Dysrhythmias, Cardiomyopathy, Acute and Chronic AKI
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| MVS Sign? | dyspnea on exertion
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| MVS secondary to? | Rheymatic fever
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| MVS common dysrhythmia | Afib
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| MVR Sign | cool extremities, pulmonary edema, S3 (lubb, dubb, whoosh)
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| MVP Sign | Click murmur, chest pain without relief with nitroglycerin
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| AVS Sign | SAD - Syncope, Angina, Dyspnea
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| AVS Treatment note | NO NITRO! Chest pain worsens
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| AVR Sign | Water hammer pulse, L HF Sympotms
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| What does stenosis mean? | narrowing... not opening
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| what does regurgitation mean? | no closing
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| failure to capture | heart didn't hear pacemaker
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| failure to sense | pacemaker didn't hear heart
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| asytole | absence of hear rate
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| diastole | atria open
aortic and pulmonary valves are closed
ventricles are filling
dubb
120
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| systole | ventricles open
aortic and pulmonary valves are open
atria are filling
lubb
80
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| EKG lead placement | white is right
grass under clouds
smoke above fire
fire under smoke
brown in middle, far from fire (right, 4th intercostal space)
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| tachycardia med | adenosine - push hard and fast, flush immediately
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| bradycardia med | atropine
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| PAC on EKG | abnormal P wave
short PR interval
irregular rhythm
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| PAC leads to | SVT
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| PSVT on EKG | HR 100-300
hidden P wave
regular rhythm
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| Atrial flutter on EKG | Regular rhythm
Atria >200 bpm
Sawtooth P wave
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| Afib on EKG | Disorganized rhythm
atria >350 bpm
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| AFib with RVR | Disorganized rhythm
P >350
QRS >100
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| Afib without RVR | Disorganized rhythm
P >350
QRS 60-100
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| AV block - 1st degree | Prolonged PR
PR interval > 0.20
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| AV block - 2nd degree (in general) | More P's than QRS's
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| AV Block - 2nd degree Type I | Progressively longer PR intervals
Then dropped QRS
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| AV Block - 2nd degree Type II | P:QRS = 2:1, 3:1, 4:1 regular pattern
QRS > 0.12
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| AV Block - 3rd degree | independent... no communication
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| PVC on EKG | No P waves
QRS wide and bizarre
T large
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| PVC sign | Apical/radial pulse deficit
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| Vtach on EKG | 3+ PVCs in a row
QRS rate is 150-250
QRS is > 0.12 (wide)
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| Vfib on EKG | extremely irregular
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| Antidysrhythmia Classes | 1 - sodium blocker
2 - beta blocker
3 - potassium blocker
4 - calcium blocker
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| sodium blockers used for | VT, SVT, PVC, prevent Vfib (the ventriculars)
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| Examples of sodium blockers | lidocaine, procainamide
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| beta blockers used for | SVT, Afib, Aflutter
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| what do beta blockers do? | lower HR
vasodilation
lower contractilit
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| examples of beta blockers | atenolol, the -olols
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| what do potassium blockers do? | delay repolarization (increases PR and QT, widens QRS)
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| examples of potassium blockers | amiodarone, sotalol
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| what do calcium blockers do? | lower HR
vasodilation
decrease contractility
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| Calcum blockers used for? | SVT, Afib, Aflutter
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| Example of calcum blocker | amlodipine
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| What does digoxin do? | decrease HR
increase contratility
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| What does adenosine do? | decrease conduction through AV node
decrease HR
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| what does atropine do? | anticholinergic
increase HR
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| What does magnesium do? | decrease conduction through AV node
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| what does hydralazine do? | vasodilation
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| what does nitro do? | vasodilation
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| Small box on EKG | 0.04 seconds
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| Large box on EKG | 0.20 seconds
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| 5 large boxes on EKG | 1 second
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| 30 large boxes on EKG | 6 seconds (1/10th of a minute)
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| normal P wave | 0.06 - 0.12 seconds
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| normal PR interval | 0.12 - 0.20 seconds
