Medical-Surgical Nursing, Emergency Care, and Pharmacology Flashcards

Flashcards covering cardiac electrophysiology, ACLS algorithms, ear and eye disorders, emergency triage, burn management, toxicology, and acute physiological decompensations based on lecture notes.

What is the graphical electrical activity representation of the heart

Electrocardiogram (ECG)

What does altered atrial morphology usually indicate?

Atrial enlargement or ectopic atrial rhythm

What does prolongation of pr segment may suggest?

First-degree AV block

The ECG waveform representing the depolarization or activation of the right and left atrial myocardium, originating from the sinoatrial (SA) node.

P wave

The section on an ECG reflecting conduction delay at the atrioventricular (AV) node, allowing time for ventricular filling before contraction.

PR segment

The ECG complex representing depolarization of the right and left ventricular myocardium via the bundle of His, bundle branches, and Purkinje fibers.

QRS complex

What does elevation or depression of ST segment may indicate?

Myocardial ischemia or injury

ST Segment

The portion of an ECG representing early ventricular repolarization and the plateau phase of the ventricular action potential.

T Wave

The ECG waveform representing the repolarization of the ventricular myocardium as the ventricles return to a resting state.

U Wave

An ECG wave representing late repolarization of Purkinje fibers or papillary muscles, frequently seen in hypokalemia or bradycardia.

What wave can be seen in hypokalemia or bradycardia

U wave

ECG Grid Time Values

On standard ECG paper, $1\,\text{small box} = 0.04\,\text{seconds}$, $1\,\text{large box} (5\,\text{small boxes}) = 0.20\,\text{seconds}$, and $5\,\text{large boxes} = 1\,\text{second}$.

How many seconds are equivalent to 1 small box?

0.04 seconds

How many seconds is equivalent to 1 big box?

0.20 seconds

30 large boxes is equivalent to how many seconds? And how any small boxes?

6 seconds, 150 small boxes

Precordial Lead Placement

Standard chest lead locations where C1 is at the right 4th intercostal space, C2 at the left 4th intercostal space, C4 at the left midclavicular line 5th intercostal space, C3 between C2 and C4, C5 between C4 and C6, and C6 at the mid-axillary line 5th intercostal space.

Six-Second Strip Method

A heart rate calculation performed by counting the number of R waves in a $6\text{-second}$ ECG strip ($30\,\text{large boxes}$) and multiplying by $10$.

Division Method (ECG Rate Calculation)

A method to determine heart rate by dividing the constant $1,500$ by the number of small boxes between two consecutive R waves.

Atropine IV Dosage (ACLS Bradycardia)

First dose of $1\,\text{mg}$ bolus given every $3\text{--}5\,\text{minutes}$, up to a maximum cumulative dose of $3\,\text{mg}$.

Synchronized Cardioversion

The delivery of an electrical shock timed to the peak of the QRS complex, indicated for unstable supraventricular tachycardia, atrial flutter, monomorphic ventricular tachycardia, and atrial fibrillation.

Adenosine IV Dosage (ACLS Tachycardia)

First dose of $6\,\text{mg}$ rapid IV push followed by normal saline flush; second dose of $12\,\text{mg}$ if required.

Hypotension, altered LOC, signs of shock, ischemic chest discomfort, acute heart failure

What should we assess for if the pt have adult bradycardia?

Atropine, transcutaneous pacing, dopamine infusion, epinephrine infusion

What is our medical intervention for our adult patient with bradycardia?

Atropine IV doses for adult bradycardia

1st dose: 1mg bolus, repeat every 3-5 minutes with maximum of 3mg

Dopamine IV infusion for adult bradycardia

Infusion rate of 5-20 mcg/kg per minute, titrate to pt response

Epinephrine IV infusion for adult bradycardia

2-10 mcg per minute

Possible causes of adult bradycardia

MI, toxicologic of CCB, BB, digoxin, hypoxia, elecrolyte abnormality

If the adult tachycardia with a pulse is causing persistent tachyarryrthmia like hypotension, altered LOC etc. what is the intervention?

Synchronized cardioversion. Consider sedation. If regular narrow complex, consider adenosine

With a patient who have adult tachycardia with a pulse, no persistent tachyarrythmia signs and wide QRS more than 0.12 sec. What is the medical intervention?

