Questions and Answers
What is the primary hemodynamic effect of dopamine >10 mcg/kg/min?
What causes the S3 sound?
Pulmonary hypertension and cor pulmonale; Mitral, aortic, or tricuspid insufficiency.
When are coronary arteries perfused?
During diastole.
What may you hear before crackles when a patient is going into heart failure?
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What is variant or Prinzmetal's angina?
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What type of MI is indicated by changes in leads II, III, aVF?
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What type of MI is indicated by changes in leads V1, V3, V4?
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What type of MI is indicated by changes in leads V5, V6, I, aVL?
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What type of MI is indicated by changes in leads V5, V6?
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What type of MI is indicated by changes in leads I, aVL?
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What type of MI is indicated by changes in leads V1 and V2?
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What type of MI is indicated by changes in leads V3R, V4R?
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What are some signs of reperfusion following fibrinolytic treatment of a STEMI?
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What should you do if a patient experiences unrelenting chest pain and ST elevation after PCI?
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What is happening if a patient has severe back pain and hypotension after PCI?
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What is a normal ankle-brachial index (ABI)?
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How should you care for the affected extremity in a patient with PAD after bypass graft?
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What deadly rhythm can prolonged QT lead to?
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What are causes of prolonged QT interval?
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What do you do if a pacemaker patient goes into V-tach and becomes unresponsive?
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What are signs of right-sided heart failure?
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What are signs of left-sided heart failure?
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What is a Ventricular Assist Device (VAD)?
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What is the function of IABP?
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What are complications of CABG?
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What are signs of cardiac tamponade?
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What is the normal PAWP (pulmonary artery wedge pressure)?
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What does a PAWP of 1-3 mmHg mean?
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What does a PAWP of >12 mmHg indicate?
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What is considered anatomic dead space?
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What causes alveolar dead space?
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How should you position a patient with left-sided pneumonia?
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What is the normal V/Q ratio?
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What is a pathologic shunt?
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What is the normal level for carbon monoxide?
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What are contraindications to NIV (BiPAP/CPAP)?
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What is indicated for patients with increased WOB/hypoxic respiratory failure?
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What is indicated for patients who need both ventilation and oxygenation?
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What is the treatment for status asthmaticus?
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What are ventilator considerations for a patient in status asthmaticus?
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What does a silent chest indicate?
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What could a patient developing petechiae, cough, low-grade fever, and anxiety after a femur fracture indicate?
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What are common causes of non-cardiogenic pulmonary edema?
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Should steroids be used in ARDS?
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What is the plateau pressure limit in ARDS?
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What should Vt be limited to in ARDS?
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Is tension pneumothorax worse than regular pneumothorax?
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What are the signs and symptoms of regular pneumothorax?
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Where should the ETT be placed?
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What is the typical Vt for a patient?
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Which cranial nerve is responsible for swallow and gag reflex?
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What do you check to assess cranial nerve III?
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If a patient has a right-sided head injury, where would you expect a blown pupil?
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If a patient has a right-sided head injury, where would you expect a positive Babinski reflex?
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What does a positive dolls eyes reflex indicate?
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Is it bad if the eyes do not move with the dolls eyes maneuver?
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Is the oculovestibular reflex a good sign?
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What kind of neuro problem indicates hyperventilation?
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What type of neuro problem indicates apneustic breathing?
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What kind of neuro problem does ataxia indicate?
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If your patient has a left-sided stroke, where may his eyes deviate?
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If a patient is having hemianopsia in the left eye, what kind of stroke did they have?
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In an uncal herniation, what will you see first, LOC change or blown pupil?
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What is the most common cause of uncal herniation?
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What happens in central herniation?
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What are signs of pontine stroke?
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Why is Decadron given in neuro cases?
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What is the first sign of increased ICP?
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What is considered a normal ICP?
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How to calculate cerebral perfusion pressure?
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What is the average CPP?
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What does high ICP with hypotension indicate?
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What does Cushing's triad consist of?
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What do A waves of ICP monitoring indicate?
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What do B waves of ICP monitoring indicate?
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What do C waves of ICP monitoring indicate?
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What results in A waves and high ICP?
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Should you give 0.45 NS to a patient with high ICP?
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Should you give D5W to a patient with high ICP?
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Should hyperventilation be used to decrease ICP?
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What could a skull fracture associated with CSF drainage indicate?
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What is death due to cerebral hypermetabolism in status epilepticus?
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What kind of meningitis presents with low glucose in CSF?
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What kind of meningitis presents with normal glucose in CSF?
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After how long would you reconnect the vent and do an ABG for apnea test?
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What does a positive apnea test for brain death indicate?
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What does the Tensilon test evaluate?
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What are the symptoms of cholinergic crisis?
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What are pulmonary complications of pancreatitis?
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What does Grey Turner's sign indicate?
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What does Cullen's sign indicate?
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What electrolyte abnormality is seen in pancreatitis?
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What does Kehr's sign indicate?
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Where is the injury if there is intraabdominal bleeding with Cullen's sign?
