CCP Final Exam Prep Flashcards
1
Q
Killip Classification for Heart Failure
A
Quantifies severity of heart failure in ACS and predicts 30-day mortality.
Class I: No signs of congestion/CHF
Class II: S3 and basal rales on auscultation and/or JVD
Class III: Acute pulmonary edema
Class IV: Cardiogenic shock
2
Q
clinic features of right heart STRAIN on echo
A
- dilatation of the RV (ideally measured in the RV focused apical 4 chamber view)
- interventricular septal flattening (commonly referred to as “D sign”. look for the presence of septal flattening in LV via parasternal short axis)
- paradoxical septal motion
- right atrial enlargement
- right ventricular hypertrophy
- right ventricular systolic dysfunction (RV free wall hypokinesis with apical sparing “McConnell’s sign”)
- RV hypokinesia
- fat IVC (diameter >2.1cm with loss of phasic variation throughout the respiratory cycle)
- tricuspid regurgitation
3
Q
define right heart STRAIN (or more precisely right ventricular strain)
A
- ventricular dysfunction where the RV is deformed
- used to denote the presence of RV dysfunction usually in the absence of an underlying cardiomyopathy
- can be caused by PHTN, PE, RV infarction, chronic lung disease (pulmonary fibrosis or COPD), pulmonic stenosis, bronchospasm, and pneumothorax
4
Q
ECG signs of right heart strain
A
- Tachycardia
- Right axis deviation
- RBBB
- S1Q3T3 (insensitive and non-specific)
- T-wave inversion anterior leads
5
Q
these conditions pre-dispose geriatrics to cervical spine injury
A
- osteoarthritis (OA)
2. cervical stenosis
6
Q
what percent of geriatric patients develop life threatening ICH following minor head trauma
A
Fifteen percent (15%)
7
Q
what percent of the north american geriatric population is on anticoagulants
A
Ten percent (10%)
8
Q
discuss age-related Anatomic/physiologic/pharmacologic changes that affect the pathophysiology of head trauma in the elderly
A
- compared to young people, subdural hematomas (along with intraparenchymal bleeds) are the most common types of geriatric intracranial bleeds
- This is d/t ↑ adherence of the dura to the skull in elderly patients → the underlying bridging veins in the elderly being more likely to be damaged in head trauma
- As the bridging veins bleed, intracranial subdural hematomas form (as opposed to epidural hematomas, which are more common in young patients)
- advancing age → to progressive brain atrophy → more room for ↑ bleeding for the subdural hematoma within the cranial cavity
- This situation → delayed onset of symptoms → elderly patients to seek care later → Delay in presentation and delays in initiation of treatment
- higher incidence of chronic dementia in the elderly also → delays in presentation and treatment
- ~10% of geriatric population is on anticoagulation → increased risk of intracranial bleeding
9
Q
pulmonary changes in geriatric patients
A
- ↓ in elastic fibers, ↓ intercostal muscle mass, ↓ rib articulation, changes in thoracic vertebral body height, osteoporosis, ↓ in alveolar surface area, ↓ gas exchange, ↓ mucociliary clearance and cough reflexes, and underlying pulmonary disease
- These changes lead to ↓ pulmonary reserve, with ↓ FEV, ↓ FRC, ↓ VC.
- Additionally, the elderly may mount only half of the compensations for hypoxia or hypercarbia compared to their younger counterparts, potentially leading to rapid decompensation
- The frail chest wall in the elderly patient ↑ their susceptibility to trauma, as low-impact forces may result in sternal + rib fractures w/ pulmonary contusions, leading to ↑ morbidity and mortality
10
Q
Cardiovascular changes in geriatric patients
A
- after 40yo vasculature + myocardial connective tissue hardens d/t elastin and collagen changes
- ↑ sympathetic activity and norepinephrine baseline levels lead to ↑ SVR.
- These physiologic changes in aging lead to ↓ vascular compliance and an ↑ in systolic HTN.
- β-adrenergic responses to endogenous and exogenous stressors in the geriatric patient are also altered, resulting in an inappropriate ionotropic and chronotropic compensation for traumatic insults.
- Vital signs in the geriatric trauma patient may be unreliable and may appear normal, given that a baseline of HTN is common in this population.
- The blunted response may also be altered by medication use (eg, beta blockers).
11
Q
neurologic changes in geriatric patients
A
- Underlying dementia, visual, auditory, and cognitive decline, slower reaction times, and concomitant medication use may influence mental status evaluation (eg, GCS)
- After the age of 40 y, brain volume ↓ 5% per decade of life
- An occult brain bleed, commonly d/t shearing of the bridging veins resulting in a SDH, is possible given the ↑ potential space d/t age-related brain atrophy that can be occupied by an intracranial bleed before clinical symptoms become apparent
- ↓ cerebral autoregulation with aging renders the geriatric trauma patient with head injury more sensitive to hypotension
12
Q
Musculoskeletal changes in geriatric patients
A
- ↓ in bony and cartilaginous mass and volume
- OA is a risk factor for fractures
- geriatric trauma patient is prone to ↑ rates of fractures, even from low MOI
13
Q
Renal/Hepatic changes in geriatric patients
A
- renal function decline is common in the geriatric population, GFR ↓ approx ~7.5 mL/min per decade in geriatrics
- renal changes contribute to disturbances in electrolyte hemostasis and worsened autoregulation of volume status
- hepatic mass ↓ up to 40% w/ advancing age, correlating with a ↓ in function
- pharmacokinetics in the geriatric patient are affected by ↓ renal + hepatic function, resulting in altered absorption, elimination, distribution, and metabolism of drugs
14
Q
explain how drug METABOLISM is altered in the elderly (pharmacokinetics)
A
- Diminished phase one metabolism, resulting in accumulation of phase-1-dependent medications
- Diminished hepatic blood flow, resulting in altered metabolism
15
Q
age-related changes to the Resp system in elderly
A
- Decreased VC
2. Decreased compliance
