SCOPE Education

Phenylephrine a pure alpha-1 adrenergic agonist which means it causes systemic vasoconstriction which increases afterload. It also has venoconstriction properties which increases our preload as more blood 🩸 is redirected to the heart. 🔑 Key effects Best effects if SVR < 700 dynes ⬆️ SVR which ⬆️ MAP Indications: 1️⃣ Shock ⚡️(especially vasodilatory shock, neurogenic shock, hyperdynamic sepsis) 2️⃣ Pre and post intubation for BP control (hypotension with tachycardia) 3️⃣ Anesthesia induced hypotension 4️⃣ Tachydysrhythmia with hypotension (afib RVR with hypotension) 5️⃣ Patients who are hypotensive with aortic stenosis Effects on cardiac output 🫀 💡CO= stroke volume X heart rate ⬆️ CO due to preload ⬇️ CO due to reflex bradycardia and increased afterload Difficult to determine how a patient will react to the phenylephrine and is based on clinical context as it is variable. Example: Patients with cardiac dysfunction (systolic heart failure) won’t be able to tolerate the increased preload and will result in a decreased cardiac output. ⚠️ May cause reflex bradycardia #FOAMed #nurse #paramedic #ems #emt #medical #meded #medicaleducation #criticalcare #flightnurse #criticalcaremedicine #criticalcaretransport #nursing #nclex #emergencynursing #intensivecare #medicine #flightparamedic #ambulance #physician #physicianassistant #PANCE #PANCEprep #nremt #phenylehrine #pharmacology

Our sinoatrial node (SA node) is innervated and influenced by autonomic nerves which can increase and decrease heart rate 🫀. Graph 📈 X axis is time Y axis is the membrane potential (mV) Parasympathetic ⬇️🫀 The vagus nerve (cranial nerve X) releases acetylcholine, which binds to muscarinic receptors. This ⬇️ heart rate by prolonging repolarization and slowing the rate of depolarization. The heart rate decreases due to the extended repolarization time and reduced depolarization rate. Sympathetic ⬆️🫀 ⬆️ sympathetic activation causes norepinephrine to bind to beta adrenergic receptors, leading to an influx of calcium into the cells. This shortens repolarization time and increases the depolarization rate, resulting in a higher heart rate. #FOAMed #meded #medicaleducation #nurse #paramedic #emergencymedicine #criticalcare

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🌊 Riding the Wave: End Tidal Capnography ETCO2 Basics 🌊 🫁 Ventilation: ETCO2 ⬆️ with hypoventilation due to it building up in the blood stream and ⬇️ with hyperventilation as the body is rapidly expelling the CO2 ❤️ Circulation: ETCO2 also correlates with cardiac output. Lower values may indicate shock or low perfusion ⚡ Metabolism: Changes in metabolic rate (hyperthermia) can alter ETCO2 readings The classic waveform consists of: 0️⃣ Inspiration (CO2 drops to zero) 1️⃣ Expiration begins (initial upstroke) 2️⃣ Rapid rise in CO2 3️⃣ Alveolar plateau (ETCO2 measured) Normal ETCO2 range is 35-45 mmHg 🚨 Abnormal Waveforms: 🔻 Hypoventilation: ETCO2 > 45 mmHg and can have a prolonged Phase III. The Morphology may appear to be stretched out 🔺 Hyperventilation: ETCO2 < 35 mmHg, with increased CO2 elimination. You can sometimes see a gradual decrease in ETCO2 as time progresses ⏳ 🦈 Shark Fin Morphology: Seen in obstructive airway conditions like bronchospasm or COPD exacerbations, this is shown by a slanted Phase II and lack of a clear plateau

🫁💉Arterial Blood Gas (ABG) is the gold standard for determining the patient’s metabolic and respiratory status. ✨Must Know Values✨ 1️⃣ pH (7.35-7.45): how acidotic or alkalotic the patient is 2️⃣ PaCO2 (35-45): partial pressure of CO2 3️⃣ HCO3 (22-26) Bicarbonate levels 4️⃣ PaO2 (80-100) partial pressure of oxygen Acid base balance 🧪 Increased Hydrogen ions= acidemia Decreased Hydrogen ions= alkalemia We can use the formula pH= -LOG [H+] which means our pH is inversely proportional to the amount of Hydrogen ions. Our bodies like being in homeostasis and will use compensatory mechanisms to normalize our pH. If the issue is metabolic, the lungs will compensate. If the issue is respiratory, the kidneys will compensate. ⏰Lungs can compensate faster than kidneys Ex: In respiratory acidosis, there is a build up of CO2 due to hypoventilation. CO2 combines with water to make carbonic acid. Kidneys will increase bicarbonate reabsorption and excrete hydrogen ions. CO2 + H2O ↔️ H2CO3 ↔️ H + HCO3 In COPD patients, they can have chronic respiratory acidosis and will have less symptoms and could be compensated (HCO3 ⬆️ 4 mmol/L for every 10 mmHg ⬆️ in PaCO2) 💡Metabolic acidosis you should check the anion gap. Tic Tac Toe Method 🎯 Place your pH, CO2, and HCO3 in either an acidotic, normal, or alkalotic column. If the pH is in the same column as PaCO2, it is respiratory, if it is in the same column as HCO3 it is a metabolic problem. 🏛️ ROME Another useful trick: Respiratory Opposite: pH and CO2 move in opposite directions Metabolic Equal: pH and HCO3 move in the same direction Compensation 🔴 Uncompensated: pH is abnormal, and either PaCO2 or HCO3 is normal. 🟡 Partially Compensated: pH is still abnormal, and both PaCO2 and HCO3 are abnormal. 🟢 Fully Compensated: pH is back to normal, but PaCO2 or HCO3 is still out of range, meaning the body has corrected the pH but not the underlying problem. #FOAMed #meded #medicaleducation #nurse #paramedic #ABG

