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CC Exam 1

Trivette MC 2013

Virchow's triad blood stasis, endothelial injury, hypercoagulability
+ D-dimer possible clots
- D-dimer no clots
HTN emergency Nitroprusside (Nipride) or Beta blockers
Pericardial Fluid amount 20-25 ml
Which Coronary perfuses the most RCA
MAP Calculation (diastolicx2)+systolic/3
SV 60-70 ml
EF >50%
Preload is effected by venous return, atrial kick, volume, Starling's law
Afterload is effected by HTN & tense of wall
Constriction increases preload
Meds for constriction dopamine & Levafed
dilate decreases preload
meds for dilation nitro, morphine, opiate
Acute chest pain assessment 3 parts chief complaint, precipitating events, current medications
ascites is a sign of R Heart failure
A/V no hair venous
A/V thin shiny dry skin arterial
A/V flaking, mottled, dermatitis,stasis venous
A/V ulcers present at the ankles & moist venous
A/V pressure points dry & pale arterial
A/V pallor or dependent rubor arterial
A/V brown patch rubor, mottled, cyanosis dependent venous
A/V nails thick & brittle arterial
A/V varicose veins venous
A/V cool skin arterial
A/V warm skin venous
A/V >3 secs arterial
A/V foot to calf edema venous
A/V pulses 0-1 rating arterial
S3 causes fluid increase or in kids
S4 causes hypertrophy, hyperkinetic, regurgitation
murmur scale 1 faint-6 without stethoscope
HyperK wide QRS, tall peaked T
HypoK PVC & U waves
HyperCa bradycardia, blocks, HTN, pot dig.
HypoCa decrease CO, VT, hypotension, asystole
HypoMg U waves, prolonged PRI, T flattened, wide QRS=SVT, VT, torsade
Which electrolyte/mineral do you need to correct 1st? Mg
Troponin 1 elevates 3-12 hrs. Peak 24hrs. base 5-10 days
Troponin T elevates 3-12hrs. Peak 12-48hrs. base 5-14 days.
CKMB elevates 3-12 hrs. Peak 24hrs. base 2-3 days
BNP >400 very probable 100-400 with hx or suspicion probable
INR <1 anticoag 2-3
aPTT 28-38 sec anticoag 1.5-2.5xnorm
PTT 60-90 sec anticoag 1.5-2xnorm
ACT 0-120 sec <130 without CAD
LDL <100 no risk <750 with risk
Triglycerides <150
HDL >40 men >50 women
after cardiac cath how long extremity immobilized? 6-12 hr
DM 70-100 normal 100-125 Pre >126 Diabetic
R/L HF GI S right
R/L HF pulmonary left
R/L HF weak peripheral perfusion left
R/L HF nocturia left
R/L HF JVD & edema right
R/L HF mental changes right
R/L HF hepatojugular reflex right
complications with HF pink frothy sputum, cardiac asthma, < 30 EF and increased dysrhythmias & A Fib
diuretics decrease preload
vasodilators decrease afterload & resistance
morphine peripheral dilation & decreases anxiety
+ inotropes decrease contractility
S&S endocarditis fever, stroke, septic emboli, HF, cough, & pleuretic chest pain
S&S CAD TIA, Neuro deficits, reversible ischemic neuro, completed stroke
CAD Tx antithrombotic therapy, surgery, stents
Variant angina spasm
pritzmetal angina spasm
MONA Morphine O2 Nitro ASA/Analgesia
3 mechanisms of MI plaque rupture, thrombosis, coronary artery spasm
ischemia T inverts or depresses
injury ST elevated
infarction patho Q waves
transmural MI/Q all muscle layers
NSTEMI no Q wave subendocardial
V dsyrythmia tx only if >6/min, closely coupled, polymorphic, multifocal, bursts, runs
meds for preventing V remodeling ACE I
dys prevention beta blockers
Aneurysm tx outpt for 4 cm or smaller
MAP decrease for HTN 20-25% over mins-hr
HTN urgency meds diuretics or oral antiHTN
fixed asych
demand synch
AV sequential dual
rate control # of impulses 60-80
output control milliamp to threshold
sensitivity millivolts
undersensing inability to sense spontaneous depol showing after or unrelated spots
oversensing inappropriate sensing of extraneous electrical signals causing unnecessary trigger/inhibit
protect from microshocks by covering with rubber caps & preventing static electricity
cardiac resynch 3 leads RA, RV, LV via coronary sinus
atria arrhythmia suppression prevents A Fib. & can have non-p wave tracking when rapid is sensed
Fibrinolytic therapy criteria no more than 12 hr. onset, unresponsive to Nitro, ST elevation or new onset of left bundle branch block, no predsiposition for hemorrhage
non specific clotting med SK
S&S reprefusion chest pain stops, ST elevation returns to baseline, dysrhythmia, peaking of creakine kinase or Troponin
PCI Complication late restenosis & thrombosis
contract induced renal failure prevention increase fluids & take Na bicarb
PCI most dangerous for complications 8-12 hrs
Physiological of Cardiopulmonary bypass that are most fluid volume deficit & myocardial deficit
cold postop bypass constriction increasing BP & afterload
how to fix cold postop bypass nitro, nitropresside, IVF, vasopressor
S&S of Tamponade increasing wedge & CVP pressure, decreased CO, JVD, muffled heart sounds, pulseless paradoxys
TX Tamponade emergency sternotomy at bedside
how soon should you try to get off a vent postop bypass surgery 4-8 hrs
intraaortic balloon pump inflates when? diastole & when aortic valve closes
balloon its important to watch for migration or perforation
ventricular assist devices used ot bridge to recovery, bridge to transplant, or a destination therapy
Created by: midnight1854