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Early signs of decreased neuro
- Decreased LOC
- Decreased Pupil Constriction
- Restless
- Agitation
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Venous System
_______ pressure
_______ volume
_______% of total blood
_______ sensitive to meds
- Low pressure
- High volume
- 70% of total blood
- less sensitive to meds
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Arterial System
_____ pressure
_____ volume
_____ % of blood
_____ sensitive to meds
- High pressure
- Low volume
- 30% of total blood
- More sensitive to meds
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How to treat increased preload
- Too much volume
- - Diuretics (lasix, mannitol)
- - Vasodilate (nitro)
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Define CI
- Output based on BMI
- 2.5 - 4.2
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Define C.O.
- Amount of blood ejected by ventricles
- 4-8 L/mm
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What is PS?
- Pressure Support
- - Pushes patients own breath deeper
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Cholesterol
less than 200
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Triglycerides
Less than 150
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SaO2
- 92-100
- Less than 90 = hypoxic
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Goal for FiO2
less than 60%
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What is this wave? What does it mean?
- TOMBSTONES
- - elevated ST waves
- - myocardial injury occuring
- RIGHT NOW
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What is this wave? What does it mean?
- Q wave
- MI already happened, necrotic tissue present
- Infarction
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Define AMI
Ischemia with cell death
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In an AMI, cell will remain viable if blood flow is re-established within ____ mins!
20
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Name and describe 2 classes of MI's
- SEMI - Q wave, total occlusion of coronary arter
- NON STEMI - No Q wave, partial occlusion of coronary artery
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What do you do when suspected MI occurs?
(6)
- 1. O2
- 2. Nitro
- 3. Morphine
- 4. Aspirin
- 5. 12 lead EKG
- 6. ROMI panel
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Indications for CABG
- Multivessel disease
- Stent failure
- Left main failure
- Stable angina not treatment successfuly
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What do statins do? 3 side effects?
- Lower LDL's/ total cholesterol
- Side Effects: headache, weakness, constipation, nausea, flatulence
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Why is aspirin given? Why are aspirin + plavix given together?
- Aspirin is an anti-platelet
- Aspirin + plavix decreases risk of clotting especially in patient with history of heart events/MI
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Define heart failure
Hearts inability to pump enough blood to meet demands of tissues
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S/S of heart failure
- Dyspnea
- Fatigue
- Exercise Intolerance
- Fluid Retention
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Left sided heart failure will cause ______ edema
pulmonary
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Why do we intubate?
(4)
- -Establish airway
- -Assist in secretion removal
- -Prevent aspiration
- -Provide mechanical vent
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After intubating, what 2 assessments do I complete?
- 1. Lood for chest rise/fall
- 2. Listen to chest/stomach
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Right sided heart failure will cause _____ edema
Peripheral
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Why do we trach?
(4)
- 1. Long term vent (>2 weeks)
- 2. Better tolerated
- 3. Easier oral care
- 4. More secure
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Why ET suction?
(4)
- 1. Visible secretions
- 2. Coughing/Rhonchi
- 3. Decreased O2 Sat
- 4. Change in V/S, dyspnea, restless, increasd PIP or high pressure alarm
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3 lab values that indicate need for mechanical vent
- 1. pO2 < 60
- 2. pCO2 > 50
- 3. pH < 7.25
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Describe SIMV
- Synchronized Intermittent Mandatory Ventilation
- - Preset # of breaths and TV
- - Can have own breaths with own TV
- - Prevents respiratory muscle weakness
- ***WEANING***
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Describe AC
- Assist Control
- - Preset # of breaths and TV
- - Patient can take own breath but machine will give TV
- - Used when vent needs to do the most work
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