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MOST COMMON ECGs:
SINUS RHYTHM
SINUS BRADYCARDIA
SINUS TACHYCARDIA
SINUS ARRHYTHMIA
SINUS EXIT BLOCK
SINUS ARREST
NSR WITH PAC
SVT
ATRIAL FIBRILLATION
ATRIAL FLUTTER
NSR WITH FIRST DEGREE AV BLOCK
SECOND DEGREE AV BLOCK TYPE I
SECOND DEGREE AV BLOCK TYPE II
SECOND DEGREE AV BLOCK 2:1
THIRD DEGREE AV BLOCK
NSR WITH PJC
JUNCTIONAL RHYTHM
ACCELERATED JUNCTIONAL
JUNCTIONAL TACHYCARDIA
NSR WITH PVC
IDIOVENTRICULAR RHYTHM
ACCELERATED IDIOVENTRICULAR RHYTHM
VENTRICULAR TACHYCARDIA
VENTRICULAR FIBRILLATION
AGONAL RHYTHM
OTHERS:
ACUTE MI
ANTERIOR WALL MI
HYPERKALEMIA
FAST AND SECURE
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Monday, May 3, 2010
Sunday, May 2, 2010
CORONARY CARE
Hospital Care And The Coronary Care Unit (CCU)
Most patients suspected of having suffered an acute heart attack are admitted to a hospital's coronary care unit (CCU). The CCU is intended to be a quiet, calm, and restful area in which patients can be further evaluated and closely monitored. A specially trained nurse who works with doctors and other members of the medical team provides individualized care. Visiting hours are usually restricted.
The length of stay in the CCU varies, depending on :
• Whether or not the diagnosis of a heart attack is confirmed
• The severity of the heart attack
• The presence and severity of associated complications
A patient with a heart attack without complications spends about two to three days in a CCU before being transferred to a step-down unit. A step-down unit offers less intensive care than the CCU but still permits continuous ECG monitoring to screen for abnormal heart rhythms or other complications. The patient usually goes home five to seven days after hospital admission.
What Are The Goals Of Care In The CCU?
Care in the CCU focuses on:
• Relief of chest pain and anxiety
• Further assessment (diagnostic tests) to confirm a diagnosis
• Limiting the size of the heart attack and the area of heart muscle that dies
• Reducing the work of the heart
• Identifying, preventing, and treating complications from the heart attack
In the CCU:
• Care for the patient begun in the emergency setting continues
• Additional diagnostic tests are ordered
• Doctors determine appropriate medical-surgical intervention.
• The patient's level of activity and diet is restricted
Diet And Activity Levels
Additional precautions taken during the stay in the CCU and step-down unit, include
• Restricting the diet
For the first 24 hours, the patient is placed on a clear liquid diet to reduce the possibility of aspiration due to nausea and vomiting. A healthy food plan, including complex carbohydrates and fiber-rich foods, is later introduced. All individuals who have suffered a heart attack need to permanently adopt a healthy diet.
• Limiting activity levels
All patients are initially placed on bed rest. Patients who are stable, free of pain, and free of complications are sometimes to get out of bed to use the commode. Patients who remain free of complication often begin limited physical activities within 24 hours.
Progression Of Activity
Days 1-2
• Sitting up with feet dangling over the side of the bed
• Lifting and lowering of the arms, called range-of-motions exercises, to prevent muscle and joint stiffness and to prevent blood clots from forming in the legs
Days 3-4
• Bathing and dressing while sitting on the bed or in a chair
• Taking short walks around the hospital room
• Taking supervised walks outside the hospital room
• Showering without shampooing hair (no raising of arms above head)
Days 5-7
• Walking about 600 feet three times a day
• Shampooing hair (activities with arms over the head)
• Climbing stairs with supervision
• Undergoing an exercise tolerance test
After several days in the hospital, a patient with an uncomplicated heart attack can go home. Physical activity is then gradually increased over the next three to six weeks. Doctors may recommend the patient attend cardiac rehabilitation.
Nice to Know:
While still hospitalized, the patient may get to know members of the cardiac rehabilitation team. Cardiac rehabilitation services can involve many health care providers, including:
• Doctors, including the family doctor, a heart specialist or cardiologist, and a surgeon.
