ACP2 CPGs Flashcards
Clinical features of aortic dissection
- Sudden chest pain often described as sharp/ripping/tearing
- Pain linked to dissection location (anterior, neck/jaw, scapula, lumbar/abdominal)
- Pulse differences between heart beats and radial
- Visceral symptoms (pallor, vomiting, diaphoresis)
- Paraplegia
- Altered sensation in extremities
- Chest pain with associated neurological deficit
- Syncope
- Clinical features associated with cardiac tamponade
Risk factors for development of acute aortic dissection
- Males
- > 50 years
- Increased aortic wall stress (HTN, stimulant use, stress, blunt trauma)
- Medical conditions affecting connective tissues (Ehlers-Danlos syndrome, Marfans syndrome)
- Iatrogenic wall injury
- Pregnancy
Rx points to consider for suspected aortic dissection
- Oxygen
- IV access
- Analgesia
- Antiemetic
- IV fluids
- Blood products (request support)
Clinical features of acute coronary syndrome (ACS)
- Chest pain/discomfort
- Referred pain (arms/jaw/teeth)
- Dyspnoea
- Diaphoresis
- N+V
- Feeling of impending doom
Typical presentation of RVMI
- Hypotension
- Jugular vein distension
- Clear lung fields
Rx points to consider for ACS
- Oxygen
- IV access
- Aspirin
- GTN
- Antiemetic
- Fentanyl
Conditions associated with cardiac classified bradycardia
- Diseased SA node/AV node/His-Purkinje system
Types of conditions associated with non-cardiac classified bradycardia
- Environmental
- Metabolic
- Endocrine
- Toxicology
Clinical features of bradycardia
- Hypotension
- Syncope
- ALOC
- Chest pain/discomfort
- Congestive heart failure (CHF)
- Dyspnoea
- Diaphoresis
- N + V
- Dizziness
Common cause and initial mx focus for bradycardia
Hypoxia - mx should focus on improving oxygenation and ventilation
Definition of cardiac arrest
Cessation of blood circulation due to the inability of the heart to maintain adequate tissue perfusion
Two shockable cardiac rhythms
- Pulseless ventricular tachycardia (VT)
- Ventricular fibrillation (VF)
Two non-shockable cardiac rhythms
- Pulseless electrical activity (PEA)
- Asystole
Definition of cardiogenic shock
Prolonged hypotension with inadequate tissue perfusion perfusion in spite of adequate left ventricular filling pressure
Possible causes of cardiogenic shock
- AMI
- Drugs (beta blockers, calcium channel blockers, some chemo rx)
- Hypocalcaemia
- Ventricular hypertrophy
- Cardiomyopathy
- Aortic stenosis
- Aortic or mitral regurgitation
- Malignant HTN
- Catecholamine excess
Clinical features of cardiogenic shock
- AMI
- Chest pain/discomfort
- Diaphoresis
- Cold mottled/cyanotic peripheries
- ALOC
- Tachycardia/bradycardia
- Hypotension
- Respiratory distress secondary to pulmonary oedema (tachypnoea, hypoxia, wheeze)
Rx points to consider for cardiogenic shock
- Oxygen
- IPPV/CPAP
- IV access
- Aspirin
- Adrenaline
- IV fluids
Clinical features of broad complex tachycardia
- Palpitations
- Chest pain/discomfort
- Dyspnoea
- ALOC
- Syncope
- Haemodynamic compromise
Mx considerations for broad complex tachycardia without haemodynamic compromise
- Amiodarone
- Magnesium sulphate
Mx considerations for broad complex tachycardia with haemodynamic compromise
Synchronised cardioversion
Aetiology associated with cardiac classified narrow complex tachycardia
- SVT (due to stimulants, increased sympathetic tone, electrolyte/acid-base disorders, hyperventilation, emotional stress, pre-excitation syndromes [WPW])
- Atrial (AF, multiple atrial ectopics, atrial flutter)
Aetiology associated with non-cardiac classified narrow complex tachycardia
- Pain/anxiety
- Hyperthermia/fever
- Drug induced
- Anaemia
- Shock
Clinical features of narrow complex tachycardia
- Palpitations
- Chest pain/discomfort
- Dyspnoea
- ALOC
- Haemodynamic instability
Mx considerations for narrow complex tachycardia
- Oxygen
- Aspirin (if MI suspected)
- Modified Valsalva (if not compromised and regular)
- IV fluid (if compromised)