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) Kussmaul 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 If tube goes lower than pt level – contaminated

Mark Klimek Audio Notes 2 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 Route determines TAP – Not the drug

Mark Klimek Audio Notes 3

TROUGH PEAK

IV 30 MIN BEFORE NEXT DOSEIV 15-30 min after its done IM 30 MIN BEFORE NEXT DOSEIM 30-60 min after its given SUB Q 30 MIN BEFORE NEXT DOSESubling 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

VFib: you DFib

Mark Klimek Audio Notes 4

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 1.Clamp 2.Cut 3.Put in Water 4.Unclamp Chest tube comes out 1.Cover with gloved hand 2.Vaseline gauze 3.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

Tetralogy of Fallot: VarrieD PictureS Of A RancH