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BL MRCS Part B > Circulation > Flashcards

Circulation Flashcards

1
Q

What is Blood Pressure?

A

BP = CO x SVR

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2
Q

What is Cardiac Output?

A

CO = SV x HR

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3
Q

Draw the Arterial Blood Pressure waveform

A
  1. Systolic Peak
  2. Dicrotic notch (aortic valve closure)
  3. Diastolic Trough
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4
Q

What is MAP?

A

MAP = 1/3rd of distance from diastolic to systolic BP

It is the area under the curve of the arterial BP waveform

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5
Q

What blood products do you know of?

A

Blood products:

  1. RBC
  2. Platelets
  3. Fresh Frozen Plasma
  4. Cryoprecipitate

Plasma Products:

  1. Human Albumin Solution
  2. Coagulation factor concentrate
  3. Immunoglobulins
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6
Q

What are the constituents of RBC and how is it treated and stored etc?

A

RBC = Red Blood Cells
Stored at 2-6 degrees
Lasts 35 days from donation

Irradiated for graft vs host and washed for plasma

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7
Q

What are the constituents of Platelets and how is it stored?

A

Platelets
Stored at room temperature
Shelf life of 5 days

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8
Q

What are the constituents of Plasma and how is it stored and treated?

A

Plasma taken from Males only to avoid transfusion related lung injury
Cryoprecipitate + cryosupernatant (factors)
Storage at -25 degrees
Lasts 36 months frozen but 24 hours once thawed
Methylene blue inactivates bacteria/viruses

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9
Q

What are the constituents of cryoprecipitate?

A

The supernatant obtained from thawing FFP.

Generally used as a more concentrated form of fibrinogen than FFP (promotes clotting)

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10
Q

What is blood screened for?

A 
Hep B
Hep C
HIV
HTLV (human T-Lymphocyte Virus)
Syphillis
?CMV if required
Removal of leucocytes to avoid CJD
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11
Q

How can you classify the complications of blood transfusion?

A
  1. Complications of massive transfusion
  2. Complications of repeated transfusion
  3. Infective
  4. Immune
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12
Q

Define a massive transfusion, and list some complications

A

Whole blood volume in 24 hours (5-6L)

Complications:

  1. Fluid Overload
  2. Reduced functioning platelets (thrombocytopenia)
  3. deficiency of coagulation factors
  4. 2,3-BPG does not store well so can cause reduced oxygen capacity
  5. Hypothermia
  6. Hypocalcaemia (chelating agent in citrate)
  7. Hyperkalaemia (leakage from stored cells)
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13
Q

When would you suspect that unit of blood has bacterial contamination?

A
  1. Clots in the bag
  2. High degree of haemolysed cells
  3. this can cause lethal septic shock
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14
Q

What immune reactions can occur after transfusion, and how might you classify these?

A

Severe (life-threatening):

  1. Acute haemolytic reaction (ABO)
  2. Anaphylaxis
  3. Allergy to IgA (rare)
  4. Transfusion related Lung injury - antibodies causing oedema.
  5. Overload

Less Severe:
1. Febrile non-haemolytic transfusion reaction (pyrexia and shivering)

Delayed:

  1. Delayed haemolytic transfusion reaction (<24 hours)
  2. Purpuric Reaction (5-12 days)
  3. Graft vs Host (HLA incompatible) (7-14 days fatal)
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15
Q

How do you manage an immediate haemolytic transfusion reaction?

A

ABCDE approach

  1. Stop infusion
  2. Give fluids and maintain output
  3. Repeat crossmatch
  4. Coomb’s test
  5. Full set of bloods especially for DIC
  6. Send blood cultures
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16
Q

Define major haemorrhage

A
  1. Loss of blood volume in 24 hours

2. Loss of 50% in <3 hours

17
Q

In a typical PQRST ECG waveform, where do the heart sounds occur?

A

1st Heart sound = AV node closure = end of R wave

2nd Heart sound = VA node closure = end of T wave

18
Q

What does the P wave represent?

A

Atrial depolarisation

19
Q

How do you measure the PR interval and what does it represent?

A

Measure from start of P to start of Q
Should be 3-5 small squares
Represents SA node signal to ventricle

20
Q

What does the QRS complex represent?

A

Ventricular Depolarisation

< 3 squares

21
Q

Define and how would you measure the QT interval?

A

This is from start of Q to end of T wave

Represents complete Ventricular depolarisation and repolarisation cycle

22
Q

What is QTc

A

This is QT standardised to 60bpm

Normal range is around 1 big wave

23
Q

What does the T wave represent and why is it in the same direction as the QRS?

A

Ventricular Repolarisation

Occurs in opposite direction to QRS depolarisation from episode to endocardium

24
Q

What are the different types of Heart Block?

A

1st Degree: prolonged PR

2nd Degree Type I: gradually lengthening PR till skipped beat
2nd Degree Type II: randomly missed Beat following P

3rd Degree: Complete block. No relationship between P and QRS

25
Q

what are the fluid compartments of the body and their percentages?

A

Total = 42L
2/3rds Intracellular
1/3rd Extracellular

BL MRCS Part B (4 decks)

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