STEMI
The defining characteristic of a 12-Lead ECG when a patient is experiencing a STEMI.
What is ST elevation
Door to needle (thrombolytic agent Alteplase, tenecteplase (TNK)) should be within this time frame.
What is 60 minutes or less?
Goal of a sepsis alert.
What is expedite sepsis core measures and transferring patient to the appropriate level of care?
What is prevent further decline of patient?
The nurse finds an adult patient with no pulse, pushes the code blue alarm on the wall, and should immediately perform this intervention.
What are chest compressions at a rate of 100 to 120 per minute with a depth of 2 to 2.5 inches allowing for full chest recoil between compressions?
Oxygen easily makes its way through the air passages to the alveoli and then easily diffuses across the respiratory membrane to this system.
What is the capillary system?
The main difference of the type of arterial blockage between a STEMI and a non-STEMI.
What is: a STEMI involves an artery that is totally occluded, and a non-STEMI usually involves an artery with partial occlusion.
F.A.S.T includes these assessments.
What is facial droop, arm weakness, altered speech, and time of last normal
The ED staff performs these steps upon arrival for a patient presenting with sepsis.
What is establish a patent airway, initiate IV access, draw initial lactate, obtain 2 sets of blood cultures before antibiotic administration, administer crystalloid fluids for hypotension at 30 ml/kg or ideal body weight if BMI >30, determine identified or suspected source of infection, monitor vital signs closely
The code blue team arrives to the patient's room and knows this should be done for ventricular fibrillation and unstable ventricular tachycardia without a pulse.
What is defibrillate. Biphasic 120 to 200 joules
Monophasic 200-300-360 joules
When reduced, the oxygen in this in this red blood cell protein has a high affinity (attraction) for oxygen in the capillary system.
What is hemoglobin?
The percentage of people who die within 30 days after a STEMI.
What is 2.5-10%
This exam must be completed before administering thrombolytic therapy.
What is a non-contrast head CT
What is temperature >38.0 C or <36.0 C (>100.4 F and <96.8F)
Heart rate >90
Resp. Rate >20
WBC > 12,000/mm or <4,000/mm or Bands >10%
The patient's primary nurse observes the code blue team member assigned to chest compressions checking for a pulse and reminds this member not to spend more than this many seconds off the chest.
What is 10 seconds or less.
A patient admitted to the Burn ICU following exposure to smoke inhalation and second-degree burns to both arms and legs is now requiring increased oxygen support and higher peep setting on the ventilator. The nurse understands that direct injury/inflammatory insult to the epithelial membrane permeability of the lung can be reduced leading to pulmonary edema, alveolar collapse /fibrosis. The patient's most recent chest x-ray showed diffuse pulmonary infiltrates and decreased lung volumes. The critical care pulmonary intensivist adds this diagnosis to the patient's progress note.
What is ARDS? (Acute Respiratory Distress Syndrome)?
The baseline labs that should be collected when a patient having a STEMI and arrives to the ED.
What is troponin, hemoglobin, hematocrit, platelets, potassium, creatinine, PT/INR, aPTT
The time limit of hours when alteplase/TNK can be administered for an ischemic stroke from the last known normal for most patients.
What is 4.5 hours
The signs of severe sepsis.
What is change in mental satus. What is organ dysfunction: decrease in urine output 0.5 ml/kg/hr for 2 consecutive hours, creatinine >20 or 0.5 mg dl from baseline, lactate 2.0 mmol/L, hypotension SBP decrease >40 mmHg from baseline, platelet count <100,000/mcl, INR >1.5 or aPTT >60 seconds, total bilirubin >2.0 mg/dl
It is a pulse and rhythm check during a code blue. The nurse sees sinus rhythm on the cardiac monitor but does not feel a femoral or carotid artery pulse. The nurse reports this rhythm to the code team.
What is pulseless electrical activity (PEA)
The ED nurse is triaging a frail appearing 69-year-old female with a history of smoking 1 pack of cigarettes a day for 50 years, who is complaining of SOB at rest that is unrelieved with her rescue adrenergic bronchodilator (albuterol 90 mcg per actuation) and her prn home oxygen at 2 liters/min per nasal cannula. She is afebrile. Her 12-lead ECG shows normal sinus rhythm with a rate of 98. Her pulse oximeter reading on 2 liters of oxygen is 83% and she is leaning over the table with noticeable use of her intercostal muscles with a respiratory rate of 28. The nurse anticipates the ED physician to admit the patient to the medical floor for this primary diagnosis.
What is acute exacerbation of COPD?
The time frame goal of first medical contact to balloon/stent.
What is 90 minutes or less
Contraindications for a patient to receive thrombolytic therapy for an ischemic stroke.
What is SBP greater than 185/110 mmHg, prior ischemic stroke, brain or spine surgery in the previous 3 months, and stroke after a traumatic head injury?
Signs of Septic shock
What is severe sepsis PLUS: hypotension AFTER initial fluid bolus of 30 ml/kg and requires vasopressor therapy.
The patient achieves a return of spontaneous circulation (ROSC) but is comatose and requires ventilatory support. The primary nurse is prepared to initiate this therapy.
What is targeted temperature management (therapeutic hypothermia)?
The nurse caring for a 29-year-old male on an ortho-spine surgical floor who is status-post day 2 following an IM nailing of his right distal femur and right humerus due to injuries sustained in a motorcycle accident. He puts his call light on to report a sudden onset of shortness of breath. His respiratory rate is 26, pulse oximeter reading is 79% on room air and his lungs sound clear. The nurse applies 4 liters of oxygen per nasal canula and raises his bed to 90 degrees. The nurse then notifies the physician of these findings and expects to receive orders for these tests.
What is CT pulmonary angiogram, chest x-ray, MRI, d-dimer, lower extremity doppler (not urgent), ABGs (hypoxemia with respiratory alkalosis)?