Cardiac Tutoring EKG StripsDysrhythmias.pdf

EKG Strips/Dysrhythmias

Flutter – beats happening

Fibrillation – quivering

Atrial fibrillation – no discernable P wave

oNeed anticoagulant therapy for the rest of your life

oControlled – vent response rate <100

oUncontrolled – vent response rate >100

Small QRS – atria, Large QRS – ventricles

Ventricular tachycardia – code with no pulse

Ventricular fibrillation – always code

Sinus bradycardia

oMetaprolol, Cardizem – slow heart rate, do not give

oAtorvastatin, Atropine

BE FAMILIAR WITH DRUGS

Contraindications to tPA administration

oWhen you can give – 12 hours?

oContraindicated: Hemorrhagic stroke, cerebral aneurysm history, closed head injury

history

oER with chest pain: EKG and MONA B

MI complications – dysrhythmias, CHF, cardiogenic shock (not full capacity – cannot effectively

pump blood forward)

Muscle pain – Atorvastatin

MID-CABG – Preoperative antibiotics and a beta blocker, instead of bypass machine

Complication after CABG – hiccupping (diaphragm)

50% of MIs visible on EKG

Heart Failure

Systolic vs. Diastolic (Ejection Fraction)

oNormal EF: 60-70

o<60 systolic (pumping issue)

oNormal EF = diastolic (filling failure)

Most common cause:

oLeft-sided HF: CAD and HTN

oRight-sided HF: left-sided HF

Cor Pulmonale – Right-sided failure caused by pulmonary disease

Furosemide (Lasix) – decreases preload by pulling fluid from the intravascular space

Albumin helpful with Lasix

ACE inhibitor – decreases afterload

Lipitor – not used directly for heart failure

Most concerning for a patient on digoxin for heart failure: hypokalemia

oLower the potassium, more digoxin toxicity

oLow therapeutic range: 1-2

oToxicity: halos, anorexia, n/v, arrhythmias

Sodium intake <2g daily

Decrease intravascular volume

oLasix

Decreased venous return

oACE inhibitor, little bit of Beta-blocker

ACE inhibitors – decreased preload and afterload

Improve gas exchange

oOxygen therapy

Improve cardiac function (squeeze)

oDigoxin, bedrest

Reduce anxiety

oMorphine

Hypertension

Essential vs. Secondary

Causes of essential HTN:

oDiabetes Mellitus – altered lipid metabolism

oIncreased weight

oIncreased sodium intake

oIncreased stress

oAlcohol

Know stages of hypertension

Lifestyle change first, then medications

First line HTN meds: Thiazide diuretics (problem is fluid overload)

Pharmacology – Autonomic Nervous System

200-400 mg NSAIDS - pain

600-800 mg NSAIDS – inflammation

Adrenergic = sympathetic nervous system

Cholinergic = parasympathetic nervous system

oNeurotransmitter: acetylcholine (CHOLINErgic)

Catecholamines = DINE

oD – dopamine and dobutamine

oI – isoproterenol

oN – norepinephrine

oE – epinephrine

oCannot take orally (can’t dine on cats!)

oInduce the stress response – cats are agonizing and stressful

Noncatecholamines – not cats, other pets

oP – phenylephrine

oE – ephedrine

oT – terbutaline

oCan give orally

oAlso agonizing and stressful – induces stress response

Alpha – 1

oAlpha wolf – chief dog

oMajority of hunting – BP high

oControls HI/bladder sphincter tone – doesn’t have to pee while hunting

oDilates his pupils to see at night (mydriasis)

Alpha-2

oNot the top dog, does not like to hunt

oAntagonizes alpha-1 all the time, inhibits everything he does (inhibits stress response

Reduce BO

Relief of pain

Inhibits release of norepinephrine

Beta-1

o1 heart – causes the stress response in the heart

oIncreased force of contraction

oIncreased heart rate

Beta-2

o2 lungs – causes the stress response in lungs

oBronchial dilation

Beta-blockers

oSome are cardioselective – block beta-1

oIf blocks both – also constricts bronchioles

Cardioselective- BEAMing hope to those with asthma

oBasiprolol

oEsmolol

oAtenolol

oMetaprolol

Students also viewed