Critical Care Hesi Final Exam

Critical Care Hesi Final ExamCritical Care Hesi Final Exam Cardiac o SVT: supraventricular tachycardia  No p waves seen  Treatment:  Adenosine – give 6mg, then 12mg, then another 12mg  Cardioversion if pt not tolerating rhythm  Don’t defibrillate!!!  Have someone bring crash cart to room o Atrial fibrillation:  Chaotic atrial activity  Irregularly irregular  Controlled: vent rate 100  On digoxin at home and has controlled a fib  look at digoxin level  Uncontrolled: vent rate 100  P waves are fibrillatory  High risk for clots  give anticoagulant  Common in elderly  Holiday heart syndrome: alcohol and emotional stress o Atrial flutter:  Ventricular rhythm stays regular  Sawtooth waves  Cardiovert! o Asystole: flat line  Patient is essentially dead  Give CPR and epi  Pulse is gone  Patient in asystole for 20 minutes  talk to family, patient is dead o 3rd degree heart block  Look at patient’s blood pressure, bradycardia  Give atropine, epinephrine, pacemaker o Alcoholic EKG  Wide QRS and flat T = life threatening  Flat T means hypokalemia o Peaked t waves are usually from hyperkalemia o STEMI: ST elevation myocardial infarction  Give thrombolytics within 4 hours of onset o MI vs. Indigestion  Classic symptoms of MI: dull chest pain radiating down left arm  Women, elderly, pt’s with hx of DM may not have classic symptoms, instead:  N/V  Belching  Indigestion  Diaphoresis