JANUARY 24, 2018 - MARK KLIMEK LECTURE #3 JANUARY 24, 2018 CALCIUM...

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MARK KLIMEK

LECTURE #3

JANUARY 24, 2018

CALCIUM CHANNEL BLOCKERS

• 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 FIBRILLATION

Chaotic QRS depolarizations

TX: defibrillation (shock them)

VENTRICULAR TACHYCARDIA

Wide bizarre QRS’s

TX: Lidocaine & amiodarone

3

pulse)

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, • Atrial fibrillation • Atrial flutter

• PVC

In order of

4

HOW DO YOU TREAT SUPRAVENTRICULAR (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 TUBES

• 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