What to do first if patient has chest pain. - ANSWER Rest!
ECG changes in an acute MI - ANSWER ST elevation in 2 or more contiguous leads. Ischemia d/t full thickness loss of muscle. EMERGENCY.
Inferior leads - ANSWER II, III, aVF. RCA occlusion.
Septal leads - ANSWER V1 & V2.
What to do first if patient has chest pain. - ANSWER Rest!
ECG changes in an acute MI - ANSWER ST elevation in 2 or more contiguous leads. Ischemia d/t full
thickness loss of muscle. EMERGENCY.
Inferior leads - ANSWER II, III, aVF. RCA occlusion.
Septal leads - ANSWER V1 & V2.
Anterior leads - ANSWER V1 - V4. LAD lesion.
Lateral leads - ANSWER V5, V6, I, and aVL. Circumflex lesion.
Cardiac enzymes - ANSWER Troponins, CK-MB, and CK
Changes in CK - ANSWER Rise: 3-6 hours
Peak: 24 hours
Normal: 3-4 days
Changes in CK-MB - ANSWER Released after myocardial necrosis. Specific for myocardial damage.
Rise: 3-12 hours
Peak: 24 hours
Normal: 2-3 days
Troponin I - ANSWER Protein found in cardiac muscle. High sensitivity.
, Rise: 3-12 hours
Peak: 24 hours
Normal: 5-10 days
Failure to fire/pace - ANSWER No pacer spikes seen
Failure to sense - ANSWER Pacemaker does not detects heart's intrinsic activity or interprets noncardiac
activity as intrinsic activity. Spikes in inappropriate times.
Normal PR - ANSWER 0.12 - 0.20
Normal QRS - ANSWER 0.04-0.10
Normal QT - ANSWER Less than 0.48. Varies by age, HR, and gender.
Indication for dopamine/Intropin - ANSWER Acts on SNS to increased HR and BP. Indicated for
hypotension, low CO, decreased renal blood flow. Use if patient is bradycardic.
Doses of dopamine - ANSWER Low: 0.5-2 mcg/kg/min (dopaminergic)
High: over 10 mcg/kg/min (alpha receptors, vasoconstrict)
SE of dopamine - ANSWER Watch volume and starting BP. Use central line. Inactivated by sodium bicarb.
Can cause acidosis. SE: ectopic beats, tachycardia, tissue necrosis d/t extravasation
, Treatment of dopamine extravasation - ANSWER Phentaolmine 5-10 mg and possibly nitropaste to
vasodilate
Indication for norepinepherine/Levophed - ANSWER Indicated for diastolic hypotension (specifically
decreased SVR) and septic shock. Stimulates alpha & beta receptors. Increased contractility, HR, and
vasoconstriction.
Doses of norepinepherine - ANSWER 2-12 mcg/min. Immediate onset.
SE of norepinepherine - ANSWER Replace volume first because it can cause GI and renal hypoperfusion.
Have a central line. SE: dizziness, HA, hyperglycemia, myocardial/mesenteric/renal ischemia, tissue
necrosis with extravasation.
Treatment of norepinepherine, epinepherinem, dobutamine, and Neosynephrine extravasation -
ANSWER Phentaolmine 5-10 mg.
Indications for epinepherine/Adrenalin - ANSWER Simulates alpha and beta receptors. Used post cardiac
surgery for "stunned" myocardium. ACLS protocol. Bronchial relaxation at low doses, increased
contractility at high doses.
Dosages of epinepherine - ANSWER 2-20 mcg/min. Immediate onset. Irritating to heart, so only good for
emergency use.
SE of epinepherine - ANSWER SE: myocardial/mesenteric/renal ischemia, tachycardia, hyperglycemia,
HA, tissues necrosis with extravasation
SE of phenylephrine/Neosynephrine - ANSWER Pure alpha stimulator. Used during C/P bypass,
anesthesia induced hypotension, vascular failure in shock. Vasoconstricts arterioles without cardiac
effect.
Dosages of Neosynephrine - ANSWER 10-100 mcg/min. Immediate onset.
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