BKAT Study Exam Questions And Answers
What to do first if patient has chest pain. - Answer Rest!
ECG changes in an acute MI - Answer ST elevatio... [Show More] n in 2 or more contiguous leads. Ischemia d/t full thickness loss of muscle. EMERGENCY.
Inferior leads - Answer II, III, aVF. RCA occlusion.
Septal leads - Answer V1 & V2.
Anterior leads - Answer V1 - V4. LAD lesion.
Lateral leads - Answer V5, V6, I, and aVL. Circumflex lesion.
Cardiac enzymes - Answer Troponins, CK-MB, and CK
Changes in CK - Answer Rise: 3-6 hours
Peak: 24 hours
Normal: 3-4 days
Changes in CK-MB - Answer Released after myocardial necrosis. Specific for myocardial damage. Rise: 3-12 hours
Peak: 24 hours
Normal: 2-3 days
Troponin I - Answer Protein found in cardiac muscle. High sensitivity.
Rise: 3-12 hours
Peak: 24 hours
Normal: 5-10 days
Troponin T - Answer Protein found in cardiac muscle. High sensitivity.
Rise: 3-12 hours
Peak: 12-48 hours
Normal: 5-14 days
Common conditions that cause a murmur - Answer Aortic dissection, aortic regurgitation (both acute & chronic), mitral valve regurgitation (both acute & chronic), mitral valve stenosis
Drugs to decrease afterload/SVR/PVR - Answer (Arterial Dilators) Nitroprusside, nitroglycerin, amrinone, alpha (Regitine) & Ca channel blockers
Drugs to increased afterload/SVR/PVR - Answer (Vasopressors) Epinepherine, norepinepherine, dopamine, neosynephrine
Drugs to decrease contractility/SVI - Answer Beta blockers (atenolol, metoprolol, propranolol, labetolol, esmolol) and Ca channel blockers
Drugs to increase contractility/SVI - Answer Positive inotropes, dobutamine, dopamine, milrinone, and digoxin
Drugs to decrease preload/CVP/PAWP - Answer Venous Dilators - Nitroglycerin, nitroprusside, amrinone, alpha & Ca channel blockers
Diuretics - Furosemide, bumex, mannitol
Drugs to increase preload/CVP/PAWP - Answer Volume - Colloid, crystalloids, blood, hetastarch
Dysrhythmia control - antirhythmics, pacemaker, AICD
Complications when using thrombolytics - Answer Allergic reaction, bleeding/hemorrhage, stroke
Failure to capture - Answer Pacer delivers a stimulus at the appropriate time but no depolarization occurs. No P or QRS wave after pacer spike.
Failure to fire/pace - Answer No pacer spikes seen
Failure to sense - Answer Pacemaker does not detects heart's intrinsic activity or interprets noncardiac activity as intrinsic activity. Spikes in inappropriate times.
Normal PR - Answer 0.12 - 0.20
Normal QRS - Answer 0.04-0.10
Normal QT - Answer Less than 0.48. Varies by age, HR, and gender.
Vasopressors - Answer Epinepherine, norepinepherine, dopamine, phenylephrine/neosynephrine, vasopressin/pitressin, milrinone/Primacor, dobutamine/Dobutrex
Indication for dopamine/Intropin - Answer Acts on SNS to increased HR and BP. Indicated for hypotension, low CO, decreased renal blood flow. Use if patient is bradycardic.
Doses of dopamine - Answer Low: 0.5-2 mcg/kg/min (dopaminergic)
Intermediate: 2-10 mcg/kg/min (beta receptors, increases CO)
High: over 10 mcg/kg/min (alpha receptors, vasoconstrict)
SE of dopamine - Answer Watch volume and starting BP. Use central line. Inactivated by sodium bicarb. Can cause acidosis. SE: ectopic beats, tachycardia, tissue necrosis d/t extravasation
Treatment of dopamine extravasation - Answer Phentaolmine 5-10 mg and possibly nitropaste to vasodilate
Indication for norepinepherine/Levophed - Answer Indicated for diastolic hypotension (specifically decreased SVR) and septic shock. Stimulates alpha & beta receptors. Increased contractility, HR, and vasoconstriction.
Doses of norepinepherine - Answer 2-12 mcg/min. Immediate onset.
SE of norepinepherine - Answer Replace volume first because it can cause GI and renal hypoperfusion. Have a central line. SE: dizziness, HA, hyperglycemia, myocardial/mesenteric/renal ischemia, tissue necrosis with extravasation.
Treatment of norepinepherine, epinepherinem, dobutamine, and Neosynephrine extravasation - Answer Phentaolmine 5-10 mg.
Indications for epinepherine/Adrenalin - Answer Simulates alpha and beta receptors. Used post cardiac surgery for "stunned" myocardium. ACLS protocol. Bronchial relaxation at low doses, increased contractility at high doses.
Dosages of epinepherine - Answer 2-20 mcg/min. Immediate onset. Irritating to heart, so only good for emergency use.
