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🫀 Adaptasyon Fizyolojik · Leson 5 sou 10 · 8 min

MI ak Ensifizans Kadyak: Minit ak Liv

MI and Heart Failure: Minutes and Pounds

⏳ Pou yon kriz kadyak, revèy la se minit: 12-plis nan 10, balon nan 90. Pou ensifizans kadyak, revèy la se liv: 2 oswa 3 nan yon nwit vle di rele. Egzamen an verifye toude revèy yo.

⏳ For a heart attack, the clock is minutes: 12-lead within 10, balloon within 90. For heart failure, the clock is pounds: 2 or 3 overnight means call. The exam checks both clocks.

💡 Ide prensipal

MI: ECG nan 10 minit, aspirin, nitro, PCI nan 90 minit pou STEMI, veye aritmi. Ensifizans kadyak: goch se poumon, dwat se kò; pwa chak jou; 2 rive 3 liv nan yon nwit vle di rele.

MI: ECG in 10 minutes, aspirin, nitro, PCI within 90 minutes for STEMI, watch for arrhythmias. Heart failure: left is lungs, right is body; daily weights; 2 to 3 pounds overnight means call.

🧠 Poukisa sa enpòtan

ENFAKTIS MYOKAD: doulè oswa presyon nan pwatrin ki kraze, ki pa soulaje ak repo oswa nitroglycerin, ki gaye nan bra, machwè oswa do, ak dyafòrèz, noze ak dispne; fanm, granmoun aje ak dyabetik ka gen fatig, endijesyon oswa souf kout olye. Jwenn yon ECG 12-plis nan 10 minit apre arive ak nivo TROPONIN. Bay ASPIRIN moulen, nitroglycerin (kenbe si BP sistolik anba 90 mm Hg, yo sispèk enfaktis vantrikil dwat, oswa yo te pran yon inibitè phosphodiesterase-5 resamman), oksijèn si satirasyon anba 90%, ak morphine pou doulè nitrat pa soulaje; pou MI ak elevasyon ST objektif la se entèvansyon koronè pèkitan nan 90 minit apre arive, oswa fibrinolitik nan 30 minit apre arive lè PCI alè (nan 120 minit apre premye kontak medikal) pa posib. Kontwole aritmi, kòz prensipal lanmò bonè, ak ensifizans kadyak ak chòk kadyojenik. ENSIFIZANS KADYAK: ensifizans bò GOCH retounen nan poumon yo ak krepitasyon, dispne, òtopne, kracha woz mous ak yon tous; ensifizans bò DWAT retounen nan kò a ak distansyon venn jigulè, èdèm periferik, epatomegali ak pran pwa. PWA chak jou nan menm lè chak maten; yon ogmantasyon 2 rive 3 liv nan yon jou oswa 5 liv nan yon semèn vle di rele founisè a. Anseye restriksyon sodyòm, limit likid jan yo preskri, ak medikaman: sacubitril-valsartan (oswa yon inibitè ACE oswa ARB); yon beta blocker; spironolactone (yon MRA); yon inibitè SGLT2; dyiretik pou likid; epi pafwa digoxin. BNP monte ak ensifizans. ÈDÈM POUMON egi: chita dwat ak janm yo pandan, oksijèn wo debit, IV furosemide, nitrat ak morphine jan yo preskri.

MYOCARDIAL INFARCTION: crushing chest pain or pressure unrelieved by rest or nitroglycerin, radiating to the arm, jaw or back, with diaphoresis, nausea and dyspnea; women, older adults and diabetics may have fatigue, indigestion or shortness of breath instead. Obtain a 12-lead ECG within 10 minutes of arrival and TROPONIN levels. Give chewed ASPIRIN, nitroglycerin (hold if systolic BP is below 90 mm Hg, right ventricular infarction is suspected, or a phosphodiesterase-5 inhibitor was taken recently), oxygen if saturation is below 90%, and morphine for pain not relieved by nitrates; for ST-elevation MI the goal is percutaneous coronary intervention within 90 minutes of arrival, or fibrinolytics within 30 minutes of arrival when timely PCI (within 120 minutes of first medical contact) is not possible. Monitor for arrhythmias, the leading cause of early death, and for heart failure and cardiogenic shock. HEART FAILURE: LEFT-sided failure backs up into the lungs with crackles, dyspnea, orthopnea, frothy pink sputum and a cough; RIGHT-sided failure backs up into the body with jugular venous distention, peripheral edema, hepatomegaly and weight gain. Daily WEIGHTS at the same time each morning; a gain of 2 to 3 pounds in a day or 5 pounds in a week means call the provider. Teach sodium restriction, fluid limits as ordered, and medications: sacubitril-valsartan (or an ACE inhibitor or ARB); a beta blocker; spironolactone (an MRA); an SGLT2 inhibitor; diuretics for fluid; and sometimes digoxin. BNP rises with failure. Acute PULMONARY EDEMA: sit upright with the legs dependent, high-flow oxygen, IV furosemide, nitrates and morphine as ordered.

🏥 Nan lavi reyèl

⚖️ Yo voye yon pasyan ki gen ensifizans kadyak lakay ak yon balans ak yon règ. Kat jou apre li peze 3.5 liv plis pase jou anvan an epi cheviy li anfle, kidonk li rele klinik la olye li tann souf kout. Yon ajisteman dyiretik kenbe li deyò lopital la. Règ pwa a mache paske likid parèt sou balans lan yon jou oswa de anvan li parèt nan poumon yo.

⚖️ A client with heart failure is discharged with a scale and a rule. Four days later she weighs 3.5 pounds more than the day before and her ankles are puffy, so she calls the clinic instead of waiting for breathlessness. A diuretic adjustment keeps her out of the hospital. The weight rule works because fluid shows up on the scale a day or two before it shows up in the lungs.

