▪ change in condition make take priority over ABCs (ex: post op bleeding is priority over
an O2 Sat% of 90%)
▪ pick the patient that is going to die first - Answer Priority questions...something to
consider
CPR, press the code button - Answer You walk into your patient's room and they *don't
have a pulse*, what are you going to do?
bag resuscitation, press the code button - Answer You walk into your patient's room and
they are *not breathing but have a pulse*, what are you going to do?
▪ unconscious, pulseless
▪ shock them with the AED! - Answer If you walk into a room with a patient that is in
*ventricular fibrillation (v fib)*
▪ How will they present?
▪ What must we do to get them out of that state?
, ▪ make them bear down (valsalva maneuver)
▪ make them cough (vagal maneuver) - Answer If you walk into a room and a patient is
alert and oriented, speaking to you, has a pulse, but their cardiac monitor shows they
are in *ventricular tachycardia*
▪ What are you going to do?
Supraventricular Tachycardia (SVT) - Answer Which cardiac rhythm requires the patient
to take *adenosine*?
▪ they may end up with a *blood clot* because the blood is pooling in the atria - Answer
What is our priority concern for a patient in *atrial fibrillation (a-fib)*?
*control RVR for patient:*
▪ give anticoagulants
▪ beta blockers, digoxin, diltiazem
▪ if meds don't work...cardioversion (synchronized shock to re-start the rhythm)
▪ if cardioversion doesn't work...ablation - Answer Nursing Interventions: *A-fib RVR*
▪ chest pain
▪ SOB
▪ diaphoresis
▪ N/V
▪ hypertension
▪ tachycardia
▪ jaw pain, anxiety, indigestion (women)
▪ elevated troponin levels
▪ EKG changes - ST elevation - Answer If you have a patient who comes into the ED
and they are having an MI, what are the signs/symptoms? lab values to confirm this?
*Oxygen* - 1st
*Nitro* - given sublingual, 3 doses q 5 min (home), drip (hospital), drops BP
(vasodilator)
*Aspirin* - antiplatelet, stops clotting, 325 mg, chew it
*Morphine* - calms the patient down, helps pain - Answer Treatment: *Myocardial
Infarction*
▪ CPK
▪ troponin
▪ CK-MB
▪ BNP - Answer Name the cardiac enzymes
angioplasty
stent the artery
angiogram
remove clots
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