SE of epinepherine - Answer SE: myocardial/mesenteric/renal ischemia, tachycardia, hyperglycemia, HA, tissues necrosis with extravasation
SE of phenylephrine/Neosynephrine - Answer Pure alpha stimulator. Used during C/P bypass, anesthesia induced hypotension, vascular failure in shock. Vasoconstricts arterioles without cardiac effect.
Dosages of Neosynephrine - Answer 10-100 mcg/min. Immediate onset.
SE of Neosynepherine - Answer Use central line. Wean this first! SE: Reflex bradycardia, myocardial/mesenteric/renal ischemia, tissue necrosis with extravasation.
Indications for vasopressin/Pitressin - Answer Antidiuretic hormone used to vasocontric. Endogenous hormone. Vasoconstricts peripheral arterioles & vasodilates coronary, pulmonary, and CNS circulation. Effective for hypotension, shock, decreases needs of other pressors, and Cardiac surgery.
Dosages of vasopressin - Answer 1-10 units/hr. Long half-life. Not titrated.
SE of vasopressin - Answer SE: Skin/mesenteric ischemia, bradycardia, decrease UOP & result in hyponatremia, use with caution in neurosurgery patients
Indications for dobutamine/Dobutrex - Answer Beta I stimulator. Used to increase CO for systolic heart failure, cardiogenic shock, MV regurgitation, post MI, post cardiac surgery, C/P bypass for "stunned" myocardium.
Dosages for dobutamine - Answer 2-15 mcg/kg/min.
SE of dobutamine - Answer Less effect on HR than dopamine. Use central line. Check compatibilities. Can be used peripherally during an emergency. SE: ectopic beats, tachycardia, arrhythmias, tissue necrosis with extravasation.
Indications for nitroprusside/Nipride - Answer Causes peripheral vasodilation by acting on venous and arterial smooth muscle. Decreases BP, SVR, preload, and afterload therefore increasing CO. Used for HTN, CHF, and hypertensive emergency.
Dosage of nitroprusside - Answer 0.5-0.10 mcg/kg/min. Light sensitive. Start with low dose.
SE of nitroprusside - Answer Make sure there is adequate volume and the BP is above 90. May incompatibilities (can use with nitro & heparin). Can cause thiocyanate toxicity with higher doses. Monitor for metabolic acidosis. SE: hypotension, HA, nausea, and vomiting.
Indications for milrinone/Primacor - Answer Positive inotrope with vasoactive activity. Increases CO and decreases SVR. Used in CHF and to increase CO.
Dosage of milrinone - Answer Bolus (50 mcg/kg over 10 minutes) and then gtt (0.3750.75 mcg/kg/min). Precipitates with lasix. Longer half-life. Not titrated.
SE of milrinone - Answer Renal excretion. SE: arrythmias, decreased BP, HA, hypokalemia
Indications for nitroglycerin/Nitrostat - Answer Direct relaxation of vascular smooth muscle and vasodilation. Used for HTN, angina, CHF, and MI to decrease O2 demands.
Dosage of nitroglycerin - Answer 5-200 mcg/min. Start low. Immediate response.
SE of nitroglycerin - Answer Use with caution for patient dependent on preload for CO (inferior wall MI or right sided MI). May see tolerance after 24 hours. SE: Hypotension, reflux tachycardia, HA, flushing, nausea.
IV antidysrhythmics - Answer Atropine = bradycardia
Lidocaine = VT, ventricular irritability
Amiodarone = afib, VTACH, Vfib
Pronestyl = VTACH, Vfib (can cause torsades)
Verapamil = CA channel block, IV push
Diltiazem = Ca channel blocker, afib, make sure BP good
Adenosine = SLAM IT, SVT, short half-life
Indications for a pacemaker - Answer Treat sudden cardiac death, EF < 35%, sustained VT, refractory HF despite optimal medical management
Problems with pacemakers - Answer Failure to capture, over sensing, and under sensing
Signs and symptoms of cardiac tamponade - Answer Rise in filling pressure with decreased CO & hypotension. CVP=PAOP=PAD. Sudden drop in bleeding. Narrowing pulse pressure. Tachycardia, dysrhythmias, decreased ECG voltage. Decreased UOP. Anxiety and restlessness. Low blood pressure and weakness. Chest pain radiating to neck, shoulders, or back. Trouble breathing or taking deep breaths. Rapid breathing. Discomfort that is relieved by sitting or leaning forward.
Postoperative care of chest tubes - Answer Assess q15 for first few hours to monitor drainage changes. Output to average ~100 cc/hr and should gradually decrease. Average is a total of 1L output. Chest tubes are removed when total drainage is < 100 ml for 8 hours. If output > 100 ml/hr then order PT, PTT, and platelets.
Purpose of Swan (PA) catheter - Answer Measure vascular capacity, blood volume, pump effectiveness, and tissue perfusion.
Visual of PA catheter waveforms - Answer
Normal CVP/RAP - Answer 1-8 mm Hg
Normal PAWP/LVEDP (left ventricular end diastolic pressure) - Answer 4-12 mm Hg
Normal PAP - Answer Systolic: 15-25 mm Hg
Diastolic: 6-12 mm Hg
If PAWP is low? - Answer Hypovolemia [Show Less]
