ACPO Flashcards

1
Q

what is the most common cause of CPO

A

LSHF

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2
Q

what happens in left sided heart failure that leads to CPO

A

LV becomes unhealthy and it can’t pump effectively, blood backs up in the pulmonary veins and capillaries

increased pulmonary pressure leadings to fluid from the interstitum pushing into the lungs

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3
Q

why dose severe HTN lead to CPO

A

LV cannot overcome the force required due to high after load

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4
Q

what is heart failure

A

inability of the heart to pump blood/ supply enough blood

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5
Q

what are the two types of heart failure

A

systolic were the ventricles can’t pump hard enough during systole

and diastolic, where not enough blood fills into the ventricles during diastole

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6
Q

how dose heart failure lead to arrhythmia

A

muscle wall becomes thins or thickens

heart cell irritation or ishcemia

arrhythmia

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7
Q

guidelines treatment of CPO

A

Acquire a 12 lead ECG.

Administer 0.8 mg of GTN SL.
Continue to administer 0.8 mg GTN SL every five minutes as above if the patient is not improving. Increase the dosing interval to ten minutes if caution is required.

Apply CPAP if the patient has moderate to severe respiratory distress that is not rapidly improving (see the ‘CPAP’ section). If backup for CPAP is unavailable or delayed, apply PEEP.

Commence a GTN infusion IV if the patient is not rapidly improving.

Fentanyl in 10-20 mcg doses IV or morphine in 1-2 mg doses IV may be administered every five minutes as required for severe anxiety

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8
Q

role of GTN in CPO

A

reduces preload and after load, off loading some strain from the heart, thus reducing the volume and ejection force required for the heart to pump

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9
Q

role of CPAP in CPO

A

decreased WOB and increased cardiac output by provoking a constant trend of positive pressure treating alveolar collapse

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10
Q

what is negative pressure pulmonary oedema

A

during any form of asphyxiation, negative pressure can develop in the thoracic cavity as a result of inspiratory effort against a closed airway

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11
Q

common mistakes with CPO

A

mistaking COPD for CPO

pneumonia for CPO

fail to identify route cause e.g. STEMI

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12
Q

how to treat negative pressure pulmonary oedema

A

do not go down CPO pathway, no CPAP or GTN, treat hypoxia

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13
Q

how to treat a CPO who is on a long acting vasodilator

A

reduce GTN dose to 0.4 mg and increase dose interval to 10 mins, prioritise CPAP

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14
Q

presentation of severe/ life threatning ACPO

A

Distressed, anxious, fighting to breathe, exhausted, catatonic

Words only or unable to speak

fine crackles - full field, with possible wheeze Marked chest movement with accessory muscle use, intercostal retraction+/- tracheal tugging

alt LOC

tacky ++ or Brady late sign

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15
Q

moderate CPO presentation

A

distressed

speaking 2-3 words

crackles at bases/ mid zone

decreased SP02

accessory use

pale and diaphoretic

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16
Q

name some common classes of antihypertensives

A

Direct-acting vasodilators (hydralazine, minoxidil, nitrates, nitroprusside)

Calcium channel blockers (verapamil, diltiazem, nifedipine, amlodipine)

An antagonist of the renin-angiotensin-aldosterone system (angiotensin receptor blockers, angiotensin-converting-enzyme inhibitors)

Beta-2 receptor agonist (salbutamol, terbutaline)