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Medicine Y3 TCD 13-24 > 18. AAA lectures > Flashcards

18. AAA lectures Flashcards

Blood transfusion, intro to vascular disease, management of shock

1
Q

What are the main early signs that someone has significant blood loss

A

clinical shock so high HR low BP

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2
Q

When stopping a catastrophic bleed and someone is on warfarin for example, how do you reverse the action of the warfarin

A

with PCC - prothrombin complex concentrate

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3
Q

what anti-fibronoltyic agent helps to stabilise blood clotting and should be given within the first hour of haemorrhage occurring

A

tranexamic acid

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4
Q

when ordering blood which blood type would you use;
a) in an extreme emergency
b) if you can wait about 15 minutes from the sample arriving in the lab
C) the safest product if time allows (around 45-60mins)

A

a) group O RhD negative
b) group specific (ABO and RhD compatible)
c) crossmatched (fully screened for antibodies)

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5
Q

What are the components of pack 1 of the major haemorrhage pack

A

4 units of red cells

4 units of fresh frozen plasma (FFP)

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6
Q

what are the components of pack 2 of the major haemorrhage pack if the bleeding continues

A

4 units of red cells
4 units of FFP
1 dose platelets
2 packs of cryoprecipitate

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7
Q

once the haemorrhage is under control, what is the patient at risk of

A

thrombosis and so they will eventually need thromboprophylaxis

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8
Q

when you generally look at the patient in a vascular examination what things do you comment on (in notes you’ll see it abbreviated to An/J/Cy/Cl

A

no anaemia, jaundice, cyanosis and clubbing

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9
Q

if someones femoral pulse is rock hard what does this suggest

A

calcification

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10
Q

Again what are the 6 Ps in critical limb ischemia

A

pale
perishing cold
pulseless
painful

parenthetic
paralysed

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11
Q

in critical skin Ischaemia which are the most worrying signs (which of the 6ps)

A

Paraesthetic (muscle tenderness)

paralysed (numb mottled)

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12
Q

in chronic ischemia what does the Fontaine classifications I-IV mean

A

I - asymptomatic
II- claudication
III- rest pain
IV- tissue loss

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13
Q

what is claudication

A

aching muscles on effort
predictable
worse on hills, with loads, at speed
settles swiftly with rest

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14
Q

what are the main treatment options for peripheral vascular disease

A
  • Stop smoking
  • Antiplatelet therapy (aspirin 75mg od)
  • Blood pressure control (sBP less than 140)
  • Cholesterol reduction
  • Regular exercise
  • Weight loss
  • Controlled diabetes
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15
Q

In cerebrovascular disease what are the main issues.

A

atheroma in the carotid artery
can lead to stroke, TIA (stroke symptoms the recover within 24 hours), amaurosis (transient blindness in ipsilateral eye)

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16
Q

what are the investigations for cerebrovascular disease

A

Carotid duplex scan or angiography

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17
Q

what are the indications for a carotid endarterectomy

A

symptomatic patients within the past 6 months of symptoms
arterial disease greater than 70%. stenosis of the ICA
must be fit for surgery and have at least a 2 year life expectancy

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18
Q

What is the difference between abnormal dilation of an artery and ectasia

A

abnormal dilation of an artery is greater than 50% of its diameter
ectasia is dilation of up to 50%

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19
Q

what is arteriomegaly

A

generalise dilation of the arteries

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20
Q

what is the main aetiology of aneurysm

A

Atherosclerotic meaning you get it with age
mycotic meaning you get it from an infection of the arterial wall
connective tissue disorder such as marfans or Ehlers-Danlos syndromes (EDS)

21
Q

the shape of an aneurysm can be described as fusiform or saccular, what is the difference

A

saccular means asymmetrical dilatation whereas fusiform is symmetrical

22
Q

fill out the normal transverse diameter sizes for the following;

a) a normal aorta
b) ectasia
c) small AAA
d) large AAA

A

a) 2.5 cm
b) less than 3.5cm
c) less than 4.5
d) greater than 5.5 cm

23
Q

what is your stereotypical at risk patient of AAA

A

males that are 60 years or older who are hypertensive, smokers and have a FH of AAA

