RCIS EXAM 2023 with verified questions and answers

Creatinine 1.5 mg/dL Kidney function A chemical waste molecule from muscle metabolism. Produced from creatine the energy in muscles and filtered by kidneys. High levels warn kidney failure BUN 7-22 mg/dL Blood, Urea, Nitrates Kidney function 30 = CHF, shock 3 = Liver failure Platelet Count 150,00-450,000 /mcL (micro liters) Hep B Most contagious than HC, HA, HIV OSHA Occupational Safety and Health Admin - government department of labor created to assure safe and healthful working conditions for healthcare workers, such as regulations on blood borne pathogens Lactic acid in large amts found in coronary sinus Indicates coronary ischemia CK-MB 3-6 hr peak Creating Kinase-MB Cardiac enzyme marker for MI Myoglobin 1 1-4 hr onset Earliest to show Troponin I 3-12 hr onset of chest pain 24-48 hr peaks Baseline returned 5-14 days LDH 3 days, slowest Leukocytosis -increased number WBC Ca++ Calcium (electrolytes) .8-1.0 mg/L Hypercalcemia causes Abnormal T wave, extremely wide QRS Hypocalcemia causes narrow QRS, no T wave, prominent U Mg++ Magnesium (electrolytes) 1.5-2.5'mEq/L Heart and nervous system Hypermag causes weakness, low BP, dyspnea, cardiac arrest Hypomag causes loss of appetite, nausea, vomiting, sleepiness, muscle spasms, seizures. Cl- Chloride (electrolyte) 95-105 mEq/L Hyperchloremia indicates dehydration, Cushing syndrome, kidney disease, CHF, metabolic alkalosis, respiratory acidosis Metabolic alkalosis Happens when tissues are too basic or alkaline Respiratory acidosis Happens when lungs can't remove enough CO2 carbon dioxide from body AO valve area CO (L/min) / square root (peak - peak gradient mmHg) CO / sq root (LV SYS / AO SYS Peak - Peak gradient = LV sys / AO systole Peak - Peak Gradient LV systole - AO systole AO Flow CO/(SEP x HR) Na+ Sodium 135-145 Helps keep fluids in normal balance, key roll in normal nerves and muscle function Hyponatremia causes confusion, sluggish, could be heart failure, kidney failure, use of diuretics Hypernatremia involves dehydration, thirsty, confused, muscle twitches HGB 12-15 g/dL women 14-18 g/dL men Hemoglobin protein in rbc carries oxygen to body Low =anemia High uncommon K+ Potassium 3.5-5.5 millimoles per liter mmol/L K+ chemical electrolyte critical for function of nerve and muscle cells, particularly the heart's electrical activity Hypokalemia 3.5 Causes hyperexcitability, SVT, AFib, A flut, A Tach, Trosades T wave flattened or inversed U wave prominent, P wave increased amplitude Causes Trorsades de Pointes Hyperkalemia 5.5 Causes bradycardia, cardiac arrest, asystole, V Fib, PEA Reduces myocardial excitibility Supressed impulse of SA node Reduced conduction of AV node and His-Purkinje Peaked T waves No P wave or flattened and widened Bizzare and prolonged QRS HCT 40% (vol%) women 45% (vol%) men Hematocrit = Volume percentage of RBC in blood Used to identify anemia (low) and polycythemia (high) erythrocyes or RBC Erythrocytes RBC ACT Activated Clotting Time Pre Cath 250-300 sec Norm is 75-100 Platelets and proteins called coagulation factors are activated in steps to cause blood clotting. High doses of heparin prevents clots ACT Sheath removal 150-180 seconds ACT performed after heparin administered 10 minutes after heparin is administered PT - Prothrombin Time 18 sec Measures how long it takes blood to clot Norm 12-15 Nitroglycerin Cardiac nitrate blades med vasodilation smooth muscle in arterioles and venous smooth muscle Chief effect is to pool blood in veins which reduces preload, fixation of spastic arteries and arterioles which reduces afterload Inderal, Popranolol Beta blocker interfere with beta adrenergic sympathetic system CCB Negative inotropic effects and relax vascular smooth muscle Nifedipine, Procardia CCB Diltiazem, Cardizem CCB Verapamil, Isoptin CCB, prevents muscle spasm by relaxing smooth musvle Ibutilide Used in Cardio versions of atrial fib easier by blocking potassium channels Digoxin , digitalis Slows heart rate and increases contraction Positive Inotropic effect hypes up chemical contractility Cardiotonic and catecholamine dugs Induce positive inotropic state slowing HR and increasing force of contraction Furosemide Lasix Diuretic drug for severe CHF Promotes urination and venodilation Reduces preload Thiazide Diuretic make you diurese or pee Reduces preload Renin-Angiotensin-Aldosterone blockers ACE Inhibitor is an Angiotensin Converting Enzyme inhibitor Given post MI to reduce LV dilation and remodeling