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Cardio questions

Cardio questions. What is shock?. Acute failure of circulation resulting in impaired or absent perfusion to tissues and subsequent insufficient oxygen provision to cells (hypoxia). What are the 5 main types of shock?. Hypovolaemic Cardiogenic Neurogenic Septic Anaphylactic.

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Cardio questions

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  1. Cardio questions

  2. What is shock? • Acute failure of circulation resulting in impaired or absent perfusion to tissues and subsequent insufficient oxygen provision to cells (hypoxia).

  3. What are the 5 main types of shock? • Hypovolaemic • Cardiogenic • Neurogenic • Septic • Anaphylactic

  4. Hypovolaemic shock • Causes • Blood loss • Massive vomiting and/or diarrhoea • Pathophysiology • Loss of circulating volume, reduced venous return, reduced SV, reduced CO, lower BP, reduced O2 delivery, impaired cellular function • S&S • Cold, clammy peripheries • Tachycardia • Prolonged cap refill time • Empty Veins • Management • Fluids

  5. Cardiogenic • Causes • Pump failure – e.g. ischaemia, arrhythmias, electrolyte disturbances • Pathophysiology • Backlog of blood builds up in the lungs • S&S • Cold, clammy peripheries • MAY have tachycardia • Prolonged cap refill time • MAY have raised JVP • Management • Inotropes (venodilators)

  6. Septic/Anaphylactic • Septic shock • Infection of the blood results in systemic inflammatory response and mass vasodilation – fluids leaks out • Anaphylactic shock • IgE mediated – type I hypersensitivity • Allergen stimulates IgE to bind mast cells which then degranulate and release histamine. • Vasodilation and increased capillary permeability. • S&S • Warm, dry peripheries • Tachycardia • Short cap refill time • BOUNDING pulse

  7. Management of sepsis? • FBC & serum lactate • High flow oxygen • IV fluids • Accurate urine output measurement • Blood culture • IV empirical antibiotics

  8. Management of anaphylaxis? • Adrenaline • Oxygen • Fluids if needed • Steroids and antihistamines for support

  9. Name the three shunts in foetal circulation… • Ductusarteriosus • collapses after birth, becomes ligamentumarteriosum • Foramen ovale • closes after birth, becomes fossa ovalis • Ductusvenosus • collapses after birth, becomes ligamentumvenosum

  10. Tetralogy of Fallot? • Pulmonary stenosis • RV Hypertrophy • Over-riding aorta • VSD

  11. What are the 3 layers of blood vessels? • Tunica intima • Tunica media • Tunica adventitia

  12. Murmurs • Systolic? • MR • Pansystolic • AS • Ejection systolic • Diastolic? • MS • Late diastolic • AR • Early/mid diastolic • Continuous? • PDA

  13. Describe where you would auscultate for murmurs…

  14. What is this? Ventricular Tachycardia Would you shock it? IF PULSELESS

  15. What is this? Ventricular Fibrillation Would you shock it? YES

  16. What are these? Atrial Fibrillation Atrial Flutter

  17. Where would you find this action potential? Pacemaker cells • Na ‘funny channels’ open and Na moves out • Na channels close and t-type Ca channels open • T-type Ca channels close and L-type open • L-type Ca channels close and K channels open (repol)

  18. Where would you find this action potential? Cardiomyocytes 0. Depol – fast Na channels open • Early repol – Na channels close and K channels open • Plateau – Ca channels open • Repol – Slow K channels open and Ca channels close • Resting

  19. What are the 2 types of hypertrophy in the heart? • Concentric • Wall thickness increases • No increase in volume • Usually caused by high pressure • Eccentric • Volume increase • Usually caused by mitral/aortic regurg

  20. What is pericarditis? (5 Ps) • Pleuritic positional pain with a preceding pyrexial illness

  21. 3 Degrees of heart block? • First Degree • Slowed impulse >PR interval • Second Degree • Wenckebach = progressively increasing PR interval until dropped beat • Mobitz type 2 = P:QRS fixed ratio e.g. 2:1, 3:1 etc. • Third Degree • Complete heart block = no relationship between P and QRS rhythms

  22. What would you use to reverse Warfarin? • Vitamin K • Prothrombin Complex Concentrates • FFP

  23. What would you use to reverse heparin? • Protamine sulphate

  24. Causes of chest pain? • Cardiovascular: Ischaemia, Pericarditis, Aortic dissection • Respiratory: Infection, PE, Pneumothorax • Neuromuscular: intercostal muscle myositis / strain • Arthritic/Orthopaedic: costochondritis, rib fracture, metastasis • GI: Reflux oesophagitis, Oesophageal spasm, Gastritis • Excitement: anxiety attack, hyperventilation

  25. That’s all folks!

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