Myocardial Infarction (MI) | - Chest Pain (CP): Lasting > 20 minutes but < 12 hours.
- CP described as crushing, gripping, smothering.
- Feeling of impending doom.
| - Unstable Angina: CP with exertion, not resolved with rest, requiring Nitroglycerin (NTG).
- C-Reactive Protein (CRP): Indicates degree of atherosclerosis.
- B-type Natriuretic Peptide (BNP): Elevated in CHF exacerbation.
| Initial Assessment & Monitoring- EKG monitoring (initially, then every 10 minutes while patient is having CP).
- Cardiac Enzymes drawn immediately (then Q6H for 24 hours).
| - CK-MB (Creatine Kinase-MB): Cardiac specific; may not rise until 4 hours post-onset.
- Troponin: Found in skeletal/cardiac muscle; detectable within the 1st hour of onset.
| - Chest X-ray (CXR)
- Electrocardiogram (EKG)
- Cardiac Catheterization (Card Cath)
| - Aspirin 325 mg
- Oxygen
- Nitroglycerin (NTG) if CP persists.
- Morphine if pain is not relieved by NTG.
- Metoprolol (Beta-blocker)
- Anticoagulation therapy (e.g., Heparin).
- Admission to Cardiac ICU/Telemetry.
| Reperfusion Strategy- Start treatment within 6 hours.
- Thrombolytic Therapy: If symptoms < 12 hours.
- Contraindications: Active internal bleeding, previous hemorrhagic stroke, pregnancy, recent surgery.
Monitoring Thrombolytics- Reperfusion problems (EKG changes: PVCs, VTach, HR changes, pain).
- Reocclusion (Chest pain, increased Troponin).
PCI/CABG- PCI (If contraindications exist): Stent placement (long-lasting); Balloon angioplasty (often for 1st MI, unstable).
- Monitor post-PCI for Retroperitoneal Bleed.
- CABG: Indicated for severe Left Main Coronary Artery compromise, triple vessel disease, re-stenosis, or coronary artery rupture.
|
Congestive Heart Failure (CHF) | - Orthopnea: Shortness of breath (SOB) when lying flat.
- Paroxysmal Nocturnal Dyspnea (PND): Sudden SOB at night while sleeping.
- Fatigue
- Jugular Venous Distension (JVD)
- Dependent Edema
| - Common cause: Ischemic Cardiomyopathy.
- Ischemic Cardiomyopathy (IC) = Coronary Artery Disease (CAD) + Hypertension (HTN).
| NYHA Functional Classification- Class I: Strenuous exercise causes symptoms.
- Class II: Ordinary activity (e.g., grocery trip) causes symptoms.
- Class III: Less than ordinary activity (e.g., cooking dinner) causes symptoms.
- Class IV: Symptoms occur at rest.
| - BNP: Shows CHF exacerbation; unreliable alone, can be elevated with inflammatory processes.
| - Echocardiogram (Echo)
- Chest X-ray (CXR)
| Slowing Progression- ACE Inhibitors (e.g., Captopril): Monitor Potassium (K) and renal status.
- Beta-blockers (e.g., Carvedilol): Slows HR and drops BP; ensure HR > 60 bpm before administration.
- Diuretics (e.g., Lasix/Furosemide).
| |
Ischemic Bowel Disease (IBD) | Symptoms often overlap with assessment findings. | - Postoperative state
- Low blood pressure (Hypotension)
- Atherosclerosis
| - Dark or bright red blood and clots from rectum (Hematochezia).
- Fever
- Abdominal pain
| | - KUB/X-ray generally not helpful.
- CT scan with contrast is preferred.
| | - Restore circulation to the bowel.
- Fluid resuscitation as needed (PRN).
- Antibiotics (Abx) if infection is suspected.
|
Hypovolemic Shock | - Low Blood Pressure (BP), Cardiac Output (CO), Cardiac Index (CI), Urine Output (UOP).
- Mean Arterial Pressure (MAP) < 60 mmHg.
- High Heart Rate (HR) and Systemic Vascular Resistance (SVR).
| - Hemorrhage
- Dehydration
- Burns
- Vomiting/Diarrhea (V/D)
- Third Spacing
| - Mental Status: Agitation → Confusion → Coma.
- Early Respiration: Tachypnea, hyperventilation.
- Late Respiration: Labored, shallow.
- Weak, thready pulse.
- Cool, clammy skin.
- Urine is dark and concentrated.
| | | Treatment Goals- Hemoglobin (Hgb) > 7 g/dL
- MAP > 60 mmHg
- Systolic Blood Pressure (SBP) > 100 mmHg
| |
Septic Shock | - Normal or high Cardiac Output (CO)/Cardiac Index (CI).
- Pulmonary infiltrates.
- Slow bowel sounds.
- Extreme cases: Ischemia/necrosis of extremities.
- Coagulopathies.
| Infection leading to systemic inflammatory response. | - Early: Level of Consciousness (LOC) changes, increased Respiratory Rate (RR).
- Fever or low temperature (Hypothermia).
- Progressive: Third spacing.
- Higher WBC trend (Note: unreliable in chemotherapy patients).
- Positive or negative blood cultures (BlCx).
Pathophysiology- Thrombotic/fibrinolytic response to infection.
- Mediator release stimulates an unregulated procoagulant state.
- Platelet aggregation & adhesion leads to microcirculatory clots (potential for necrosis).
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Pancreatitis (Panc) | | | | | | | |
Cerebrovascular Accident (CVA) | | | | | | | |
Ascites | | | | | | | |
Esophageal Varices (Esoph V) | | | | | | | |
