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NNSOCM 2023 > CIRCULATION W2 > Flashcards

CIRCULATION W2 Flashcards

1
Q

What are the 4 bloodtypes?

A

A, B, AB, O

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2
Q

Blood contains of

A

Plasma 55%
Formed elements 45%

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3
Q

What are the layers of the heart called?

A

Pericardium (outer)
Myocardium (muscle)
Endocardium (inner)

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4
Q

Name the 2 types of chambers in the heart

A

Atrium (right and left)
Ventricles (right and left)

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5
Q

What is the “pacemaker center”in the heart called?

A

Sinoatrial node (sinus node)

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6
Q

How does the pre capillary sphincters affect blood flow?

A

Regulates amount of blood going into the capillaries by constricting the entrances

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7
Q

Name the 3 layers of the vessels

A

Tunica interna (in contact with blood)
Tunica media (with smooth muscle)
Tunica externa (connective tissue)

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8
Q

What does the hydrostatic pressure accomplish in relation to fluid balance

A

Facilitates filtration of water out of the vessels into the interstitial space

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9
Q

What does the coloid osmotic pressure accomplish in relation to fluid balance

A

Large molecules like Albumin (protein) draws water from the intertistial space into the vessels due to osmosis. This is called reabsorbtion

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10
Q

What facilitates venous blood to flow against gravity?

A

Venous pumps (muscle movement)
Venous valves (prevents backflow)

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11
Q

What is an embolism?

A

The condition were a blood clot, air bubble or foreign object has travled with the blood stream and is stuck in a vessel causing ischemia.

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12
Q

How much blood is expected ind an average adult of 87kg

A

70 ml x 87kg = 6090ml

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13
Q

How is the blood normally distributed anatomically between arterial and venous vessels?

A

75% in venous vessels
20% in arteries
5% in capillaries

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14
Q

How does the sympathetic nervous system directly affect the heart?

A

Generally increases CO (cardiac output) via:
Increase in HR (Heart rate)
Increase in SV (Stroke volume)

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15
Q

How does the parasymphatetic nervous system directly affect the heart

A

Decreases HR

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16
Q

What do we call EDV-ESV

A

SV (stroke volume)

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17
Q

The desaturated vessels running from the right ventricle to the lungs are called?

A

Pulmonary arteries

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18
Q

Saturated vessel running from the left ventricle is called

A

Aorta

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19
Q

The valve between the right atrium and ventricle is called

A

Tricuspid (AV-valve)

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20
Q

The valve between the left atrium and the ventricle is called

A

Mitral / Bicuspid (AV-valve)

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21
Q

What are the early signs of hemorrhagic shock

A

Hypotension (absent or weak radial pulse)
Altered mental status

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22
Q

What are the compensative responses of shock

A

Increased RR (respiratory rate)
Increased HR (heart rate)
Decreased urine output

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23
Q

You have treated a guy for hemorrhagic shock with TQ and blood infusion, but he is still having signs of shock. What should you consider?

A

Refractive shock
(e.g. obstructive shock - Tension pneumothorax)

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24
Q

What are the early mechanics of hemorrhagic shock

A
  1. Vasocontriction in both veins and arteries
  2. Redistribution of blood from the GI-Tract to the other parts of the circulatory system
  3. Heart tries to maintain BP by increasing HR
  4. Respiration rate and depth increases resulting in increased venous return
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25
Q

What are the late mechanichal signs of hemorrhagic shock

A
  1. Redistribution of fluids from extracellular space into vessels due to decreased hydrostatic pressure.
  2. Urine retention
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26
Q

Name 4 types of shock

A

Obstructive shock
Cardiogenic shock
Distributive shock
Hypovolemic shock

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27
Q

Causes of obstructive shock

A
  1. Tensionpneumathorax
  2. Cardiac tamponade
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28
Q

Causes of cardiogenic shock

A
  1. MI (myocardial infarction)
  2. Arytmia
  3. Valvedysfunction
  4. Damage to heart muscle due to trauma
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29
Q

Causes of hypovolemic shock

A
  1. Dehydration due to: Vomit, burns, diarrhea
  2. Hemorrhage: loss of blood
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30
Q

Causes of distributive shock

A
  1. Sepsis (systemic infection)
  2. Analphylaxia (systemic allergic reaction
  3. Neurogenic (spinal injury)
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31
Q

What can happen with the blood vessels caudal to an severe spinal injury around T4 and why?

A

The can dilate excessive due to injury to the sympathetic nervous system. Therefor the parasymphatetic nervous system controls vessels alone.
Bloodpressure may descrease and signs of shock may be present.

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32
Q

Desaturated blood collects in two big veins before entering the heart. They are called?

A

Superior Vena Cava
Inferior Vena Cava

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33
Q

What are the main arteries going towards the head called?

A

Carotid arteries

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34
Q

What is the artery on the top of the foot called?

A

Dorsalis pedis

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35
Q

What are the arteries supplying the heart muscle called?

