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Lindsey Jones 3C1
Lindsey Jones 3C1 - Therapeutics : Circulation
| Question | Answer |
|---|---|
| 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
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