We are excited to be collaborating with Cardiovisual and Medicalvisual for this instagram live and working on video content for them! My good friend Jennifer from Cardiology Made Easy and I will be talking about atrial fibrillation Friday 8:00pm EST on instagram live so come check it out!

A first degree AV block is essentially a delay in the AV node ⏳ ECG findings include: 1️⃣ PRI > 0.2 sec (>200ms) 2️⃣ No extra P waves Causes ⚠️ Can include a high vagal tone, normal in your athletic patients, or inferior MI 🫀 #FOAMed #nurse #paramedic #ems #emt #medical #meded #medicaleducation #criticalcare #flightnurse #criticalcaremedicine #criticalcaretransport #nursing #emergencynursing #intensivecare #medicine #flightparamedic #ambulance #physician #physicianassistant #ekg #ecg #cardiology

Virchow’s Triad consists of 1️⃣ Hypercoagulability 2️⃣ Stasis of blood 3️⃣ Endothelial injury These are required for thrombosis. Hypercoagulability Malignancy, pregnancy, inflammation, estrogen therapy, sepsis, dehydration Stasis of blood 🩸 Immobility, obesity, afib, bradycardia Endothelial damage 💉 Physical trauma, venepuncture, trauma after delivery (pregnancy) #FOAMed #nurse #paramedic #ems #emt #medical #meded #medicaleducation #criticalcare #flightnurse #criticalcaremedicine #criticalcaretransport #nursing #emergencynursing #intensivecare #medicine #flightparamedic #ambulance #physician #physicianassistant #PANCE #PANCEprep #NREMT #virchowstriad #trauma

I want to make it clear that it isn’t super reliable to look at the morphology of the QRS and be able to accurately determine what the K+ is. This is because your average joe might follow this progression well, while patients who are more resistant to hyperkalemia due to dialysis might have different QRS morphologies such as just a peaked T wave with a potassium of 9. The “typical” progression of hyperkalemia goes: 1. Peaked T waves due to repolarization abnormalities 2. Prolonged PRI due to atrial paralysis (showing a first degree AV block) 3. P wave is flattened until it no longer exists 4. QRS widening until it reaches a Sine wave pattern due to conduction abnormalities. Hyperkalemia is the great imitator and can mimic anything from heart blocks, VT, Brugada syndrome, to STEMIs. #FOAMed #nurse #paramedic #ems #emt #medical #meded #medicaleducation #criticalcare #flightnurse #criticalcaremedicine #criticalcaretransport #nursing #emergencynursing #intensivecare #medicine #flightparamedic #ambulance #physician #physicianassistant #ecg #ekg #hyperkalemia #cardiology

Down and dirty preeclampsia Preeclampsia occurs when there is new onset hypertension (>140/90) typically after 20 weeks gestation ➕ protein iris or protein:Cr >0.3 OR New onset hypertension with end organ dysfunction. Symptoms 🤕 Headache Dyspnea Blurry vision 👀 Abdominal pain Edema Triad ⚠️ 1️⃣ Edema 2️⃣ Proteinuria 3️⃣ Hypertension You can also remember it by “PRE”eclampsia Proteinuria Rising BP Edema Preeclampsia with severe features BP: >160/110 Plt: <100,000 Serum creatinine: >1.1 mg/dL or 2X baseline ALT/AST: 2X normal or persistent RUQ/epigastric pain Pulmonary edema Severe headache Flashing lights/photopsia #FOAMed #nurse #paramedic #ems #emt #medical #meded #medicaleducation #criticalcare #flightnurse #criticalcaremedicine #criticalcaretransport #nursing #emergencynursing #intensivecare #medicine #flightparamedic #ambulance #physician #physicianassistant #PANCE #PANCEprep #nremt #preeclampsia