Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CCRISP > cardiac/cardiac monitoring and support > Flashcards

cardiac/cardiac monitoring and support Flashcards

1
Q

Conditions associated with bradycardia

A

Autonomic
-Raised ICP
-Visceral pain
-Drugs (beta blockers)
-Epidural

Non autonomic
-MI
-Hypoxia
-Hypothermia
-Hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Heart territories ecg

A

Anterior: V1-V4
Inferior: 2, 3, aVf
Posterior infarct: Isolated ST depression V1, V2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment of STEMI

A

-Aspirin
-PCI followed by anticoagulation with heparin/LMWH/thrombolysis
-glycoprotein 2b/3a inhibitors
-Glycaemic control
-Beta blockers
-Thrombolysis if pci not availabe if not contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Contraindications to thrombolysis:

A

<2 weeks post op
-Active peptic ulcer
-Previous haemorrhagic stroke
-Recent head injury
-Prolonged traumatic CPR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What main parameters affect cardiac function?

A

Preload
Intrinsic cardiac function
Afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the causes of cardiac failure

A

Factors affecting preload:
-Hypovolaemia
-Fluid overload
-Pneumothorax/cardiac tamponade

Factors affecting intrinsic myocardial function
-ACS
-Arrythmia
-Chronic heart failure + ‘operative stress’
-Pneumothorax/cardiac tamponade
-Electrolyte disturbance (e.g. cardiac tamponade)

Conditions affecting afterload
-Aortic stenosis
-PE
-Pneumothorax/cardiac tamponade
-Aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How would you manage someone in acute heart failure?

A

-CCRISP principles
-Oxygen, sit pt up, CPAP if practicable
-Stop IVI
-IV diuretics (80mg furosemide IV)
-IV morphine (2.5-5mg diamorphine) to aid vasodilatation (reduce afterload)
-Nitrates (patch, sublingual/buccal/IV)
-ECG
-Tx underlying cause (Arrythmia/PE/tamponade)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the definition of cardiogenic shock?

A

-Severe impairment of cardiac function with hypotension <90mmhg or 30mmhg less than patients ‘normal’systolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common cause of cardiogenic shoci?

A

Ischaemia/infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the important points in managing a patient with a pacemaker?

A

-Any pt undergoing surgery should have had recent pacemaker check
-Diathermy should be as far from pt as possible (e.g. on thigh or under buttocks). Never put it behind the pacemaker
-Short bursts of diathermy rather than long bursts
-Bipolar is safer
-Avoid diathermy near pacemaker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the definition of shock?

A

-Acute circulatory failure, with inadequate tissue perfusion causing cellular hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the most common mechanisms of shock?

A

-Hypovolaemic
-Cardiogenic
-Obstructive
-Vasodilatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the causes of hypovolaemic shock? (preload)

A

-Haemorrhage
-Dehydration
-Fluid loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of cardiogenic shock (intrinsic cardiac function)

A

-MI
-Arrythmia
-Heart failure
-Cardiac contusions due to trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of obstructive shock (intrinsic myocardial function)

A

-PE (obstruction to right ventricular outflow)
-Cardiac tamponade (construction on heart)
-Pneumothorax (pressure on heart)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Vasodilatory (afterload)

A

-Sepsis
-Neurogenic shock
-Anaphylaxis
-Adrenal insufficiency

17
Q

Neurogenic shock

A

-Follows spinal transection (above level of T6) or brainstem injury with loss of sympathetic outflow beneath the level of the injury and consequent vasodilation

18
Q

What is the definition of cardiogenic shock?

A

-Inadequate tissue perfusion resulting directly from myocardial dysfunction

19
Q

CVP interpretation

A

High CVP (>15mmhg)–> right ventricular/biventricular failure

Low CVP (<5mmhg) –> hypovolaemia

Normal CVP: >8mmhg

Static measurement can be misleading; young pt may have normal CVP due to vasoconstriction but may be underfilled

FLuid challenge can resolve doubt: small fluid challenge can be given (100-200ml) and then CVP measured, if significant rise and remains high this suggests myocardial failure/dysfiunction

20
Q

What are the indications for invasive cardiac monitoring?