ACE Inhibs are shown to reduce mortality and morbidity during and post MI Norepinephrine, Dopamine in high dose Vasopressors vasoconstrictperipjerslmarterioles Which raise BP "Pressers" Name three stress test drugs Vasodilator infusions of: Dobutamine Adenosine (brands Adenoscan, Adenocard) Dipyridamole For pts with pacemaker or orthopedic problems Increase myocardial O2 demand by increasing contractility, HR, and BP. Only use Dobutamine as a last resort due to strength. Fentanyl Analgesic drug for pain relief 100x potent than morphine Dosage for Adenosine (Adenoscan, Adenocard) (6,12,12 mg) 6 mg rapid IV push If no conversion, give adenosine 12 mg rapid IV push; may repeat 12 mg dose once SVT with aberrancy. Vagal Maneuver try this treatment if the patient's QRS is narrow and rhythm is regular. If no change give adenosine 6,12,12 mg Avoid AV nodal blocking agents such as adenosine, digoxin, diltiazem, verapamil. If pre-excited atrial fibrillation (Atrial Fibrillation in Wolff-Parkinson-White Syndrome) Patient has significant signs or symptoms of tachycardia AND they are being caused by the arrhythmia. The tachycardia is unstable. Immediate cardioversion is indicated. Patient has a pulseless ventricular tachycardia. Follow the Pulseless Arrest Algorithm. Deliver unsynchronized high-energy shocks. Patient has polymorphic ventricular tachycardia AND the patient is unstable. Treat the rhythm as ventricular fibrillation. Deliver unsynchronized high-energy shocks. What does Coumadin (warfarin) inhibit vitamin K Used for long term anticoagulation, like pts w/artificial valves or thromboembolic disease. discovered as rat poison by bleeding rats to death What is Fibrinolytic therapy used for Ischemic stroke or brain attack within 3 hrs of symptoms What is Streptokinase (Streptase) Clot dissolving IV med tPA (Alteplase) thrombolytic Reteplase (Retavase Recombinant) thrombolytic TNKase (Tenecteplase) thrombolytic Abciximab Reopro blood thinner (anticoagulant) aka GP IIb.IIIa inhibitor, blocking platelet aggregation Used extensively in ACS (acute coronary syndrom Heparin blood thinner (anticoagulant) prevents thrombus from becoming larger blocks prothrombin from converting to thrombin Half-life of 5000 U IV heparin bolus approx 40 min give 25 mg protamine for 5000 units heparin 40 min later What drug has severe side effects if given to diabetic pt on NPH Insulin? Protamine Protamine Counteracts anticoagulation of Heparin 10 mg of Protamine counteracts 1000 units of heparin Aspirin antiplatelet agent inhibits thromboxane (TXA2) and cyclo-oxygenase formation makes platelets slippery Atropine Belladonna effects on ANS chronotopic, blocks parasympathetic increases heart rate and contractility by reducing vagal tone treats brady Anaphylactic reaction Allergic reaction hypersensitivities result in life-threatening respiratory distress followed by vascular collaspe, and shock Hives, itching and wheals Atropine dose for brady 0.5 mg IV if IV access is available Repeat every 3 to 5 minutes up to 3mg or 6 doses. Antihistamine class drug does what Drug Benadryl Diphenhydramined blocks histamine prevents increased capillary permeability that leads to edema, itching, and smooth muscle contraction that leads to bronchospasm Epinephrine Dosage: 0.5 - 1.0 mg IV bolus every 3-5 minutes higher dosage in no standard response (3,5, 10, 15 mg) VF, PULSELESS VT, ASYSTOLE, and PEA strong vasoconstrictor enhances defibrillation Beneficial effects alpha-adrenergic stimulating properties increase myocardial and cerebral blood flow during cpr norepinephrine class autonomic drug is Sympathomimetic which is a classic catecholamine that stimulates SNS ups HR and contractility (beta 1 effect) and cause vasoconstriction (alpha effect) Dobutamine synthetic catecholamine Increases contractility in CHF catecholamines Drugs Norepinephrine, Epinephrine, Dopamine, Norepinephrine effects are increases in heart rate, blood pressure, blood glucose levels, and a general reaction of the sympathetic nervous system Isuprel, Isoproterenol units administered IV? ug/min or mcg/min .5mcg/min initial dose Classes: Beta1/Beta2 Adrenergic Agonists For serious episodes of heart block and Adams-Stokes attacks (except when caused by ventricular tachycardia or fibrillation) Treats CHF bronchospasm occurring during anesthesia. Preliminary First Action performed before the " A " of the primary ABCD Survey • Assess responsiveness • Call for help fast • Appropriately position victim • Appropriately position