HAN 417 Midterm Review

adult and adolescent compression ratio

30:2

adult CPR

5 cycles of 30 compressions and 2 breaths

adult cpr compressions per minute

100-120

full chest recoil

allow chest to return to original position after each compression

Adult CPR depth

2 inches

infants age

younger than 1 year

children

1 year of age to puberty

adults

adolescents and older

infant pulse check

brachial artery

adult pulse check

carotid

2 rescuer child cpr

15:2

Why is early defibrillation important?

Eliminates abnormal heart rhythm

rescue breaths should be delivered over

1 second

AED special circumstances

hairy chest, water, implanted defibrillators and pacemakers, transdermal medication patches

infant and children rescue breathing

1 breath every 2-3 seconds

for victims 8 and older use

adult pads

for a patient with a stoma

place a BVM or pocket mask device directly over the stoma

artificial ventilation may result in

gastric distention

active compression-decompression CPR

Involves compressing the chest and then actively pulling it back up to its neutral position

impedance threshold device (ITD)

A valve device placed between the endotracheal tube and BVM limits air entering lungs during recoil phase between chest compressions.

mechanical piston device

Depresses sternum via compressed gas-powered or electric powered plunger

load distributing band CPR or vest CPR

A circumferential chest compression device composed of constricting band to backboard

When to not start CPR

if the scene is not safe and of that patient has obvious signs of death

foreign body airway obstruction in adults

use abdominal thrust maneuver

use chest thrusts for the following responsive patients

women in advanced stages in pregnancy and obese patients

right side of the heart receieves

oxygen poor blood from the body and tissues and then pumps it to the lungs to pick up oxygen and dispel carbon dioxide

left side of the heart receives

oxygenated blood returning from the lungs and pumps this blood throughout the body to supply oxygen and nutrients to the body tissues

systematic circuit

blood vessels that transport blood to and from all the body tissues

pulmonary circuit

blood vessels that carry blood to and from the lungs

heart is located in

mediastinum

weight of heart

25-350 gm about 1 pound

3 layers of pericardium

fibrous, parietal, visceral

3 layers of heart wall

epicardium, myocardium, endocardium

epicardium

outermost layer

myocardium

the muscle

endocardium

lining the chambers

2 atrias are divided by the

interatrial septum

2 ventricles divided by the

interventricular septum

tricuspid valve

RA to RV

pulmonary valve

RV to pulmonary trunk

mitral valve

LA to LV

aortic valve

LV to aorta

pattern of flow

body to right heart to lungs to left heart to body

LV is thicker than RV because

it forces blood out against more resistance; the systemic circulation is much longer than the pulmonary circulation

atria are thin because

ventricular filling is done by gravity requiring little atrial effort

blood goes to

RA then RV then lungs then LA then LV then body

S1

closing of AV valves at the start of ventricular systole

S2

closing of the semilunar valves at the end of ventricular systole

murmurs

the sound of flow

routine places to auscultate

right and left sternal border and at apex

conduction system

SA node, AV node, Bundle of His, bundle branches, Purkinje fibers

sympathetic

increases rate and force of contractions

parasympathetic

slows the heart rate

base of the heart is

top portion

apex of heart is

pointy bottom

primary pacemaker

SA node

cardiac depolarization

resting potential, action potential, repolarization

artifact

muscle tremors, shivering, patient movement, loose electrodes, 60 hertz interference, machine malfunction

information from a single lead shows

rate and regularity, time to conduct an impulse

a single lead cannot

identify/locate an infarct, identify axis deviation or chamber enlargement, identify right to left differences in conduction, show the quality or presence of pumping action

