Cardio-Respiratory

*** ANGINA: • Chest pain, increases on exertion, relieved by rest/nitro • *Rx: ** sublingual nitroglycerine 0.4 mg q 5 min x3 or pain free ** O2 ** rest

*** ACUTE MI: • Chest pain > 30 min, shortness of breath, left arm/neck pain, diaphoresis, hypotension • *Rx: ** O2 • 2-4 L/min ** Nitro-glycerine 0.4 mg SL q 5 min x 3 ** Morphine liq sublingual

*** HYPERTENSIVE CRISIS: • BP > 200/120 • Headache • Epistaxis • Blurred Vision *Rx Catapress (clonidine) 0.1 mg q 1hr until DBP < 115 (total dose 0.8 mg) ** Procardia (Nifedipine) 5-10 mg swallow q 1 hr (x3), no sublingual may drop BP rapidly ** Nitroglycerine SL

*** HYPERTENSION: • Diuretics • Beta-blockers: no asthma/CHF • ACE inhibitors • Calcium channel blockers • Alpha 1 blocker: men with prostatic hypertrophy

*** DYSPNEA: Breathlessness, severe shortness of breath, 70% in cancer # lung-ca, CHF, COPD/Emphysema, CNS metastases, pain, anxiety, Anemia, Infection, terminal event, SVC • superior vena cava synd (edema above neck & upper extremity) • hrs or days ¢ infection • weeks ¢ tumor or chronic diseases *Rx: ** Treat the cause if possible ** relaxation ** reassurance ** breathing exercises ** fan ** cold humidified air ** Fowler’s position ** pursed lip breathing ** Bronchodilators ** Prednisone, control pain • Asthma / COPD: Albuterol, Atrovent inhaler, Beclovent inhaler, ** Theophylline for COPD, • CHF: raise head of bed, Diuretics, Digoxin, ACE inhibitors • Infections: antibiotics unless near and symptomatic death # Death rattle: ** turn patient on side; Scopolamine Patch; Atropine 1% 1-2 drops SL/PO Q 4 hrs ** Small doses of Ativan or Valium as anxiolytics • Anemia: Transfusion (affects lasts 2 days) • SVC or TUMOR: Radiotherapy +/- Corticosteroids • O2 • Morphine

*** COUGH: # Pneumonia, bronchitis, lung abscess, COPD, Cancer, Smoking, CHF, LVH, ACE inhibitors, GERD *Rx: ** remove irritants ** oral hydration ** steam ** antibiotics for infections except actively dying ** expectorants • Bronchospasm: Bronchodilator; Atrovent; Proventil inhalers • Post nasal drip: Anti-histamines / decongestants; Pseudoephedrine (Sudafed= decongestant) • CHF: Diuretics, Digox-in, raise head of bed, (ACE inhibitors may induce cough) • Dry cough: ** hydration, humidity and or steam, Bronchodilators, terpin hydrate • Productive cough: ** Antitussive, Dextrometh-orphan, Codeine PO; Scopolamine sublingual / patch ** Atropine PO or SL ** Corticosteroids • Cancer: radiation or chemotherapy • Dying with ineffective cough: ** morphine ** atropine drops ** Scopolamine patch

*** LYMPHEDEMA: Unilateral painless non-pitting edema # post-mastectomy: immediately or yrs. later; radiotherapy; Pelvic malignancy • document limb circumference *Rx: ** elevate the extremity ** avoid infection ** Compression stockings ** lymphatic compression pump ** light massage ** exercise ** no Diuretics A physical therapy (Home?) pneumatic compression 1 hr/d for 1 month ** TS proximal & distal to the swelling ** short course of decahedron ** if very painful consider infection or tumor invasion

***PERIPHERAL EDEMA: causes : *Heart, liver & kidney failure, Fluid retention, Immobility, Hepatomegaly, Low serum albumin, CHF, Pelvic tumors, nephrotic syndrome *Rx: ** Elevate extremities ** Exercise ** Ted Hose ** Start Diuretics ** Reduce the dose or D/C Steroids

*** DVT: ** Elevate leg ** moist heat ** Heparin ** Coumadin

*** BRONCHOSPASM: *Rx: Albuterol ** amino-phyline ** steroids ** Radiotherapy: large carc-inoma ** Opiods: the most powerful central cough suppressants ** Nebulized Lidocaine: 2% can bring dramatic relief

*** SUPERIOR VENA CAVA SYNDROME (SVC): # Right apical lung ca; breast; lymphoma; mets, 80% direct extension of tumor # Headache, swelling of the face & right arm, swollen eyes, pain, dilated neck veins, visual changes, incerase BP in that arm *Rx: ** Decaderon 8-12 mg per day ** Radiation ** Chemotherapy, ** symptomatic therapy