blood flow Flashcards
A 22-year-old woman presents to A+E with abdominal pain and fever. She reports the pain started generalised, but is now worse in the RIF. Her blood pressure is 85/55, HR 119.
What type of shock does she have?
septic shock
a greater than 50% rise in serum creatinine within past week
definition of AKI
what is ohms law
voltage( pd between two points- equivalent to bp) = current(flow from point A-B, how much blood gets pushed around each min) x resistance(hinderance to flow-blood vessels on blood)
voltage =
current x resistance
blood pressure
cardiac output x stroke volume
starling cure
the more the heart is stretched the stronger it contracts ( preload)
this increases stroke volume to a point before it decreases
less circulation means less stretch which means less powerful contraction
high HR can also lead to less stretching( less time to fill) and so lead to reduced output)
flow =
pressure change x vessel radius^4
all divided by
blood viscosity x vessel length
regulation of blood flow can be neurological
humoral
local - auto regulation and active hyperaemia
true
the autonomic system regulates bp by what hormones
adrenaline and noradrenaline
humoral - renin
what things increase the blood pressure and what things decrease it
aldosterone - keeps sodium in and potassium out
adrenaline - larger blood volume and flow
ADH - acts in kidney stored in psotiero pituitary
angiotensin II -
ANP and BNP - decrease it as dilate the kidney made in the heart
active hyperaemia
local mechanism of increasing blood flow to tissues/organs to meet metabolic demna
oxygen and ph decrease
pco2 , lactare , temperate and adenosine ( k) increase
NO release in vascular wall
A 58-year-old man is brought to ED by ambulance. He is drowsy and confused, with a temperature of 38.4 degrees, HR 112, BP 90/72, and sats of 86%. His chest x-ray is shown. Over the next few hours, his urine output drops considerably.
What is the diagnosis?
What organisms are most likely responsible?
What SIX things does the patient need?
pneumonia - septic shock
strep pneumoniae
sepsis 6 check lactate urine output blood cultures
give
antibiotic
Iv fluid
oxgen
sepsis 6
check
lactate
urine output
blood cultures
give
antibiotic
Iv fluid
oxgen
A 69-year-old man presents with progressive breathlessness and dizziness, especially on exertion. On examination he has normal observations, with an ejection systolic murmur, and a slow rising pulse.
What is the likely diagnosis?
How do we investigate it?
What treatment options are there?
aortic stenosis
ECHO
valve replacement - surgery and balloon
A 25-year-old man is involved in a road traffic collision, when his bike collides with a car. He has multiple broken bones, and has lost a considerable amount of blood. His blood pressure is low, heart rate high, and temperature low.
how are we gonna manage
give blood
major haemorrhage protocol
stop bleeding
replace the lost blood or avoid lethal triad
lethal triad during bleeding
hypothermia - make warm
acidosis - give oxygen and blood - ABG
coagulapthy - give platelets
inadequate blood flow systemic
Brain Confusion Drowsiness Reduced consciousness Kidneys Reduced urine output AKI Heart Angina Reduced cardiac function Muscles Lactate production acidosis increased respiratory rate Gut Reduced gut function Liver Ischaemic hepatitis
A 62-year-old man with a history of obesity and hypertension presents with chest pain. He looks unwell and is very sweaty. His ECG is shown below.
What is the diagnosis?
What treatment does he need now?
What medications will he most likely be given afterwards?
STEMI
PCI
ACEi beta blockers spironolactone antiplateltss statins
A 72 year old smoker with a history of MI’s and strokes presents to his GP with painful calves. He reports pain when he walks that improves with rest. His feet feel cold and his pedal pulses are week
What is the most likely diagnosis?
What are the risk factors for this condition?
What are the treatment options?
intermittent claudication - painful in both legs
smoking
stop smoking
surgery and vasodilators
peripheral vascular disease - narrowing of barterers leading to reduced blood flow and apparent during increased activity causing ischaemic pain and deep ache - intermittent claudication
RF - diabetes, hyperlipidemiam and hypercholesterstromia
A 54 year old woman is brough in by ambulance. She has developed slurred speech, and her face looks droopy. A CT-scan is normal. The symptoms developed 6 hours ago.
What is the most likely diagnosis?
What is the immediate management?
What further imaging is required?
stroke
IV injection of ( recombinant tissue plasminogen activator) tPA - ischemic stroke
CTHead
inadequate blood flow - local
Brain (e.g. stroke) Weakness Confusion Slurred speech Heart (e.g. heart attack) Myocyte death Reduced cardiac function Kidneys (e.g. renal artery stenosis) AKI Gut (e.g. mesenteric thrombosis) Gut ischaemia Perforation Sepsis Limb (e.g. peripheral arterial disease) Cold, pulseless, painful limb Ischaemia and necrosis
