Critical care HESI Final Exam 1 –ALL the 55 Questions And the Answers.

• Cardiac o SVT: supraventricular tachycardia ▪ No p waves seen ▪ Treatment: • Adenosine – give 6mg, then 12mg, then another 12mg • Cardioversion if pt not tolerating rhythm • Don’t defibrillate!!! ▪ Have someone bring crash cart to room o Atrial fibrillation: ▪ Chaotic atrial activity ▪ Irregularly irregular ▪ Controlled: vent rate 100 • On digoxin at home and has controlled a fib  look at digoxin level ▪ Uncontrolled: vent rate 100 ▪ P waves are fibrillatory ▪ High risk for clots  give anticoagulant ▪ Common in elderly ▪ Holiday heart syndrome: alcohol and emotional stress o Atrial flutter: ▪ Ventricular rhythm stays regular ▪ Sawtooth waves ▪ Cardiovert! o Asystole: flat line ▪ Patient is essentially dead ▪ Give CPR and epi ▪ Pulse is gone ▪ Patient in asystole for 20 minutes  talk to family, patient is dead o 3rd degree heart block ▪ Look at patient’s blood pressure, bradycardia ▪ Give atropine, epinephrine, pacemaker o Alcoholic EKG ▪ Wide QRS and flat T = life threatening ▪ Flat T means hypokalemia o Peaked t waves are usually from hyperkalemia o STEMI: ST elevation myocardial infarction ▪ Give thrombolytics within 4 hours of onset o MI vs. Indigestion ▪ Classic symptoms of MI: dull chest pain radiating down left arm ▪ Women, elderly, pt’s with hx of DM may not have classic symptoms, instead: • N/V • Belching • Indigestion • Diaphoresis • Dizziness • Fatigue