Cardio Flashcards
Symptoms of Sepsis
- AVPU = VPU
- new confused state
- systolic less than 90
- heart rate over 130
- Resp rate over 25 per min
- Need O2 to maintain O2 over 92%
- Non-blanching rash
- Mottled, ashen and cyanosis
- No urine passed in 18hrs - UO less than 0.5ml/kg/hr
- Recent chemotherapy
- Temperature over 39 or under 36
- Amber - AKI present
Priorities Sepsis
- Give O2 - 94-98% NICE 2022
- Take blood cultures
- Give antibiotics (source control, broad)
- Give IV fluids - if hypotenisve r lactat over 2mmol/l) - give 500ml bonus less than 15 minutes - crystalloid sodium chloride (NICE, 2016)
- Take serial lactate if over 4mmol/l call critical care
- Take urine output using catheter if needed
References of sepsis
UK sepsis trust - 2022
NICE 2016 - suspected sepsis - recognition and diagnosis
Peate et al. 2021
Pathophysiology of sepsis
- distributive shock (effect blood vessels)
- result of widespread infection
Peate et al. 2021
Pathophysiology anaphylaxis
- shock
- widespread allergic reaction
Symptoms anaphylaxis
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
Priorities of anaphalaxis
- stop trigger eg. infusion
- lay flat unless exacerbate - as increase blood pressure and increase blood flow to heart
- adrenaline - ad - 500mcg - ch - 300-150-100mcg - BNF - NICE 2022
- airway established - O2 - 94-98% NICE 2022
- Fluid bolus - 500ml or child - 10ml/kg - NICE 2022 - 0.9% sodium chloride - NICE 2013
Prostin
Keep hole in heart open
Pathophysiology cardiogenic shock
heart can not pump enough blood to meet bodies needs
commonly caused by heart attacks
Symptoms of cardiogenic shock and acute heart failure
- fatigue
- heart failure
- breathless
- drownigh feeling
- anxiety
- hypoperfusion - mottled, ashen and cynosis
- cool extremities
- decreased urine
- increased blood pressure and increased heart rate
- chest pain
Priorities of cardiogenic shock
- airway support - O2 - 94-98% NICE 2022
- Diuretic therapy - to reduce congestion - need to monitor weight, urine output, renal function
- Consider inotopes if suspected reversible - eg. adrenaline or dopamine
- start beta blockers - increase O2and balance the demands
- Blood test - monitor troponin
- Cardio echo or angiogram
NICE 2014
Specifics of fluid bolus emergency fluids
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
Reference adult fluid bolus
NICE 2013
500ml Crystalloid
Reference children fluid bolus
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
Reference - child maintenance fluids
NICE 2015
Child - 100ml/kg first 10kg - 50ml/kg second 10kg - 20ml/kg more than 20kg
Neonate - day old dependant
Pathophysiology myocardial infarction
- occlusion of coronary artery
- O2 deprive t myocardial cells
- can lead to necrosis
Symptoms of myocardial infarction
- chest pain - in left arm
- rapid/irregular pulse
- hypotensive
- excessive sweating
- nausea, vomiting and palpation
- losss consciousness
- cynosis
- anxious
Priorities for myocardial infarction
- If emergency 2222 - crash team and commence CPR and use defibrillator
- continuous ECG - look for ST elevation and site of occlusion
- blood glass - compensate low CO2 with higher lactate
- Check bio markers - troponin - released in response - to control calcium due to myosin and actin
- CR - dimensions of left heart
- Echocardiogram- ventricle function
- angiogram - can place stent
- glucose test - as increased lactate means flight and fight response - increased glucose as lactate is converted to glucose
Pathophysiology heart failure and congestive heart failure
- inability heart to sustain normal cardiac output
- poor perfusion of tissues
- systolic and diastolic congestion and weakness
- right and left sided
Symptoms of heart failure and congestive heart failure
- pitting oedema
- enlarged ryan’s
- pleural effusion
- visible jugular veins
- difficulty breathing
- nausea
- anorexia
- fatigue
- jaundice
- dizziness
- cynosis
- tachycardia
- wheezing
Priorities in treatment heart failure and congestive heart failure
- O2 therapy
- position upright to assist breathing
- monitor fluid - should excess 30ml/hr
- reduce salt intake - cause fluid retention
- lifestyle changes - increase exercise and reduce weight
- give ace inhibitors to dilate blood vessels
- give diuretics to reduce fluid load
Guidelines of fevers under 5 what is the suggested fluid therapy
20ml/kg of 0.9% saline
NICE 2007 - Fever under 5
Maintainance fluid guideline children
NICE 2015 algorithm of IV fluid therapy - routine maintenance
- 100ml/kg/day for first 10kg
- 50ml/kg/day for second 10kg
- 20ml/kg/day for any weight over 20kg
Not exceed 2500 in male and 2000 female
Sodium Chloride - 0.9% crystalloid isotonic
Maintainance fluid therapy in neonates
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)
