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What situations would you use synchronized cardioversion?
SLOWS DOWN A FAST RHYTHM!!
1. Afib
2. A-flutter
3. SVT
4. VTach with a pulse
How is cardiac output calculated and what is the normal value?
HR x SV (heart rate x stroke volume)
4-8 L/min
What is normal pulmonary artery pressure?
8-20 mmHg
What does an increase in pulmonary artery pressure indicate?
Pulmonary HTN
What is the normal CVP (central venous pressure) value?
0-5 cm H2O
Chronological steps for synchronized cardioversion
1. Turn on defibrillator
2. Attach leads to patient
3. Ensure proper display of patient's rhythm
4. PRESS SYNC control button
5. Look for markers on R waves
6. If patient awake, give sedation (midazolam)
Preload, afterload, contractility. This is the volume of blood pumped out of the left ventricle of the heart during each systolic cardiac contraction
Stroke volume
What is the normal pulmonary artery wedge pressure?
6-12 mmHg
What is cardiac output?
The volume of blood in liters pumped by the heart in 1 minute (normal 4-8 L/min)
These drugs increase preload
Vasoconstrictors
Chronological steps for defibrillation
1. Turn on defibrillator
2. Attach pads
3. Charge
4. Clear
5. Shock
___ is determined by he amount of blood filling the chamber/size of the chamber
Preload
This law states that the more a myocardial fiber is stretched during filling, the more it shortens during systole - the greater the force of the contraction
Frank-Starling law on the effects of preload
As preload increases, force generated in the subsequent contraction increases, thus ___ and ___ increase
stroke volume, cardiac output
1. Vasodilators
2. Hypovolemia
3. Cardiac tamponade
4. Constrictive pericarditis
What situations would you use defibrillation?
2. Pulseless VTach
This is the resistance that must be overcome by the ventricles (systolic contraction)
Afterload
Increased afterload results in decreased ___ and increased ___ demand
Cardiac output; oxygen
These drugs can reduce afterload
Vasodilators (milrinone)
SBP + 2(DBP) / 3
normal MAP = 65- 100
Initial intervention priorities for dysrhythmias if patient is unresponsive
Assess CAB (circulation, airway, breathing)
Initial intervention priorities for dysrhythmias if patient is responsive
1. Monitor ABC (airway, breathing, circulation)
2. Apply O2 via nasal cannula or NRB (non-rebreather)
3. Obtain baseline vitals, including O2 sat
4. Obtain 12-lead EKG
5. Begin continuous EKG monitoring
6. Identify underlying rate and rhythm
7. Identify the dysrhythmia
8. Establish IV access
9. Obtain baseline labs (CBC, electrolytes, etc.)
Ongoing monitoring for patients with dysrhythmias
1. Monitor:
A. ABCs
B. Vitals
C. LOC
D. O2 sat
E. Heart rhythm
2. Anticipate:
A. Need for antidysrhythmic
B. Need for intubation if respiratory distress is evident
C. Need to begin ACLS
This is the opposition encountered by the left ventricle, measures the tone of vasculature. What is this and what is the normal value?
SVR (systemic vascular resistance), 800 - 1400
This is the opposition encountered by the right ventricle
Pulmonary vascular resistance