A

Coronary arteries

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36
Q

What is the most preferable fluid for resuscitation hemorrhagic shock per TCCC guideline?

A

Cold stored low titer whole blood

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37
Q

What can cause decreased venous return?

A

Positive pressure ventilation (bagging)

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38
Q

What is the goal of resuscitation?

A

Palpable radial pulse
Improved mental status
Stabile vital signs
“Deliver a live and warm body to the surgeon”

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39
Q

What does the MAP indicate?

A

General perfusion state of vital organs

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40
Q

What are the main physiological factors in BP?

A
  1. CO (Cardiac output)
  2. SVR (Systemic vascular resistance)
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41
Q

What are the steps of treating hemorrhagic shock?

A
  1. Stop bleeding
  2. Give blood
  3. TXA and Calcium
  4. Airway and respiration management
  5. Hypothermia prevention
  6. Pain management
  7. Surgery
42
Q

What are the preferred types of blood for infusion in prioritised order?

A
  1. Cold stored low titer whole blood
  2. Pre selected low titer whole blood
  3. Blood products (RBC, Plasma, Platelets) 1-1-1 ratio
  4. RBC and plasma 1-1 ratio
  5. RBC or plasma alone
43
Q

What is primary hemostasis

A

Plug of platelets

44
Q

What is secondary hemostasis?

A

RBC form clots with fibrin strings

45
Q

What are the formed elements in blood?

A

RBC 95,1%
WBC 0,1%
Platelets 4,8%

46
Q

What determines the blood pressure?

A

BP = CO x SVR
BP is the result of cardiac output and systemic vascular resistance

47
Q

What are the receptors that measure blood pressure called?

A

Baroreceptors in the aortic arch and carotid artery

48
Q

What effect does TXA have on fibrinolysis?

A

TXA prevents the body’s natural way of breaking down fibrin. This causes clots to “stay around for longer”

49
Q

What are the 3 regulations of blood pressure?

A
  1. Autoregulation
  2. Nural
  3. Hormonal
50
Q

What is cardiac tamponade?

A

Blood surrounding the heart in the mediastinum (heart cavity) due to blunt or penetrating trauma causing the heart to pump ineffectively.

51
Q

RIGHT heart failure causes what? (congestion)

A

Build up of fluids in the legs primarely
(systemic edeema)

52
Q

LEFT heart failure causes what? (congestion)

A

Build up of fluid in the lungs
(pulmonary edeema)

53
Q

Bradycardia is when…

A

HR is under 60 Bpm (for a person at rest)

54
Q

Tachycardia is when…

A

HR is above 100 Bpm (for a person at rest)

55
Q

A stroke volume (SV) of 50 ml and a Heartrate (HR) of 100 Bpm equals what cardiac output (CO)?

A

5000ml
CO = SV x HR
CO = 50ml x 100 Bpm = 5000ml

56
Q

If end diastolic volume (EDV) is 80ml and end systolic volume (ESV) is 20ml how much is the stroke volume (SV)?

A

60 ml
SV = EDV - EST
SV = 80ml - 20ml = 60ml

57
Q

Factors that increases end diastolic pressure (EDV)

A
  1. Increased symphatetic activity
  2. Increased blood volume (after fluid or blood infusion)
  3. Increased skeletal muscle activity
  4. Increased respiration (more venous return)
58
Q

Normal CRT (Capillary refill time)

A

Under 2-3 seconds

59
Q

Signs & symptoms of MI (myocardial infarction)

A
  1. Central chest pain
  2. Radiating pain to arm/neck/jaw
  3. Signs of cardiogenic shock
  4. Vomiting
60
Q

What is the main concern about DVT (deep venous thrombosis)

A

The thrombosis might travel to the lungs via the bloodstream and cause a pulmonary embolism

61
Q

What is the function of the lymphatic system?

A

Drains and transports excessive fluids from the intertistial space to lymph notes and back to the venous vessels. Plays an important role in the immunesystem.

62
Q

Normal MAP (mean arterial pressure)

A

65-100 mmhg

63
Q

Types of responsiveness to treatment

A

Non-responders
Transient-responders
Responders

64
Q

Signs & symptoms of septic shock (field diagnostic criterias)

A

Proven infection +
RR >22
Altered mental state
BP <100 mmhg

65
Q

The problem with systemic allergic reaction (analphylactic shock) is?

A

Systemic vasodialation and loss of fluid from vessels into extracellular space

66
Q

TQ applied during CUF should be placed

A

High and tight

67
Q

TQ replacement during TFC should be placed

A

Directly onto skin
5-6cm proximal to injury

68
Q

Atrial fibrillation (AFIB) is when…

A

Cells in atriums do not contract coordinated causing an irregular heart rhythm

69
Q

Ventrical fibrillation (VFIB) is when…

A

Ventricles do not contract coordinated causing no CO and no measurable BP.