rescuer ABCD's of cardiac distress/arrest First drug given is O2 ABCD's are done first Primary Survey • Airway : Open the airway • Breathing : Look, Listen & Feel for breathing • Circulation : Check pulse, start CPR • Defibrillation : Attach ECG Monitor / defibrillator Focus on basic CPR and defibrillation Consider causes that are potentially reversible *Hypovolemia *Hypoxia *Hydrogen ion - acidosis *Hyper-/hypokalemia, other metabolic *Hypothermia *"Tablets" (drug OD, accidents) *Tamponade, cardiac *Tension pneumothorax *Thrombosis, coronary (ACS) *Thrombosis, pulmonary embolism Name some vasopressors and their effects Levarterenol Norepinephrine Levophed (alpha & beta) Peripheral vasoconstrictive action by stimulating alpha adrenergic receptors Nitroglycerin tabs deteriorate when exposed to air and light Also deteriorates in PVC plastic tubing and bags, so it's often mixed in glass Watt Second or Joule is a unit of Energy defibrillators are charged from 50-360 Joules of energy Tridel Tridel, Nitroglycerine counteracts the Erg's precipitated coronary vasospasm transducer converts one form of energy into another Thermistors transducer temperature into electrical energy Zero Transducer 13.6 mmH2O Piezoelectric transducers (crystals) electrical wavers into ultrasound waves then they record the reflected pressure waves and convert them back to electrical energy so we can view the echogram Medical pressure transducers convert BP energy inot electrical energy asepsis means absence of infectious agents aseptic skin prep is directed at cleanliness and eliminating alcl infectious agents or pathogens skin cannot be sterilized as microorganisms or resident skin flora live with us constantly and are considered nonpathogenic Isometric (static) exercise pushing against a wall Increase BP and systemic vascular resistance with LITTLE changes in CO and O2 demand consumption Isotonic (dynamic) exercise muscular contraction of large muscle groups that results in movement calcified plaque is often associated to what unstable angina, thrombus formation myocardial infarction considered a "complicated lesion" is an unstable ruptured plaque ASHD plaque atherosclerotic heart disease THREE PHASES 1. FATTY STREAKS 2. RAISED FIBROUS PLAQUES 3. COMPLICATED LESIONS ARE CALCIFIED FIBROUS PLAQUES , which rupture, hemorrhage in the plaque and/or thrombus. Stunned mycardium brief period of severe coronary ischemia the LV dysfunction may gradually improve over a three hour period hibernating myocardium recovers over a period of days or months dyskinetic LV wall bulges severely ischemic areas hypokinetic LV wall fails to contract more mildly ischemic areas Prinzmetal or variant angina occurs at rest without warning due to coronary spasm, not CAD EMD electromechanicalbb dissociation is termed Pulseless Electrical Activity or PEA state with organized electrical depolarization in heart, but not contractions or undetectable. Synchronized cardioversion treats AFib/flutter and SVT arrhythmias If meds fails, get good ECG SYNCHRONIZE THE DEFIB PULSE TO R WAVE RRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRR white clot injured endothelium collects white clot from Platelets or thrombocytes Midazolam Versed short-acting benzo CNS depressant sedative is contraindicated in pts with narrow angle glaucoma Heart biopsy Left heart - 5000 units heparin - no protamine Right heart - no heparin Valium, Diazepam Most common anti anxiety agent used Ergonovine and methergine require nitroglycerin on hand Ergo maleate and Methergine stimulate alpha-adrenergic and serotonin receptors in smooth muscle of coronary and can cause spasm in Prinzmetal angina pts Ergo not used much in US and was replaced by Methergine Also used to stimulate uterine muscle contractions during birthing Increased iodine in contrast makes it radiopaque due to heavy metal that absorbs x-ray cimetidine prednisone iv meds given with benadryl for prophylaxis amrinone, milrinone Increases cardiac contractility, vasodilator. Blood pressure support It can treat congestive heart failure digitalis Treats CHF atrial arrhythmias. Increases blood flow and reduces edema in hands and ankles Strengthen the force of the heartbeat by increasing the amount of calcium in the heart's cells. (Calcium stimulates the heartbeat.) Hypaque, renografin high osmolar contrast agent cheaper, but increases preload Renografin-60 Generic Name: diatrizoate meglumine and diatrizoate sodium Dosage Form: Injection Loxaglate, hexabrix low-osmolar