Cardiorespiratory assessment and management Flashcards

1
Q

What are the main signs and symptoms of bacterial endocarditis?

A

Lethargy
SoB
Splinter haemorrhages
Janesway’s legions

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2
Q

What does an inspiratory and expiratory wheeze that clears with a cough signify?

A

Bronchitis

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3
Q

What is the difference in breathing drive for patients with and without COPD?

A

Non-COPD patients’ respiratory drive is regulated by too much CO2
COPD patients have chronic hypercapnia so their respiration is driven by too little oxygen

Over oxygenation of patients with COPD can cause a dangerous reduction in respiratory drive

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4
Q

Where can the aortic valve be auscultated?

A

Second intercostal space
Right sternal border

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5
Q

Where can the tricuspid valve be ausculated?

A

Fifth intercostal space
Left sternal border

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6
Q

Where can the mitral valve be auscultated?

A

Fifth intercostal space
Right mid-clavicular line

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7
Q

Where can the pulmonary valve be auscultated?

A

Second intercostal space
Left sternal border

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8
Q

How are thrills assessed?

A

With a hand placed horizontally over each valve, feeling with fingers and palm

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9
Q

What are thrills?

A

Palpable chest vibrations caused by turbulent blood flow

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10
Q

How are heaves assessed?

A

The palm of hand placed vertically over the apex of the heart

Feel for your hand being lifted with each systole

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11
Q

What are heaves and what can they signifty?

A

A lifting of an assessors hand with each systole, can be a sign of left ventricular hypertrophy

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12
Q

What are you looking for during hand inspection during a cardiovascular exam?

A

Finger clubbing
Cyanosis
Nicotine staining
Cap refill
Osler’s Nodes
Janeway Lesions
Splinter haemorrhages

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13
Q

What are you looking for during head, face and neck inspection during a cardiorespiratory exam?

A

Jaundice of eyes
Anaemia of eyelids
Corneal arcus
Xanthelasma
Malar flush
Cyanosis
Venous distention

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14
Q

What are you looking for during chest inspection during a cardiorespiratory exam?

A

TWELVE
Scars
Pacemakers/ICDs
Barrel chest
Chest rise and expansion
WoB
Accessory muscle use

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15
Q

In the abscence of circulatory compromise, what can cause an increased CRT?

A

Peripheral Vascular Disease
Old age
Hypothermia/cold ambient temperature

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16
Q

Why should special attention be given to knee mottling and what can cause it to be more severe?

A

It has been shown to independently predict mortality.

Mottling usually begins at the knees and can be quantified according to a mottling score (scored 0-5, with a higher score correlating with increased mortality).

High doses of vasopressors can make skin mottling more severe and lead to purpuric changes.

17
Q

What patients with circulatory collapse may have a bounding pulse?

A

A strong bounding pulse is associated with the vasodilation of sepsis or anaphylaxis.

18
Q

What can a weak ‘thready’ pulse signify?

A

A weak thready pulse, or one with a low pulse volume, is associated with low cardiac output, most likely due to hypovolaemia

19
Q

Why should you have a higher index of suspicion for hypotension in elderly or usually hypertensive patients?

A

Elderly patients and those with known (or untreated) hypertension may require a higher MAP to maintain organ perfusion

20
Q

Why is it important to monitor pulse pressure in patients with circulatory collapse or volume loss?

A

The systolic and diastolic blood pressures can change in different ways and at different rates.

Generally, the sytolic BP will not reduce until approximately one-third of the circulating blood volume has depleted and the heart begins to fail.

The diastolic BP will start to rise with the vasoconstriction brought about by the compensatory measures.

21
Q

What values are considered narrow and wide pulse pressures?

A

If the difference is less than 25 percent of the systolic blood pressure, the pulse pressure is considered to be narrow.

A wide pulse pressure is considered to be greater than 50 percent of the systolic blood pressure.

22
Q

In the hypovolaemic patient, what does a narrowing pulse pressure signify?

A

It indicates a decreasing cardiac output and an increasing peripheral vascular resistance

23
Q

What are the signs and symptoms of a tension pneumothorax?

A

TENTION P-THORAX

Jugular venous disTENTION
Pleuritic pain/IPsilateral chest rise
-
Tachypnoea/cardia/Trachael deviation
Hypoxia/Hypotension/Hyper-resonance
Onset sudden
Reduced breath sounds/respiratory effort (dyspnoea)
Absent fremitus
X-ray shows lung collapse