06.03 Multi-System CCRN Important Points for CCRN Review

Nursing Points

General

1. Important points for testing
   
   1. Massive blood transfusion–> Large amount over 24-hour period
      1. High amounts of citrate which can cause hypocalcemia
      2. Citrate = Preservative in blood donation bag
         1. Binds to calcium and inactivates it
         2. Citrate then reduces calcium level in blood
         3. Removed from blood by liver quickly but not in large amounts and not in trauma patients
   2. TPN (Total Parenteral Nutrition)
      1. Creats increase in insulin
         1. Causes cellular shift of phosphate
            1. Results in hypophosphatemia
   3.  Amphogel-> Medication for gastric acid and it reduces phosphate levels
   4. ARDS ( Acute Respiratory Distress Syndrome)
      1. Fluids leak into lungs–>Causes difficulty breathing
      2. Decrease fluids in these patients
   5. Acidosis–> Increases potassium
   6. MCL1 (Modified Chest Lead, Marriott’s Chest Lead, Modified Central Lead)
      1. On 12 lead EKG
         1. Negative electrode below left clavicle
         2. Positive electrode on 4^th intercostal space
      2. MCL1 will differentiates Ectopy vs. Aberrancy