Cardio OSCE Flashcards
Describe how and ECG should be Interpretated
Rate, Rhythm, Axis
P-wave and PR interval
QRS complex
ST segments
T wave morphology
Any special notes
Cardiac output monitoring normal values
SVV - <10%
RAP - 2 to 6
RVP - 25/0
PAP - 25/8
MPAP - 10 to 20
PAWP - 6 to 12
CO - 4 to 8
CI - 2.5 to 4
SV - 60 to 100
SVR - 800 to 1200
SVRI - 1970 to 2390
DO2 - 950 to 1150
DO2I - 500 to 600
PiCCO vs LiDCO
PiCCO vs LiDCO
Transpulmonary thermodilution vs transpulmonary lithium dilution
PiCCO requires central line and thermistor tipped arterial line
LiDCO - standard art line and peripheral cannula
Both use pulse contour wave analysis
PiCCO assumes area under systolic portion of pulse wave proportional to SV
LiDCO assumes fluctuations of arterial pressure around mean prop. To SV
Direct measurements = HR/BP/MAP
Indirect = SV/CO/CI/DO2/SVR
What is an Oesophageal Doppler and how does it work?
Probe is 90cm long, markers to aid placement, usually measures at around 35-40cm
Velocity-time curve from RBC travelling down aorta
Area under the velocity/time curve = stroke distance
Using estimated aortic diameter (from nomogram) x stroke distance = SV
Peak velocity used as a marker of LV contractility
Flow corrected time - the time the heart spends in systole corrected for HR (normal = 330-360 ms) - low means high afterload (hypovol.) and high means low afterload (septic vasoplegia)
Assumptions:Angle of probe is constant
Aortic cross-section constant throughout cardiac cycle
Laminar flow in aorta
70% of blood enters the descending aorta
What is a PAC? What can it measure? Complications?
Usually 8F
Distal lumen (sampling and pressure)
Proximal lumen (30cm from tip - inject cold saline)
Thermistor 3.7cm prox to tip - can also have a thermal filament
Balloon
Measured = CVP/RAP/RVP/PAP/PCWP/SvO2/temp
Derived = CO/CI/SV/SVI/SVR/SVRI/PVR/PVRI
Complications:
CVC - bleeding, air embolism, Vasular injury, pneumothorax, tamponade
Floating - Arrythmias, Tamponade, Valve injury, knotting catheter
PAC in-situ - VTE, pulm infarction, pulm artery rupture
PAC-man (2005) - no diff in mort or LOS with PAC - 10% complication rate
ScvO2 vs SvO2
SvO2 = mixed central venous blood in pulm circ
ScvO2 = central venous blood from SVC
SvO2 > ScvO2 = brain has higher O2 extraction compared to body so blood from SVC has lower O2 content
What are some of the ECG changes you might see post ROSC
Trifasicular block
Paced rhythm
RBBB - old infarct
STEMI - V1-4 = LAD
V5-6 and I, aVL = LCx,
II, III and aVF = RCA
LBBB
Hyperkalaemia
AFP-mitrale
Inferior ST elevation
Severe Brady
How does an Intra Aortic Ballon Pump work? Contra indications? Complications?
Insert via fem art
Inflation with middle of t-wave or dicrotic notch - deflation with peak R-wave
Contraindications - AR, Aortic dissection, severe PVD, coagulopathy
Complications:
1 - Vascular - bleeding, dissection, perforation
2 - Balloon - branch vessel ischaemia, helium embolus, haemolysis, low plts
How can you diagnose IE?
Duke criteria:
Pathological - microorganism on culture in vegetation or abscess
Clinical - 2 major or 1 major/3minor or 5 minor
Major - Bld culture positive (typical organism 2 separate cultures)
- Echo evidence of SBE or new valve regurgitation
Minor
- IVDU or predisposing heart condition - Fever
- Vascular phenomenon
- Immunological phenomenon
- Micro evidence that does not meet the major criteria IVDU patients
- right heart lesions, pseudomonas with high rate of CNS involvement
What is Post-cardiac Arrest Syndrome? How do you manage it?
Post-cardiac arrest syndrome
1 - Hypoxic brain injury
2 - Myocardial dysfunction
3 - Systemic ischaemic repurfusion syndrome
4 - persistent precipitating disease
Inx:
Bloods
ECG
ECH
OCT brain
CTPA
Mx:
ABCDE
- CVS support, vol resus, CO monitoring, IABP, lung prot vent, cont seizure, cont blood sugars
- Treat cause
- PCITTM - avoid hyperthermia
- TTM:No diff between 33-36
- HYPERION:33 for 24hrs then 37 or 37 for 48hrs - low temp group better neuro outcomes, no mort difference
