BEH Response Flashcards
Describe the Chain of Survival (adult), and the implications of each component
Early Recognition
- AMI progression to cardiac arrest is 21-33% in 1st hour
- 80% of patents will show signs before cardiac arrest
- Rapid activation of ambulance service
Early CPR
- Fundamental in an attempt to restore life
- Buys time, preserving the brain
- Each 1/60 delay chance of survival drops by 3-4%
Early Defibrillation
- Restarts the heart
- Double to triples the survival from a VF cardiac arrest
- Within 3-5 min survival rates 49-75%
- With each 1/60 delay chance of survival decreases 10-12%
Effective Post Resuscitation Care
- Targeted to preservation of heart and brain, notice blue brain, therapeutic hypothermia
Describe the Paediatric Chain of Survival
Prevention
- SIDS
- Injury (MCA)
- Congenital malformations
Early CPR
Prompt access to Emergency Services
Rapid Paediatric Advance Life Support PALS
Integrated post cardiac arrest care
Describe the progression for Newborn life support:
Describe the progression of Paediatric Basic Life Support
Describe the progression of Adult Basic Life Support
Describe the progression of Adult BLS with AED
Describe the progression of Adult ALS
Describe the progression of Paediatric ALS
Alteration of the level of consciousness usually begins with reduced awareness of one’s self, followed by reduced awareness of the environment, and finally by an inability to be aroused.
Describe the 6 categories of ACS:
Categories of Altered Conscious State
Consciousness
A state of awareness of both self and environment
Confusion
loss of clear thinking, usually manifested by impairment of cognitive abilities and decision making
Disorientation
Often accompanying/ preceding confusion, disorientation to place and then by deficiency in short-term memory
Lethargy
Resembling profound slumber, movement or speech limited, can be aroused by moderate external stimulation, but immediately relapses into a state of limited responsiveness
Stupor
A condition of deep sleep or unresponsiveness from which the pt can be aroused only with repeated vigorous stimuli
Vegetative State
No evidence of self awareness, may open eyes spontaneously giving appearance of a state of arousal - poorly sustained and sluggish
Coma
Unresponsive to all stimuli including pain
Describe the major causes of Altered Conscious State using AEIOU TIPS
AEIOU TIPS
- *A**lcohol
- *E**pilepsy, Encephalopathy, Electrolyte abnormalities, Endocrine disorders
- *I**nsulin, Ischemia
- *O**verdose, Oxygen deficiency
- *U**remia
- *T**rauma, Temperature
- *I**nfection
- *P**oisoning
- *S**hock, stroke, space occupying lesions
Describe some of the effects of alcohol:
Effects of Alcohol
- Complex effects on neurons in the brain
- Depression of CNS functioning
- Respiratory depression in high doses
- Irritation of the oesophageal and stomach lining
- Increased risk of vomiting
- Depression of gag reflex
- Lead to non traumatic deaths such as aspiration
- Hypothermia can result for peripheral vessel vasodilation
- Hypotension
- Increased HR
- Altered conscious state
- Effects exacerbated in elderly due to
- Decrease in lean body mass
- reduced liver function
- decrease in gastric motility
Describe the Visual Signs of Intoxication
Visual Signs of Intoxication
- Flushing
- Altered cognition
- Inappropriate emotional responses
- Smell of alcohol
- Slurred or incoherent speech
- Mood swings
- Increased sedation
- Ataxia
- Analgesic effect - despite injury or illness
- Altered behaviour
- Decreased consciousness
Describe the classification of Epileptic Seizures:
Classification of Epileptic Seizures
- Partial
- Simple Patrial Seizures
- Complex Partial Seizures
- Genralised
- Absent
- Myoclonic
- Tonic Clonic
Describe a Simple Partial Seizure
Simple Partial Seizure
No impact on conscious state, can present with localised motor movement and sensory disturbance (aura or prodrome, i.e. tingling, gustatory or olfactory) Can also present with Tc, diaphoresis, hT, HT or pupillary changes
Describe the effect of a Complex Partial Seizures
Complex Partial Seizure
- Impairs consciousness, can start localised and become generalised. They are accompanied by automatisms (unconscious behaviours) such as lip smacking, gracing, patting/ pulling clothes
- Post ictal state (after seizure), confusion, sense of deja vu, Jamais vu, detached, depersonalised
Describe the effects of an Generalised Absent Epileptic Seizure
Generalised Absent Epileptic Seizure
- Non convulsive, disturbances in consciousness, although limited signs or symptoms mainly occurring in children.