contrast agent is much safer and do not increase preload as much lower osmolarity agents don't draw as much extracellular fluid into the circulation Lanoxin inotropic form of Digitalis dose: .1-.5 mg daily Dobutrex form of Digitalis dose? Amrinone form of digitalis Quabain form of digitalis dose lohexol, Omnipaque low-osmolar contrast agent is much safer and do not increase preload as much q.i.d. four times a day Isoproterenol, Isuprel chronotropic response chrono = rate increases HR by ^ sympathetic tone Isoproterenol, Isuprel stimulates beta 1 receptors morphine hemodynamic effects Increases venous capacitance Decreases PVR peripheral vascular resistance Decreases myocardial O2 demand Decreases preload and afterload Thus, reducing venous and arterial pressures Treats ischemic chest pain and acute pulm edema Relieves pulmonary congestion Analgesic and hemodynamic benefits V.I.P. for shock therapy (Acute Circulatory Failure) 1. V= Ventilation via nasal cannula, abc's of cpr airway 2. I = Infusion IV line to admin fluids and meds, elevate legs 3. P = Pump by improving pump performance (cpr) Lidocaine dosage: 1 mg/Kg body weight (approx 5-100 mg) initial IV bolus to be administered over 1-2 minutes Repeats boluses 50-57 mg very 5-10 mins w/a max of 225 mg. Treat after 3 unsuccessful defib attempts and epi admin Treats ventricular ectopy - VT and VF treats V-Fib Concentration formula Amt/Vol C to F 32 + (1.8 x C) F to C conversion (F-32) / 1.8 q4h every 4 hours qid 4 x daily qod every other day npo nothing by mouth high dose IV Dopamine effects 10 mg/Kg/min cause peripheral vasoconstriction increases BP Meds usded to provoke intra-ventricular pressures in HOCM Slow and relax heart at rest and exercise to reduce interventricular gradient Isoproterenol, Inderal Nitroglycerine Valsalva maneuver Mainstays of therapy for HOCM beta blockers Med used for VSD cath to test fixed pulmonary vasoconstriction O2 or NO by face mask Since PVR = (PA - LA) / CO, the resistance is = to the PA mean pressure. Electrical cardiovert is dangerous if what drug is present? ELEVATED Digitalis are contraindicated can cause dangerous arrhythmias whereas therapeutic levels are not Primary therapy for vasovagal reaction Elevate feet, admin fluids Atropine is a classic vagal blocking drug "pril" Ace Inhibitor "mine or ine" vasopressors lol beta blockers "pine" 'mil" CCB Diltiazem CCB Dopamine vasopressor Propranolol beta adrenergic blocker Neosynephrine vasopressor quinidine antiarrhythmic treats AFib and malaria Labetalol beta adrenergic blocker blocks adrenalin and norepinephrine at the beta adrenergic receptors reduces work of heart and BP, contractility, and HR Metoprolol beta adrenergic blocker Aramine, metaraminol vasopressor that raises BP in shock Isordil sublingual nitroglycerine tablet prior to pci to prove stenosis is not just a spasm SL Nitrates CHF relief w/dyspnea, orthopnea, and basilar rales reduce pulmonary capillary pressure that causes it. Swan Ganz best diagnostic tool diuretics digitalis O2 PEEP respiratory acidosis is treated with hyperventilation, so increase ventilation pH measurement of acidity or alkalinity, based on the hydrogen (H+) ions present normal range 7.35 - 7.45 PaO2 partial pressure of O2 that is dissolved in arterial blood normal range 80-100 mmHg 28-48 mmHG for venous PaCO2 Amount of carbon dioxide dissolved in arterial blood. Partial pressure of arterial CO2 Normal Ranges 45 -35 mmHg HCO3 Calculated value of the amount of bicarbonate in the bloodstream. An anion of carbonic acid. - not a gas. Normal Range 22 - 26 mEq/L B.E. Base excess indicates the amount of excess or insufficient level of bicarbonate in the system. It is the amount of H+ ions that would be required to return the pH to 7.35 if the pCO2 was normal Normal Range -5 to +3 or -2 to +2 mEq/L SaO2 Arterial oxygen saturation Normal range 95 to 100 percent via oximeter PTCRA Percutaneous Transluminal Coronary Rotational Atherectomy Catheter based interventional procedure using high-speed rotational device designed to ablate atherosclerotic plaque and restore luminal patency invented by David C Auth, PhD, PE and owned by Boston Scientific Corp Approved by FDA in May 1993 Rotablator Atherectomy ablates plaque to what size Into micro particles, approx 5 microns in size, which is smaller than a RBC differential cutting allows the RB to only cut inelastic tissue and not elastic tissue. Benefits include minimized vessel wall stretch, elastic recoil, and producing smooth luman