NREMTP Review-Justin D. 🚑🚒 Acidosis/EKG
What do these conditions all have in common?
Shock
Renal Failure
Hyperkalemia
Diarrhea
Crush Injury
Rhabdomyolysis
Respiratory Failure
!!!!!The body hates ACID more than anything else!!!!!
Normal Blood Ph
7.35-7.45
There are many types of Acids!!!
Acidosis
CO2-Carbon Dioxide=Carbonic ACID
Potassium=ACID
Biproduct of hypoperfusion=Lactic ACID
Ketones=ACID
Bicarbonate (Electrolyte)
Produced in the kidneys
takes hours to days to produce more bicarbonate
MOA-Fights acid, it neutralizes it, buffers it, and increases the pH level
Potassium
Lives inside the cells
Intracellular electrolyte
Responsible for nerve conduction and muscle contraction, especially the heart (Excitability)
EKG Changes (Hyperkalemia)
Peaked T-Waves
Absent or flattened P-waves
Widened QRS complex
Paramedic Treatment for Metabolic Acidosis from Hyperkalemia
Sodium Bicarbonate
Neutralizes and fights the acid, increasing the ph. level
Calcium Chloride
A cardiac protectant. It protects the heart from fatal dysrhythmias (V-tach/V-Fib)
Albuterol
It pulls the potassium out of the blood, and puts it back into the cells
Renal Failure
Chronic kidney failure=Dialysis
No urine production=CANNOT get rid of POTASSIUM!!!!!
Metabolic Acidosis
Perforated=RUPTURED
Naproxen, Ibuprofen, Motrin, Toradol (NSAID)-cause GI bleeding, and it is rough on the kidneys
Pedal edema & Crackles=Acute Renal Failure
Abdominal Quadrants & Organs
LUQ
Stomach
Spleen
Pancreas
Small/Large intestine
RUQ
Liver
Gallbladder
Intestines
RLQ
Appendix
Ovary
Intestines
LLQ
Ovary
Intestines
Diverticulum (Inner lining of the large intestine=Colon)
Rhabdomyolysis
Acute Renal Failure
Patho-A breakdown of skeletal muscle tissue, it produces a biproduct called MYOGLOBIN, which accumulates and travels to the kidneys, decreasing their function, causing DARK COCA-COLA colored urine
They will have a low urine output=leads to Hyperkalemia=Metabolic Acidosis
Nor-epinephrine (Levophed)
Vasopressor
Given for distributive shock (Septic shock & Neurogenic shock) for low BP, when fluids have failed to improve the BP
Vasoconstriction=Increases the BP
Depolarization=Contraction
Repolarization=Relaxation (Fill)
P-wave
Atrial Depolarization
QRS Complex
Ventricular Depolarization
T-wave
Ventricular Repolarization
1 small box=0.04 sec
1 large box=.20 sec
5 large boxes=1 second
EKG strip=6 seconds (30 large boxes)
"The RULES"
What is the HR?
Is it Regular or irregular?
Is there a single consistent P-wave in front of each QRS?
What is the PR Interval? ********
Is there any ectopy? (PVCs)
Normal PRI
.12-.20 sec (3-5 small boxes)
QRS Width
.04-.12 sec (1-3 small boxes)
QT Interval
Start of the Q wave to the end of the T-wave
*Normal .40-.48
Sinus Rhythms
ALWAYS REGULAR
ALWAYS have a Normal PR Interval
Single P-wave w/ every QRS
HR is 60-100=NSR
>100=Sinus Tachycardia
<60=Sinus Bradycardia
Symptomatic Bradycardia
Stable
Normal BP
NO AMS
NO Syncope
NO ischemic CP
weakness
dizziness
nausea
Paramedic Treatment
IV
Atropine 1 mg (MR to a total of 3 mg)
Unstable
AMS
Hypotension
Syncope
Ischemic chest pain
Paramedic Treatment
Atropine 1 mg
TCP
Dopamine (5-20 mcg/kg)
OR
Epinephrine drip
Ventricular Tachycardia (V-Tach)-Wide complex Tachycardia
ALWAYS REGULAR
Widened QRS
NO P-waves
NO T-Waves
V after V after V after V
V-Tach w/ Pulses (Stable)-normal BP, No AMS, No syncope
Amiodarone-150 mg in 50 ml bag over 10 min
OR
Lidocaine 1 mg/kg
Unstable
Immediate cardioversion
Drugs
V-Fib
NEVER A PULSE=ALWAYS CARDIAC ARREST
3-year-old scribbling on the wall
No organization
Unable to see any definable waveforms
Fibrillation=Quivering
A-Fib
ALWAYS IRREGULAR
No discernable single p-wave in front of each QRS
No rate rule
If the HR is >110=A-fib w/ RVR or Rapid A-fib
Stable
IV
Calcium Channel Blockers
Cardizem
Diltiazem
Verapamil
Unstable
Immediate cardioversion
A-Flutter
Almost always Regular
Saw toothed P-waves
may be anywhere between 2, 3, 4, 5, or even 6 saw tooth p-waves
SVT
ALWAYS REGULAR
NO P-waves
HR >150 bpm
Narrow QRS
Stable
Vagal Maneuvers (Bearing down, Diving Reflex
Mammalian Diving Reflex=Place the pts. face in a bowl of ice or cold water
IV in the Left AC
Adenosine 6 mg RIVP
MR at 12 mg
Unstable
Immediate cardioversion
The BLOCKS
1st Degree Block
ALWAYS REGULAR
Everything looks sinus except for 1 thing
The PRI is >.20 sec
2nd Degree Type 1 (Mobitz I or Wenckebach)
ALWAYS IRREGULAR
NO rate rule
The PRI gets longer...longer...then drops a QRS
2nd Degree Type II (Mobitz II)
It may be regular or irregular
2 or more P-waves in between any of the QRS complexes
The P-wave closest to the QRS has a normal PR Interval
3rd Degree Block (Complete AV Block)
May be regular or irregular
May have 2 or more P-waves between QRS
Often, wide QRS
The P-wave closest to the QRS has NO relationship. It has such a long PRI you will not measure it