- Characterised by: blank stare, motionlessness, unresponsiveness, automatisms, changes in postural tone
- Are brief in nature and can be unnoticed
Describe the effects of a Genralised Myoclonic Seizure:
Genralised Myoclonic Seizure
- Brief involuntary muscle contractions, bilateral rigid violent contraptions of muscles, fixing the limbs in strained positions
- Impaired consciousness during, Post ictal state same as partial complex seizure
- confusion, sense of deja vu, Jamais vu, detached, depersonalised
Describe the effects of a Generalised Tonic Clonic Epileptic Seizure
Generalised Tonic Clonic Epileptic Seizure
- Most common, a sharp tonic contraction with extension of the extremities and immediate loss of consciousness, incontinence is common, as is cyanosis, followed by clonic phase, bilateral contraction and relaxation of extremities (jerking)
- Deviation of eyes, normally lasts 60-90 seconds
- In the post ictal state patient is confused, disorientate, detached, agitated, tired and sleepy
Describe Hepatic Encephalopathy and its common signs and symptoms
Hepatic Encephalopathy
CNS manifestation due to liver failure
Ammonium ion produced as a metabolite not being broken down to urea before entering the general circulation, the ammonium ion builds up in the blood and enters the cerebral circulation where it has vast impacts
Signs & Symptoms
Decreased mental alertness, confusion, agitation, memory loss, coma, convulsions
Hypernatraemia is seen at what plasma Na concentration, breifly describe how this could occur and its common signs and symptoms
Hypernatraemia
Plasma Na conc >145 mEq/L
Loss of water or Increase in Na Serum levels
Signs and Symptoms
- Oliguria/ anuria
- Polydipsia (excessive thirst)
- Dry skin with poor skin turgor
- Tachycardia with a thready and weak pulse
- hT/ vascular collapse
- headache
- Agitation/ decrease in reflexes
- Seizure
- Coma
Hypornatraemia is seen at what plasma Na concentration, breifly describe how this could occur and its common signs and symptoms
Hypernatraemia
Plasma Na conc <135 mEq/L
Loss of Na or Excessive water intake
Signs and Symptoms
- Muscle cramps
- Weakness
- Headache
- Depression
- Apprehension - feeling of impending doom
- Personality changes
- Lethargy/ Stupor
- Coma
List the Endocrine glands that may cause Hormone imbalances
Endocrine Glands
- Adrenal glands
- Hypothalamus
- Ovaries
- Parathyroid
- Pineal gland
- Pituitary gland
- Testes
- Thymus
- Thyroid
- Pancreas
Describe some of the causes and implications of ACS as a result of the activity of insulin:
Insulin Considerations
- Insulin OD
- Increased metabolic rate
- GI disturbances, where glucose absorption is effected
- delay in ingestion of food after insulin administration
- Hypoglycaemia shows a quick onset of ACS
- Hyperglycaemia shows a slower onset of ACS
- Both can lead to coma and death
Describe the impacts of ischemia on the brain, with respect to time
**Impacts on the Brain **
- 10 s - depletion of O2
- 2-4 min - Depletion of glucose - conversion to anaerobic metabolism
- 4-5 min - Exhaustion of cellular ATP
- 5+ min - Cell dysfunction resulting in:
- Na & Ca influx, drawing in water with them
- Cell swells - Dies - Infarcts
Describe Oxygen Deficiency and the affects on the brain
Oxygen Deficiency
Hypoxia will occur with any interruption of normal respiration, pure hypoxia is the deprivation of oxygen with a maintained blood flow
-
Affects the brain quickly, leading to a depressant effect. Ongoing hypoxia leads to cell ischemia, dysfunction and injury, brain cell swelling, ICP increase, decreased blood flow, CPP decrease, increasing ischemia, brain cell death
What is Uremia and what are its complications?
