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Critical Care I
N303
| Question | Answer |
|---|---|
| Balance of Fluids & Electrolytes | Homeostasis |
| is vital to neuromuscular function and acid based balance | Electrolyte balance |
| Inflammation and decreased protein cause | Fluid shifts |
| Fluids are drawn to | Na+ and glucose |
| Decreased concentration to increased concentration (cell -> Vasc. space) | Osmosis |
| Increased concentration to decreased concentration (vasc. space -> cell) | Diffusion |
| Pulls fluid in | Osmotic pressure |
| Push fluid out | Hydrostatic pressure |
| Decreased BP, Hypovolemia, Hyponatremia, Hyperkalemia cause: | Adrenal gland to secrete aldosterone; Kidney retains H2O & Na+, Excretes K+ |
| The concentration of fluid that affects the movement of water between fluid compartments | Osmolality |
| The higher the osmolality the greater the pulling power of water. (_______ pressure) | Osmotic |
| Drawn to H+ ions | Chloride |
| Maintain acid balance | Bicarbonate |
| Move fluids into diff. spaces Intravasc. -> ICF/ECF | Crystalloids |
| D5 & H2O: Iso in bag, _____ in body. Body metabolizes sugar, H2O is _____. | Hypotonic |
| Hypotonic solution | Cells grow |
| Isotonic Solution | Volume Expansion |
| Hang Blood | Hang ISO |
| D5 1/2 NS ________ in bag ________ in body | Hyper Hypo |
| Hypertonic solution | Cells Shrink |
| Contain proteins (ex. albumin) that remain intravascular and pull fluid from cells & interstitial space (very high osmotic pressure) | Colloid |
| Interstitial edema, +2 pitting edema Swollen legs -> fluid in interstitial spaces | Second Spacing |
| M: 37 - 49 F: 36 - 46 | Hematocrit (HCT) |
| 8 - 22 mg/dL | Blood Urea Nitrogen (BUN) |
| 135 - 145 mEq/L | Na+ |
| 70 - 110 mg/dL | Glucose |
| Fluid accumulates where fluid is not normally at in large amounts: anasarca | Third Spacing |
| Give colloids + diuretics to get the fluid back where it belongs | Third Spacing |
| 98 - 106 mEq/L | Chloride (Cl-) |
| 8.5 - 10 mg/dL | Calcium (Ca+) |
| 3.5 - 5.0 mEq/L | Potassium (K+) |
| 1.3 - 2.1 mEq/L 1.6 - 2.6 mg | Magnesium (Mg+) |
| 1.7 - 2.6 mEq/L 2.5 - 4.5 mg | Phosphate (PO4-) |
| 275 - 295 mOsm/kg | Serum Osmolality |
| M: 14 - 18 gm/dL F: 12 - 16 gm/dL | Hemoglobin (Hgb) |
| First line med for V-tach | Amiodarone |
| 2nd line med for V-tach | Lidocaine |
| Shockable??? | V-tach V-fib |
| Unstable, pulseless V-tach | Call Help Call Code Start CPR D-fib Epinephrine Vasopressin Amiodarone Lidocaine Resuscitation |
| Stable V-tach w/pulse | Amiodarone Lidocaine Mg+, K+ Sync Cardiovert |
| HR >180 Acute MI, CAD, Cardiomyopathy, Heart Failure, Valvular disease K=, Mg+ imbalance Artifact - Ck. Pt. | V-Tach |
| Amiodarone Lidocaine | Antiarrhythmics |
| 40 - 60 bpm No P wave - No Atrial Kick Always Regular | Junctional Escape |
| HR 150 - 250 bpm Always Regular May or may not see P waves Drug of choice: Adenosine | Superventricular Tachy (SVT) |
| O2 IV access Heart monitor Vagal maneuvers Adenosine | Stable SVT Treatment |
| ADENOSINE - Chest pain, Dropping BP, other distress Ca+ Chan Blocker Beta Block Cardiovert - LAST RESORT | Unstable SVT Treatment |
| Control HR & Rhythm Diltiazem Amiodarone Digoxin | Atrial Tachy Treats |
| Sinus Node Disease Meds (Beta Blocks) Hypoxia Athletes | Sinus Brady Causes |
| O2 IV Access Atropine Sulfate(if symptomatic) Continuous Monitoring | Sinus Brady Treats |
| Blocks PNS to Increase HR anticholinergic | Atropine Sulfate |
| "Early" Atrial depolar Usually Asymptomatic Treat the cause | PAC - Premature Atrial Contraction |
| Stress, anxiety, fatigue, infection, lack of sleep, meds, cafiene, Heart failure, Electrolyte imbalance, MI | PAC causes |
| Chaotic firing of Atrium - No Pattern Irregularly - Irregular No meaningful P waves Loss of Atrial Kick Decrease C.O. 20 - 30% | A-Fib |
| Amiodarone | A-fib (treats arrhythmias) |
| HR 100 - 150 ALWAYS has a cause: anxiety, pain, fever, activity, dehydration, Heart fail, anemia FIX CAUSE -> FIX RHYTHM | Sinus Tachy |
| FIX CAUSE -> FIX RHYTHM Give O2 Beta Blocks (lopressor) Ca+ Chan Blocks (Decrease HR) | Sinus Tachy Treats |
| Beta Blocker - Decreases HR | Lopressor |
| HR>250 bpm - SAWTOOTH Conduction Ration P:QRS -> 4:1 | A-Flutter |
| Cardioversion Ca+ Channel Blocks Beta Blocks Digoxin | A-Flutter Treats |
