Alert and Oriented.: marzo 2012

martes, 20 de marzo de 2012

Dementia:

Alzheimer's Dementia
Vascular Dementia
Lewy Body Dementia
Parkinson's Disease
Normal Pressure Hydrocephalus
Huntington's Disease
Wernicke-Korsakoff's Syndrome
Creutzfeldt-Jakob Disease
Down's Syndrome

jueves, 15 de marzo de 2012

AWESOME website for studying EKGs!

http://meds.queensu.ca/courses/assets/modules/ts-ecg/ecg_index.html

Can you tell that I'm about to take my first ACLS class?

Adenosine (for fast heart rate):

Brand Name: Adenocard, Adenoscan
Class: Antiarrhythmic
Indication: Supraventricular tachycardia (SVT), Paroxysmal SVT
Quick-acting, short-term therapy used to restore a normal heart rate and rhythm when there is SVT present
Always given when hooked up to EKG
Given intravenously (IV)
May be used to diagnose tachycardia
Will slow the heart rate when it is due to abnormal electrical pathway in the heart; will not work if the fast heart rate is due to other cause
May slow heart rate for a short time if you also have atrial fibrillation or atrial flutter
Side Effects:

Skin flushing in the face
Shortness of breath
Headache
Nausea
Chest pain or pressure

Supraventricular Tachycardia:

Supraventricular tachycardia (SVT): a fast heart rate that begins in the upper part of the heart (atria), above the ventricles
Normally, the heart's electrical system precisely controls the heart's rhythm; in this condition, abnormal electrical connections cause the heart to beat too fast.
Most supraventricular tachycardias result from abnormal electrical connections (bypass tracts) in the heart that short-circuit the normal electrical system and cause an increase in electrical activity.
Supraventricular tachycardia may cause an uncomfortable feeling that the heart is racing, pounding, and/or beating irregularly (palpitations). Additional symptoms include feeling dizzy or lightheaded, near-fainting or fainting (syncope), shortness of breath, chest pain, throat tightness, and sweating.
Some supraventricular tachycardias do not cause symptoms and may not need treatment. But if supraventricular tachycardia recurs, medicines or a procedure called catheter ablation may be needed to correct the abnormal heartbeat.

Catheter Ablation:

Catheter ablation (ab-LA-shun) is a medical procedure used to treat some types of arrhythmia (ah-RITH-me-ah). An arrhythmia is a problem with the rate or rhythm of the heartbeat.
During catheter ablation, a series of catheters (thin, flexible wires) are put into a blood vessel in your arm, groin (upper thigh), or neck. The wires are guided into your heart through the blood vessel.
A special machine sends energy to your heart through one of the catheters. The energy destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start.
Catheter ablation often involves radiofrequency (RF) energy. This type of energy uses radio waves to produce heat that destroys the heart tissue. Studies have shown that RF energy works well and is safe.

Sources:

Difference between NSAID and acetaminophen

So, I've always known that Aspirin and Tylenol weren't the same exactly, but I really never understood why. And when I did, I would often forget the difference. Here's the breakdown:

Non-steroidal anti-inflammatory drug (Aspirin):

reduces pain
reduces fever
reduces inflammation
causes stomach irritation/damage (biggest disadvantage of this medication)

inhibits the production of prostaglandins --> inhibits protection against acidity
prostaglandins

local hormones that transmit pain information to the brain
modulate hypothalamic thermostat
activate inflammatory response
stimulates constriction and clotting of platelets
involved with induction of labor
involved with GI tract (inhibits acid synthesis and increases secretion of protective mucus)
increases blood flow in kidneys
bronchoconstrictor (used for asthma)

reduces blood clot formation

Aspirin is the only NSAID with an antiplatelet effect

Common types: Aspirin, Ibuprofen, Naproxen, Advil, Toradol, Motrin

These drugs differ in their mechanism of action, although they accomplish the same task

Acetaminophen/Paracetamol (Tylenol):

reduces pain
reduces fever
not indicated for anti-inflammatory purposes because it exhibits weak anti-inflammatory activity
does NOT reduce blood clot formation
better tolerated in those with gastric acid problems
Common types: Tylenol, Genapap, Feverall, Actamin, Altenol, Aminofen, Anacin Aspirin Free, Apra

Sources:

Mnemonics to help:

Aspirin is NOT acetaminophen
Acetaminophen = A for Analgesic!

Important note

When treating a patient with a heart condition (i.e. heart failure, heart attack) we have to remember not to give the patient nitroglycerin if they are taking any phosphodiesterase inhibitors (commonly used for erectile dysfunction). Phosphodiesterase inhibitors are peripheral vasodilators and can actually be used to treat hypertension, too. Nitroglycerin is a nitrate, given to treat patients with angina and is classified as a coronary vasodilator, meaning that it will increase the size of blood vessels leading directly to the heart. When you mix both nitroglycerin (nitrate) and phosphodiesterase inhibitors together, your patient is at risk of dropping their blood pressure to an extremely low level, possibly leading to a heart attack or stroke since not enough blood (aka oxygen) would effectively travel to the heart or to the brain.

This is a very useful bit of information to know -- especially useful for anyone interested in ICU, ED, or telemetry since there are many patients with heart conditions who may be taking a medication for erectile dysfunction.

More info on phosphodiesterase inhibitors: http://www.mayoclinic.com/health/erectile-dysfunction/MC00029
More info on nitroglycerin: http://www.mayoclinic.com/health/drug-information/DR602937

Really interesting topics to look up

Ibuprofen (acetaminophen) vs. Acetaminophen (Tylenol)
Torsades de pointes
Indications of magnesium, atropine, epinephrine, dopamine
Summary of one research article in the American Journal of Critical Care
Summary of one research article in the American Journal of Nursing