Cardiorespiratory assessment and management Flashcards
What are the main signs and symptoms of bacterial endocarditis?
Lethargy
SoB
Splinter haemorrhages
Janesway’s legions
What does an inspiratory and expiratory wheeze that clears with a cough signify?
Bronchitis
What is the difference in breathing drive for patients with and without COPD?
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
Where can the aortic valve be auscultated?
Second intercostal space
Right sternal border
Where can the tricuspid valve be ausculated?
Fifth intercostal space
Left sternal border
Where can the mitral valve be auscultated?
Fifth intercostal space
Right mid-clavicular line
Where can the pulmonary valve be auscultated?
Second intercostal space
Left sternal border
How are thrills assessed?
With a hand placed horizontally over each valve, feeling with fingers and palm
What are thrills?
Palpable chest vibrations caused by turbulent blood flow
How are heaves assessed?
The palm of hand placed vertically over the apex of the heart
Feel for your hand being lifted with each systole
What are heaves and what can they signifty?
A lifting of an assessors hand with each systole, can be a sign of left ventricular hypertrophy
What are you looking for during hand inspection during a cardiovascular exam?
Finger clubbing
Cyanosis
Nicotine staining
Cap refill
Osler’s Nodes
Janeway Lesions
Splinter haemorrhages
What are you looking for during head, face and neck inspection during a cardiorespiratory exam?
Jaundice of eyes
Anaemia of eyelids
Corneal arcus
Xanthelasma
Malar flush
Cyanosis
Venous distention
What are you looking for during chest inspection during a cardiorespiratory exam?
TWELVE
Scars
Pacemakers/ICDs
Barrel/pidgeon/funnel chest
Chest rise and expansion
Inflamed right supra-clavicular lymph node
WoB
Accessory muscle use
In the abscence of circulatory compromise, what can cause an increased CRT?
Peripheral Vascular Disease
Old age
Hypothermia/cold ambient temperature
Why should special attention be given to knee mottling and what can cause it to be more severe?
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.
What patients with circulatory collapse may have a bounding pulse?
A strong bounding pulse is associated with the vasodilation of sepsis or anaphylaxis.
What can a weak ‘thready’ pulse signify?
A weak thready pulse, or one with a low pulse volume, is associated with low cardiac output, most likely due to hypovolaemia
Why should you have a higher index of suspicion for hypotension in elderly or usually hypertensive patients?
Elderly patients and those with known (or untreated) hypertension may require a higher MAP to maintain organ perfusion
Why is it important to monitor pulse pressure in patients with circulatory collapse or volume loss?
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.
What values are considered narrow and wide pulse pressures?
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.
In the hypovolaemic patient, what does a narrowing pulse pressure signify?
It indicates a decreasing cardiac output and an increasing peripheral vascular resistance
What are the signs and symptoms of a tension pneumothorax?
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
What may a collapsing pulse signify?
Aortic regurgitation
Patent ductus arteriosus
