Mark Klimek Audio Notes 1

Mark Klimek Audio Notes 1

Acid Base ABG’s

As pH goes, so does my Pt! Except for K

pH ↓ Pt goes ↓ (HR, RR, all vitals) K goes ↑ pH ↑ Pt goes ↑ K goes ↓ Except for K – it does the opposite

pH ↑ : Alkalosis

• Seizures, hyperactivity, borborgemy (↑BS)

Kausmal breathing = MacKausamal (Metabolic Acidosis breathing)

Lung: Respiratory

Everything else: Metabolic

When you don’t know: it’s probably metabolic acidosis (It’s super common)

Ventilators

High Pressure Alarm • Obstructed airflow • Having to use too much pressure • Kinks, water collection in tube, mucous • Turn, cough, deep breathe Low Pressure Alarm • ↓ Resistance – machine finding job too easy • Disconnected tube • 02 sensor disconnected

Mark Klimek Audio Notes 2

If tube goes lower than pt level – contaminated

Amino Glycosides

A Mean Old Mycin Amino Glycosides only treat Mean old Infections!

True mean old Mycins don’t have “Thro” If it has “Thro” – Thro it away!

• Ex: Zithromycin

Mean Old Mycins destroy ears (ototoxicity) and kidneys (nephrotoxicity) • Must check Creatinine for Nephrotoxicity – NOT urine output

• Toxic to Cranial nerve 8 give q8h

Mean Old Mycins do NOT get absorbed – they go in and out and sterilize/clean

PO Mean Old Mycins are for bowel sterilizing • NeoMYCIN • KanoMYCIN Who can sterilize my bowel?? NEO KAN!

Drawing TAP Levels (Peak and Trough)

For drugs that have a narrow therapeutic level and are toxic

Mark Klimek Audio Notes 3

Route determines TAP – Not the drug

TROUGH PEAK

IV 30 MIN BEFORE NEXT DOSE IV 15-30 min after its done IM 30 MIN BEFORE NEXT DOSE IM 30-60 min after its given SUB Q 30 MIN BEFORE NEXT DOSE Subling 5-10 min after its in the system

PO 30 MIN BEFORE NEXT DOSE

Heart Rhythms

Ca Channel Blockers are chill pills for the heart • They end in DEPIM or ZEM

Rhythms

Asystole: No QRS – Lethal

Flutter: Sawtooth

Afib: Chaotic with QRS pattern

Vfib: Chaotic without QRS pattern – Lethal

Vent tachy: Wide bizarre QRS

SVT: Narrow QRS

PVC: random rhythm change – only concerned if > 6 or 6 in a row

Change in rhythm: check pulse or BP for cardiac output

Treat ventriculars with lidocaine

• V → L

Treat SVT (it’s actually an atrial) A denosine – puts you in asystole for 20 seconds B eta bockers – all end it “lol” C a channel blockers D igitalis

Mark Klimek Audio Notes 4

VFib: you DFib

Asystole: epinephrine then atropine

Chest Tubes

The only chest surgery that doesn’t require a chest tube is a pneumonectomy – because you remove the entire lung Water seal breaks

• Clamp
• Cut
• Put in Water
• Unclamp

Chest tube comes out

• Cover with gloved hand
• Vaseline gauze
• Sterile dressing taped on 3 sides

Bubbling: Where? When?

Water Seal

• Intermittent: good

• Continuous: bad (air leak)

Suction Control

• Intermittent: bad (dial up suction)

• Continuous: Good

Do NOT clamp chest tube longer than 15 seconds

Congenital Heart Defects

Two classes: Trouble and No Trouble

Trouble defects all start with “T” • R → L defects are Trouble

All CHD have a murmur