📌 Sa pou retni

  • ECG nan 10 minit; aspirin, nitro, oksijèn si anba 90%; pou STEMI, PCI nan 90 minitECG within 10 minutes; aspirin, nitro, oxygen if under 90%; for STEMI, PCI within 90 minutes
  • Ensifizans goch: krepitasyon ak dispne; ensifizans dwat: èdèm ak JVDLeft failure: crackles and dyspnea; right failure: edema and JVD
  • Pwa chak jou: 2 rive 3 lb nan yon jou oswa 5 lb nan yon semèn vle di releDaily weight: 2 to 3 lb in a day or 5 lb in a week means call

📖 Tèm nan leson sa a

Ensifizans kadyak bò gòch (Left-sided heart failure): Ensifizans ki voye san an tounen nan poumon yo, ki lakòz krakman, dispne, òtopne ak krache kim.

Ensifizans kadyak bò dwat (Right-sided heart failure): Ensifizans ki voye san an tounen nan kò a, ki lakòz distansyon venn jigoulè, èdèm ak fwa ki ogmante.

MONA (medikaman kriz kadyak) (MONA (heart attack drugs)): Morphine, Oxygen, Nitroglycerin, Aspirin: lis rapèl klasik pou yon sispèk kriz kadyak; jodi a aspirin vini anvan, oksijèn sèlman anba 90% satirasyon, epi morphine sèlman si nitrates yo pa mache.

LEFT = LUNGS, RIGHT = REST (bò ensifizans kadyak) (LEFT = LUNGS, RIGHT = REST (heart failure sides)): Ensifizans bò gòch tounen nan Poumon yo (krakman, dispne, krache kim) epi ensifizans bò dwat nan Rès kò a (èdèm, venn kou, fwa): triye sentòm ensifizans kadyak la.

Sacubitril-valsartan: Yon konbinezon pou ensifizans kadyak ki diminye lanmò ak sejou lopital; pa janm bay li nan 36 èdtan apre yon inibitè ACE oswa bay moun ki te gen anjyoedèm sou yon inibitè ACE oswa yon ARB, veye tansyon, potasyòm ak kreyatinin, epi sispann li nan gwosès.

Antiplakèt (aspirin, clopidogrel) (Antiplatelets (aspirin, clopidogrel)): Anpeche plakèt yo fè boul apre kriz kadyak, konjesyon serebral oswa yon stent; toude lakòz senyen epi anjeneral yo sispann yo 5 a 7 jou anvan operasyon dapre òd, aspirin pa janm bay timoun ki gen maladi viral (sendwòm Reye), epi omeprazole febli clopidogrel.

✅ Teste tèt ou

Yon pasyan ki gen ensifizans kadyak rapòte li pran 3 liv depi yè maten epi li santi plis souf kout. Kisa enfimyè a dwe konseye?A client with heart failure reports gaining 3 pounds since yesterday morning and feeling more short of breath. What should the nurse advise?
  1. Ogmante konsomasyon likid pou chase sodyòm nanIncrease fluid intake to flush out the sodium
  2. Kontakte founisè a jodi aContact the provider today
  3. Tann yon semèn epi peze ankòWait a week and weigh again
  4. Sote dyiretik jodi a pou wè si li amelyoreSkip today's diuretic to see if it improves

Repons: B · Kontakte founisè a jodi a

Yon ogmantasyon 2 rive 3 liv nan yon nwit, ansanm ak souf kout ki agrave, endike akimilasyon likid. Yo dwe kontakte founisè a menm jou a pou evalye pasyan an epi ajiste tretman an. Sote dyiretik, ogmante likid oswa tann ta kite surchaj likid agrave.

A gain of 2 to 3 pounds overnight, together with worsening shortness of breath, indicates fluid accumulation. The provider should be contacted the same day to evaluate the client and adjust treatment. Skipping diuretics, increasing fluids or waiting would allow fluid overload to worsen.

Yon pasyan rive ak doulè nan pwatrin ki gaye nan bra goch ak dyafòrèz. Ki aksyon ki priyorite nan premye 10 minit yo?A client arrives with chest pain radiating to the left arm and diaphoresis. Which action is the priority within the first 10 minutes?
  1. Jwenn yon istwa familyal detayeObtain a detailed family history
  2. Pwograme yon echocardiogramSchedule an echocardiogram
  3. Jwenn yon ECG 12-plisObtain a 12-lead ECG
  4. Kòmanse ansèyman pou dechajBegin discharge teaching

Repons: C · Jwenn yon ECG 12-plis

ECG 12-plis la idantifye elevasyon ST epi li dirije desizyon repèfizyon ki kritik nan tan an. Yon echocardiogram se yon tès kadyak itil, men li pa ka montre elevasyon ST epi li pa fè pati premye 10 minit yo.

The 12-lead ECG identifies ST elevation and drives the time-critical reperfusion decision. An echocardiogram is a useful cardiac test, but it cannot show ST elevation and does not belong in the first 10 minutes.

Ki rezilta ki endike ensifizans kadyak bò GOCH?Which findings indicate LEFT-sided heart failure?
  1. Distansyon venn jigulè ak èdèm cheviyJugular venous distention and ankle edema
  2. Epatomegali ak asitHepatomegaly and ascites
  3. Pran pwa ak distansyon nan vantWeight gain and abdominal distention
  4. Krepitasyon, òtopne ak kracha mousCrackles, orthopnea and frothy sputum

Repons: D · Krepitasyon, òtopne ak kracha mous

Vantrikil goch la retounen san nan poumon yo; vantrikil dwat la retounen li nan sikilasyon sistemik la.

The left ventricle backs blood into the lungs; the right ventricle backs it into the systemic circulation.

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