➫
PCCN exam Questions and Answers tachycardia
hypotension
ScvO2 JVD
➫ saturation of central venous O2 R sided echo will show blood backing up in the R side of the heart, poor forward
blood sample from a central line flow to the L side of the heart
goal >70% tx: fluids ( preload dependent), + inotrope- dobutamine, avoid meds that lower
preload- nitrates, morphine, beta blockers, diurectics
R side of the heart is stunned with poor wall movement
inferior MI 12 lead ekg changes
➫ ST elevation in leads II, III, aVF
inferior wall MI s and s/ tx
reciprocal ST depression changes in I and aVL
RCA affected in 65%, L circumflex in others ➫ bradycardia- if symptomatic us atropine
high grade AV heart block (maybe temp perm)
Second dree type 1
right ventricular infarction 12 lead ekg changes
hypotension
➫ V1, V2R-V4R
n/v
proximal RCA and inferior wall MI
diaphoresis
monitor for s and s of R vent infarction
R vent infarction s and s/ tx
,septal wall Mi ekg changes new loud murmur= suspect ventricular septal rupture or papillary musc rupture=
get an echo!
➫ ST elevation change in V1-V2
reciprocal ST depression changes in leads II,III,aVF
LAD affected lateral wall Mi ekg changes
➫ ST elevation in leads I, aVL, V5-V6
no reciprocal changes
anterior wall MI ekg changes
L circumflex and LAD affected
➫ ST elevation in lead V2-V4
st depression in leads II, III, aVF can be associates with other MI locations (inferior and anterior)
artery affected: LAD/ L main
posterior wall MI ekg changes
Anterior and septal wall MI s and s ➫ St elevation in posterior leads V7-V9
St depression in leads V1-V2
➫ L vent failure: s3 and s4 heart sounds
shock RCA affected in 90%, L circumflex 10%
2nd degree type 2, third degree Tall upright R waves in V1-V2
prepare to pace! associated with inferior or lateral wall MI
bundle branch block
LAD perfuses
,➫ septum and L anterior wall ➫ 35-45
RCA perfuses norm HCO3
➫ the inferior wall, r vent, r atrium ➫ 22-26
posterior wall in 90% of ppl
norm base deficit
L circumflex perfuses ➫ -2 to +2
➫ the posterior wall in 10% of people, L lateral wall of the L vent
SaO2
normal ph levels ➫ 95-100%
➫ 7.35-7.45
normal urine specific gravity
norm PaO2 ➫ 1.010-1.02
➫ 80-100
normal urine osmolarity
norm PaCO2 ➫ 500-850 mOsm/ kg
, normal urine Na ➫ Dehydration
➫ 40-100
Excess administration of NaCl or NaHCO3
Hypertonic enteral feedings
normal BUN/Cr ratio
➫ 10:1-15:1 hypernatremia s and s
➫ Thirst
norm mg Tachycardia
➫ 1.5-2.5 Hypotension
Restlessness
norm K Irritable
➫ 3.5-5 Lethargy
Muscle weakness
norm Na
Flushed skin
➫ 135-145 Oliguria (with dehydration)
May also see increased hematocrit (hemo-concentrated)
hypernatremia causes
Increased chloride
Often >106 increased serum osmolarity
PCCN exam Questions and Answers tachycardia
hypotension
ScvO2 JVD
➫ saturation of central venous O2 R sided echo will show blood backing up in the R side of the heart, poor forward
blood sample from a central line flow to the L side of the heart
goal >70% tx: fluids ( preload dependent), + inotrope- dobutamine, avoid meds that lower
preload- nitrates, morphine, beta blockers, diurectics
R side of the heart is stunned with poor wall movement
inferior MI 12 lead ekg changes
➫ ST elevation in leads II, III, aVF
inferior wall MI s and s/ tx
reciprocal ST depression changes in I and aVL
RCA affected in 65%, L circumflex in others ➫ bradycardia- if symptomatic us atropine
high grade AV heart block (maybe temp perm)
Second dree type 1
right ventricular infarction 12 lead ekg changes
hypotension
➫ V1, V2R-V4R
n/v
proximal RCA and inferior wall MI
diaphoresis
monitor for s and s of R vent infarction
R vent infarction s and s/ tx
,septal wall Mi ekg changes new loud murmur= suspect ventricular septal rupture or papillary musc rupture=
get an echo!
➫ ST elevation change in V1-V2
reciprocal ST depression changes in leads II,III,aVF
LAD affected lateral wall Mi ekg changes
➫ ST elevation in leads I, aVL, V5-V6
no reciprocal changes
anterior wall MI ekg changes
L circumflex and LAD affected
➫ ST elevation in lead V2-V4
st depression in leads II, III, aVF can be associates with other MI locations (inferior and anterior)
artery affected: LAD/ L main
posterior wall MI ekg changes
Anterior and septal wall MI s and s ➫ St elevation in posterior leads V7-V9
St depression in leads V1-V2
➫ L vent failure: s3 and s4 heart sounds
shock RCA affected in 90%, L circumflex 10%
2nd degree type 2, third degree Tall upright R waves in V1-V2
prepare to pace! associated with inferior or lateral wall MI
bundle branch block
LAD perfuses
,➫ septum and L anterior wall ➫ 35-45
RCA perfuses norm HCO3
➫ the inferior wall, r vent, r atrium ➫ 22-26
posterior wall in 90% of ppl
norm base deficit
L circumflex perfuses ➫ -2 to +2
➫ the posterior wall in 10% of people, L lateral wall of the L vent
SaO2
normal ph levels ➫ 95-100%
➫ 7.35-7.45
normal urine specific gravity
norm PaO2 ➫ 1.010-1.02
➫ 80-100
normal urine osmolarity
norm PaCO2 ➫ 500-850 mOsm/ kg
, normal urine Na ➫ Dehydration
➫ 40-100
Excess administration of NaCl or NaHCO3
Hypertonic enteral feedings
normal BUN/Cr ratio
➫ 10:1-15:1 hypernatremia s and s
➫ Thirst
norm mg Tachycardia
➫ 1.5-2.5 Hypotension
Restlessness
norm K Irritable
➫ 3.5-5 Lethargy
Muscle weakness
norm Na
Flushed skin
➫ 135-145 Oliguria (with dehydration)
May also see increased hematocrit (hemo-concentrated)
hypernatremia causes
Increased chloride
Often >106 increased serum osmolarity
