MARK KLIMEK LECTURE #3 – CARDIAC Calcium Channel Blockers are like Valium for your heart (calms your heart down) CCB’s are negative inotropics, negative dromotropics, and negative chromotropics. Weaken, slow down, and depress the heart. Cardiac depressant. They treat: A, A-A, and A-A-A Anti-hypertensive – relaxes heart and blood vessels – BP goes down Anti-Angina – relaxes the heart – decreases oxygen demand – pain goes away Anti-Atrial-Arrhythmia= it treats everything atrial related = treats supra ventricular tachycardia (supra means above, above the ventricle is the atrial). Side effects: Headache & Hypotension Headache (vasodilation in the brain) Hypotension (relaxes the heart and the blood vessels) Monitor BP intermittently. If systolic is <100, hold! Names of CCB’s: Names ending in “dipine” (You're dipping in the calcium channel) amlodipine, felodipine, isradipine, nicardipine, nifedipine, nisoldipine Verapamil, Diltiazem, Cardizem [Cardizem = Continuous IV drip] For drip, monitor BP continuously. If systolic BP is 98 titrate it down. This study source was downloaded by 100000784304942 from CourseHero.com on 04-28-2022 18:55:21 GMT -05:00 https://www.coursehero.com/file/65067074/Mark-Klimek-Audio-Lecture-3-Cardiacdoc/ Cardiac Arrhythmias (#03 – time13:33) 1. Normal sinus rhythm - Peaks of p waves are evenly spaced 2. V-fib - Chaotic squiggly line. No pattern 3. V-tach - Sharp peaks & jags. There's a pattern 4. Asystole - Flat line 5. Atrial Flutter 6. Atrial Fibrillation 7. PVCs This study source was downloaded by 100000784304942 from CourseHero.com on 04-28-2022 18:55:21 GMT -05:00 https://www.coursehero.com/file/65067074/Mark-Klimek-Audio-Lecture-3-Cardiacdoc/ Terminologies (time 19:50) P wave- Answer will always be atrial Lack of a P wave- is ventricular QRS depolarization- Answer will always be ventricular Six rhythms most tested on NCLEX 1. Asystole – “a lack of QRS” depolarization’s (a straight line); NO ventricular action at all 2. Atrial flutter – “SAW TOOTH” Rapid P-wave depolarization’s in a saw-tooth (flutter) Fibrillation - always described with the word CHAOTIC 3. Atrial fibrillation Chaotic P-wave depolarization’s (lacks any discernable pattern) 4. Ventricular fibrillation Chaotic QRS depolarization Tachycardia – always describe with the word BIZARRE 5. Ventricular tachycardia Wide, bizarre QRS’s Tachy is always discernable repeating pattern 6. Premature ventricular contractions (PVCs) Periodic wide, bizarre QRS’s – short run of VTachs Generally are low to moderate priority. unless everyone else has a normal rhythm Be concerned, if: 1. More than 6 PVCs per minute - if there is any change in rhythm Check Pulse and BP 2. If there are 6 PVCs in a row 3. PVC falls of T-wave of previous beat Low Priority: Premature ventricular contraction (PVC) A bunch of PVC’s is like a short run of V-Tach Moderate Priority: If more than 6 PVC’s in a minute, or if there are more than 6 PVCs row, or if the PVC falls on the T wave of the previous beat. (R on T phenomenon) High Priority Lethal / Life Threatening: Kills you in 8 mins or less. Prioritize!! – THERE IS NO CARDIAC OUTPUT Asystole- No pulse V-fib- No pulse Potentially Life Threatening: V-Tach- Patient has a pulse – still have cardiac output They are NEVER a high priority! This study source was downloaded by 100000784304942 from CourseHero.com on 04-28-2022 18:55:21 GMT -05:00 https://www.coursehero.com/file/65067074/Mark-Klimek-Audio-Lecture-3-Cardiacdoc/ Treatment: (time 29:20) (Ventricular) PVC’s & V-Tach Use Amiodarone or Lidocaine (Atrial) Supra Ventricular Tachycardia (SVT) Atrial Flutter ABCD + Heparin Atrial Fibrillation ABCD + heparin Use ABCD Adenocard (Adenosine): Push in less than 8 secs Don't worry about Asystole (about 30secs if not, then meds not working!) When it comes to IV push, when you don’t know go slow Beta blockers (ending in “lol”) Treats Just like CCB’s, same treatment, same side effects A A-A be careful of patients with asthma – some are bronchoconstrictors A-ACalcium channel blockers A Better for asthmatics (same effect with Beta Blockers) Digoxin/Digitalis (Lanoxin) Last resort because of possible digoxin toxicity V-fib D-fib D-fib – defibrillation + Epinephrine + Amiodarone AsystolE – needs positive ino/dromo/chromo Epinephrine (GIVE FIRST) Atropine (Give only if Epi didn’t work) This study source was downloaded by 100000784304942 from CourseHero.com on 04-28-2022 18:55:21 GMT -05:00 https://www.coursehero.com/file/65067074/Mark-Klimek-Audio-Lecture-3-Cardiacdoc/ This study source was downloaded by 100000784304942 from CourseHero.com on 04-28-2022 18:55:21 GMT -05:00 https://www.coursehero.com/file/65067074/Mark-Klimek-Audio-Lecture-3-Cardiacdoc/ This study source was downloaded by 100000784304942 from CourseHero.com on 04-28-2022 18:55:21 GMT -05:00 https://www.coursehero.com/file/65067074/Mark-Klimek-Audio-Lecture-3-Cardiacdoc/ This study source was downloaded by 100000784304942 from CourseHero.com on 04-28-2022 18:55:21 GMT -05:00 https://www.coursehero.com/file/65067074/Mark-Klimek-Audio-Lecture-3-Cardiacdoc/ This study source was downloaded by 100000784304942 from CourseHero.com on 04-28-2022 18:55:21 GMT -05:00 https://www.coursehero.com/file/65067074/Mark-Klimek-Audio-Lecture-3-Cardiacdoc/ Powered by TCPDF (www.tcpdf.org)
