I’ve been telling the World….

Weekly Reading

Week 9 Reading NS240&241 Rm114

Week 10 Reading NS240&241 Rm114

CVD Notes:

Atheroma: abnormal accumulation of lipid & fibrous tissue in intima of coronary artery walls that changes their structure and function

Major manifestation : CP due to impaired blood flow > 70% blockage

What are the various Metabolic Syndromes which will increase risk of Coronary Artery Disease?

Elevated C-Reactive Protein          > 3mg

Central Obesity                               > 35” W, 40” M

Fasting BS                                       > 100

Elevated BP                                      > 140/90

Triglycerides                                    > 150

Angina Pectoris – not completely occluded

♥     Stable Angina – Reversible, relieved by rest

♥     Unstable Angina –  Progressive, plaque ruptures, occurs at rest (Pre-infarction, Crescendo)

♣ Prinzmetal (variant or resting) Angina – Coronary Artery ‘Spasm’, occurs only at rest.

♥     Intractable (refractory) Angina – severe incapacitating chest pain

♥     Silent Ischemia – objective evidence, but asymptomatic. DM

Myocardial Infarction (MI) – Occlusion

♥     Non ‘Q’ Wave MI (nontransmural) – only myocardium

♣   T Wave Inversion Ischemia

♣   Elevated ST segment Injury

♥     Q Wave Infarct (transmural) – involves all 3 layers

 

Ischemia & Tx Differences

Unstable Angina: thrombus partially or intermittently occludes the coronary artery; CP, s/s occurs at rest with exception: limits activity > 10 min.; Bio-markers are NOT elevated. Tx: MONA, ABCS-Ph,

Non-ST Segment Elevation: thrombus partially or intermittently occludes the coronary artery; CP, s/s occurs at rest with exception: limits activity – longer in duration and more severe than in unstable angina; Bio-markers ARE elevated. Tx: MONA, ABCS-Ph, include cardiac catherization and possible PTCA

Non-ST Segment Elevation: thrombus FULLY occludes the coronary artery; CP, s/s occurs at rest with exception: limits activity – longer in duration and more severe than in unstable angina; ST segment elevation or new left bundle branch block on EKG, Bio-markers ARE elevated. Tx: MONA, ABCS-Ph,  – PTCA within 90 minutes of medical evaluation to keep vessel open; Fibrinolytic therapy within 30 minutes of medical evaluation.

TPA

Tissue plasminogen activator (alteplase) activates plasminogen to break clot.

IV bolus → infusion → IV heparin or LMWH and ASA

*relief of pain, early peak enzymes, reverses EKG changes, saves cardiac muscle.

*complications: hemorrhage, reperfusion arrhythmis – Tx: with amiodarone!

Reperfusion injury: damaged tissue from reperfusion leads to dysrhythmias.

 

Cardiogenic Shock (end stage of LV dysfunction due to extensive damage. Loss of contractility, marked reduction in CO, inadequate perfusion to vital organs) : Too much fluid volume – leads to inadequate tissue perfusion / shock syndrome: Tx: If hypervolemic=diuretics, if hypovolemia=albumin,

Norepinephrine

S/S: Weak rapid pulse

 

Pulmonary Effusion: fluid is normally only 50mL. Tx: Pericardiocentesis, pericardiotomy

Pulmonary Edema: when head is above heart (HOB ele.) you have Jugular vein distention, and blood – tinges frothy sputum. (RV is supplying more blood than LV can handle and accumulates into pulmonary beds leaking from capillaries into airways.) = Hypoxemia!

Cardiac Tamponade: falling systolic BO, narrowing Pulse Pressure, Rising venous pressure (increased JVD) muffled heart sounds.

 

 

Hypothermia

What is hypothermia good for: Neuroprotection.  Unconscious adults  w/spontaneous circulation (<1 hr) , out of hospital cardiac arrest for 12-24hrs at 32-34C when initial rhythm was V Fib. MAP > 60, Systolic BP > 90

Contraindicated: bleeding, infection, head trauma, unstable arrhythmia, downtime > 10min w/o BLS, < 18 not an adult, Pregnancy

Works if <10 to BLS  a witnessed Arrest!

