Cardiovascular Flashcards
Discuss the physical examination parameters used to assess the cv system
HR - bradycardic? Tachycardic?
Mm membranes - pink, cyanotic? Hyperaemic? Jaundice?
CRT - prolonged? Quicker? Normal?
Peripheral pulses - initial stages of hypovolaemia they become narrower but taller (hyperdynamic) CO = HR x SV increased heart contracility but less volume , after this cardiac output plateaus then falls
Compare and contrast the physical examination findings in hypovolemic, distributive and cardiogenic shock
Cardiogenic - should be a heart murmur?
Distributive shock - injected mm, fast CRT
Hypovolaemic shock -
Classify hypoperfusion as mild, moderate or severe on the basis of physical examination findings
Mild -> tachycardia, pale mm, hyperdynamic pulses, quicker CRT
moderate-> tachycardia, pale mm, prolonged crt, weak metatarsal and femoral pulses
severe-> Bradycardia? Pale/ white muddy mm, prolonged/absent crt, absent metatarsal pulse .
Autotransfusion initial shock
When blood is lost, fluid flows from the interstitial space to fill the deficit (due to sudden dorp in capillary hydrostatic pressure, Starlings forces) - except that the protein and haematocrit levels are lower in this fluid than blood, so you see a decrease in PCV and TP. splenic contraction, however, can correct the PCV initially, so you will see a proportionally greater drop in TP than PCV. This movement of fluid is called autotransfusion.
Baroreceptor-mediated response to shock
Low pressure detected by baroreceptors in carotid bodies and aortic arch
Cause sympathetic tone to increase, para to decrease, and release of vasopressin
Increase HR and systemic vascular resistance (so see paler mm, slower crt and high HR) (more targetted towards peripheral beds, splanchnic, and skeletal muscle to protect vital organs)
RAS is also stimulated by haemorrhage and associated decrease in CO
Describe how diagnostic tests and monitoring can be used to further assess cardiovascular abnormalities