ECG components

P wave, QRS complex, T wave, U wave

each box on ecg paper is

0.04 sec

time interval of PR interval

0.12-0.20

time interval of QRS interval

0.08-0.12

time interval of QT interval

0.33-0.42

refractory periods

absolute and relative

electrocardiogram 5 step procedure

analyze rate, rhythm, p waves, pr interval, qrs complex

causes of dysrhythmias

myocardial ischemia, necrosis, infarction, autonomic nervous system imbalance, distention of the chambers of the heart, blood gas abnormalities, electrolyte imbalances, trauma to myocardium, drug effects and drug toxicity, electrocution, hypothermia, cns damage, idiopathic events, normal occurrences

mechanisms of impulse formation

ectopic foci and reentry

sinus bradychardia

Sinus Tachycardia

\>100 bpm

sinus tachycardia results from

An increased rate of SA node discharge

sinus bradycardia may result in

decreased cardiac output, hypotension, angina, or CNS symptoms

sinus dysrhythmia

an irregular sinus rhythm.

sinus dysrhythmia/arrhythmia etiology

often a normal finding, sometimes related to the respiratory cycle. rate gradually increases with inspiration and decreases with expiration. May be caused by vagal tone

regular sinus rhythm with sinus arrest

normal to slow rate and irregular rhythm

sinus arrest etiology

occurs when the sinus node fails to discharge

sinus arrest may result from

ischemia of the SA node, digitalis toxicity, excessive vagal tone, or degenerative disease

clinical significance of sinus arrest

Frequent or prolonged episodes may decrease cardiac output and cause syncope. Prolonged episodes may result in escape rhythms

dysrhythmias originating in the atria

wandering atrial pacemaker, multifocal atrial tachycardia, premature atrial contractions, paroxysmal supraventricular tachycardia, atrial flutter, atrial fibrillation

Wandering Atrial Pacemaker

usually normal rate, slightly irregular rhythm, pacemaker site varies among the SA node, atrial tissue, and AV junction

Wandering Atrial Pacemaker p waves and qrs

variable or present and QRS is normal

wandering atrial pacemaker etiology

variant of sinus dysrhythmia, which is a natural phenomenon in the very young or old and may also be caused by ischemic heart disease or atrial dilation

Multifocal Atrial Tachycardia

rate of more than 100 and irregular rhythm, pacemaker site are ectopic sites in atria

Multifocal Atrial Tachycardia p waves and qrs

p waves organized, non sinus P waves at least 3 forms. QRS is variable

Multifocal Atrial Tachycardia etiology

often seen in acutely ill patients, may result from pulmonary disease, metabolic disorders, ischemic heart disease, or recent surgery

clinical significance of multifocal atrial tachycardia

often indicates a serious underlying illness

premature atrial contractions

rate depends on underlying rhythm and the rhythm is usually regular except for the PAC

premature atrial contractions may result from

use of caffeine, tobacco, or alcohol, sympathomimetic drugs, ischemic heart disease, hypoxia, or digitalis toxicity, or may be idiopathic

premature atrial contractions etiology

single electrical impulse originating outside the SA node

paroxysmal supraventricular tachycardia

150-250 bpm and regular rhythm

paroxysmal supraventricular tachycardia etiology

rapid atrial depolarization overrides the SA node, may be precipitated by stress, overexertion, smoking, caffeine

paroxysmal refers to the

starting and stopping of the rhythm

atrial flutter

atrial rate of 250-350 and ventricular rate varies, rhythm is usually regular

atrial flutter etiology

results when the AV node cannot conduct all the impulses, impulses may be conducted in fixed or variable ratios, usually associated with organic diseases such as congestive heart failure

atrial flutter clinical significance

generally well tolerated, rapid ventricular rates may compromise cardiac output and result in symptoms, may occur in conjunction with atrial fibrillation

atrial fibrillation

atrial rate of 350-750 and irregularly irregular rhythm

atrial fibrillation etiology

results from multiple ectopic foci; AV conduction is random and highly variable. Often associated with underlying heart disease

atrial fibrillation clinical significance

atrial fail to contract effectively, reducing cardiac output, well tolerated with normal ventricular rates, high or low ventricular rates can result in cardiac compromise

stroke volume times heart rate gives

cardiac output