Cardiac Management and Dysrhythmias

A-fib/A-Flutter Control

• Control rate: Lopressor, BB, Control rhythm: Digoxin, Amiodarone (doesn't affect BP), Diltiazem.
• Anticoagulants: Heparin & Warfarin.
• Cardioversion: First TEE A-Fib (no P wave for every QRS), not regular A-Fib w/ RVR.
• Shockable: VFIB, SVT uncontrolled V tach (180+ rate).
• Non-shockable: PEA, symptomatic bradycardia (low HR).

Heart Block

• 3rd degree heart block: Pacemaker.

Pacemaker

• Pacemaker to treat heart block.

Dysrhythmias

• Vagal maneuvers, Adenosine for supraventricular tachycardia.
• Epi (first), CPR if no response during dysrhythmias.

Myocardial Infarction (MI)

• Signs/symptoms: Midsternal chest pain radiating, syncope, N/V, feeling of impending doom, pale and diaphoretic, dysrhythmias, dyspnea, hypotension.
• Treatment: Nitroglycerin (every 5 minutes, 3 doses).
• Call 911 if not relieved.

Post-Op CABG

• Monitor for decreased CO (cardiac output).
• Assess for bleeding; lower BP, less CO, & decreased urine output.

Cath Lab

• MONA: Morphine, O2, Nitro, Aspirin.
• STEMI: ST elevation; immediate angiogram/arteriogram w/ contrast dye (monitor kidneys).
• Revascularization with stent placement.
• Post-op: Monitor distal pulses, bleeding, CMS (circulation, motor, sensation), neuro status.
• Teaching: Antiplatelet meds increase bleeding risk.

Cardiovascular Complications

• Elevated PAWP: Diuretics.
• Decreased PAWP: Increase fluids.
• CVP: Central line, measures blood return to heart from vena cava; tells fluid status.
• CO (cardiac output): HR x Stroke Volume.
• CI (cardiac index): CO/body surface area.
• Afterload and preload impact stroke volume.
• Digoxin & dobutamine, epinephrine are positive inotropes (increase heart contraction).
• BB (beta blockers) and Calcium channel blockers (CaCB) are negative inotropes (decrease heart contraction, slow HR).
• Hemodynamics: increased PAWP = diuretics, decreased PAWP = fluids.

Shock

• Hypovolemic shock: Fluid loss (vomiting/diarrhea/hemorrhage).
• Cardiogenic shock: Heart failure to pump effectively.
• Distributive shock: Severe vasodilation (neurogenic, anaphylactic, septic).

Other Topics

• Sepsis: Widespread infection; assess for hypotension, tachycardia, altered mental status.
• Acute Pancreatitis: Assess for nausea, vomiting, extreme abdominal pain, cannot hold fluids down.
• High risk Sepsis: Assess for hypotension/tachycardia, altered mental status, lactate greater than 2 mmol/L.
• MAP (Mean Arterial Pressure): Goal of >60 mm Hg in shock state.
• Hypoxia/Ventilation: Assess and treat promptly for oxygen exchange.
• Chest Tubes: Assess chest tubes for bubbling, position, and securement.
• Organ Donation: Assess for possible organ donation.
• Other Procedures/Interventions: Identify procedures and intervene appropriately (thoracotomy, fluid boluses, etc.).

This quiz covers important aspects of cardiac management, including control of A-fib/A-flutter, heart block treatment, pacemaker usage, and the signs and responses to myocardial infarction. Additionally, it highlights post-operative care for CABG patients and key interventions for dysrhythmias. Test your knowledge on these critical topics!