24
Q

what are the main surgical options for AAA and what are the cons of each one

A
  1. open surgery: replace the affected segment with plastic graft, rube or bifurcate
    - major cardiovascular stress and mortality is 5%
  2. end-vascular surgery/repaire (EVAR): reline the aorta
    - only 70% of aneurysm are suitable for this type of treatment and a lot of people get an endoleak
25
Q

what triad would make you think of an AAA rupture

A

collapse
hypotension
lower back/flank pain

26
Q

After correction of an AAA, what are the two most common causes of mortality

A

acute renal insufficiency

myocardial infarction

27
Q

How do you define shock

A

acute clinical syndrome initiated by ineffective perfusion and cellular hypoxia, resulting in severe dysfunction of organs vital to survival

28
Q

what are the key features of shock

A 
o	Acute tissue/organ hypo-perfusion 
o	Impaired delivery of oxygen to cells
o	Supply inadequate to meet demand 
o	Generalised cellular hypoxia 
o	Consequences for cellular respiration 
o	Haemodynamic abnormalities but shock isn’t simply the presence of hypotension
29
Q

? x ? = cardiac output

A

HR X SV

30
Q

? X ? = mean arterial pressure

A

CO x vascular tone

31
Q

what are the 4 types of shock

A

hypovolaemic - reduced intravascular volume
distributive- vasodilation and malperfusion
cardiogenic- intrinsic cardiac (pump) failure
obstructive- failure of circulatory flow

32
Q

give some examples of hypovolaemic shock

A

haemorrhage
burns
GI losses ( vomiting, diarrhoea, fistula)
dehydration (heat exposure, polyuria DKA)

33
Q

give some examples of distributive shock

A

systemic inflammatory response syndrome (SIRS) related - sepsis, pancreatitis, trauma, burns
neurogenic- spinal cord injury
Anaphylacxis

34
Q

give some examples of cardiogenic shock

A

myocardial infarction/ischaemia
arrhythmia
acute valve pathology.

35
Q

give some examples of obstructive shock

A

tension pneumothorax
pericardial tamponade
pulmonary embolism

36
Q

what is the physiological response of hypovolaemia

A
  • Sympathetic system activated (via the baroreceptors)
  • Adrenal catecholamine release
  • Compensatory cardiovascular responses
  • Sodium and water retention
  • Coagulation system activation
  • Cortisol release
37
Q

Give some signs of organ hypo-perfusion

A

o Skin
o Oliguria
o Cognitive changes
o Metabolic acidosis

38
Q

Give some examples of crystalloids

A

normal saline
hartmanns
ringers lactate
glucose solutions

39
Q

give some examples of colloids

A 
Gelofusine 
starch 
dextran 
blood 
plasma 
platelets
40
Q

in shock what are the important diagnosises that need to be ruled out

A

tension pneumothorax
pericardial tamponade
PE
Acute MI

41
Q

what medication can you give to increase the contractility of the heart

A

ionotropes

42
Q

A massive transfusion is defined as more than _____ bags in 24 hours or more than ______ bags in one hour

A

10 bags in 24 hours

4 bags in an hour

43
Q

Which pathway does the PT time look at

A

extrinsic pathway - increased in liver disease

44
Q

which pathway does the APTT time look at

A

intrinsic pathway

45
Q

for clotting to occur what 2 cells do you need in your body

A
  • one with TF (which is usually hidden in a healthy blood vessel) such as fibroblasts and macrophages
  • platelets
46
Q

what is DIC

A

disseminated intravascular coagulopathy

  • unregulated clots and lysis
  • blood clots form within the blood vessel and as clotting factors and platelets are used up, bleeding may occur
47
Q

whilst on ICU what is a patient at risk of developing after a massive haemorrhage

A

acute lung injury
renal dysfunction
DIC

48
Q

What is the issue with clotting associated with massive blood transfusion

A

dilution of platelets and clotting factors are recognised causes
• Transfused associated acute lung injury (TRALI)
• Transfusion associated circulatory overload (TACO)

49
Q

what are the main issues associated with prolonged stay on ICU

A 
o	Muscle weakness and wasting 
o	Nutritional deficiencies 
o	Sleep disorders
o	Inability to swallow effectively and micro aspiration of food 
o	Recurrent chest infections

Medicine Y3 TCD 13-24 (32 decks)

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