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Pre-Hospital > Circulation > Flashcards

Circulation Flashcards

1
Q

What proportion of TBW is intracellular volume?

A

2/3rds TBW - 70kg man = approx 28 litres

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2
Q

What proportion of the ECF is plasma volume?

A

20%

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3
Q

What proportion of the ECF is interstitial fluid?

A

80%

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4
Q

What proportion of TBW is the extracellular fluid?

A

1/3rd

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5
Q

What is the definition of shock?

A

Inability of the circulatory system to meet end organ perfusion requirements.

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6
Q

What are the different types of shock?

A
  • Distributive
  • Obstructive
  • Cardiogenic
  • Hypovolaemic
  • Neurogenic
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7
Q

How does the body respond to hypovolaemia?

A
  • Tachycardia
  • Increased contractility of the heart
  • Peripheral vessel constriction - maintain oxygenation to brain and heart
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8
Q

What are the 5 major sites for major haemorrhage?

A

On the floor and 4 more:

  • 3 main central cavities - Chest, abdomen, pelvis
  • Long bones
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9
Q

Why are pelvic fractures such a bleeding risk?

A

There are numerous sources of bleeding in pelvic fractures:

  • Bones
  • Venous plexus
  • Arterial plexus

https://www.youtube.com/watch?v=nvgp4K9OmpQ

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10
Q

Why can pelvic fracture cause such a large loss of blood?

A

Pelvic ring is disturbed, meaning that tamponade of any bleeding does not occur allowing the blood to communicate to the retroperitoneal space (which has a furhter 5L of volume), the thighs and the peritoneum

Therefore pelvic fractures can be considered bleeding into a free space potentially able to hold the entire blood volume

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11
Q

How would you approach assessing circulation in someone in a pre-hospital setting?

A
  • Inspect - major haemorrhage, patient status
  • Palpation - CRT, Pulse rate and rhythm, peripheral pulses, skin temp
    • GET ACCESS AT THIS POINT - IV/IO
  • Auscultate - heart sounds
  • Blood pressure measurement
  • Assess major bleeding sites
  • AVPU - are they cerebrating
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12
Q

What are you looking for when inspecting the patient for circulation?

A
  • Hands/face blue
  • Mottled skin
  • AVPU - quick cranial perfusion assessment
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13
Q

What does pallor/cyanosis indicate?

A

Poor perfusion to tissues

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14
Q

What is normal for a Capillary refill time (CRT)?

A

2 seconds or less

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15
Q

Where can cap refill be performed?

A
  • Peripherally - Nail bed
  • Centrally - sternum, forehead
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16
Q

What would tachycardia and hypotension indicate in a patient who is suscpected to be bleeding?

A

Severe shock

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17
Q

What would a weak/thready pulse indicate?

A

Hypovolaemia

18
Q

What is an absent radial pulse indicative of in terms of management?

A

Begin IV fluids

19
Q

Is a low BP in isolation indicative of shock?

A

No - need other clinical signs such as tachycardia, pale skin, decreased consciousness

20
Q

What is regarded as the minimum BP that a radial pulse is palpable at?

A

>80 mmHg

21
Q

If the femoral pulse is palpable but the radial is absent, what would you guess the blood pressure is roughly sitting at?

A

70-80 mmHg

22
Q

What is the minimum systolic BP that the carotid pulse is palpable at??

A

>/= 60 mmHg

23
Q

Does hypotension usually occur early or late in shock?

A

Late - occurs with over 25% blood loss

24
Q

What is the order in which pulses become absent as hypovolaemia worsens?

A

Radial absent -> femoral absent -> carotid absent

25
Q

How would you manage external haemorrhage?

A
  • Pressure and elevation
  • Wound Packing
  • Tourniquet
26
Q

Why can it sometimes be difficuult to obtain IV access?

A

People can be peripherally shut down - access should be established early if needed

27
Q

What are complications that can occur when gaining IV access?

A
  • Thrombophlebitis
  • Thromboembolism
  • Sepsis
  • Air embolism
  • Arterial puncture
28
Q

When is intraosseous access considered/indicated for?

A
  • To prevent an emergent situation
  • When obtaining peripheral or central intravenous access is difficult
29
Q

What is intraosseous access?

A

Involves inserting a needle into the vascular intramedullary space that, in turn, provides direct access to the central circulation via the Volkmann canals. It is fast and reliable

30
Q

What are contraindications to IO access?

A
  • Inability to locate landmarks
  • Fractures in the same extremity as targeted bone
  • Previous surgery involving hardware in the targeted bone
  • Infection at insertion site/within target bone
  • Local vascular compromise
  • Previous failed IO within 24 hours in target bone
31
Q

What are complications of IO access?

A
  • Incorrect positioning leading to extravasation/sub-periosteal infusion
  • Osteomyelitis
  • Physeal plate injury
  • Local infection, pain
  • Compartment syndrome
  • Fat embolism
32
Q

How would you insert EZY-IO access?

A

https://www.youtube.com/watch?v=j3QRXjn-Owc

  1. Skin cleaned and limb stabilised.
  2. Needle gently inserted at 90o to insertion site until contact felt with bone
    • If 5mm mark on the needle is not visible then a larger needle is needed.
    • If 5mm mark is visible then gentle and steady pressure + drill power applied until:
    • Sudden ‘give’/‘pop’ is felt - entry to the medullary space.
    • The desired depth is obtained
  3. Remove power driver and stylet from catheter, aspirate to confirm the placement
  4. Flush and dress the site appropriately.
33
Q

What are the main types of IO access?

A
  • IO needle
  • EZY-IO
  • FAST1
34
Q

What locations are used for IO access?

A
  • Proximal tibia - Tibial tuberosity
  • Distal tibia - medial malleolus
  • Humeral head
  • Distal femur
  • Iliac crest
35
Q

Which site for IO access can achieve higher flow rates, Humeral head or tibia?

A

Humeral head

36
Q

Rank access sites for IO in terms of flow rate?

A
  1. Humerus
  2. Femur
  3. Malleolus
  4. Tibia
37
Q

What are risks of giving someone fluids in a pre-hospital setting?

A
  • Delay to patient transfer
  • Re-bleeding
  • Increased blood loss
38
Q

Why can re-bleeding occur in someone who has been given fluids in a pre-hospital setting?

A

An increase in blood flow can lead to re-bleeding from sites where bleeding may have previously ceased. This is described as ‘popping the clot’ whereby an increase in hydrostatic pressure cause displacement of the clot leading to re bleeding

39
Q

When should fluids not be given in a pre-hopital setting?

A

If the radial pulse is palpable

40
Q

How much fluid should be given to someone if they are deemed to require fluids?

A

250 ml Bolus saline, then reasess. If radial pulse still not palpable, give another 250mL bolus

Pre-Hospital (15 decks)

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