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CCRN "Sneak Peek"

Updated: Aug 14, 2022

1. S3 heart sound is heard in heart failure and Cor pulmonale.

2. Afterload is pressure measured by PVR (lungs) and SVR (body). Afterload (SVR) is low in distributive shock (neurogenic, anaphylaxis, sepsis).

3. Wolff-Parkinson-White (WPW) is an accessory pathway disorder characterized by a “Delta” wave - short PR interval and wide QRS on upstroke.

4. ST segment elevation in leads II, III, AVF indicates an Inferior MI (commonly the right coronary artery).

5. Prinzmetal’s (Variant) Angina due to vasospasm of coronary arteries, seen with stimulant use; hallmark sign is chest pain at rest. Treat with calcium-channel blockers, not beta-blockers.

6. Pericarditis (Dressler’s Syndrome) – pleuritic retrosternal chest pain, worse with inspiration and supine position. Global concave ST segment elevation on EKG. Friction rub heard best at left sternal border with diaphragm. Treat with NSAIDs (Aspirin) and allow to lean forward.

7. Dilated (systolic) cardiomyopathy – most common, can’t eject due to stretched thin ventricles, systolic dysfunction, OB and alcoholic cardiomyopathy.

8. ARDS – pathologic shunt resulting in refractory hypoxemia and damage to type II alveolar cells. P/F ratio < 201, “white out” on x-ray. TX: Oxygen, low TV 6 ml/kg, increase PEEP (15 or >) and give Surfactant to prevent alveolar collapse, prone position.

9. Carbon Monoxide (CO) poisoning - do not trust SpO2. TX: 100% FiO2 until carboxyhemoglobin < 10%, consider hyperbaric oxygenation.

10. Tension Pneumothorax – S/S: dyspnea, absent or reduced breath sounds on injured side, tracheal shift away from injured side, hypotension. TX: Emergency treatment is needle decompression mid-clavicular line of affected side and insert a chest tube.

11. Epidural hematoma - Middle meningeal artery tear from temporal bone injury. Rapid onset - unresponsive, lucid period, second unresponsiveness.

12. Guillain-Barre - Post viral infection, demyelination of lower motor neurons. S/S: ascending symmetrical paralysis, diaphragmatic involvement may cause respiratory distress. TX: monitor vital capacity for respiratory status and urine output for retention; corticosteroids, IV IG or plasma exchange.

13. Acute Pancreatitis - S/S: epigastric pain radiating to back, rigid abdomen, low-grade fever. DX: elevated amylase, lipase, glucose and decreased Calcium level. TX: fluid, calcium, potassium, and magnesium replacement; pain control; glucose control. Complications: Left pleural effusion, ARDS.

14. Diabetes Insipidus (DI) - low levels of ADH so lose volume, but hypernatremia. Risk is hypovolemic shock. Treat with desmopressin, Pitressin (ADH) and fluids.

15. DIC – consumption of clotting factors. DX: decreased platelets, H&H, fibrinogen. Increased fibrin degradation (split) products, D-dimer, PT, PTT, INR, and bleeding times.

CCRN References

1. American Heart Association, Manual of Advanced Life Support (ACLS), 2020.

2. Barron’s Adult CCRN Exam, 2nd ed., 2020 by Pat Juarez, MS, APRN, CCNS, CCRN-K.

3. Emergency Nurses Association (ENA). Sheehy, S. Sheehy’s Emergency Nursing: Principles and Practice, 7th ed. Elsevier, 2020.

4. Emergency Nurses Association (ENA). Trauma Nursing Core Curriculum, 8th ed., 2019.

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