A&P Flashcards
CPR Rates:
Adult
Child
Newborn
Adult:
30: 2 pausing for ventilations
15: 1 no pause for ventilation once advanced airway inserted.
Children:
30: 2 single responder
15: 2 dual response
15: 2 dual response no pause with advanced airway
Newborn:
3: 1 single responder
3: 1 dual response
Reasons for adrenaline in arrest (4)
Alpha effects – vasoconstrictive qualities. An increase in peripheral vascular resistance
increases venous return and eventually cardiac output and coronary perfusion pressures.
Beta 1 – increases the irritability of the ventricles and hopefully enable the generation of
a rhythm.
Beta 1 – increases myocardial contractility and hopefully cardiac output.
Has a short ½ life
ICP role in cardiac arrest
- Insertion of a definitive airway – ETT
- Further drug therapy for prevention, or control of lethal arrhythmias.
- Education
- Treat complications arising from clinical presentations and prevent them from occurring.
LMA Indications and Contra indications
Indications:
- Unconscious patient without gag reflex
- Ineffective ventilation with BVM/oxysaver and airway Mx (OPA / NPA)
- > 10/60 assisted ventilation required
- Unable to intubate - difficult/failed intubation
Contraindications:
- Intact gag reflex or resistance to insertion
- Strong jaw tone + trismus
- Suspected epiglottitis or upper airway obstruction
LMA Precautions
- Inability to prepare the patient in the “sniffing position”
- Pts who require high airway pressures eg advanced pregnancy, morbid obesity,
decreased pulmonary compliance (stiff lungs due to pulmonary fibrosis) or increased
airway resistance (severe asthma) - Pts less than 14 years of age due to enlarged tonsils
- Significant volume of vomit in airway
Function of the Heart
The heart is a muscle located in the central chest to the left. Its primary function is the pumping
of blood around the body, providing nutrients and removing waste.
Flow of blood
Blood enters from the body into the right atrium via the superior vena cava
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From right atrium through the tricuspid valve into the right ventricle
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From the right ventricle into the pulmonary vein to the lungs
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Blood returns from the lungs to the left atrium via the pulmonary vein
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From the left atrium through the mitral valve into the left ventricle
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From the left ventricle to the body via the aorta
Define ACS
The spectrum of conditions ranging from unstable angina through to NSTEMI to STEMI, which
all share the common pathophysiology of a disrupted atherosclerotic lesion.
Unstable angina (UA) and NSTEMI are characterized by a non-totally occlusive white thrombus; the difference being that UAP resolves prior to death of any myocardium and NSTEMI involves some myocardial death. STEMI is characterized by a totally occlusive red thrombus.
Define AMI
Necrosis or death of myocardial tissue, usually due to prolonged ischemia resulting from an
atherosclerotic plaque with superimposed thrombus.
Define Angina pectoris
Angina is an episodic, clinical syndrome that results from transient myocardial ischemia, causing
pain in any of the cardiac sites.
Define Unstable Angina
Advanced angina with presence of transient thrombi formation over atherosclerotic lesions.
There is impending infarction.
Define Atherosclerosis
Initiated and compounded by inflammatory response, it is a progressive disease characterized by
thickening and hardening of an artery over time, caused by soft deposits of lipids, cellular debris,
fibrin, and calcium in the lining of large arteries (in the intima).
Define Atheroma
A sub-intimal collection of lipids and cellular debris leading to raised plaques and complicated
lesions subject to fissuring, haemorrhage or rupture.
Pathophysiology of Coronary Artery Disease and Acute Coronary Syndrome
Build up of fatty plaque, lipids and blood products
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Injury to tunica intima wall
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Infiltration of lipoproteins, RBC‟s, WBC‟s, macrophages, collagen, with smooth muscle proliferation – all
within the wall of the tunica intima
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Formation of non-obstructive fatty streak
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Atherosclerotic plaque formation will begin to project into the lumen of coronary arteries.
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The plaque cap is disrupted causing the contents of the plaque to mix with passing blood.
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Contact between tissue products and blood, this can cause platelet aggregation on the surface of the intima.
