE**
WHAT ARE THE S/S OF BLEEDING
1.DECREASED HCT AND HGB
2.LOW BP
3.INCREASED HR
FOR MAJOR BLEEDING FROM THROMBOLYTIC,WHAT IS TO BE DONE?
D/C THROMBOLYTICS,APPLY PRESSURE,NOTIFY MD