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Where is the injury if there is intraabdominal bleeding with Grey Turner's sign?
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Where is the injury if there is left shoulder pain with abdominal trauma?
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Where is the injury if you hear bowel sounds in the chest after abdominal trauma?
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What does free air on X-ray indicate?
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Study Notes
Hemodynamic Effects of Dopamine
- High-dose dopamine (>10 mcg/kg/min) increases afterload.
- Potential hemodynamic effects include increased preload, decreased preload, and decreased contractility.
Heart Sounds and Conditions
- S3 heart sound indicates heart failure and may be heard before crackles.
- Conditions causing S3 include pulmonary hypertension, cor pulmonale, mitral, aortic, or tricuspid insufficiency.
Coronary Artery Perfusion
- Coronary arteries are primarily perfused during diastole.
Angina Types
- Variant or Prinzmetal's Angina presents as unstable angina with transient ST segment elevation; can occur at rest and is often triggered by substances like nicotine or alcohol.
Myocardial Infarction (MI) Recognition
- RCA (Right Coronary Artery) inferior changes observed on leads II, III, aVF.
- LAD (Left Anterior Descending) anterior changes observed on leads V1, V3, V4.
- Circumflex artery changes seen in leads V5, V6, I, and aVL.
Reperfusion Signs Post STEMI
- Signs of reperfusion after fibrinolysis include ST segment resolution and relief of chest pain.
- Monitoring for reperfusion arrhythmias, such as VT or VF, and marked elevation of troponin levels.
PCI Complications
- Unrelenting chest pain within 24 hours of PCI may indicate coronary artery re-occlusion. Immediate contact with a physician is necessary.
- Sudden severe back pain and hypotension post-PCI suggest retroperitoneal bleeding; nursing interventions include fluid resuscitation.
Ankle-Brachial Index (ABI)
- A normal ankle-brachial index is >1, indicating no significant vascular occlusion.
Patient Care for PAD
- In patients with PAD post-bypass graft, do not elevate the affected extremity, as it could reduce perfusion. Use a reverse Trendelenburg position.
Prolonged QT Interval
- Causes of prolonged QT include medications like Amiodarone, Haldol, and electrolyte imbalances.
- Torsades de pointes is a dangerous arrhythmia resulting from prolonged QT.
Heart Failure Symptoms
- Right-sided heart failure symptoms: JVD, dependent edema, weight gain, hepatomegaly.
- Left-sided heart failure symptoms: shortness of breath, crackles, oliguria, frothy sputum, displaced apical pulse.
Mechanical Ventricular Support
- A Ventricular Assist Device (VAD) assists in pumping blood, reducing heart workload in specific cardiac failures.
Intra-Aortic Balloon Pump (IABP)
- Inflates during diastole to increase coronary artery perfusion and deflates before systole to reduce afterload.
Cardiac Tamponade Signs
- Indicators include narrowed pulse pressure, pulsus paradoxus, restlessness, JVD, hypotension, and diminished heart sounds (Beck's triad).
Cerebral Monitoring
- Normal pulmonary artery wedge pressure (PAWP) ranges from 4-12 mmHg.
- A PAWP of 1-3 mmHg indicates hypovolemia, while >12 mmHg indicates hypervolemia.
Airway and Ventilation Management
- Anatomic dead space includes airways not involved in gas exchange (trachea, bronchi).
- Positive pressure ventilation is indicated when simultaneous ventilation and oxygenation are required (e.g., BiPAP, CPAP).
Respiratory Complications
- ARDS causes a pathologic shunt, leading to severe hypoxemia not corrected by increasing FiO2.
- Ventilator settings in ARDS should limit tidal volume to 4-6 ml/kg to avoid pulmonary injury.
Head Injury Signs
- Changes in pupil response, such as blown pupils or positive Babinski reflex, can indicate neurological compromise.
- The “doll's eye reflex” assesses brainstem function; abnormal responses indicate serious brain injury.
Stroke Indicators
- Eye deviation toward or away from the pathology in stroke cases signifies brain function status.
Intracranial Pressure (ICP) Management
- Cushing's triad (elevated BP, bradycardia, irregular respirations) indicates increased ICP.
- Normal ICP is maintained between 0-10 mmHg; values exceeding this may lead to severe neuro complications.
Meningitis Differentials
- Low glucose levels in cerebrospinal fluid (CSF) are characteristic of bacterial meningitis; viral meningitis typically retains normal glucose levels.
Trauma Assessment
- Cullen's sign (periumbilical ecchymosis) and Grey Turner's sign (flank bruising) indicate internal bleeding due to abdominal trauma.
Pancreatitis Signs
- Complications of pancreatitis can manifest as signs like bruising (Grey Turner's sign) and low calcium levels leading to potential seizures or extended QT intervals.
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Description
This quiz covers key concepts related to hemodynamic effects of dopamine, heart sounds, coronary artery perfusion, and angina types. Test your knowledge of myocardial infarction recognition and relevant cardiac conditions. Perfect for medical students and professionals in cardiology.