Lynn Shared "Perfusion 2005" - 14 Picmonics

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Perfusion 2005

Peripheral Artery Disease (PAD)
Mechanism
Atherosclerosis
Assessment
Intermittent Claudication
Pain with Exercise
Paresthesias
Arterial Ulcers
Critical Limb Ischemia
Amputation
Consideration
Ankle-Brachial Index (ABI)
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1 min
Types of Strokes
Warning Signs
Transient Ischemic Attack (TIA)
Reversible Ischemic Neurologic Deficit (RIND)
Types
Ischemic
Thrombotic
Atherosclerosis
Embolic
Atrial Fibrillation
Hemorrhagic
Severe Hypertension
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3 mins
Stroke Management
1) Non-contrast CT
A) If hemorrhagic:
Keep BP below 160/105
Nitroprusside
Reverse anticoagulation
Consult neurosurgery
NIH Stroke Scale
Supplemental O2
2) Ischemic stroke/TIA
Keep below 220 over 120
Pressors MAP under 60 or SBP under 90
Decide if tPA indicated
IF tPA contraindicated, give aspirin/clopidogrel
Long-term treatment
Workup/management (within days of stroke)
1) EKG
If AFIB present
Warfarin or LMWH
2) Echocardiogram
Heparin-warfarin bridge if thrombus present
3) Carotid artery ultrasound
If over 70 percent occluded AND symptomatic
OR just 80 percent occlusion
Carotid endarterectomy
Aspirin for everyone (long term)
Statin (everyone)
Labetalol, nicardipine
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Ischemic stroke management
<3 hrs tx. is thrombolytics
tPA (tissue plasminogen)
> 3hrs tx. anti-platelets
Aspirin + dipyridamole
Clopidogrel (Plavix)
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Right Hemisphere Stroke Assessment
Opposite Side Weakness (Hemiplegia)
Poor Proprioception
Disoriented to Person, Place, Time
Can't Recognize Faces (Prosopagnosia)
Loss of Judgement and Awareness
Impulsiveness
Personality Changes
Tonal Hearing Loss
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2 mins
Left Hemisphere Stroke Assessment
Opposite Side Weakness (Hemiplegia)
Side to Side Discrimination
Aphasia
Agraphia
Slow Performance
Aware of Deficits
Anxiety
Depression
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2 mins
Myocardial Infarction Assessment
Assessment
Substernal Chest Pain
Crushing or Dull Sensation
Arm, Jaw, and Neck
> 20 Minutes
Unrelieved by Nitro
Palpitations
Diaphoresis
Fear of Impending Doom
Nausea and Vomiting
Shortness of Breath
Considerations
Monitor for Arrhythmias
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2 mins
Myocardial Infarction Diagnosis
Diagnosis
12 Lead ECG
ST Elevation
Q Wave
T Wave Inversion
Troponin T and I
CK-MB
Considerations
Early ECG
Cardiac Stress Test
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2 mins
Myocardial Infarction Interventions
MONA
Morphine
Oxygen
Nitrates
Aspirin
Thrombolytics (tPA)
Invasive Procedures
Cardiac Catheterization
Stent Placement
Angioplasty
Coronary Artery Bypass Grafting (CABG)
Considerations
Decrease Modifiable Risk Factors
Resuming Activity (Physical, Sexual)
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2 mins
Coronary Artery Bypass Grafting (CABG)
Indications
ST-Segment Elevation Myocardial Infarction (STEMI)
Cardiovascular Disease (CAD)
Uncontrolled Angina
Considerations
Internal Mammary Artery
Saphenous (Leg) Vein
Transient Limb Edema
Closely Monitor Patients
Venous Thromboembolism (VTE) Prophylaxis
Incentive Spirometer
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2 mins
Cardiac Catheterization
Considerations
Fluttering Sensation
Contrast Media
NPO 6-12 Hours
After Procedure
Bed Rest
Assess Circulation
Assess for Bleeding
Monitor Vital Signs
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2 mins
Evolution of Myocardial Infarction and Complications
Hours to Days
Arrhythmia
Before 7 Days
Fibrinous Pericarditis
Papillary Muscle Rupture
Interventricular Septum Rupture
Before 14 Days
Ventricular Pseudoaneurysm
Ventricular Free Wall Rupture
After 14 Days
True Ventricular Aneurysm
Dressler Syndrome
Other
Left Ventricular Failure
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2 mins
Coronary Arteries
Aortic Root
Right Coronary Artery (RCA)
Right (Acute) Marginal Artery
Posterior Descending Artery (PDA)
Left Coronary Artery (LCA)
Left Anterior Descending (LAD) Artery
Circumflex Artery
Left Marginal Artery
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1 min
Atherosclerosis
Very common. Disease of elastic arteries and large- and medium-sized muscular arteries.
A form of arteriosclerosis caused by buildup of cholesterol plaques
Progression is in separate picmonic
LOCATION
Abdominal aorta > coronary artery > popliteal artery > carotid artery
RISK FACTORS
Modifiable: smoking, hypertension, hyperlipidemia (Increased LDL), diabetes.
Nonmodifiable: age, sex (Increased risk in men and postmenopausal women), family history.
SYMPTOMS
Angina
Claudication
Can be asymptomatic
COMPLICATIONS
Aneurysms
Ischemia
Infarcts
Peripheral Vascular Disease
Thrombus
Emboli
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