| Ideal RASS Score | -2: Lt. Sedation - Briefly awakens w/eye contact to voice (<2 secs) |
| HOB > 30* Prevent Stress Ulcer DVT Prophylaxis Sedation Vacation Oral Care q2hrs Weaning Trial | Vent Bundle |
| Low Pressure Alarm | Leak in Line or disconnection |
| High Pressure Alarm | Resistance in circuit: Kinked Tube Pt. Biting Tube |
| AIR IN Amt air delivered to lungs -> 1 breath 5-12 mL | Tidal Volume |
| 3-5 cm H2O > 20 + Dmg can occur Keeps Alveoli inflated during expiration | PEEP |
| Hyper inflated lungs take space from Heart -> Heart can't fully open and close -> Increases PEEP -> | Increased PEEP -> Decreased C.O. |
| Assist Control Vent (set # of guaranteed breaths) | CPAP to wean from vent (Pt breathes on own -> alarm for Apnea) |
| Coumadin Reversal | Fresh Frozen Plasma |
| Left Heart Failure Manifestations? | Decreased C.O. -> Weak peripheral Pulses |
| Electrical CHAOS!!! Vents wiggle -> No Squeeze -> No Pulse -> Pt. Always Unconscious #1 Cause: Acute MI D-Fib w/in 5 mins or DEAD! SHOCKABLE!!! | V-Fib |
| #1 Cause of V-Fib | Acute MI |
| Hypo & Hyperkalemia can cause: | V-Fib |
| Hypovolemia Hypoxia Hypoglycemia Hypothermia | V-Fib Causes |
| Conduction problem in the AV Node | AV Blocks |
| A-V Node Conduction Delay PR >.20 Usually age, Asymptomatic & Benign | 1st* AV Block |
| Mobitz I (Wenkebach) Mobitz II | 2nd* AV Block |
| PR Lengthens PROGRESIVELY Less Serious Treat Symptoms AV Node can't keep up - usually temporary and fixes itself | Mobitz I (Wenkenbach) |
| PR same & constant More Serious Some QRS's Drop | Mobitz II |
| MI AV Node/Bundle Branch disease More serious than Type I | AV Block Type II |
| Atropine Dopamine Epinephrine Temporary Pacemaker, if unstable | AV Block Type II - Treatments |
| AV Node can't keep up _-> P progressively lengthens until QRS drops off -> Starts over -> Temporary, No treatment | Mobitz I (Wenkenbach) 2nd* AV Block |
| P wave w/o QRS -> usually rqrs. Pacemaker (if unstable) -> Atropine, Dopamine, Epinephrine | Mobitz II 2nd* AV Block |
| Complete Heart Block Decreased C.O. LOC, Syncope, can progress to Asystole SERIOUS!!! | 3rd* AV Block |
| Atria <- No Communication with -> Ventricle ALWAYS more P's than QRS's | AV Block Type III |
| Meds: Digitalis toxicity Degenerative Heart Disease Acute MI Myocarditis | 3rd* AV Block Causes |
| Treat symptoms Usually gets perm. pacemaker Atropine, Dopamine, Epi. - while awaiting pacemaker | 3rd* AV Block Treats |
| One of the 2 Bundle Branches is blocked Wide QRS >0.12 12 lead EKG -> determine R or L Not treated unless acute | Bundle Branch Blocks (BBB) |
| Causes Acute conditions - MI or Heart Fail Increased HR | Bundle Branch Blocks (BBB) Temporary |
| Causes: Infarct of Bundle Branch Congenital Heart Disease Rheumatic Heart disease Cardiomyopathy Severe aortic stenosis Any heart disease causing scarring of conduction system | Bundle Branch Blocks (BBB) Permanant |
| Pt: HR 40, Sinus Rhythm, SOB, Chest pain, BP 87/60 | Symptomatic Bradycardia Give Atropine 1 mg IV to increase HR |
| Pt: Heart beating out of chest, diaphoretic, Tachypneic, BP 70/40 Heart Monitor: SVT Valsalva & 3 doses Adenosine - NOT working Immediate action?? | Unstable SVT Valsalva & Adenosine Failed... Prepare for Synchronised Cardioversion |
| 8 hrs. post CABG: Report what? Mediastinal drainage of 100 mL/hr T: 98.8* BP 160/80 K+ 3.8 | Increased BP -> Increased Vascular pressure may cause bleeding @ incision sites |
| 35 - 45 | PaCO2 |
| 22 - 26 | HCO3- |
| Necrosis of Heart Muscle do to lack of O2 Decreased O2 & Increased Demand | MI |
| Peripheral Edema Jugular Vein Distension Ascites Heptomegaly Fatige | R Sided Heart Failure |
| Tachycardia Dyspnea Decreased Cerebral perfusion SOB, Wt Gain, Confusion | L Sided Heart Failure |
| CHEST PAIN?? M.O.N.A. | Morphine O2 Nitro Aspirin |
| Congestive Heart Failure UNLOAD FAST | Upright Nitrates Lasix O2 Ace inhibitors Digoxin Fluid Restrict Afterload Decreased Sodium restiction Test (Dig, ABG, K+) |
| Block Beta Receptors in Heart: Decrease HR, Force of contraction, Rate of AV Conduction | Beta Blockers |
| Bradycardia, Lethargy, CHF, Depression, GI Disturbances, Decreased BP | Beta Blockers S/E |
| PropranOLOL (Inderal) AtenOLOL (Tenormin) MetroprOLOL (Lopressor) | Beta Blockers |
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