lec 3: Cardiac, chest tubes, congenital heart defects

Calcium channel blockers effect on heart

• like valium → slow hr down and relax muscle

what do CCBs treat

A, AA, AAA

• A: antihypertensives (cause vasodilation and decreased bp)

• AA: Anti-Angina (decreases O2 demand for the heart)

• AAA: Anti Atrial Arrhythmia (all atrial arrhythmias & supra ventricular tachy bc supra ventricular is the atria)

CCB side effects

• constipation, hypotension

• do not give if bp or hr is too low

nifedipine

CCB

Verapamil

CCB

Diltiazem

CCB

Amlodipine

CCB

normal sinus

V- fib
* emergency!

• no cardiac output

• V-fib → D-fib (shock them!)

• no pulse or perfusion

• most common after/durring cardiac arrest

Ventricular tachycardia

• sometimes pulse sometimes no, if not, defib at once

A fib

• increases risks of clots

• if pt is symptomatic, cardiovert

• if chronic, pt needs anticoag

asystole

• no electrical activity

• CPR, identify and treat cause (overdose, electrolyte imbalance ect)

• Epinephrine and vasopressin

premature ventricular contraction

• ventricle contracts prematurely, may cause palpitations

• only a problem if many and symptomatic

3rd degree heart block

• atria faster than ventricles

• missing QRS complex

• may be caused by digitalis, BB, CCB

• often requires pacemaker

if question mentions “QRS depolarization“

ventricular problem

if problem mentions “p wave“

problem with Atria

chaotic

referring to fibrillation

bizarre

referring to tachycardia

electrical conduction of the heart

Sweet apples have a big price

• SA node

• AV node

• His bundle

• Bundle branches

• Purkinje fibers

pneumothorax

• air in plural space

• place tube in apical location (high in chest)

hemothorax

• blood in plural space

• place tube in basilar location, near bottom of lung area

water seal of chest tube breaks

• emergency

• place tube in sterile water

if chest tube gets pulled out of pt

• first cover wound with gloved hand

• best cover hole with vasaline gauze

water seal continuous bubbling

bad- sign of a leak

water seal intermediate bubbling

good

suction chamber continuous bubbling

good

suction chamber intermediate bubbling

bad- may need to get order to turn up suction

thoracentesis

basically non-long term chest tube

dr uses needle to remove fluid

subcutaneous emphysema

• occurs when air escapes into the tissue just beneath the skin, commonly presenting as a crackling sensation called crepitus

• if area affected is growing, contact dr

direction of blood shunt in trouble congenital heart defects

right to left (tRoubLe)

how to identify dangerous congenital heart defects

start with T → they are Trouble

s/s of all babies with chd’s

• will have murmur and need an echocardiogram

• for both both trouble and not trouble

list 4 defects of Tetralogy of Fallot

VarrieD PictureS Of A RancH

• Ventricular defect

• Pulmonary Stenosis

• Overriding Aorta

• Right hypertrophy

• a ventricular septal defect (hole between the lower chambers), pulmonary stenosis (narrowed valve), an overriding aorta, and right ventricular hypertrophy (thickened chamber wall)