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Activation of a clotting factor creates a continues in a cascade until fibrinogen is converted into fibrin.
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Clot grows and forms an occlusion of the blood vessel
ACS Risk Factors
P - Post menstural H - HTN A - age over 40 (men) D - Diabetes H - HyperChol H - History (family) O - Obesity R - Race (black) S - Smoking S - Sedintary
Chest Pain Assessment
Sweating Palpitations Nausea/Vomiting Dizziness/Lightheaded SoB Calf Pain Peripheral Oedema BP L vs R Diarrhea Constipation
AMI Path Flow Chart
Occlusion
No O2 supply. Irritation, ECG changes
Anerobic Metabolism
Increased intraacellular sodium
Cell swells, and ruptures
Released enzymes and ions - further ECG changes
Cell death
Cardiogenic Shock with Right Ventricular Involvement
Approx 1/3 of patients with inferior AMI have right ventricular involvement.
The most serious complication of right ventricular infarction is SHOCK – decrease in preload, less in right
ventricular ejection therefore less returning to left side of heart – causing decrease in stroke
volume
Cardiac Failure – LVF
Up to 20% of AMI patients present with some congestive failure. Generally speaking the more
severe the LLVF the higher the mortality.
Increased pulmonary oedema.
Coronary Blood Supply
SA, AV, Atrium and Ventricles
SA supplied by
55% RCA 45% LCx
AV and Bundle of HIS supplied by
90% RCA 10% LCx
Right Atrium: sinus node artery (which is a branch of the RCA in 55% of cases & LCx in 45%)
Left Atrium: is supplied by the LCx
Right Ventricle (posterior portion): RCA and posterior descending branch (PDA) & LAD
Right Ventricle (anterior portion): RCA and LAD
Left Ventricle (posterior) is supplied by LCx, PDA & LAD, Anterior Left main, LAD & LCx
Apex is supplied by LAD
Septum is supplied by septal branches of LAD, PDA and AV nodal branch of RCA.
Define Collateral Circulation
An arteriolar to arteriolar anastomosis between branches of the same of different coronary
arteries. Collateral circulation develops when circulation to an area declines. They develop more
efficiently when obstruction to the area is gradual as opposed to sudden.
Goals of Treatment - ACS
Increase O2 delivery to the heart
Decrease myocardial O2 demand
Reduce BP to minimize further plaque rupture
Prevent cardiac failure
Minimize progression of injury/infarction
Minimize clot formation and platelet aggregation
ACS Treatment
ICP Aspirin Monitor Oxygen if required GTN Pain Relief Anti emetics if required
Define Cardiac Failure
The inability of the heart to independently provide adequate cardiac output to perfuse the tissues
with vital blood-borne nutrients
LVF Signs (12)
dyspnoea, DOE, use of accessory muscles, crackles (usually fine end expiratory), pink/white frothy sputum, fatigue, lethargy, weakness, anorexia, insomnia, tachycardia, diaphoresis, pallor, low SpO2
RVF Signs (9)
weight gain, oedematous lower limbs, abdominal distention, ascites, hepatomegaly, splenomegaly, neck vein distension, anorexia, nauseam feeling of gastric fullness
Define Cardiogenic Shock
Shock of cardiac cause, give that shock is a progressive syndrome of inadequate cardiac output.
Normal metabolic demand for O2 and nutrients is not met and metabolic waste products
accumulate in the cell. Progressive cell and organ ischemia leads to death of the cell, organ and organism.
Sympptoms Cardiogenic Shock
Hypotension
Tachycardia
Altered conscious state
Define Pulmonary Oedema
Leakage of fluid from the pulmonary circuit and interstitium into the alveolar spaces.
Whether Cardiogenic or non-Cardiogenic in origin, regulation and balance between capillary hydrostatic
and oncotic pressure, lymphatic drainage and alveolar permeability is compromised.
This results in the shift and thus accumulation of fluid in the alveoli, causing respiratory
compromise
Causes APO (5)
Volume overload Pressure overload Filling disorders Myocardium dysfunction High output states
