QUESTIONS AND SOLUTIONS FULL VERSION
◉ Dosage of milrinone Answer: Bolus (50 mcg/kg over 10 minutes)
and then gtt (0.375-0.75 mcg/kg/min). Precipitates with lasix.
Longer half-life. Not titrated.
◉ SE of milrinone Answer: Renal excretion. SE: arrythmias,
decreased BP, HA, hypokalemia
◉ Indications for nitroglycerin/Nitrostat Answer: Direct relaxation
of vascular smooth muscle and vasodilation. Used for HTN, angina,
CHF, and MI to decrease O2 demands.
◉ Dosage of nitroglycerin Answer: 5-200 mcg/min. Start low.
Immediate response.
◉ SE of nitroglycerin Answer: Use with caution for patient
dependent on preload for CO (inferior wall MI or right sided MI).
May see tolerance after 24 hours. SE: Hypotension, reflux
tachycardia, HA, flushing, nausea.
◉ IV antidysrhythmics Answer: Atropine = bradycardia
Lidocaine = VT, ventricular irritability
,Amiodarone = afib, VTACH, Vfib
Pronestyl = VTACH, Vfib (can cause torsades)
Verapamil = CA channel block, IV push
Diltiazem = Ca channel blocker, afib, make sure BP good
Adenosine = SLAM IT, SVT, short half-life
◉ Indications for a pacemaker Answer: Treat sudden cardiac death,
EF < 35%, sustained VT, refractory HF despite optimal medical
management
◉ Problems with pacemakers Answer: Failure to capture, over
sensing, and under sensing
◉ Signs and symptoms of cardiac tamponade Answer: Rise in filling
pressure with decreased CO & hypotension. CVP=PAOP=PAD.
Sudden drop in bleeding. Narrowing pulse pressure. Tachycardia,
dysrhythmias, decreased ECG voltage. Decreased UOP. Anxiety and
restlessness. Low blood pressure and weakness. Chest pain
radiating to neck, shoulders, or back. Trouble breathing or taking
deep breaths. Rapid breathing. Discomfort that is relieved by sitting
or leaning forward.
◉ Postoperative care of chest tubes Answer: Assess q15 for first few
hours to monitor drainage changes. Output to average ~100 cc/hr
and should gradually decrease. Average is a total of 1L output. Chest
, tubes are removed when total drainage is < 100 ml for 8 hours. If
output > 100 ml/hr then order PT, PTT, and platelets.
◉ Purpose of Swan (PA) catheter Answer: Measure vascular
capacity, blood volume, pump effectiveness, and tissue perfusion.
◉ Visual of PA catheter waveforms Answer:
◉ Normal CVP/RAP Answer: 1-8 mm Hg
◉ Normal PAWP/LVEDP (left ventricular end diastolic pressure)
Answer: 4-12 mm Hg
◉ Normal PAP Answer: Systolic: 15-25 mm Hg
Diastolic: 6-12 mm Hg
◉ If PAWP is low? Answer: Hypovolemia
◉ If PAWP is elevated? Answer: Hypervolemia and indicative of left
ventricular failure.
◉ Normal CO Answer: 4-8 L/min