cardiac

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Removing kidney stones. HUGE stone! #throwback 

anonymous asked:

So I get that it's like a common misconception that people in a hospital get their hearts restarted with a defibrillator, that's only for hearts that have an irregular rhythm. But then what do hospitals actually use to restart a heart that's stopped? I'm having a weirdly hard time finding this information online. Thanks so much!

That’s a really good question!

Treating asystole comes down to this: Maintain life for as long as possible with CPR, figure out what’s wrong, and, if at all possible, fix it before the person dies for real.

There are 10 “reversible” causes for cardiac arrest:

  • Hypoxia: Too little oxygen in the blood (due to inability to get air into lungs (asthma, COPD), injury to lung tissue, or too little oxygen in the environment.).
    Reverse by getting oxygen into the blood by either CPR/ventilation or ECMO (heart-lung machine) if it can be set up fast enough.
  • Hypovolemia: Too little blood volume, due to dehydration or blood loss.
    Reverse
    by getting IV fluids/blood into the person.
  • Hyper or Hypokalemia- Too high or low potassium levels, which cause irregular heart beats and can eventually cause ineffective heart rhythms.
    Reverse
    by adding IV potassium if too low, or filtering potassium with a dialysis machine if too high.
  • Hyper or Hypothermia- Extreme high or low body temperature, where the body can no longer carry out normal functioning, due to extremely hot or cold environment, fever, or brain damage.
    Reverse
    by returning the person’s body temperature to normal with temperature controlled IV fluids, heating/cooling blankets.
  • Hydrogen Ions- body becomes too acidic either due to respiratory changes (carbon dioxide is acidic) or metabolic changes.
    Reverse
    by giving drugs that change body pH.
  • Tension Pneumothorax- Air in the chest cavity puts pressure on the lungs to they can’t effectively expand. Leads to hypoxia.
    Reverse
    by relieving pressure in the chest with a chest tube/thoracostomy.
  • Tamponade (cardiac)- blood or other fluid builds up around the heart and puts pressure on it.
    Relieve by pericardiocentesis (sticking a needle into the sac around the heart to relieve the pressure).
  • Thrombosis- a blood clot to vessels supplying the heart with blood, killing heart muscle (heart attack).
    Reverse by getting blood to the dying portion of the heart with either a stent or by dissolving the clot with a drug called TPA.
  • Thromboembolism- Same as thrombosis, but in the lung, killing lung tissue.
    Reverse
    same as above, but more likely with the TPA.
  • Toxins- drug overdose or poisoning.
    Reverse
    by figuring out what drug it was, and if available, giving the antidote.

During the time it takes to do any of this, someone would be doing CPR and giving epinephrine every 3-5 minutes. You’re really just hoping a pulse comes back on its own before there’s too much brain damage, TBH.

But unfortunately, that’s the nice version of the answer. Because in real life, it is exceedingly rare to survive asystole, even in a hospital setting with a code team and a crash cart. But hey, you’re writing a story, and anything you want can happen.

Side note: I have personally seen asystole shocked in real life. It was actually more of a demonstration for all the residents and med students participating than an attempt to save the guy, because he’d been an unwitnessed arrest and they’d been coding him for about 25 minutes at that point. Obviously it didn’t work, but that would be a situation where you might see it done.

My heart skip skips a beat

HEARTBEATS!!

The pause is to allow the atria to fully empty into the ventricle.

Heartbeat on an ECG trace

P Interval (Ventricular Diastole)

  • Atria and ventricles are relaxed
  • blood is flowing into the atria from the veins. 
  • Atrial pressure increases above that of the ventricle, AV valves open allowing blood to flow into the ventricle

P Wave (Atrial Systole) P-Q

Signal transduction from SA to AV nodes. 

  • SA node fires 
  • Atria contract causing atrial systole 
  • which forces all blood into the ventricles
  • emptying the atria.

Q Interval (End of Ventricular Diastole)

Depolarisation of interventricular (IV) septum 

  • AV valves remain open - all remaining blood squeezed into the ventricles. 
  • impulse from the SA node reaches the AV node 
  • which spreads the signal throughout the walls of the ventricles via bundles of His and Purkinje fibres
  • R peak is the end of ventricular diastole and the start of systole.

