theory 2

med surgeeee

what kind of chest pain can radiate, so we always give famotidine upon ED chest pain?

gastric

waht kind of chest pain changes upon palpatory status

musculoskeletal

what kind of chest pain is nonreproducable, sometimes radiates to r epigastric area/jaw

cardiac

STEMis are extra dangerous because the ekg shows us that what part of the heart is damaged?

ventricles

nonstemis are partial ________ of coronary arteries while stemis are complete

occlusionn

ischemia is decreased perfusion, while nstemi is actual _______ of the muscle

necrosis

nstemi frequently presents with a _________ ST segment

depressed

t/f : trops are elevated in demand ischemia

true

what drug in mona dilates blood vessels

nitro

perfusion involves 3 ps; pu——- pi—— pl——-

pumps pipes plasma

preload is aka

fluid volume

preload is before what enders into the _____

svc

to decrease preload we use what

diuretics

we use crystalloids, colloids, PRBCs, isotonic solutions like lactated ringers and ns to increase what?

preload

the strength of the heart is called

contractility

the hearts contractility is cued by how much it is

stretched

a further stretched out diastole means the next constriction will be more/less powerful

more

digoxin, dobutamine, and dopamine are all given to increase what

contractility

meds that help the heart beat better (better contractility)

positive inotrope

meds that control the rate of the heart

chronotrope

pressure in aorta/venous system

afterload

vasopressor decrease CO (epinephrine and NE) do what?

increase afterload

vasodilators increase CO (nitroprusside and nitrates) do what

decrease afterload

normal trop level if not in ischemic distress

under .04

an ekg has multiple leads to show different _______ of the heart electrical activity

angles

if an EKG shows a stemi, what do we go straight to

cath lab

the p wave of an ekg shows what

atria

the qrs of an ekg shows what

ventricles

the t wave of an ekg shows what

repolarization

what do we use to see the ejection fraction of the heart

echo

normal EF

55-70

under what % EF is heart failure

40

what do we have to hold when doing a stress test

beta blockers

when doing the exercise portion of a stress test we make them treadmill while what is on them to see if reproducable pain

ekg

nuclear imaging for resting stress test : pt is NPO< then injected with

nucleotides

resting portion of the stress test makes sure that there is enough blood getting to the heart even when the blood is shunted to the

gut

dr inserts a wire and a balloon to open up plaque, most of the time a stent is placed

angioplasty

before injecting this chekc BUN, CKD because _________ is nephrotoxic

contrast

coronary angioplasty with stenting aka

pci

post cath care includes checking teh ________ of where the cath originally entered and if its bleedin

perfusion

if theres any bleeding/bruising from a cath insertion spot use p_________ and a towel/s________

pressure sandbag

if we enter. a cath thru femoral artery we should after check what pulses/ put pulse ox where

pedal toe

we need to be bedrest ofr how many hrs after cath/ immobilize

4

procedure that starts with splitting the sternum, putting pt on ecmo bypass, then taking a leg or a mammary vein to bypass

cabg

which side HF backs up into lungs

left

hwich side HF backs up into body (neck/abdomen/hips/legs)

right

which side hf presents with edema, hepatomegaly, ascietes, anorexia and vomiting, weakness, weight gain, jvd

right

which side hf presents with dyspnea, cough, crackles, orthopnea, nocturnal dypsnea

left

chf is overload of waht

fluid

in what kind of HF chamers are too thin/weak to pump bc muscle is damaged

systolic

in what kind of HF vent wall is too thick and so cant fill/contract enough blood volume? (hypertrophy)

diastolic

how do we diagnose HF

echo

lab value that is assoc w fluid overload bc the heart releases it when it is stressed

BNP

common causes of heart failure could be genetic, damage to tissue (like an ____), or things that would lead to weak pump or effect filling like vascular disase or drugs

MI

left sided HF would be pulm edema, ________ congestion (whiteout cxr)

vascular

sob that changes positionally, normally from hf or copd

orthopnea

right side HF findings: J___, LE edema (r/o dvt w ultrasound), and venous i________ or stasis

jvd insufficency

in venous insufficiency _____ don’t work so we use SCDs and wraps and socks

valves

beta blockers (metoprolol/carvedilol) inhibit SNS, slowing heart, lowering BP- this means they in/decrease BOTH pre load and afterload

decrease

HF pts have lower or higher bp?

lower

we keep bp and hr low so that the heart can rest and work more e_________ when it does actually beat

efficently

we use ________ to decrease preload in a pt with major 3rd spacing edema

diuretics

lasix and furosemide are not like ________ sparing aldactone, so we have to give them this PO/iv

potassium

if pts are 3rd spaced, diuretics draw from iv not interstitial space. how do we get fluid back to iv?

albumin

we limit hf pts to how many g salt/day?

2

we limit hf pts to how many L fluid/day?

1.5-2

pt gaining 2-3lb/day or 5/week is what, can get prn lasix

water weight

4 respiratory pressures: airway, intra________, intra______, intra________

pleural alveolar thoracic

which respiratory pressure is slightly negative

intrapleural

what is expresses as ratio of change in lung volume/change in lung pressure

compliance

what lowers surface tension, increases lung compliance, provides stability for alveoli inflation, and assists in preventing pulm edema

surfactant

movement of air betwen atmosphere and body

ventilation

o2 and co2 between pulm capillaries and alveoli

diffusion

o2 and co2 in the blood and to/from cells

perfusion

pertains to gas exchange in alveoli

respiration

mechanical involving movement of air

ventilation

v<q- pna, airway obstruction

shunt

v>q- pe, cardiogenic shock

dead space

paO2 supposed to be waht

80-100

measurement of saturation of o2 in arterial blood (93-99%)

SaO2

we order what to r/o PE

vq scan

we do this r/o pna / test what kind of

sputum test

spo2 reflects arterial o2 saturation of _________

hemoglobin

anemia can change the reading of

spo2

the perfent oxygen a patient is being given

fio2

atmospheric fio2, +1L NC fio2

21 4

simple mask fio2 %

35-60

to prevent exhaled co2 accumulation w/in simple face mask must be more than how many L/min

6

non rebreather io2 %

60-91

venturi mask Fio2 %

24-50

venturi mask is good because it gives more _______ fio2

specific

high flo Fio2 %

21-100

hi flo both humidifies and delivers

PEEP

why does hi flow give peep? to keep a_________ o____

alveoli open

cpap stands for _______ positive airway pressure

continuous

bipai stands for _______ positive airway pressure

bilevel

atelectasis is when V__Q?

<

geri: decreased c____ and m____ and g__ r_____

cillia mucus gag reflex

do geri have thinner or thicker alveolar/bronchial walls?

thicker

inflamation to lung parenchyma from infection

pna