 

CCP for R ventricular function and systemic fluid status.  Normal 2-6

http://www.rnceus.com/hemo/cvp.htm

Burn Cards

Burns drug cards .doc

Burns drug cards.pdf

Can you name it?

This ECG is abnormal – what is going on? Leave a comment

What’s Up?

I know there isn’t very many post these days. It is very busy this fourth semester. Two full clinical days and a full day of lecture. It doesn’t leave as much time for playing around. If I can get the time to place some info on the site I will – maybe during the spring break. My advice for incoming fourth semester students – read up the harder sections during your summer break, so it will give you some time later. Do your own work. Do your objectives. Fully understand the disease process by signs and symptoms.

Study hard!

Week 8 Reading

Week 8 Reading NS240&241 Rm114 .doc

Week 8 Reading NS240&241 Rm114 .pdf

Heart Sounds

S1, Lub Dub

watch MV on TV

S2, Lub Dub

have some fun in AV & PV

 

S3, Ken-(tuck-y)

Too much fluid, in little old me.

 

S4, (Ten-ne)-see

The artrial gallops, and I’m as stiff as can be.

(by HTN & CAD)

Week 7 Reading

Week 7 Reading NS240&241 Rm114 .doc

Week 7 Reading NS240&241 Rm114 .pdf

GI Medications

Gastrointestinal Medications

What is the Gleason Scale used for?

(http://en.wikipedia.org/wiki/Gleason_Grading_System)

Drag your cursor over the image for the answer

According to the Wiki site mentioned above – this is how the math is done:

Primary, secondary, and tertiary

A pathologist examines the biopsy specimen and attempts to give a score to the two patterns.

• First called the primary grade, represents the majority of tumor (has to be greater than 50% of the total pattern seen).
• Second – a secondary grade – relates to the minority of the tumor (has to be less than 50%, but at least 5%, of the pattern of the total cancer observed).

These scores are then added to obtain the final Gleason score.

Increasingly, pathologists provide details of the “tertiary” component. This is where there is a small component of a third (generally more aggressive) pattern. So there could be a Gleason 3+4 with a tertiary component of pattern 5 – this would be considered to be more aggressive than a prostate cancer that was Gleason 3+4 with no tertiary pattern 5. Although it is debatable as to what the full extent the tertiary component has on the aggressiveness of a cancer. (http://en.wikipedia.org/wiki/Gleason_Grading_System)

The Destruction of the Force of Water

Go to this site to see some amazing images of the destruction of the Japan Tsunami.

IMAGES

Week 6 Reading

Week 6 Reading NS240&241 Rm114

Week 6 Reading NS240&241 Rm114

Crackles to Tamponade

Another way to look at ABG’s – Love this!!

This helps to identify the Compensated ABGS – is it Metabolic or Respiratory? Just follow your arrows!

Nasal Fracture, Nasal Obstruction and Epitaxis

Okay Epitaxis should be done in 3rd semester right off the bat. Probably the most common thing I saw in Pediatrics at the schools (besides DM) was a bloody nose!

These are Topic Sheets for the above Respiratory Problems.
epitaxis
nasal fracture.
nasal obstruction

KUB

The first radiologic test that is performed is the plain abdominal X-ray or KUB. The majority of stones (90%) are radiopaque and can be easily identified on X-rays. The KUB, or Kidney-Ureter-Bladder X-Ray is a simple, noninvasive procedure to identify the location of stones. Some stones are radiolucent such as uric acid and some cystine stones. These may not appear on plain X-rays.

Male Repro Drugs

My notes on Tx Drugs from Brunner’s and other places.

male repro drugs

Week 5 Reading

Week 5 Reading NS240&241 Rm114 .doc

Week 5 Reading NS240&241 Rm114 .pdf