Term
| Definition of Cardiac Output |
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Definition
The amount of blood pumped by the heart each minute
Cardiac Output= StrokeVolumexHR |
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Term
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Definition
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Term
| Definition of Stroke Volume |
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Definition
| The volume of blood pumped by the heart with each heartbeat |
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Term
| What is the equation for Stroke Volume? |
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Definition
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Term
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Definition
| The number of beats per minute |
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Term
| Normal range for heart rate |
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Definition
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Term
| Definition of Cardiac Index |
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Definition
| This is a calculated value that corrects cardiac output based on body size |
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Term
| What is the equation for Cardiac Index? |
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Definition
| CO/Body surface area (BSA) |
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Term
| What is the normal Cardiac Index? |
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Definition
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Term
| What is preload and how does it affect stroke volume? |
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Definition
| Preload is the amount of stretch in the myocardial fibers at the end of diastole. High preload= high volume. Low preload= low volume |
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Term
| Define contractility and how it affects stroke volume |
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Definition
| It is the hearts ability to fuction as a pump and work independent of preload and afterload. |
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Term
| What is a normal ejection fraction? |
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Definition
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Term
| Define afterload and how it affects stroke volume |
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Definition
Afterload is the resistance the heart meets when it pumps blood.
When afterload increases, stroke volume decreases. The ventricles cannot pump effectively. |
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Term
| What is the Frank Starling law of the heart? |
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Definition
| It states that the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart when all other factors remain constant. |
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Term
| Assessment findings of right heart preload |
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Definition
Increased: JVD, Ascities, Hepatic engorgement, peripheral edema
Decreased: poor skin turgor, dry mucous membranes, orthostatic HTN, flat jugular veins |
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Term
| Assessment findings of left heart preload |
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Definition
Increased: dyspnea, cough, heart tones S3 and S4
Decreased: currently no noninvasive assessments to evaluate |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Range for Pulmonary Artery Wedge Pressure (PAWP) |
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Definition
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Term
| Range for Right Atrial Pressure (RAP) or Central Venous Pressure (CVP) |
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Definition
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Term
| Range for Systemic Vascular Resistance |
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Definition
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Term
| What is Systemic Vascular resistance (SVR)? |
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Definition
| opposition by the left ventricle |
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Term
| What is pulmonary vascular resistance (PVR)? |
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Definition
| opposition encountered by the right ventricle |
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Term
| Drugs that increase and decrease contractility |
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Definition
POSITIVE INOTROPES (increase):Epinephrine, norepinephrine (levophed), isoproterenol, dopamine, dobutamine, digitalis-like drugs, calcium, and milrinone
NEGATIVE INOTROPES (decrease): alcohol, calcium channel blockers, beta-adrenergic blockers, propranolol, barbiturates and clinical conditions like acidosis |
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Term
| How do you find the phlebostatic axis? |
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Definition
| Draw two imaginary lines with the patient SUPINE. First, horizontal line through midchest. Second line, vertical line through the FOURTH intercostal space at the sternum |
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Term
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Definition
| USED DURING INVASIVE PRESSURE MONITORING: Referencing is when you position the transducer so that the zero reference point is at the level of the atria of the heart (to do this, use the phlebostatic axis) Use the stopcock nearest the transducer |
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Term
| How do you "zero" when using invasive pressure monitoring? |
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Definition
| Open the reference stopcock to room air and observe the monitor for a reading of zero. We need to zero the transducer during the inital setup, immediately after insertion of the aterial line when the transducer has been disconnected from the pressure cable or the pressure cable has been disconnected from the monitor, and when the accuracy of the measurements is questioned. |
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Term
| What is a dynamic response test? (or square wave test) |
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Definition
| It is performed every 8-12 hours when the system is opened to air or the accuracy of the measurements is questioned. It involves activating the fast flush and checking that the equipment reproduces a distortion-free signal. |
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Term
| What happens if the transducer is placed higher or lower than the phlebostatic axis? |
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Definition
Transducer higher than phlebostatic axis: falsely low readings
Trasducer lower than phlebostatic axis: falsely high readings |
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Term
| In Invasive Pressure Monitoring, how often should you change the pressure tubing, flush bag, and transducer? |
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Definition
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Term
| In invasive pressure monitoring, what should we do to maintain line patency and limit thrombus formation? |
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Definition
1. Pressure bag stays inflated to 300 mm Hg
2. Flush bag contains fluid
3. System is delivering 3-6 mL per hour |
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Term
| Before inserting a PA catheter, what should we check? |
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Definition
| Patient's electrolyte, acid-base, oxygenation, and coagulation status |
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Term
| Why is it nessecary to monitor the ECG continuously during insertion of a PA catheter? |
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Definition
| Because of the risk for dysrhythmias, particularly when the catheter reaches the right ventricle. |
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Term
| When measuring the PAWP, do not inflate the balloon for more than? |
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Definition
| 4 respiratoryn cycles or 8-15 seconds |
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Term
| What does a high and low CVP indicate? |
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Definition
High CVP: right ventricular failure or volume overload
Low CVP: indicates hypovolemia |
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Term
If your SVR is above 1200 what does it mean?
