Cardiac Flashcards
Task management of an arrest call-what order do you perform the tasks?
AED, compression, ventillations (steps of the primary assessment are performed simultaneously)
What is a witnessed arrest?
Onset seen or heard by EMS
What are the most advantageous rhythms for defibrillations?
Ventricular tachycardia
Ventricular fibrillation
Who gets immediate defibrillation?
Now all patients get immediate defibrillation no matter who witnessed the arrest
Full COVID atire
Gloves, N95, face visor, gown, hair and foot covers
Transport of a medical arrest patient:
ROSC
ALS decides it is time to move
Three consecutive no shocks
Nine total shocks
How much blood does a perosn have?
70 cc/kg (6-8 L)
What is the liquid component of blood and how much is it by volume?
Plasma, 55%
What are the formed elements and percent by volume of blood?
Erthrocytes, thrombocytes, leukocytes
45%
RBC’s are anucleated, so are produced in the ___
Bone marrow
What carries blood? What is it? What is its active ingredient?
Hemoglobin is a protein that has an active ingredient of iron
____ of O2 is carried by RBCs. The rest is dissolved in ___
97%
Plasma
___ of CO2 is carried by RBC’s on the hemoglobin, ___% is dissolved in plasma and 70% enters the RBCs (NOT hemoglobin) and undergoes____
23%
7%
CO2+H2O->H+ + HCO3-
Two types of leukocytes
Lymphocytes->Antigen specific antibody production
Macrophages->destroy foreign invaders, scavenger
Plasma is ___% water and ___% stuff. The stuff is:
91%
9%
Glucose, electrolytes, cholesterol, antibodies, proteins
Layers of the artery
Tunica intima, tunica medians, tunica adventitia
The tunica intima is made up of a smooth layer of ____ cells
Endothelial cells
Due to low blood pressure, the venous system has ____, so if there are any blackflows, this captures blood flow and keeps blood distributed throughout the venous system
Semi-lunar valves
Pressure exterted by solutes in the fluid. Often, in an attempt to acheive equilibrium, will pull water out of the circulatory system
Oncotic pressure
Examples of oncotoic pressure
Salt water drowning, DKA
Junction of the capillaries and arteriole: sphincter
Metarteriole
The metarteriole is influenced by three factors:
1) Local factures: temperature, hypoxia, hisamine (causes vasodilation)
2) Neural effects: sympathetic versus parasympathetic
3) Hormonal effects: Adrenaline, norepinephrine
Pressure that pushes fluid out of the vessel
Hydrostatic fluid
Examples of hydrostatic pressure
CHF, peripheral edema, kidneys work this way
Hydrostatic pressure and CHF
If reduce the amount of blood able to pump out,the blood coming back from the pulmonary vien (which is not experiencing a back up) begins to exert more hydrostatic pressure on the walls of the vessels than the vessels. Therefore, see blood going out into the aveoli
Location of the apex of the heart
Around the 5th intercostal space off to the left, apex is tilted anteriorly
Location of the base of the heart
Second intercostals space, base is tilted posteriorly
Business layer of the heart
Myocardium
Layers of the heart
Fibrous pericardium, parietal pericardium, visceral pericardium/epicardium, myocardium, endocardium
____ are located in the middle of the heart vessels and attached to the cordae tendonea
Papillary muscles
Heart strings
Cordae tendonea
Purpose of the papillary muscles
Prevents prolapse
Assists in opening the valves during relaxation
Inflammation causes excess fluid between the heart and the sac surrounding the heart
Pericardial effusion
Issue due to faulty valve, it may be prolapsed or inverted
Heart mummer
Cardiac muscle is ____ because of the interlocking of the cells
Syncytium
Blood flow in the myocardium
Left Ventricle-> aorta->Left and Right coronary arteries->smaller arteries (LCA:left anterior descending coronay artery and circumflex)->arterioles->capillary beds->coronary venules->small veins->larger veins->coronary sinueses->right atrium
Where does the blood flow from the coronary viens before entering into the right atrium
Coronary sinus-small chamber in atrial septum
Calcium into smooth muscles/hardening of vessles. Soft tissue stiffens so less elastic. Natural consequence of aging
Arteriosclerosis
Deposting of plaque along the tunica intima, walls thicken/lumen narrows, resistance increses
Atheroscleorsis
Intrinisic rates of the nodes
SA node=60-100
AV node=40-60
Bundle of His=40-60
Pujinke fibers=20-40
Rate of SA node firing
Chronotropy
Intensity of the contraction
Inotropy
Duration of contraction which is related to the speed of conduction
Dromotropy
In an EKG, region between S and T (i.e. the ST segment) where there is an elevated segment
STEMI
Region between S and the end of the T wave
Refractory period
Reion between the S and beginning of the T wave
ST segment
Perfusion
Adequate: Bloodfloow, oxygen, nutrients and waste removal
LV Ejection fraction
Fraction of the blood in your ventricles you push out. Stroke volume/End diastolic volume
End systolic volume
End diastolic volume-stroke volume
Increased stretch results in increased contractility
Starlings law
Starling’s Law and cardiac ouput path
