Mark Klimek Audio Notes Acid Base ABG’s. Lecture Notes..

Mark Klimek Audio Notes 1 Mark Klimek Audio Notes Acid Base ABG’s As pH goes, so does my Pt! Except for K pH ↓ Pt goes ↓ (HR, RR, all vitals) K goes ↑ pH ↑ Pt goes ↑ K goes ↓ Except for K – it does the opposite pH ...

Mark Klimek Audio Notes 1 Mark Klimek Audio Notes Acid Base ABG’s As pH goes, so does my Pt! Except for K pH ↓ Pt goes ↓ (HR, RR, all vitals) K goes ↑ pH ↑ Pt goes ↑ K goes ↓ Except for K – it does the opposite pH ↑ : Alkalosis  Seizures, hyperactivity, borborgemy (↑BS) Kausmal breathing = MacKausamal (Metabolic Acidosis breathing) Lung: Respiratory Everything else: Metabolic When you don’t know: it’s probably metabolic acidosis (It’s super common) Ventilators High Pressure Alarm  Obstructed airflow  Having to use too much pressure  Kinks, water collection in tube, mucous  Turn, cough, deep breathe Low Pressure Alarm  ↓ Resistance – machine finding job too easy  Disconnected tube  02 sensor disconnected If tube goes lower than pt level – contaminatedMark Klimek Audio Notes 2 Amino Glycosides A Mean Old Mycin Amino Glycosides only treat Mean old Infections! True mean old Mycins don’t have “Thro” If it has “Thro” – Thro it away!  Ex: Zithromycin Mean Old Mycins destroy ears (ototoxicity) and kidneys (nephrotoxicity)  Must check Creatinine for Nephrotoxicity – NOT urine output 8 Toxic to Cranial nerve 8 give q8h Mean Old Mycins do NOT get absorbed – they go in and out and sterilize/clean PO Mean Old Mycins are for bowel sterilizing  NeoMYCIN  KanoMYCIN Who can sterilize my bowel?? NEO KAN! Drawing TAP Levels (Peak and Trough) For drugs that have a narrow therapeutic level and are toxic Route determines TAP – Not the drug TROUGH PEAK IV 30 MIN BEFORE NEXT DOSE IV 15-30 min after its done IM 30 MIN BEFORE NEXT DOSE IM 30-60 min after its given SUB Q 30 MIN BEFORE NEXT DOSE Subling 5-10 min after its in the system PO 30 MIN BEFORE NEXT DOSEMark Klimek Audio Notes 3 Heart Rhythms Ca Channel Blockers are chill pills for the heart  They end in DEPIM or ZEM Rhythms Asystole: No QRS – Lethal Flutter: Sawtooth Afib: Chaotic with QRS pattern Vfib: Chaotic without QRS pattern – Lethal Vent tachy: Wide bizarre QRS SVT: Narrow QRS PVC: random rhythm change – only concerned if > 6 or 6 in a row Change in rhythm: check pulse or BP for cardiac output Treat ventriculars with lidocaine  V → L Treat SVT (it’s actually an atrial) A denosine – puts you in asystole for 20 seconds B eta bockers – all end it “lol” C a channel blockers D igitalis VFib: you DFib Asystole: epinephrine then atropine Chest TubesMark Klimek Audio Notes 4 The only chest surgery that doesn’t require a chest tube is a pneumonectomy – because you remove the entire lung Water seal breaks 1. Clamp 2. Cut 3. Put in Water 4. Unclamp Chest tube comes out 1. Cover with gloved hand 2. Vaseline gauze 3. Sterile dressing taped on 3 sides Bubbling: Where? When? Water Seal  Intermittent: good  Continuous: bad (air leak) Suction Control  Intermittent: bad (dial up suction)  Continuous: Good Do NOT clamp chest tube longer than 15 seconds Congenital Heart Defects Two classes: Trouble and No Trouble Trouble defects all start with “T”  R → L defects are Trouble All CHD have a murmur Tetralogy of Fallot: VarrieD PictureS Of A RancH VD: ventricular defect PS: pulmonary stenosis OA: Over Riding aortaMark Klimek Audio Notes 5 RH: right hypertrophy Crutches Elbow at 30 degrees 2 pt: 2 touch 3 pt: 1 foot up 4 pt: everything moves separately Swing: amputee Stairs  Up with good  Down with bad Cane  Hold on good side  Advance with bad side Walkers: pick it up, put it down, walk towards it Electrolytes Kalemias – do SAME as prefix, except for HR and urine output  Hyperkalemia: everything goes ↑ , HR and UO go ↓ o Get rid of excess K before the heart stops o D5W with insulin R (saves you time) o Then give K-excelate  Hypokalemia: everything goes ↓ , HR and UO go ↑ o Give more K o NEVER push IV o NEVER more than 40 meg/L Calcemias do OPPOSITE of prefix  Hypercalcemia: everything goes ↓Mark Klimek Audio Notes 6  Hypocalcemia: everything goes ↑ Chvosteks: push and cheek spasms Trousseau: BP cuff inflates, and causes spasm Magnesium do OPPOSITE of prefix  Hypermagnesium: Everything goes ↓  Hypomagnesium: Everything goes ↑ Natremias: The one with the E is Dehydration, the one with the O is OverLoad  Hypernatremia: Dehydration  Hyponatermia: Fluid Overload (numbness/paresthesia) Universal S/S of electrolyte imbalance – muscle weakness / paresis Endocrine System Thyroid & Adrenal  Thyroid = Always metabolism Hyperthyroid  UP, UP, UP – Agitated, nervous diarrhea, etc Most common: Graves  You’re going to RUN yourself into the GROUND  Radioactive iodine: urine is dangerous PTU: Puts Thyroid Under (slows it down) Total ThyroidectomyMark Klimek Audio Notes 7  Lifelong thyroid hormones  Tetany Subthyroidectomy  Thyroid storms o Like Graves – but much worse. o UP, UP, UP – super high vitals o Psychotic delirium o No meds ordered – just cooling blankets and O2 (just keep them alive!) Total: can’t have thyroid storm when you don’t have a thyroid Hypothyroid  Tired, sluggish, sl