JANUARY 24, 2018 -  Calcium channel blockers are like valium fo...

MARK KLIMEK

LECTURE #3

JANUARY 24, 2018

CALCIUM CHANNEL BLOC KERS

 Calcium channel blockers are like valium for your heart. Calms the heart down.Indicators – tachycardia, tacharythmias  Negative intropic, chronotropic, dromotropic (relax your heart, calm it down)  They treat – A (antihypertensives), AA (antianginal), AAA (anti-atrial arythmia) they treat atrial dysrhythmias and supraventricular contractions (SVT)  Names – majority end in -dipine (amlodipine, nifedipine) & verapamil, cardizem (can be given as a continuous IV drip)  Side effects – headache & HYPOtension (take BP before administering, hold if systolic is <100)

CARDIAC ARRYTHMIAS

 QRS refers to – Ventricular  P refers to – Atrial

ATRIAL FLUTTER

Rapid P wave repolarizations in a saw tooth pattern

2

ATRIAL FIBRILLATION

chaotic QRS depolarizations, heart rate is irregular

TX: HEPARIN first, then ABCD

VENTRICULAR FIBRILLA TION

Chaotic QRS depolarizations

TX: defibrillation (shock them)

VENTRICULAR TACHYCAR DIA

Wide bizarre QRS’s

TX: Lidocaine & amiodarone

3

ASYSTOLE

a lack of QRS repolarizations

TX: epinehphrine & atropine

PVC

Periodic wide, bizarre QRS’S. If there are more than 6 PVCs in a minute, or 6 in a row, you elevate the priority to moderate. PVC are not priority. NOT necessary to contact HCP.

TX: lidocaine & amiodorone

LETHAL ARRYTHMIAS

 Asystole  Ventricular fibrillation

POTENTIALLY LIFE THREATENING

 Ventricular tachycardia (have a cardiac output, pulse)  Atrial fibrillation  Atrial flutter

 PVC

In order of priority

4

HOW DO YOU TREAT SUP RAVENTRICULAR (ATRIAL) ARRYTHMIAS?

Adenocard (adenosine – push in less than 8 seconds, fast and don’t worry about asystole) Beta blockers (-lol) Calcium channel blocker Digitalis (lanoxin, digoxin)

CHEST TUBES

 Purpose  re-establish negative pressure in the pleural space (negative is good in pleural space, makes things stick together)  In a pneumothorax, chest tube removes  air  In a hemothorax, chest tube removes  blood You have a patient with a chest tube in for a hemothorax, what would you report to HCP?

• Chest tube is not bubbling
• Chest tube drained 800 mL in first 10 hours
• Chest tube is not draining (because it is not doing what it is supposed to do)
• Chest tube is intermittently bubbling

LOCATION OF CHEST TU BES

 Apical chest tube  way up high, removes air because air rises (A for Apical)  Basilar chest tube  bottom of the lungs, removes blood (B for Blood)

WHAT DO YOU DO IF A WATER SEAL BREAKS?

• Clamp it (FIRST)
• Cut broken device off of tube
• Put the end of the tube in NS
• Unclamp it (because you’ve reestablished the water seal)

BEST thing to do is put in NS.