A

-Failure to maintain cardiovascular homeostasis with simple measures
-Procedures that give rise to rapid/profound changes in preload or afterload, e.g. AAA repair
-Treatement with vasoactive drugs that influence preload/afterload/myocardial function, to monitor response to treatment
-Pts at risk of developing low perfusion states e.g. high risk pt with poor cardiac function

21
Q

What is the CVP a measurement of?

A

-Preload
-Pressure within SCV as it enters right atrium, reflects ability of right heart to accept and deliver circulating volume

22
Q

What influences the CVP?

A

-Venous return
-Right heart coimpliance
-Intrathoracic pressure

23
Q

What are the indications for a central line?

A

-Administration of fluid replacement therapy for hypovolaemia when conventional access not possible, e.g. when concern exists about overtransfusion when there is uncertainty about fluid volume status
-Measure effect of vasoactive drugs on venous capacitance, particularly vasodilators
-To aid diagnosis of right heart failure: high pressure with low cardiac output
-Administration of potent drugs e.g. inotropes
-TPN (needs dedicated clean lumen)

24
Q

Complications of central line

A

Related to insertion
-Haemotoma/haemothorax
-Tension pneumothorax
-Air embolus
-Extravascular catheter placement
-Neuropraxia
-Lymphatic puncture
-Tracheobronchial puncture
-Sepsis

Related to catheter
-Knotting of catheter
-Catheter breakage

25
Q

Descrbibe noradrenaline receptor/effect/clinical use

A

Receptor
-Alpha adrenoreceptor agonist

Effect
-Arteriolar vasoconstriciton

Clinical use
-Septic shock with low SVR

26
Q

Describe Adrenaline receptor/effect/clinical use

A

Receptor
-Alpha and beta adrenoreceptor agonist, predominantly beta 1 adrenoreceptor agonist at low doses

Effect
-Positive inotropic and chronotropic. Vasoconstricts at high doses

Clinical use
-Widespread in conidtions of low cardiac output: usful in emergency situations

27
Q

Dopamine

A

Receptor:
-Alpha and beta adrenoreceptors. Dopamine (DA) 1 and 2 receptors

Effect:
-Low dose: splanchnic vasodilatation, increased renal and hepatic blood flow (DA1). High dose: vasoconstriction

Clinical use
-Used less frequently

28
Q

Dobutamine

A

Receptor:
-DA1, DA2 and beta adrenoreceptor agonist

Effect
-Reduses SVR and increases cardiac output

CLinical use
-Cardiogenic shock

29
Q

What are the functions of the kidney?

A

-Elimination of water soluble waste products of metabolism other than CO2
-Elimination of water soluble drugs
-Fluid and electrolyte homeostasis
-Acid-base balance
-BP control: RAAS system
-Endocrine function: EPO and vitamin D production

30
Q

What is normal urine output?

A

Normal: 1.5-2ml/kg/hr

Oliguria: <0/5

Anuria: <100ml/day

31
Q

What is the definition of AKI

A

-Abrupt (within 48 hrs) reduction in kidney function defined as absolute increase in creatinine of >26 micromol/L OR
-Percentage increase in serum creatinine level of >50% from baseline OR
-Reduction in UO (oliguria <0.5ml/kg/hr for >6 hrs)

32
Q

What are common causes of AKI?

A

Prerenal:
-Hypovolaemia
-Sepsis
-Low cardiac output

Intrinsic renal
-ATN
-Nephortoxics: drugs, contrast
-Abdominal compartment syndrome
-Hepatorenal syndrome
-Glomerulonephritis

Post renal
-Bladder outflow obstruction
-Bilateral ureteric obstruction

33
Q

What are nephrotoxic drungs?

A

-ACE inhibitors
-NSAIDS
-Diuretics
-Aminoglycosides

34
Q

Indiciations for renal replacement therapy

A

Absolute:
-Refractory hyperkalaemia (>6mmol/L)
-Refractory pulmonary oedema and fluid overload
-Uraemic encephalopathy

Relative
-Acidosis (pH <7.2)
-Uraemia
-Pericarditis
-Toxin removal

35
Q

What is the emergency treatment for hyperkalaemia?

A

-Continuous cardiac monitoring
-Insulin (10-20 units actrapid) in 100ml 20% dextrose intravenously over 30 minutes
-Sodium bicarb 50mmol intravenously over 5-10 mins
-10% calcium gluconate IV (10-30 ml)
-B2 agonist: nebulised salbutamol

CCRISP (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions