CEN Procedures Flashcards: 110 Practice Questions & Answers

CPAP increases intrathoracic pressure, which decreases the transmural pressure across the LV wall, effectively reducing LV afterload. It also decreases venous return (preload), which reduces pulmonary congestion. In a failing LV, the reduction in afterload often outweighs the drop in preload, improving stroke volume. BCEN Tip: Remember that while it decreases preload (usually bad for CO), in HF, the afterload reduction is the win.

Heart transplant patients have a denervated heart; the vagus nerve is severed during the procedure. Atropine works by blocking vagal (parasympathetic) tone on the SA and AV nodes to increase heart rate. Without vagal innervation, Atropine has no mechanism of action and will be ineffective. Clinical Pearl: For these patients, skip Atropine and move directly to Transcutaneous Pacing (TCP) or direct-acting chronotropic agents like Epinephrine or Isoproterenol.

This indicates Re-expansion Pulmonary Edema (REPE). Priority actions: 1. Immediately stop or clamp the drainage. 2. Administer high-flow oxygen (prepare for NPPV or intubation). 3. Position the patient with the affected side DOWN (lateral decubitus) to improve V/Q matching in the unaffected lung. 4. Support hemodynamics (diuretics are often NOT indicated as this is a permeability issue, not volume overload). CEN Strategy: BCEN emphasizes the 1-1.5L limit for initial drainage to prevent this high-mortality complication. REPE is caused by increased capillary permeability in a lung that was collapsed for a long period.

The **Mauriceau-Smellie-Veit maneuver**. The infant's body rests on the nurse's forearm; the index and middle fingers are placed on the infant's maxillary bones (malar bones) to maintain head flexion, while the other hand applies pressure on the occiput. *Clinical Note:* Breech deliveries in the ED are high-risk; the primary goal is to keep the fetal head flexed to minimize the diameter passing through the birth canal.

**Distal neurovascular status**, specifically distal pulses (Dorsalis Pedis/Posterior Tibial) and sensation/motor function. Rationale: Traction can potentially compress the popliteal artery or peroneal nerve if applied incorrectly or with excessive force. Comparison to the unaffected limb is essential. If pulses disappear or sensation changes after traction, the tension must be immediately reassessed. CEN Strategy: Check-Intervene-Recheck is a mandatory sequence for all splinting tasks.