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Killip Classification (How doctors classify MI?

) I no signs of pulmonary/venous congestion II moderate heart failure (rales, S3), tachypnea - Signs of venous/hepatic congestion - Jugular distention III severe heart failure, pulmonary edema, dyspnea, pink frothy sputum IV shock decreased BP, increased RR and CR Classification: Acute Respiratory Failure may be classified as: hypoxemia or hypercapnic either acute or chronic Hypoxemic respiratory failure (type 1) - characterized by PaO2 of less than 50 mmHg with a normal or low PaCO2 - most common form of respiratory failure and it can be associated with virtually all acute diseases of the lung which generally involve fluid filling or collapse or alveolar units - pulmonary edema, pneumonia, & pulmonary hemorrhage Hypercapnic respiratory failure (type II) - characterized by a PaCO2 of more than 50 mmHg 1.Normal Sinus Rhythm (NSR) Impluses originate at SA at normal rate.( 60-100 bpm) Rhythm originates from SA. Atrial and ventricular rhythms are regular.

2. Sinus Bradycardia Impulses originate at SA but has slow rate. (<60 bpm) Normal variation in athletes during sleep or in response to a vagal maneuver. Causes: Parasympathetic fibers (vagal tone) stimulation, slowing down of sinus node. Treatment: Treat underlying cause Atropine IV push to block vagal stimulation. ( 0.5 mg IV push Q3-5 mins.; 3 mg total dose; 6 doses in all) Pacemaker 3. Sinus Tachycardia Regular or slightly irregular except that the rate exceeds 100 bpm. Rate P wave QRS Conduction Rhythm 101-160 bmp Sinus Normal Normal Regular or slightly irregular

Causes: Congestive heart failure Hypoxia Increased temperature

Stress Response to pain Increased circulating catecholamines (sympathomimetic) Treatment: Digitalis administration, Beta-adrenergic inhibiting agents. Treat underlying cause (fever, shock, electrolyte imbalance) 4. Atrial Fibrillation Impulses take chaotic, random pathways in the atria. Baseline coarseky or finely irregular, P waves absent, Ventricular response (QRS) irregular, slow or rapid Multiple rapid impulses from many foci depolarize in the atria in a total disorganized manner. (Atria QUIVER) Treatment: Digitalis for uncontrolled fibrillation Oxygen, anticoagulants Beta blockers Rate P wave QRS Conduction 400-650 bpm Not present; wavy baseline is seen instead normal Variable AV conduction; if untreated the ventricular response is usually rapid Irregularly irregular. (HALLMARK for dysrhythmia)

Rhythm

Treatment - Digitalis uncontrolled fibrillation - O2 - Anticoagulants - Beta blockers - Cardioversion 5.Premature Ventricular Contraction - Multifocal - Unifocal - Early ventricular complexes resulting from increased irritability of ventricles; ectopic ventricular beat - May occur in healthy people - 6 or more PVC is considered Abnormal, since normal heart has PVC also Treatment - Lidocaine drip - Procainamide drip IV bolus - O2 Rate Variable P wave Usually obscured by the QRS, PST or T wave of the PVC QRS May be multifocal Conduction The impulse originates below the branching portion of the Bundle of His

Rhythm

Irregular, PVCs may occur in singles, couples or triplets or in bigeminy, trigeminy or quadrigeminy

6.Ventricular Tachycardia - Most fatal - Repetitive firing of irritable ventricular ectopic focus - Can cause cardiac arrest Causes - CAD - Digitalis toxicity - Ventricular aneurysm - CHF - Acute MI Rate P wave Conduction Rhythm Usually between 100 250 bpm Obscured if present and are unrelated to the QRS complexes As with PVCs Three or more ventricular beats in a row, regular, irregular

Treatment - Lidocaine bolus then drip - Defibrillation - Cardioversion 7.Ventricular Fibrillation - Most fatal - Impulses from many irritable Foci fire in a totally disorganized manner - Many irritable foci fire in a totally disorganized manner - Ventricles quiver - Fatal if not successfully terminated within 3-5 mins - Client lacks pulse, RR, heart sound - Results in the absence of cardiac output - Almost always occurs in serious heart diseases esp. MI Rate P wave QRS Conduction Rhythm Unattainable May be present but obscured by ventricular waves Not apparent Chaotic electrical activity Chaotic electrical activity

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