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EKG - how many big squares equals 1 sec
5 (25 little squares)
2 ways to calculate HR from an ekg
- divide 300 by the number of big boxes btwn QRS complexes
- take the number of peaks in a 6 second strip (30 big boxes) and multiply by ten
which heart block is life threatening?
what med to give it?
what drops in BP qualify a pt as orthostatic
- systolic > 20
- diastolic > 10
pediatric BP norms
children 3-5 y/o normal BP
HR norms for adults, kids, newborns
- 90-160 (norm is 127)
what is it, how to calculate, norm
- mean arterial pressure (pressure in large arteries over time) -- dependent on av blood flow and arterial compliance
- (SBP + 2xDBP)/3
- norm 70-110mmHg
RR norms for adults, kids, newborns
grade 1 HTN BP
- (either number, DBP or SPB will get you into that category)
modified Borg dyspnea scale
- 0 - nothing
- 5 - severe
- 10 - max
inability to breath in reclining or supine pos
crackles/rales -- due to what?
secretions in lungs
- 1+ light, barely noticeable
- 4+ most severe pain ever
grading scale for peripheral pulses
- 0 absent
- 2+ normal
- 4+ bounding
clubbing of fingernails
associated w what?
- excessive curvature of fingernails w soft tissue enlargement at base of nail
- chronic O2 deficiency, chronic pulm disease, heart failure
bilat edema is associated w __
congestive heart failure
which to check first - venous or arterial system?
venous -- if it's insufficient it can invalidate some arterial tests
percussion test - for what? how?
- venous valve insufficiency
- palpate one segment of vein while percussing approx 20 cm higher
- if it's felt by lower hand, the valves are shite
trendelenburg test / retrograde filling test
- supine w legs elev 60 degrees
- tourniquet put on prox thigh
- stand up
- see if veins refill in normal pattern within 30 sec
grade scale for intermittent claudication
- grade I: minimal discomfort or pain
- grade IV: excruciating, exquisite
echocardiogram assess what?
internal structures of heart -- size of chambers, wall thickness, ejection fraction, movement of valves, septum, abnormal wall mvmnt
cardiac catheterization gives info on what?
anatomy of heart, vessels, ventricular and valve function, abnormal wall mvnts, ejection fraction
tiny tube goes from brachial or femoral artery thru aorta into blood vessels
central line / swan-ganz catheter -- how? for what?
catheter inserted thru vessels into R side of heartmeasures central venous pressure, pulmnary artery pressure, pulmonary capillary wedge pressures
what lab values are raised after MI
- and also creatine kinase or creatine phosphocinase
polycythemia / erythrocytosis
increase in RBCs / high hematocrit
erythrocyte sedimentation rate - norms, indicates what?
- male < 15 mm/hr
- female < 20 mm/hr
- if higher, indicates infection, inflammation, RA, SLE, Hodgkins...
sign of angina - pt clenches fist over sternum
- happens at rest 2/2 vasospasm rather than atherosclerosis
- responds well to nitroglycerin or calcium channel blocker
congestive heart failure
- L sided heart failure
- pulmonary congestion, edema, low CO
- insult to L vent from myocardial disease, excessive work load (HTN, valvular disease, congenital defects)
R sided heart failure char by
edema, higher pulmonary vascular pressures, jugular vein distension
associated symptoms of heart failure
muscle wasting, myopathies, osteoporosis
compensated heart failure
heart returns to functional status but w reduced CO and exercise tolerance
control is achieved thru: SNS stim, LV hypertrophy, anaerobic metabolism, cardiac dilation, arterial vasoconstriction