• Nurses
• Exercise specialists
• Physical and occupational therapists
• Dietitians
• Psychologists or other behavior therapists
Most patients suspected of having suffered an acute heart attack are admitted to a hospital's coronary care unit (CCU). The CCU is intended to be a quiet, calm, and restful area in which patients can be further evaluated and closely monitored. A specially trained nurse who works with doctors and other members of the medical team provides individualized care. Visiting hours are usually restricted.
The length of stay in the CCU varies, depending on :
• Whether or not the diagnosis of a heart attack is confirmed
• The severity of the heart attack
• The presence and severity of associated complications
A patient with a heart attack without complications spends about two to three days in a CCU before being transferred to a step-down unit. A step-down unit offers less intensive care than the CCU but still permits continuous ECG monitoring to screen for abnormal heart rhythms or other complications. The patient usually goes home five to seven days after hospital admission.
What Are The Goals Of Care In The CCU?
Care in the CCU focuses on:
• Relief of chest pain and anxiety
• Further assessment (diagnostic tests) to confirm a diagnosis
• Limiting the size of the heart attack and the area of heart muscle that dies
• Reducing the work of the heart
• Identifying, preventing, and treating complications from the heart attack
In the CCU:
• Care for the patient begun in the emergency setting continues
• Additional diagnostic tests are ordered
• Doctors determine appropriate medical-surgical intervention.
• The patient's level of activity and diet is restricted
Diet And Activity Levels
Additional precautions taken during the stay in the CCU and step-down unit, include
• Restricting the diet
For the first 24 hours, the patient is placed on a clear liquid diet to reduce the possibility of aspiration due to nausea and vomiting. A healthy food plan, including complex carbohydrates and fiber-rich foods, is later introduced. All individuals who have suffered a heart attack need to permanently adopt a healthy diet.
• Limiting activity levels
All patients are initially placed on bed rest. Patients who are stable, free of pain, and free of complications are sometimes to get out of bed to use the commode. Patients who remain free of complication often begin limited physical activities within 24 hours.
Progression Of Activity
Days 1-2
• Sitting up with feet dangling over the side of the bed
• Lifting and lowering of the arms, called range-of-motions exercises, to prevent muscle and joint stiffness and to prevent blood clots from forming in the legs
Days 3-4
• Bathing and dressing while sitting on the bed or in a chair
• Taking short walks around the hospital room
• Taking supervised walks outside the hospital room
• Showering without shampooing hair (no raising of arms above head)
Days 5-7
• Walking about 600 feet three times a day
• Shampooing hair (activities with arms over the head)
• Climbing stairs with supervision
• Undergoing an exercise tolerance test
After several days in the hospital, a patient with an uncomplicated heart attack can go home. Physical activity is then gradually increased over the next three to six weeks. Doctors may recommend the patient attend cardiac rehabilitation.
Nice to Know:
While still hospitalized, the patient may get to know members of the cardiac rehabilitation team. Cardiac rehabilitation services can involve many health care providers, including:
• Doctors, including the family doctor, a heart specialist or cardiologist, and a surgeon.
• Nurses
• Exercise specialists
• Physical and occupational therapists
• Dietitians
• Psychologists or other behavior therapists
WEIGHT-BASED HEPARIN DOSING
INITIAL THERAPY - Bolus 60-80 units/ Kg
- Infusion 14-18 units/kg/hr
ADJUSTMENTS
aPTT<40 - 2000 units IV bolus, increase infusion by 2 units/kg/hr aPTT 40-44 - increase infusion by 1 unit/kg/hr aPTT 45-70 - no change aPTT 71-80 - decrease infusion by 1 unit/kg/hr aPTT 81-90 - hold for 0.5 hour - decrease infusion by 2 units/kg/hr aPTT >90 - hold for 1 hour
- decrease infusion by 3 units/kg/hr
NOTE: drain aPTT 6 hours after any bolus or change in infusion rate
- Infusion 14-18 units/kg/hr
ADJUSTMENTS
aPTT<40 - 2000 units IV bolus, increase infusion by 2 units/kg/hr aPTT 40-44 - increase infusion by 1 unit/kg/hr aPTT 45-70 - no change aPTT 71-80 - decrease infusion by 1 unit/kg/hr aPTT 81-90 - hold for 0.5 hour - decrease infusion by 2 units/kg/hr aPTT >90 - hold for 1 hour
- decrease infusion by 3 units/kg/hr
NOTE: drain aPTT 6 hours after any bolus or change in infusion rate
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