Critical Care Focus 6: Cardiology by Galley, Woolf, Silagy, Haines, Knotterus, Cooklin, Connelly,

By Galley, Woolf, Silagy, Haines, Knotterus, Cooklin, Connelly, Scully, Marinker, Charles, Malik, Fell, Trowell, Rowbotham, Tylee, Dawson, Hall, McCluskey, Stewart, Taylor, Nunn, Advanced Life Support Group, William Beachley, Warren Sanger, Thomas Vallombros

This factor of the severe care concentration sequence addresses cardiological difficulties likley to be encountered within the extensive Care Unit. It contains facing sufferers with persistent center failure and the pharmacological remedy thoughts to be had; a step-by-step method of facing arrythmias, acute coronary syndrome, advances in dimension of cardiac output,and a close overview of the guts and vasculature in septic surprise.

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Although the estimation of cardiac output by the Fick equation is probably regarded as the ‘gold standard’, and can certainly be very accurate, it requires a great degree of technical skill and relies on other measurements, each with potential errors. It is clearly not feasible as a technique that can be used routinely. Several devices use variants of the Fick principle. 2,3 With experience, Doppler estimation of cardiac output is an accurate tool. However, insertion of the oesophageal probe requires an intubated patient, and certain anatomical and mathematical assumptions must be made to extrapolate the total flow from the descending aortic flow.

If haemodynamic compromise is present, regardless of whether this is ventricular tachycardia (VT) or supraventricular tachycardia (SVT), then DC shock is the first approach. Ventricular tachycardia Most cases of broad complex tachycardia are VT, particularly in the presence of ischaemia. Confirmation requires the presence of independent 36 MANAGING ARRHYTHMIAS P-wave activity, or capture or fusion beats on a rhythm strip. In compromised patients in VT, drugs alone work in only 40% of patients as a first-line treatment, especially in the absence of correction of all the factors that might be leading to the ventricular tachycardia in the first place.

Cardiologists tend to call acute myocardial infarction with ST elevation, transmural myocardial infarction. In contrast, non-Q wave infarction is referred to as sub-endocardial infarction. You may also find these described as ST elevation myocardial infarction (STEMI) or non-ST elevation myocardial infarction (non-STEMI) respectively. 1. These conditions are, for the majority of patients, due to either rupture or erosion of atherosclerotic plaques within the coronary artery walls. Rupture or erosion of a plaque results in exposure of the contents of the plaque to the circulating blood resulting in clot formation and, when this happens in a coronary vessel, a coronary thrombus forms.

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