R Interval (Ventricular Systole)

Ventricular contraction

  • All blood is now within the ventricles
  • so pressure is higher than in the atria - AV valves close
  • ventricles start to contract although pressure is not yet high enough to open the SL (semilunar) valves

ST Segment (Ventricular Systole)

Ventricular contraction

  • Pressure increases until it equals Aortic pressure,
  • SL valves open
  • blood is ejected into the Aorta (and pulmonary artery) as ventricles contract
  • At this time the atria are in diastole and filling with blood returning from the veins.
  • plateau in ventricular arterial pressure

T Wave (Ventricular Diastole)

T= moment of Ventricular repolarisation immediately before ventricular relaxation

  • Ventricles relax
  • ventricular pressure is once again less than the aortic pressure 
  • so SL valves close

“Heart in a Box”

Transmedics Organ Care System:

Doctors call it a “beating heart transplant,” but it’s more commonly known as “heart in a box.” In the new method, doctors use a machine to keep a transplanted heart viable outside a patient’s body for up to 12 hours. The machine pumps oxygenated blood through the heart, keeping it in good condition longer.It was life-saving for DeStefano, New England’s first patient. The mother of two hopes to be home from Massachusetts General Hospital next week.Right now, about half of all donor hearts are wasted with the current method of putting them on ice because that can only keep the heart useable for four hours.

“Heart in a box” transplants are common in Europe. The device was created by Andover company TransMedics Inc.

–Source: The Boston Channel, 2012

The cardiac cycle is a term referring to all or any of the events related to the flow or blood pressure that occurs from the beginning of one heartbeat to the beginning of the next. The frequency of the cardiac cycle is described by the heart rate. Each beat of the heart involves five major stages. The first two stages, often considered together as the ventricular filling stage, involve the movement of blood from atria into ventricles. The next three stages involve the movement of blood from the ventricles to the pulmonary artery (in the case of the right ventricle) and the aorta (in the case of the left ventricle).

The first, “early diastole,” is when the semilunar valves close, the atrioventricular (AV) valves are open, and the whole heart is relaxed. The second, “atrial systole,” is when the atrium contracts, and blood flows from atrium to the ventricle. The third, “isovolumic ventricular contraction,” is when the ventricles begin to contract, the AV and semilunar valves close, and there is no change in volume. The fourth, “ventricular ejection,” is when the ventricles are empty and contracting, and the semilunar valves are open. During the fifth stage, “Isovolumic ventricular relaxation,” pressure decreases, no blood enters the ventricles, the ventricles stop contracting and begin to relax, and the semilunar valves close due to the pressure of blood in the aorta.

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Home is where the heart is…

…and when you apply this stunning anatomy themed wallpaper to your study/living room/love nest then the age old adage could not be more appropriate.

Aorta have this in the office but in the meantime, while I save up some pennies, bring your own walls to life by visiting the designer and retailer of these unique works of heart at the anatomyboutique

i-heart-histo

Source: www.anatomyboutique.com

Happy Nurses Week.

To the student nurses, who are just getting their feet wet and wondering what they’re in for.

For the new grad nurses, whose feet are wet, are still wondering what they’re in for and I’m sorry but what is this on my shoe?

For the experienced nurses, who know better than to look at their shoes any more.

For ortho nurses, who can wrangle anyone into a brace and know how to get you to the bathroom when you’re in a knee immobilizer, a shoulder immobilizer, and two wrist splints.

For cardiac nurses, who can read a rhythm strip from a mile away, are no strangers to pacer pads, and aren’t worried until your run of Vtach hits 20 beats.

For post op nurses, who can identify every drain you know and a few you don’t, who can pop stitches and staples out in 10 seconds without making you flinch, and change a surgical dressing in their sleep.

For med-surg nurses, who will handle the highest ratios and become pros at doling out 120 pills before 9am. 

For renal nurses, OR nurses, emergency nurses, observation nurses, palliative and hospice care nurses, home health nurses, wound nurses, PICC nurses, infusion nurses, clinic nurses, nurse practitioners, nursing professors, oncology nurses, critical care nurses, neuro nurses, and the literal hundreds of other nursing specialties I can’t name.

Thank you for all that you do, and all that you will do.