12 Lead EKG Interpretation

Answer:

ST elevations on V1, 2, 3 and 4

LAD

AnteroSeptal MI

Ventricular Arrythmias/High degree heart blocks

Cardiogenic shock

Antoarrythmic agents, pressors, dilators, IABP

12 Lead Interpretation

Questions:

1. The ST elevations are in what leads?

2. What kind of MI?

3. What coronary artery is affected?

4. What possible arrythmias will the patient have?

5. What are the interventions related to the arrythmias?

6. In this kind of MI, what do we want to make sure we rule out? How do we do that?

7. What would be the treatment for that?

The Answers:

1. Leads II, III and aVF

2. Inferior Wall MI

3. Right Coronary Artery

4. brady arrythmias, low degree heart blocks

5. Pacemaker, atropine when symptomatic

6. Right Ventricular Infarct. 18 lead EKG.

7. Volume, volume, volume

Blood Gas

What is your interpretation of the blood gas?

a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic alkalosis
d. Metabolic acidosis


What is the reason and how do you want to treat that?

Any changes on the ventilator settings?

Metabolic Acidosis.

The reason is due to hypoperfusion. When there is hypoperfusion, lactic acid production occurs, anaerobic metabolism ensues and that results into metabolic acidosis.

No changes on the ventilator settings. Give sodium bicarbonate as a temporary fix, treat the hypoperfusion as far as the definitive treatment.

Additional information:

What is the patient's Anion Gap?

The Anion Gap is 21. How did we do that? Add sodium and potasium, minus chloride and CO2.

An Anion gap of less than 15 is normal - that means the metabolic acidosis is due to a base loss.

An anion gap of greater than 15 means that the metabolic acidosis is an acid gain. In this case the hypoperfusion causing lactic acidosis is an acid gain.

Here is another DYK (Did You Know)

Anion gap is not useful when the patient is not on metabolic acidosis!!!

ABG
ph - 7.30
pCO2 - 40
HCO3 - 18
Base Excess - -4

Happy reading!!!

Post Ventricular Septal Rupture Repair

Immediate Post-Op

HR - 122/min
BP - 88/60 mmhg
Temp. - 35.8
PCWP - 13 mmhg
CVP - 12 mmhg
PAP - 42/14 mmhg
SVO2 - 42 mmhg
CI - 1.9
SVR - 2860
Vent settings:
VT - 600
AC - 16
FI02 - 90%


ABG
ph - 7.30
pCO2 - 40
HCO3 - 18
Base Excess - -4

Electrolytes
Na - 138
K - 3.0
Cl - 112
CO2 - 8

Hemoglobin 12
Hct - 32
WBC - 9800

IABP - 1:1 frequency
Aug - 80mmhg
MAP - 45 mmhg
Assisted Aoedp - 50
Unassisted Aoedp - 50
Assisted Systole - 80
Unassisted 81

Mediastinal tube - 60 ml
Pleural CT - no air leaks

Patient is intubated and sedated (on propofol)
Dopamine at 6 mcg/kg/min
Nipride is at 1 mcg/kg/min

Based on hemodynamic parameters, what is the most emergent situation the nurse has to do?

a. Cardiogenic Shock
b. Tension pneumothorax
c. Cardiac Tamponade
d. Septic Shock

The answer to this is cardiac tamponade because there is equalization of pressures between PAD, PCWP and CVP.

What this is?

Hello Everyone,

I want to welcome everyone to my critical care essentials blog. This blog site is more than that. It will be a place to share my thoughts, information and the funny and the sad part of being a nurse. It will be a journey for me and for you. You will get to know me, maybe like me, maybe not like me, you may agree or disagree, I maybe politically incorrect and all my entrees are not a representation of who I work for. These are my thoughts and thus I alone am responisble for it.

The other part of this blog is to share some questions with each others and try to help each other find the correct answers that can all help us out with the certification exams. I will post some questions and have you all look into it. You can post some questions as well.

The last point I want to make is that, I will be posting some thoughts from my iphone and with that said, I maybe posting things that are not grammmatically correct. I will try my very best not to do that.

So let's begin our journey!!!!

Hello