Prophecy General ICU RN A V1, V2 &V3 Prophecy General ICU RN A V1 What is cardiac tamponade? Fluid in the pericardial sac causing decreasing preload. This decreases SV and ultimately CO. Effects of Hyper/Hypokalemia and calcemia on EKG Hypokalemia causes U waves Hyperkalemia causes peaked T waves Normal BP? 90-120/60-80 Normal HR? 60-100 bpm Normal CO? 4-8 L/min Normal SVR? 800-1,200 dynes/seconds Normal PVR? 37-250 dynes/sec/cm5 Normal SVo2? 60-80% Normal PAP? Systolic: 15-30 mm Hg Diastolic: 4-12 mm Hg Normal CVP? Downloaded by SAMUEL WAM (samek2029@gmail.com) lOMoARcPSD|13778330 2-6 mmHg V-fib in relation to CO V-fib produces an ineffective stroke, decreasing SV and CO. RV failure - treatment after RV MI Right sided measurements are more related to fluid balance and build up of fluid in the peripheral side. RV failure leads to insufficient LV preload. The result is low SV and CO. Treatment involves fluid loading with hypertonic fluids (3% saline, mannitol, 20% albumin) IABP optimal timing Inflation during diastole (AV closure) and deflation during systole (QRS) IABP functions Decrease afterload and increase coronary artery perfusion IABP waveforms Unassisted Systolic Unassisted End Systolic Assisted Diastolic Assisted End Diastolic Unassisted End Diastolic MI Leads Septal V1, V2 Anterior V3, V4 Lateral I, aVL, V5, V6 Inferior II, III, aVF Endocarditis inflammation of the inner lining of the heart Where do most thrombi occur? In the legs Amiodarone Antiarrhythmic Nicardipine/Cardene Ca Channel Blocker works on periphery Downloaded by SAMUEL WAM (samek2029@gmail.com) lOMoARcPSD|13778330 Cardizem/Diltiazem Ca channel blocker works on periphery/heart Dobutamine (500 mg/250 mL) Inotrope & Dilator (Beta 1/2 agonist) Dopamine (400 mg/250 mL) Vasopressor (catecholamine, dopamine agonist at low doses, beta agonist at 5-10, and alpha agonist at larger) Epinephrine (5 mg/250 mL) Vasopressor/catecholamine (Beta agonist, alpha agonist at large doses) Esmolol (2500mg/250mL) Beta blocker Levophed/Norepinephrine (4 mg/250 mL) Vasopressor/catecholamine (more Alpha agonist, beta agonist at high doses) Lidocaine (2 g/500 mL) Antiarrythmic Neosynephrine/Phenylephrine (20 mg/250 mL) Vasopressor (alpha agonist) Nipride/Nitroprusside (50 mg/250 mL or 100 mg/250 mL) Arterial vasodilator Nitroglycerin (25 mg/250 mL) Vasodilator Precedex/dexmedetomidine (200 mcg/50 mL & 400 mcg/100 mL) Sedative Primacor/Milrinone (50 mg/250 mL & 40 mg/250 mL) Inotrope/vasodilator (useful PHTN & low RV function) (Phosphodiesterase inhibitor in vascular and cardiac tissue) Vasopressin (20 mg/100 mL)