sepsis chest pain hypotension o hypovolemia anemia hypoxia hypoglycemia

Sepsis chest pain hypotension o hypovolemia anemia

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sepsis , chest pain , hypotension o hypovolemia, anemia, hypoxia , hypoglycemia, myocardial ischemia o HF, hyperthyroidism, anxiety, fear o drugs (epinephrine, norepinephrine, Levophed, atropine, caffeine, theophylline, or hydralazine), OTC cold remdies Treatment: Assess SOB, chest pain, how they feeling, palpitations, dyspnea o the underlying cause guides the treatment . o IV beta blockers o Adenosine o Calcium channel blockers (diltiazem can be given to reduce HR and decrease myocardial O2 consumption) o Vagal maneuvers o In clinically unstable pts synchronized cardioversion is used. Paroxysmal Supraventricular Tachycardia : a dysrhythmia starting anywhere above the bifurcation of the bundle of His. PSVT occurs because of reentrant phenomenon - Rate > 150 bpm (150 to 220bpm) - Regularity: regular or slightly irregular - P waves submerge; The P wave is slightly hidden in the preceding T wave. - PR interval present and same - QRS complex: very narrow - Relationship between P and QRS: *assess patients o Factors: Overexertion, emotional stress, deep inspiration, stimulants; rheumatic heart disease, digitalis toxicity, CAD, or cor pulmonale. Manifestations include hypotension, palpitations, dyspnea, and angina. o Clinical Manifestations: hypotension, palpitations, dyspnea, and angina. o Treatment: vagal stimulation IV adenosine : the drug of choice (Adenosine slows cardiac conduction; the IV bolus of adenosine restores sinus rhythm) IV Beta-blockers (diltiazem) and calcium channel blockers (verapamil) If vagal stimulation and drug therapy is ineffective and the patient becomes hemodynamically unstable synchronized cardioversion is used.
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Third Degree AV Block - Can be lethal - Result in low HR and low CO - Rate: 30 – 40 bpm - Regularity: irregular - P waves not all the same - PR interval different - QRS complex - Relationship between P and QRS: not consistent - Treat with pacemaker device - Factor: CAD, MI, myocarditis, cardiomyopathy, systemic disease, drugs (Beta blockers, digoxin, calcium channel blockers) - Expected findings: HF, shock, ischemia - Treatment: o A transcutaneous pacemaker until a temporary transvenous pacemaker can be inserted o Medications: dopamine and epi to increase HR and support BP until temporary pacing is started o Atropine is not an effective drug
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Atrial Fibrillation - Rate: 350 – 600 bpm - Regularity: r wave is different throughout (characteristic of AFib); IRREGULAR - P waves: chaotic, fibrillatory - PR interval can’t measurable - QRS complex narrow - Relationship between P and QRS: can’t really determine - Factors: o CAD, valvular heart disease, cardiomyopathy, HF, o pericarditis, hypertensive heart disease, caffeine use, o electrolyte disturbances, stress, heart surgery, alcohol intoxication - Risks: clot stroke; MI thrombi form in the atria because of blood stasis. An embolized clot may develop and move to the brain, causing a stroke. Look for LOC changes b/c of their risks for stroke.
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