If it's below 800 what does it mean? |
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Definition
Above 1200= vasocontriction from shock, hypertension, increased release or administration of epinephrine and other vasoactive agents, or left ventricular faillure
Below 800= Vasodilation, which may occur in shock states (septic, neurogenic) or with drugs that reduce afterload. |
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Term
| How do you confirm proper placement of an ET tube? |
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Definition
| Use an end-tidal CO2 detector by measuring the amount of exhaled CO2 from the lungs |
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Term
| For oral intubation of an ET tube, what position does the patient need to be in? |
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Definition
| Supine with the head extended and the neck flexed "sniffing position" |
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Term
| What confirms location of an ET tube, PA catheter, or CA catheter? |
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Definition
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Term
| What should our ET tubes cuff pressure be maintained at? |
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Definition
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Term
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Definition
| Areas of the lungs affected by pulmonary embolus. Adequately ventilated but not adequately perfused |
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Term
| What is the D-dimer blood test? |
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Definition
| It detects evidence of endogenous fibrinolysis, which normally occurs within an hour of thrombus formation. It the test is positive, patient is sent for further DVT testing. |
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Term
| Signs and symptoms of DVT |
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Definition
| Inflammation, impaired venous circulation, calf tenderness and swelling, warmth tenderness redness or swelling in the legs, BED REST!!!!! and leg elevation |
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Term
| Which lab is checked before and during unfractioned heparin or low molecular weight heparin therapy? |
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Definition
| The only lab to monitor is platelets! If they drop below 150,000 it is called HIT (heparin-induced thrombocytopenia) and all heparin is stopped and a rapid-acting direct thrombin inhibitor is administered. |
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Term
| In the event of a heparin overdose, what is the antidote? |
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Definition
| PROTAMINE SULFATE is the antidote to heparin. OR if APTT is high and overt bleeding is present. |
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Term
| ARDS is when the patients PaO2/FIO2 is less than? |
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Definition
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Term
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Definition
| Multiple organ dysfunction syndrome. This can progress and turn into organ failure or ARDS |
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Term
| What are examples of direct lung injuries? |
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Definition
| sepsis, aspiration, PNEUMONIA, chest trauma, embolism, o2 toxicity near-drowning |
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Term
| What are examples of indirect lung injuries? |
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Definition
| Sepsis, severe bleeding or having too many BLOOD TRANSFUSIONS, injury to head or chest, pancreatitis, fat embolism, drug reaction/overdose |
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Term
| Explain the first stage of ARDS |
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Definition
| First stage is Injury or Exudative Phase. Occurs 1-7 days after initial direct lung injury. Interstitial edema forms. Fluid crosses alveolar membrane. Intrapulmonary shunt develops.Surfactant dysfunction. Atelectasis because of no surfactant. Increased hypoxemia. |
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Term
| Explain the second stage of ARDS |
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Definition
| The reparative or proliferative phase begins 1-2 weeks after initial lung injury. Inflammatory response. The lung becomes characterized by dense, fibrous tissue. Pulmonary htn. hypoxemia worsens. if this is stopped, lesions will resolve. If not,, widespread fibrosis results |
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Term
| Explain the 3rd stage of ARDS |
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Definition
| The fibrotic phase occurs 2-3 weeks after the initial lung injury. By this time, the lung is completely remodeled by collagenous and fibrous tissues. PaO2 is less than 60. pH is less than 7.30. CO2 is more than 50. Patients usually don't come out of this stage. |
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Term
| What happens to the PAWP during ARDS? |
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Definition
| It does not increase or decrease because the cause is noncardiogenic. (stays less than 18) |
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Term
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Definition
| May result from rupture of overdistended alveoli during mechanical ventilation. To avoid barotrauma, ventilate with smaller tidal volumes and varying amounts of PEEP. TO PREVENT? Use permissive hypercapnia |
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Term
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Definition
| Volutrauma occurs in patients with ARDS requiring mechanical ventilation and larger tidal volumes (10-15). Results in alveolar fractures and movement of fluids and proteins into alveolar spaces. |
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Term
| What is permissive hypercapnia? |
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Definition
| When a patient is ventilated with smaller tidal volumes (6) and varying amounts of PEEP to minimize O2 requirements and intrathoracic pressures. Result= Elevation in PaCO2. This this is OK! As long as the rise is slowly. |
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Term
| What do inotropic drugs do the CO? |
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Definition
| Increase! So if CO is low, give a positive inotropic drug like Dopamine or Dobutamine |
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Term
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Definition
| Cor pulmmonale is enlargement of the right ventricle secondary to diseases of the lung, thorax, or pulmonary circulation. |
