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MACHS > Cardio > Flashcards

Cardio Flashcards

1
Q

Symptoms of Sepsis

A
  1. AVPU = VPU
  2. new confused state
  3. systolic less than 90
  4. heart rate over 130
  5. Resp rate over 25 per min
  6. Need O2 to maintain O2 over 92%
  7. Non-blanching rash
  8. Mottled, ashen and cyanosis
  9. No urine passed in 18hrs - UO less than 0.5ml/kg/hr
  10. Recent chemotherapy
  11. Temperature over 39 or under 36
  12. Amber - AKI present
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2
Q

Priorities Sepsis

A
  1. Give O2 - 94-98% NICE 2022
  2. Take blood cultures
  3. Give antibiotics (source control, broad)
  4. Give IV fluids - if hypotenisve r lactat over 2mmol/l) - give 500ml bonus less than 15 minutes - crystalloid sodium chloride (NICE, 2016)
  5. Take serial lactate if over 4mmol/l call critical care
  6. Take urine output using catheter if needed
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3
Q

References of sepsis

A

UK sepsis trust - 2022
NICE 2016 - suspected sepsis - recognition and diagnosis
Peate et al. 2021

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4
Q

Pathophysiology of sepsis

A
  • distributive shock (effect blood vessels)
  • result of widespread infection

Peate et al. 2021

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5
Q

Pathophysiology anaphylaxis

A
  • shock
  • widespread allergic reaction
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6
Q

Symptoms anaphylaxis

A

Resus Council 2012

  • life threatening ABC problems
  • skin changes - eg. rash, itch, redness
  • alter consciousness
  • anxiety, restless feeling of impending doom
  • abdopain vomiting and diarrhoea
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7
Q

Priorities of anaphalaxis

A
  1. stop trigger eg. infusion
  2. lay flat unless exacerbate - as increase blood pressure and increase blood flow to heart
  3. adrenaline - ad - 500mcg - ch - 300-150-100mcg - BNF - NICE 2022
  4. airway established - O2 - 94-98% NICE 2022
  5. Fluid bolus - 500ml or child - 10ml/kg - NICE 2022 - 0.9% sodium chloride - NICE 2013
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8
Q

Prostin

A

Keep hole in heart open

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9
Q

Pathophysiology cardiogenic shock

A

heart can not pump enough blood to meet bodies needs

commonly caused by heart attacks

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10
Q

Symptoms of cardiogenic shock and acute heart failure

A
  1. fatigue
  2. heart failure
  3. breathless
  4. drownigh feeling
  5. anxiety
  6. hypoperfusion - mottled, ashen and cynosis
  7. cool extremities
  8. decreased urine
  9. increased blood pressure and increased heart rate
  10. chest pain
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11
Q

Priorities of cardiogenic shock

A
  1. airway support - O2 - 94-98% NICE 2022
  2. Diuretic therapy - to reduce congestion - need to monitor weight, urine output, renal function
  3. Consider inotopes if suspected reversible - eg. adrenaline or dopamine
  4. start beta blockers - increase O2and balance the demands
  5. Blood test - monitor troponin
  6. Cardio echo or angiogram

NICE 2014

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12
Q

Specifics of fluid bolus emergency fluids

A

Bolus adults - 500ml - crystalloid - NICE 2013
Children - 10ml/kg less than 10minutes - NICE 2022
Neonates - 10-20ml/kg less than 10minutes for term neonate

Isotonic eg. 0.9% saline or hartmanns

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13
Q

Reference adult fluid bolus

A

NICE 2013

500ml Crystalloid

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14
Q

Reference children fluid bolus

A

updated NICE 2022 (written in 2015)

Child - 10ml/kg over less than 10 minutes
- NICE 2022 - argument no significant difference outcomes if use 20ml/kg

Neonates - 5-10ml/kg

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15
Q

Reference - child maintenance fluids

A

NICE 2015

Child - 100ml/kg first 10kg - 50ml/kg second 10kg - 20ml/kg more than 20kg
Neonate - day old dependant

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16
Q

Pathophysiology myocardial infarction

A
  • occlusion of coronary artery
  • O2 deprive t myocardial cells
  • can lead to necrosis
17
Q

Symptoms of myocardial infarction

A
  1. chest pain - in left arm
  2. rapid/irregular pulse
  3. hypotensive
  4. excessive sweating
  5. nausea, vomiting and palpation
  6. losss consciousness
  7. cynosis
  8. anxious
18
Q

Priorities for myocardial infarction

A
  1. If emergency 2222 - crash team and commence CPR and use defibrillator
  2. continuous ECG - look for ST elevation and site of occlusion
  3. blood glass - compensate low CO2 with higher lactate
  4. Check bio markers - troponin - released in response - to control calcium due to myosin and actin
  5. CR - dimensions of left heart
  6. Echocardiogram- ventricle function
  7. angiogram - can place stent
  8. glucose test - as increased lactate means flight and fight response - increased glucose as lactate is converted to glucose
19
Q

Pathophysiology heart failure and congestive heart failure

A
  • inability heart to sustain normal cardiac output
  • poor perfusion of tissues
  • systolic and diastolic congestion and weakness
  • right and left sided
20
Q

Symptoms of heart failure and congestive heart failure

A
  1. pitting oedema
  2. enlarged ryan’s
  3. pleural effusion
  4. visible jugular veins
  5. difficulty breathing
  6. nausea
  7. anorexia
  8. fatigue
  9. jaundice
  10. dizziness
  11. cynosis
  12. tachycardia
  13. wheezing
21
Q

Priorities in treatment heart failure and congestive heart failure

A
  1. O2 therapy
  2. position upright to assist breathing
  3. monitor fluid - should excess 30ml/hr
  4. reduce salt intake - cause fluid retention
  5. lifestyle changes - increase exercise and reduce weight
  6. give ace inhibitors to dilate blood vessels
  7. give diuretics to reduce fluid load
22
Q

Guidelines of fevers under 5 what is the suggested fluid therapy

A

20ml/kg of 0.9% saline

NICE 2007 - Fever under 5

23
Q

Maintainance fluid guideline children

A

NICE 2015 algorithm of IV fluid therapy - routine maintenance

  1. 100ml/kg/day for first 10kg
  2. 50ml/kg/day for second 10kg
  3. 20ml/kg/day for any weight over 20kg

Not exceed 2500 in male and 2000 female

Sodium Chloride - 0.9% crystalloid isotonic

24
Q

Maintainance fluid therapy in neonates

A

Term aged 8 days and over

Day 5-28 - 120-150ml/kg/day
Give crystalloid including sodium with 5-10% glucose (unless critical given no sodium)

MACHS (6 decks)

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