Uremia
Urine in the blood, often a clinical manifestation of renal failure, associated with fluid, electrolyte and hormone imbalances and metabolic abnormalities. Every organ becomes affected, leading to Uremic encephalopathy
-
Complications include, seizure, coma, cardiac arrest and death. Can also cause spontaneous bleeding from GI, subdural, or worsen bleeding due to trauma
-
Normal blood has ~ 20mg/L of urea in renal failure 800+mg/L
Describe the 3 Cs of head trauma
Compression - of skull and contents
Concussion - Brain shake
Contusion - hematoma
Describe Traumatic brain injuries in terms of primary and secondary injuries
Traumatic Brain Injury
Primary Injury
- Coup injury - at site of external force
- Contra coup injury - opposite side of force where brain rebounds
- Includes diffuse axonal injury lacerations and haemorrhage
Secondary Injury
- Post impact, often diffuse and multifocal
- Includes infection, concussion and hypoxic brain injury as a result of reduced perfusion and increase in ICP
Describe how brain Trauma can lead to an increase in Cerebral Perfusion Pressure and how its affected by increase in ICP
intracranial pressure
Within the cranium, Brain 80%, Blood tissue 10% CSF 10%. Normal ICP is 0-15mmHg. CSF acts as a small buffer for pressure, only 150mls so limited
CPP = MAP - ICP
Cerebral Perfusion Pressure is the pressure perfusing the brain - Normal 70-100mmHg - Less than 40 leads to brain ischemia
MAP is DP + 1/3 pulse pressure
ICP is normally 0-15mmHg
A trauma event or illness cause increase in ICP, auto regulation starts to fail as ICP approaches MAP, CPP falls
Describe the Auto-regulation of CPP
Auto-regulation of CPP
When injury or illness occurs, cerebral blood vessels dilate, increasing flow to injured area, increase cerebral blood volume, increasing ICP, dropping CPP
A drop in CPP leads to a drop in O2 and glucose delivery, becoming ischemic
Body compensates by increasing arterial blood pressure, dilating vessels to increase CPP, increases BP to increase MAP, however these add volume to the brain increasing ICP. Positive feed back!!! in a negative way
BP will continue to increase, pulse pressure will widen, pt will eventually produce a reflex response of a drop in HR due to high BP
It affects the breathing centres of the brain - triad of symptoms:
- Widening pulse pressure with high BP
- Bradycardia
- Irregular breathing
Describe Hypothermia, it’s classifications, initaly symptoms and its progression
**Hypothermia **< 35c
Can result from, either or both:
A decrease in heat production
Increase in heat loss
Classification:
Mild - 34 -36 C
Moderate - 30 -34 C
Severe below 30 C
Initially:
- Vasoconstriction in peripheral vessels
- Metabolism in CNS increases
- BP, HR and RR all increase
- Muscle tone increases - shivering - continues till 30c where glucose is depleted - when shivering is done, you cool quicker
Progression:
- Decreases in RR, HR and BP
- Circulating fluid drops as fluids shifts from the vascular space
- Increase in urination
- Arrthymias develop
- ACS
- CNS depression
- Cardiac and respiratory arrrest
Describe Hyperthermia, its two causes and signs & symptoms
Hyperthermia
- Temperature regulating mechanisms are overwhelmed by:
- High temps in environment
- Excessive exercise in moderate to extremely high temperatures
- Temperature regulating centres of the body fail, usually in older adults or ill or incapacitated patients.
Defined as core temp > 38c - Body responds with tachypenea, Increased cardiac output- esp to muscle and skin, vasodilation, increase in sweat activity
When regulatory mechanisms break down temp can increase to 41c +, sings and symptoms at this stage include:
- Coma
- Confusion
- Irritability
- Convulsions
- Cerebral ischemia - stroke like
- Tachycardia
- Hyper ventilation
Describe the Major Causes of Shock
Shock
Cardiogenic Shock
Hypovolemic Shock
Anaphylactic Shock
Spetic Shock
Neurogenic Shock
Describe the symptoms of shock, with regards to transient or non transient
Shcok
Both: Drop in BP, limited vascular functioning, can lead to brain ischemia and death
Transient, fainting - changes in posture, environment, nutrition, hydration, emotion
Non transient leads to ongoing BP drop, increased HR, pale cool clammy skin, and ACS - coma
Describe the two types of stroke and the common symptoms:
Stroke
- Ischemic stroke - blood clot that blocks or plugs a vessel in the brain
- Hemorrhagic stroke - bleed
Signs and symptoms
- ACS
- Unilateral facial drop
- Unequal grip strength
- Slurred speech
- Unequal pupils
- Elevated blood pressure
- Dysphagia - difficulty swallowing
- Dysphasia - difficulty talking
Describe the reason behind concern for Intracranial space occupying lesions
Anything that starts displacing brain matter affects function and perfusion
CPP= MAP - ICP