Adenosine if regular and monomorphic

Adenosine IV dose for adult tachycardia with pulse

1st dose is 6mg rapid push then NS flush, 2nd dose 12 mg if required

Antiarrhytmic infusions for stable wide-QRS tachycardia with a pulse

Procainamide !V (20-50mg/min, maximum dose of 17mg/kg)

Amniodarone 150mg over 10 mins first dose, ff by maintenance infusion of 1mg/min for the first 6 hrs

Sotalol IV 100 mg (1.5 mg/kg) over 5 mins, avoid if prolonged QT)

High-Quality CPR Compression Standards

Chest compressions delivered at a rate of $100\text{--}120\,\text{compressions/min}$ and a depth of at least $2\,\text{inches}$ ($5\,\text{cm}$) in adults, allowing complete chest recoil.

Shockable Cardiac Arrest Rhythms

Ventricular Fibrillation (VF) and Pulseless Ventricular Tachycardia (pVT).

Non-Shockable Cardiac Arrest Rhythms

Asystole and Pulseless Electrical Activity (PEA).

Recovery Position

A side-lying position used for unresponsive patients with spontaneous respiration to keep the airway clear and prevent aspiration.

Premature Ventricular Contraction (PVC)

An ectopic ventricular impulse characterized by an irregular underlying rhythm, absent P wave for the beat, and a wide, bizarre QRS complex.

PVC Bigeminy

A cardiac pattern where every normal beat is followed by a PVC (Normal-PVC-Normal-PVC).

Asystole

A cardiac arrest state defined by the complete absence of discernible electrical activity on an ECG, appearing as a flat line.

Ventricular Fibrillation (VF)

A lethal cardiac arrest rhythm characterized by chaotic, unsynchronized undulations of the ECG baseline without identifiable P waves or QRS complexes.

First-Degree AV Block

A conduction delay defined by a normal P wave followed by a regular QRS complex with a prolonged PR interval exceeding $0.20\,\text{seconds}$ ($>5\,\text{small squares}$).

Second-Degree AV Block Mobitz I (Wenckebach)

An AV block characterized by progressive lengthening of the PR interval until a QRS complex is dropped.

Second-Degree AV Block Mobitz II

An AV block featuring a fixed PR interval with intermittent, unexpected dropped QRS complexes.

Third-Degree AV Block (Complete Heart Block)

A heart block where there is complete dissociation between atrial activity (P waves) and ventricular activity (QRS complexes).

Atrial Fibrillation

An irregularly irregular narrow-complex tachycardia lacking discernible P waves and presenting with chaotic atrial fibrillatory waves.

Atrial Flutter

A narrow-complex tachycardia characterized by regular saw-tooth flutter waves with an atrial rate typically between $220\text{--}350/\text{min}$.

Triage Priorities

Emergency room classification: Emergent (immediate life-threatening conditions), Urgent (serious issues requiring treatment within 1 hour), and Non-urgent (episodic conditions manageable within 24 hours).

Disaster Triage Color Coding

Disaster evaluation system: Red = Immediate priority, Yellow = Delayed treatment, Green = Minimal/Ambulatory, Black = Expectant/Deceased.

Primary Survey (ABCDE)

A rapid initial assessment used in emergency care to detect immediate life threats: Airway, Breathing, Circulation, Disability, and Exposure.

Four B's of Emergency Nursing

The core sequence of physiological priorities during stabilization: Breathing, Bleeding, Brain, and Bones.

Pediatric Emergency Danger Signs

Four critical manifestations requiring urgent pediatric intervention: Convulsions, Lethargy, Inability to Drink, and Vomiting Everything.

Hydrophobia

A characteristic late-stage symptom of rabies where painful pharyngeal spasms cause severe difficulty and fear when swallowing water.

Parkland Formula

Fluid resuscitation calculation for 2nd and 3rd degree burns: $4\,\text{mL} \times \text{TBSA (\%)} \times \text{Body Weight (kg)}$, administering $50\%$ in the first $8\,\text{hours}$ and $50\%$ over the remaining $16\,\text{hours}$.

Activated Charcoal Exclusions

Activated charcoal is ineffective for adsorbing acids/alkalis, alcohols, heavy metals, and lithium.

Acetaminophen Antidote

Acetylcysteine (Mucomyst), administered to prevent severe hepatic necrosis following acetaminophen toxicity.

Opioid Reversal Agent

Naloxone (Narcan), an antagonist used to immediately reverse opioid-induced central nervous system and respiratory depression.

Cushing's Triad

A late physiological response to Increased Intracranial Pressure (IICP) consisting of hypertension with a widening pulse pressure, bradycardia, and irregular respirations.