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Lindsey Jones 3C1

Lindsey Jones 3C1 - Therapeutics : Circulation

QuestionAnswer
What is Hemodynamic Monitoring - line insertion? Catheter is guided through a large vein, through the right atrium and ventricle into the pulmonary artery. This catheter is called a balloon-tipped, flow-directed, pulmonary artery.
what are the 4 insertions in Hemodynamic monitoring? 1. Internal jugular vein 2. subclavian artery. 3. Anti-cubital vein. 4. femoral vein.
In a Hemodynamics Monitoring where do we Locate the Catheter? Location of Catheter:RA/Just prior- 2-6mmHg. RV:2-25mmHg. PA-12:25mmHg.
what are the procedures for the insertion in Hemodynamic monitoring? Insert the ballon deflated. Advance &watch the pressure waveform on the monitor.Once in RA ballon is inflated &act as a sail, guiding catheter into RV &finally into PA.Once there ballon is deflated & Remain that way except when PCWP measurement is needed
In hemodynamic monitoring what are 4 types of data collected? 1. CVP- central venous pressure. 2. PAP - Pulmonary artery pressure. 3. PCWP - pulmonary capillary wedge pressure. 4. CO- cardiac output.
What are the goals of Hemodynamic monitoring? to Determine conditions of 1)Right & Left heart 2)Vascular system of the lungs 3)Systemic Vascular system. Also the methdology of CVP,PAP,PCWP& Cardiac Output.
What is the methodology of Hemodynamic monitoring - CVP (BEFORE THE Right Heart) Start by looking@ the CVP before the right heart- If high make a note. It could be fluid overload.
What is the methodology of Hemodynamic monitoring - PAP (AFTER the Right Heart) Start by looking@ the PAP AFTER the right heart- If high then the right must be OK because both CVP and PAP are high. If low, there must be a problem with the right heart.
What is the methodology of Hemodynamic monitoring - PCWP If high, then there is a problem w/the lung. If PAP and PCWP is high then no problem w/the lung. If PAP is high and PCWP is low then problem is in the lung.
What is the methodology of Hemodynamic monitoring - CO If PCWP is high and CO is high then left heart is not the problem. If PCWP is hihg and CO is low then left heart is the problem.
What is Cardioversion & Defibrillation? Both are methods of changing cardiac rhythms through electrical stimuli. Cardioversion is a form of defibrillation only w/ the synchronization On. This involves the placement of paddles on the chest & applying shcok to the pt.
What type of heart problems does a Cardioversion treat? For treating: NON-lethal arrhythmias 1)Atrial Fibrillation 2)Atrial Flutter 3) Ventricular Tachycardia (with pulse)
What voltage does a cardioversion start? Start @ low voltage around 50-100 joules.
How do you prepare a Cardioversion procedure? 1. Setup O2. 2. have a bag-valve-mask ready @bedside. 3. Prepare for Oropharyngeal suctioning.
What should be done in a synchornization in a Cardioversion? Synchronization must be ON. Synchronize cardioversion to the R Wave on ECG. It causes pt. to slip into a deadly rhythm like pulseless V-tach/V-fib. If so start defibrillation. It should be done w/ resuscitation equipment on-hand. Pt. sedation is helpful
What type of heart problems does a Defibrillation treat? For treating: Lethal arrhythmias 1)Ventricular Fibrillation 2)Ventricular Flutter 3) Ventricular Tachycardia (with pulseless only)
What voltage does Defibrillation starts with? 360 joules.
What should be done in synchronization in a Defibrillation? Synchronization must be set to OFF. Start at 360 joules, continue till successful. In emergency situation 100% O2 is appropriate. Must have resuscitation, equipment on-hand.
What is Basic cardiac life support (BCLS)? 1. Chest compression produce only about 30% of normal cardiac output. 2. Mouth-to-mouth ventilations will deliver no more than 17% O2 (FIO2)
What is the effectiveness of CPR in Basic cardiac life support (BCLS)? 1. Color of face & extremities. 2. Pulse can be felt during compressions. 3. If carotid artery is not accessible, use femoral artery
Basic cardiac life support (BCLS): What should we do when there is no pulse ? 1. No matter what the rhythm continue compressions if there is no pulse. 1)maybe pulseless electrical activity (PEA), 2) Formerly called electro-mechanical dysfunction(EMD)
Basic cardiac life support (BCLS): what are the hazards of CPR? 1. Pneumothorax (from broken ribs) 2. Gastric Distension or rupture 3. Liver laceration 4. Aspiration 5. Cross-contamination 6. Cardiac Contusion (bruising of the cardiac muscle) 7. Continue CPR regardless of above hazards.
Basic cardiac life support (BCLS): What are the key procedural consideration? 1. look, listen, & feel for breathing for @least 10 seconds. Use Carotid pulse. Use current BLS compression /breath ratio. Continue CPR if no pulse.
Basic cardiac life support (BCLS): What are the ventilation rates? 1. Neonates upto 1 month - 40-60/min 2. infants&children upto 8 yrs old - 12-20/min 3. Adult above 8 yrs old : 10-12/min
Basic cardiac life support (BCLS): What are the compression ratio(to breath)? 1.Neonate - 3 compressions then 1 ventilation (3:1), 2. Infant &child= 15:2 3. Adult 30:2
Advance cardiac Life support (ACLS)? it is an exact Algorithm like BCLS it changes from time to time.
Advance cardiac Life support (ACLS): What are the 4 types of Ventricular Arrhythmias? 1. Ventricular Tachycardia(pulseless), 2. Ventricular Fibrillation 3. Bardycardia 4. Asystole.
Advance cardiac Life support (ACLS): What is ventricular tachycardia(pulseless)? 1. Defibrilliate @ 360 joules - check pulse in between 2. if unsuccessful, administer epinephrine, Lidocaine, Amioderone.
Advance cardiac Life support (ACLS): What is ventricular fibrillation? 1. Defibrilliate @ 360 joules - check pulse in between 2. if unsuccessful, administer epinephrine, Lidocaine, Amioderone.3.If pt. has metabolic acidosis by a reasoned ABG - gives sodium bicarbonate.
Advance cardiac Life support (ACLS): ventricular fibrillation-What is precordial thumb? It gives the pt. transitions to v-fib or pulseless v-tach - the transition witnessed as it happened.
Advance cardiac Life support (ACLS): What is Bardycardia? Treat with Atropine, Epinephrine & may use an external pacemaker
Advance cardiac Life support (ACLS): What is Asystole? Must be confirmed in 2 leads - rules out lead dysfunction. Treat w/ Epinephrine, Atropine
Advance cardiac Life support (ACLS): What causes Hypotension? 1. Poor Contractility of the heart 2. Vasodilation 3. Dehydration - most common.
Advance cardiac Life support (ACLS): In Hypotension How do you treat poor cardiac contractility related problems? 1. Digitalis (Crystodigin) 2. Digoxin ( Lanoxin)
Advance cardiac Life support (ACLS): In Hypotension How do you treat Vasodilation related problems? 1. Norepinephrine. 2. Dopamine
Advance cardiac Life support (ACLS): In Hypotension How do you treat dehydration? 1. Administer Fluids 2. Normal saline & other saline concentrations
Created by: johnfaar