Venous return->increased pre-load->increased stretch->increased contractility->increased stroke volume->increased cardiac output
Venous return to the heart-how can it impact preload
Right sided heart failure can drop cardiac output (i.e. atrial fibrillation) Hypovolemia Tension pneumothorax Pericardial tamponade Supine hypotension syndrom
Filling time and how it can impact stretch/Starling’s Law
Profound tachycardia (HR over 160), not enough time to fill heart for adequate strech and preload
Two things that can impact pre-load/Starling’s Law
Venous return to the heart
Filling time
Afterload
Systemic vascular resistance, the greater the resistance the more difficult it is to press against resistance and generate enough pressure to overcome resistance
Circuation to the tissue that normally is not open
Collateral circulation
Two ways collateral circulation happens:
1) Small collapsed vessels open up
2) Neovascularization
Vessels can develop a vessle that connects them. Creates redundancy
Anastomosis
Modifiable risk factors for coronary artery disease (CAD)
Smoking-single biggest modifiable factor
Diet
Exercise
Non-Modifiable risk factors for coronary artery disease (CAD
Age
Genetics
Semi-Modifiable risk factors for coronary artery disease (CAD
Hypertension
Stress
Diabetes
Treatment of CAD
Thombolystics
Angioplasty
Cabg
Part of the brainstrem involved in rate and contractility
Cardiac Center
The cardiac center is involved in ___ and ____
rate, contractility
Part of the brainstem that varies the size of vessels, based upon pressure
Vasomotor center
The vasomotor center ____
Varies the size of the vessels
What two hormones control blood pressure and heart rate
Adrenaline and catecholomines
Where are the baroreceptors and what do they do?
Aorta/carotid artery-stretch receptors
Where are the chemo receptors and what do they do?
Aorta/carotid artery-measure the concentration of O2
The vascular component of the ____ is very sensitive to O2. Small drop in O2 will trigger significant sympathetic response to increase HR and BP
Chemo receptors
Shock is
poor perfusion. Maintain perfusion by maintainign cardiac output. Maintain cardiac output by maintaining BP and HR
There is a ____CO2 effect on BP and HR
Minimal
What things impact stroke volume
Preload (venous return, ventricular filling time, volume)
Contractility (nervous control, hormones)
Afterload
A afib
Non-Reproducible chest pain
1) No change upon palpation
2) No change upon movement
3) No change upon deep respiration
Reproducible chest pain
Changes with deep respiration (pleuritic)
Changes with palpation and movement (muscular skeletal)
Thoracic aortic aneurysm
"Tearing" pain Sudden onset (maximal pain at onset) Constant Radiates posteriorly between scapulae Unequal radial pulses Disparate blood pressure in both arms (>20 is significant)
Tunica intima develops a tear and separates from the medians. Creates a “false passage”
Dissection
Weakened arterial wall, “balloons out”
Thoracic aortic aneurysm
Dissections are more likely in the ___ while ruptured aneurysms are more prevalent in the ____
Chest, abdomen
With a dissection at the base of the aorta, see signs and symptoms similar to _____
Pericardial tamponade, because impinging the pericardium and coronary artery
Predispositions for thoracic aortic aneurysm
Hypertension-biggest indicator
Age
Marfansim, because generally do not have the same amount of collagen in the aorta
Acute Coronary Syndrome
Develop a “pit” in artery which triggers the release of chemicals (tissue mediator) to the site to try to effect repair
Thesese chemicals attract platlets and white blood cells (macrophages)
The tunia medians expands into the injured site, trying to fill the injured space
Now have an uneven surface which attracts more platlets and fatty streaks (i.e. lipoprotein deposits)-cholesteral
Eventually develop a fibrous encapsulation. This provides substrates for future clots
Unstable angina
Event that is aytpical for the patient
Qualitative (radiates further out, SOB that never happened before)
Quantitative (discomfortable is higher, 3 nitros instead of 1)
Different signs and symptoms for agina versus MI
Diaphoretic-MI
Time <15 for angina, >20 MI
Angina-onset due to exertion/stress. MI can be sedentary
Cardiogenic shock
Cardiac output drops to the point where you are no longer perfusing adequately
S/S due to decrease in stroke volume which leads to a left ventricular event
HR increases BP decreases Hydrostatic pressure increases in the capillary beds in lungs because blood flow from lungs is still the same-pulmonary edema, rales RR increases WOB increases Pink frothy sputum Sycope? Due to low BP
Issue that results from a decrease in stroke volume which leads to a left ventricular event
CHF
S/S HR issue, conduction issue
HR decreases Adrenaline dump=pale, cool, diaphoretic Normotensive or increased BP (because left ventricle is pushing fine) Clear and equal breath sounds Syncope due to bradycardia
HR issue, conduction issue is affecting what parts of the heart?
Right coronary event
Impacting SA node
Why are we worried about giving O2 to a person experiencing an MI?
Re-perfusion injury