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| normal QRS | 0.04 - 0.12 seconds
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| normal T wave | 0.16 seconds
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| T wave inversion | ischemia
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| ST depression | ischemia
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| ST elevation | injury
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| ST elevation + pathological Q | infarction
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| when do you defibrillate? | Vfib
Vtach
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| when do you use cardioversion? | afib
aflutter
PSVT
sinus tachycardia
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| When do you use asynchronous pacemaker? | AV block
Afib w/ RVR
BBB
Vtach
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| Defib joules rate for biphasic? | 120-200
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| Defib joules rate for monophasic? | 360
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| ICD candidates | syncope with Vtach/Vfib
survived SCD
spontaneous sustained Vtach
life-threatening dysrhythmias
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| ICD teaching? | No MRI
if it fires, call PCP
if it fires and you don't feel well, call 911
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| Pacemaker candidates | AV block
AFib with RVR
BBB
Vtach
Cardiomyopathy
HF
SA node dysfunction
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| Pacemaker teaching? | No MRI
if it fires, call PCP
if it fires and you don't feel well, call 911
take daily pulse
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| Aortic dissection signs | weak or absent pulses
different between bilateral upper extremities
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| Aortic dissection complication | cardiac tamponade (JVD, pulsus paradoxus)
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| Kidney functions | Eliminate toxins
regulate acid/base balance
erythropoietin release
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| No renal function characteristics | CA down
Phos up
anemia
metabolic acidosis
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| normal urine output | 30 ml/hr
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| kidney function (AFEVER) | A = acid base balance
F = fluid/electrolyte balance
E = elimination of wastes
V = Vitamin D
E = erythropoietin release
R - renin releaase
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| kidney failure symptoms (AFEVER) | A = acidic
F = K up, CA down, Phos up
E = retain fluids
V = CA down, hypocalcemia
E = H&H down, RBC down - anemia
R = BP up
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| when is dialysis needed | creatinine 15 or below
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| nitrogenous waste in blood | azotemia
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| condition of nitrogenous waste in blooc | uremia
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| normal creatinine | 0.6 - 12 mg/dl
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| good indicator of AKI | urine output
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| normal BUN | 6-20 mg/dl
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| crush injury | increased myoglobin
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| Does BUN or creatinine fluctuate more | BUN
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| most accurate kidney function test | creatinine clearance
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| what is creatinine | end product of muscle and protein metabolism
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| what is BUN | end product of protein metabolism
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| BUN would do what with fluid retention | BUN would go down
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| What level is oliguria? | < 400 ml/day
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| Hallmark signs of AKI | increased potassium
increased phosphorous
decreassed calcium
decreased Ph (acidic)
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| Mannitol is what? | diuretic
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| symptoms of hyperkalemia | nausea, fatigue, weakness, tingling, bradycardia, AV block
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| what to do with hyperkalemia | insuin/glucose IV
sodium bicarb
induce diarrhea
calcium supplements
phosphorous with meals
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| normal GFR | 100-125 ml/min
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| kidney diet | low salt, low potassium, fluid restrictions, low protein, no dairy
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| osmosis moves what | water
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| diffusion moves what | solvent (potassium)
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| ultrafiltration does what | pressure (like wringing out a mop)
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| dialysis complications | hypertension, cramping, disequilibrium syndrome
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| what do you do with hypertension complciation during dialysis | stop, supine, NS bolus, O2
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| what do you do with cramping complicatino during dialysis | stop, NS bolus, weight
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| what are signs of disequilibrium syndrome during dialysis | BP up, N/V, HA, convulsions
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| what do you do with disequilibrium syndrome? | decrease time, decrease flow rate, call PCP
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| what are the three types of cardiomyopathy? | dilated, hypertrophic restrictive
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| what cardiomyopathy is most common? | dilated
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| what can be the first sign of hypertrophic cardiomyopathy? | SCD
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| what is a sign of restrictive cardiomyopathy | JVD, RHF
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