Mark Klimek Audio Notes
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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
Mark Klimek Audio Notes
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If tube goes lower than pt level – contaminated
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)
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Must check Creatinine for Nephrotoxicity – NOT urine output
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
Mark Klimek Audio Notes
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Route determines TAP – Not the drug
TROUGH IV 30 MIN BEFORE NEXT DOSE IM 30 MIN BEFORE NEXT DOSE SUB Q 30 MIN BEFORE NEXT DOSE PO 30 MIN BEFORE NEXT DOSE
PEAK IV 15-30 min after its done IM 30-60 min after its given Subling 5-10 min after its in the system
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
Mark Klimek Audio Notes
VFib: you DFib Asystole: epinephrine then atropine
Chest Tubes The only chest surgery that doesn’t require a chest tube is a pneumonectomy – because you remove the entire lung Water seal breaks 1. 2. 3. 4.
Clamp Cut Put in Water 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
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Mark Klimek Audio Notes
Tetralogy of Fallot: VarrieD PictureS Of A RancH VD: ventricular defect PS: pulmonary stenosis OA: Over Riding aorta 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
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