70
Q

Asystoli is when…

A

There is no activity of the heart muscles

71
Q

When auscultating the heart the 1. sound you hear is

A

Closure of AV-valves marking the beginning of the systole

72
Q

When auscultating the heart the 2. sound you hear is…

A

Closure of semilunar-valves (pulmonary and aortic) marking the beginning of diastole

73
Q

The part of the aorta which is leading blood towards the legs are called the…

A

Descending aorta

74
Q

The two arteries you can palpate by the rist are the …

A

Radial artery
Ulnar artery

75
Q

How long can an IV site normally be used before you should replace the IV catheter?

A

Maximum of 72 hours

76
Q

Which anatomical part of the vessels distinguishes arteries from veins the most?

A

Tunica media.
Arteries are more capable of constricting due to more smooth muscle in this layer

77
Q

What 3 types of surface antigens can be prescent on RBC?

A

A, B and D (rhesus)

78
Q

If your blood type is AB Rhesus Negative you have…

A

Absence of antigen D on your RBC’s

79
Q

If your blood type is B Rhesus Positive you have…

A

Presence of antigen D on your RBC’s

80
Q

If you have B-antibodies in your plasma and receive blood transfusion with type B blood what will happen?

A

B-Antibodies (proteins) in your plasma will “kill” the transfused RBC’s with the B-antigen on their surface. This might cause systemic inflammation (sepsis) if untreated.

81
Q

Case: CAX was in MVA and presents as follows:
M: No massive bleeds
A: Airway patent
R: Tachypnea, auscultation ++
C: Pale, clammy, sweaty, weak radial pulse that intensifyes with breath cycle. Auscultation cardiac: murmur
H: A(V)PU, Pearrl.
O: No other injuries
N: Has pain in the chest

What is your initial disgnosis?

A

Cardiac tamponade with signs of obstructive shock

82
Q

What are the contents of plasma?

A

Proteins 7%
Water 92%
Waste
Nutrients
Gasses

83
Q

What 3 types of protein do we have in plasma?

A

Albumin 60%
Globulin 35%
Fibrinogen 4%

84
Q

Uncompensated or untreated shock leads to

A

Downwards spiral with:
-Decreased CO
-Decreased tissue perfusion
-Unconsciousness
-Ischemia in vital organs
Eventually: Multi organ failure and possible death

85
Q

Case
CAX presents as follows:
M: No massive bleeds
A: Patent, speaking but feels discomfort in throat
R: Tachypnea, auscultation +/+
C: Tachycardia, sweaty warm skin, weak radial pulse
H: No injuries to head, A(V)PU, pearl,
O: Signs of snakebite on calf
N: No pain
What is your initial diagnosis? And what can you do to treat it?

A

CAX may suffer from analphylactic shock due to a systemic allergic reaction to the snakebite.

Treatment: Adrenaline I.M.

86
Q

What are the function of WBC’s?

A

They are a part of the immune system. They defend the body against pathogens (diseases) and assist in repairing damaged tissue.

87
Q

RESTRICTIVE fluid therapy is preferable for…

A

Hemorrhagic shock. We do not want to give excessive fluids. Goal is to get a palpable pulse, increased mental status and BP around 80-90mmhg

88
Q

Ways to die:
Blood on the floor (and 4 more)…?

A

Sites for fatal INTERNAL bleedings:
Thorax
Abdomen
Pelvis
Femur

89
Q

What is the medical term for a bleeding in or near a joint?

A

Junctional hemorrhage

90
Q

Name 2 other main anatomical sites for bleeding besides a junctional

A

Thruncal (the core of the body)
Extremity (arms & legs)

91
Q

RBC’s are produced were?

A

In red bone marrow

92
Q

Hematocrit (crit) is a measure of…

A

Percentage of RBC’s in the blood

93
Q

Anemia is the term for…

A

Lower levels of RBC’s in the blood

94
Q

What colours of PIVC (peripheral intravenous catheter) are preferable for fluid resuscitation?

A

Green 18G (90ml/m)
Grey 16G (180ml/m)
Orange 14G (240ml/m)

95
Q

At what angle do you insert your needle in when doing IM injections

A

90 degrees

96
Q

What do you control when you aspirate the plunger of a syringe under IM injection?

A

If there is blood flowing into the syringe

97
Q

What is the reason blood might flow into the syringe when aspirating during IM injection?

A

If you have perforated a vessel. Withdraw the needle a bit and then administer the substance.

98
Q

Low titer regarding blood products means

A

Low concentration of antibodies. Low titer usually equals less risk of reaction to infusion.

99
Q

IO CENTRAL contraindications

A
  1. Fractured manubrium
  2. Adults <50kg
  3. Children <12years
100
Q

Important steps in placing humeral IO?

A
  1. Rotate arm inwards
  2. Attack the bone in 45 degrees from the saggital plane and 45 degrees above the transverse plane of the patient

NNSOCM 2023 (16 decks)

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