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Term
| What is the most common cause of Cor pulmonale? |
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Definition
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Term
| What is a physical sign of cor pulmonale? |
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Definition
| Physical signs include evidence of right ventricular hypertrophy on ECG and an increase in intensity of the second heart sound. |
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Term
| Common risk factors for PE |
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Definition
| immobility, surgery within the last 3 months, stroke, paresis, paralysis, history of DVT, malignancy, obesity in women, heavy cigarette smoking, and hypertension |
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Term
| What is the most frequently used test to diagnose PE? |
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Definition
| A spiral (helical) CT scan |
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Term
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Definition
| A laboratory test that measures the amount of cross-linked fibrin fragments |
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Term
| What are fibrinolytic agents such as tissue plasminogen activator (tPA) or alteplase (Activase) for? |
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Definition
| To dissolve the pulmonary embolus and the source of the thrombus in the pelvis or deep leg veins. |
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Term
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Definition
| It is dosed according to the aPTT |
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Term
| Explain inferior vena cava (IVC) filter |
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Definition
| To prevent further emboli an inferior vena cava filter may be the treatment of choice. It prevents migration of large clots into the pulmonary system |
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Term
| What is hypoxemic Acute Respiratory Failure classified as? |
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Definition
| PaO2 less than 60mm Hg when the patient is receiving an inspired O2 concentration of >60% |
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Term
| Hypercapneic respiratory failure is commonly defined as? |
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Definition
| a PaCO2 greater than 48 mm Hg in combination with acidemia (pH less than 7.35) |
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Term
| What kind of shunt is seen in ARDS? |
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Definition
| Intrapulmonary shunt is seen in conditions in which the alveoli fill with fluid. An intrapulmonary shunt occurs when blood flows through the pulmonary capillaries without participating in gas exchange |
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Term
| When should a closed-suction technique be used? (CST) |
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Definition
| For patient's who require high levels of PEEP (greater than 10), who have high levels of FiO2, who have bloody or infected pulmonary secretions, who require frequent suctioning, and who experience clinical instability with OST |
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Term
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Definition
| The intraaortic balloon pump provides temporary assistance to the compromised heart by REDUCING AFTERLOAD. Patient is relatively immobile. |
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Term
| Explain negative pressure ventilation |
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Definition
| involves the use of chambers that encase the chest or body and surround it with intermittent negative pressure. Causes chest to be pulled outward. |
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Term
| Explain positive pressure ventilation (PPV) |
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Definition
| It is the primary method used with acutely ill patients. During inspiration the ventilator pushes air into the lungs under positive pressure. Intrathoracic pressure is RAISED during lung inflation |
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Term
| What is Synchronized Intermittent Mandatory Ventilation? |
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Definition
| With SIMV, the ventilator delivers a preset VT (tidal volume) at a preset frequency in synchrony with the patient's spontaneous breathing. ALL BREATHS ARE NOT of the same preset volume. |
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Term
| What is Assist-Controlled Mechanical Ventilation? |
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Definition
| The ventilator delivers a preset (VT) at a preset frequency. The patient has some control over ventilation while providing some assistance. |
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Term
| Patient temperature is increased with what? |
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Definition
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Term
| Why do we measure PAWP at the end of expiration? |
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Definition
| The interthoracic pressure is most stable so reading will be least affected by respiratory variation |
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Term
| What is the thermodilution method? |
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Definition
| Using temperature changes to calculate CO. (use flush at ROOM TEMP and inject 10 mls over 4 seconds) |
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Term
| What considerations should we make before performing a heart cath? |
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Definition
| Are they allergic to iodine? The patient will be awake during procedure and have to lay flat so explain this to them |
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Term
| What drug is used to "fake" exertion for those who are unable to exercise for the non exercise stress test? |
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Definition
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Term
| What is the difference between a Transthoracic Echo and a Transesophageal Echo? |
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Definition
| Transthoracic- non invasive. TEE- INVASIVE! |
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Term
| What is the Order of Draw? |
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Definition
| 1. blood cultures, 2. red no gel with additive, 3. Blue Top Sodium Citrate, 4. Red no gel with additive, Tiger with gel, and Gold with gel, 5. Tiger Green Lithium and Lt Green Lithium, 6. Lavender EDTA, 7. Pink (Blood bank only) EDTA, 8. Grey K+Oxalate |
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