Definition of cardiogenic shock - ✔✔ evidence of tissue hypoxia d/t decreased CO in the presence of adequate intravascular volume
Causes of
... [Show More] cardiogenic shock - ✔✔ MI, cardiomyopathy, myocardial contusion, valvular incompetence, stenosis, arrhythmias
What are S/S of cardiogenic shock? - ✔✔ Cold/clammy, S3 gallop, crackles, +JVP, displaced PMI, pulmonary edema, increased preload (pwcp/cvp)
Is SVR high or low in cardiogenic shock? - ✔✔ High
Is CO high or low in cardiogenic shock? - ✔✔ Low
What is the pressor for cardiogenic shock? - ✔✔ Inotrope support (dobutamine: B1 agonist)
How can you dx cardiogenic shock? - ✔✔ TTE or TEE
If someone has pulmonary edema with cardiogenic shock, how do you treat it? - ✔✔ Diuretics (Furosemide)
What are the layers of the aorta - from innermost to outermost? - ✔✔ Intima, media, adventitia
What are s/s of an aortic dissection? - ✔✔ Chest pain (tearing, radiating to the back), severe in intensity, sudden in onset, unequal in both arms
What are RFs of an aortic dissection? - ✔✔ HTN, atherosclerosis, Ehlers-Danlos syndrome (deficiency of collagen), Marfan's syndrome, coarctation of aorta
How do you diagnose aortic dissection? - ✔✔ CTA of chest/abdomen
Is Stanford A or B involving the thoracic aorta? - ✔✔ B
Is Stanford A or B involving the ascending aorta? - ✔✔ A
Which Stanford type indicated immediate surgical intervention? - ✔✔ A
What consists of medical management with an aorta dissection? - ✔✔ Control SBP to 100-120 w/ IV esmolol, IV nitroprusside in order to decrease hydrostatic pressure in the aorta to decrease shearing forces from cardiac contraction
What is ED mgmt of an aortic dissection? - ✔✔ O2, adequate vascular checks, IVF/blood for hypotension, monitor UO, arterial line placement
When should one contact CV surgery w/ a type B dissection? - ✔✔ Rupture or impending rupture, enlarging intramural hematoma, development of aneurysm, compromise of major aortic branc
What SBP is considered elevated BP? - ✔✔ 120-129, DBP <80
What SBP is considered stage 1 HTN? - ✔✔ 130-139/80
What SBP is considered stage 2 HTN? - ✔✔ >140/90
How do you treat stage 1 HTN? - ✔✔ Lifestyle changes
How can you diagnose pts w/ HTN? - ✔✔ Requires at least 2 separate measurements on at least 2 separate office visits
When does HTN warrant immediate intervention? - ✔✔ SBP >180 or DBP >120 associated w/ evidence of new or worsening target organ damage
What is the first line management of HTN? - ✔✔ Thiazide (hydrochlorothiazide), usually used in adjunct w/ ACE & ARBs
What conditions should you use BB w/ HTN? - ✔✔ Prior MI, stable angina, atrial arrhythmias (caution w/ COPD)h
What conditions should you use ACEI w/ HTN? - ✔✔ Heart fx, DM, unstable angina, MI, CKD
What conditions should you use ARBs w/ HTN? - ✔✔ Heart fx, DM, CKD
What conditions should you use CCB w/ HTN? - ✔✔ Atrial tachycardias, Raynaud's syndrome
How do you treat essential HTN? - ✔✔ Tx and prevention focused on control of Na intake (increased blood volume = increased preload)
What is the age onset of concern for secondary HTN? - ✔✔ <30, >55
What are the recommendation tx for males that have secondary HTN? - ✔✔ Consider excess weight and alcohol use - recommendation: lose weight
What are the recommendation tx for females that have secondary HTN? - ✔✔ Consider oral contraceptives, renal vascular disease, pheochromocytoma, etc
What should be considered for new HTN in an elderly pt? - ✔✔ Consider atherosclerosis of renal arteries
Where is the tumor w/ Conn's syndrome? - ✔✔ Adrenal cortex tumor (increased aldosterone, low renin levels)
Where is the tumor w/ pheochromocytoma? - ✔✔ The adrenal medulla (pt has episodic HTN)
What is defines a HTN emergency? - ✔✔ Evidence of end organ damage
What are examples of end organ damage w/ HTN emergency? - ✔✔ Encephalopathy, stroke, retinal hemorrhage/papilledema, CHF, ACS, dissection, ARF
What is the goal SBP tx w/ HTN emergency? - ✔✔ 25% reduction of BP w/in min to hours w/ IV agents such as labetalol, nicardipine, nitroprusside etc [Show Less]