1)Athsma-CVS relation
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3)ECG - how to interpret, different manifestations of diseased conditions
how to look at QRS axis
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4)oculocardiac, barocardiac reflexes.
- the one i mistook for these maneuvers are called "VAGOTONIC maneuvers" not "vasovagal reflex".
- def. of vasovagal reflex;
a stimulation of the vagus nerve by reflex in which irritation of the larynx or the trachea results in slowing of the pulse rate
- vagotonic meneuvers = vagal meneuvers
non-pharmacological interventions used to increase parasympathetic tone and slow conductions thru AV node.
it involves several different meneuvers.
carotid sinus massage
carotid sinus pressure
-a more "gentle" CSM-
valsulva maneuver
dive-reflex
oculocardiac reflex/aschner reflex
the more commonly applied vagotonic maneuver is the "Carotid sinus Massage" where the bifurcation of ext/int carotid arteries on either side of the neck is rubbed firmly. this stimulates the baroreceptor reflex and increases vagus tone, and withdrawal of symph. tone.
used to eleminate triggered arrythmiac activity. (afterpolarizations)
- comparizons of effectiveness of 5 different vagotonic maneuvers;
-summery- order of effectiveness - in decreasing effect;
seated facial immersion in ice-water
supine application of ice-water bag
Valsulva maneuver
Carotid Sinus Massage
Oculocardiac reflex
- more detailed technique directions for valvsulva and CSM.
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5)Periphiral pulse (and their anatomical position of the more important ones)
- radial artery - lateral to the tendon of flexor carpi radialus
- The brachial artery - medial to the tendon of biceps brachii in the antecubital fossa - easier to find in superextended arm.
- carotid artery - the anterior-medial border of the sternocleidomastoid muscle, above the hyoid bone and lateral to the thyroid cartilage.
- femoral artery - halfway between the pubic symphysis and anterior superior iliac spine (mid inguinal point)
- posterior tibial artery - 2cm inferior and posterior to the medial malleulus
- dorsalis pedis - proximal part of the first intermetatarsal space, between tendon of extensor halusis longus and tendon of extensor digitorum.
- popliteal artery - in the popliteal fossa, easier to find against the tibia.
- Over the abdomen (abdominal aorta)
- The temple
- The lateral edge of the mandible
- apex beat - left 5th intercoastal space 1inch medial to the mid-clavicular line.
In making an assessment of the peripheral pulses it is worth while having a check list of questions to ask yourself.
1. Is the pulse present and is its pressure/volume similar on both sides (equally strong/weak)?
2. Is there any greater delay than would be expected from the pulses distance from the heart?
3. In the case of the carotid and femoral arteries are there any audible flow noises (bruit)?
4. Only in the evaluation of the radial pulse is the rate and (importantly) rhythm an issue to be resolved.
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6)causes of flutter/ change in heart rate
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7)how stress can cause flutter
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8)epidemiology of flutter
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9)how to deal with stressed patients
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10) embryology and congenital defects of heart
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