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Emergency Medicine > RRAPID - C > Flashcards

RRAPID - C Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Causes of circulatory problems

A

Primary cardiac = MI, ischaemia, HF, tamponade

Secondary = asphyxia, hypoxia, hypothermia, sepsis, shock

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2
Q

How do circulatory problems kill?

A

Cardiac arrest

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3
Q

Definition of shock

A

State of tissue hypoperfusion

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4
Q

What is stroke volume?

A

Volume of blood ejected by ventricle per heartbeat

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5
Q

What is preload?

A

Volume of blood returning to ventricle during diastole

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6
Q

What is Starling’s law?

A

Force of myocardial contraction is proportional to initial myocardial fibre length

Means larger the preload = larger the end diastolic volume = bigger the stretch of myocardial fibres = bigger the force of contraction = bigger the stroke volume

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7
Q

What is myocardial contractility?

A

Force with which myocardium contracts

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8
Q

What increases contractility?

A

Increasing preload or sympathetic nervous system activity

Adrenaline or inotropic drugs

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9
Q

What decreases contractility?

A

Hypovolaemia, cardiac disorder, hypoxia, hypercapnoea, acidosis, electrolyte disturbances

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10
Q

What is afterload + what is the consequence of increased afterload?

A

Tension in L ventricle during systole. 1 component is systemic vascular resistance

Increased afterload = increased myocardial work = decreased stroke volume

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11
Q

What is systemic vascular resistance?

A

Resistance of arteries to flow of blood
Directly proportional to BP
Increases with age leading to HTN

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12
Q

What is cardiac output?

A

SV X HR

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13
Q

What is MAP?

A

Mean arterial pressure = CO X SVR

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14
Q

5 categories of shock

A 
Hypovolaemic 
Vasodilatory (septic, anaphylactic)
Cardiogenic 
Obstructive (PE, tamponade, tension pneumothorax)
Neurogenic
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15
Q

What type of shock affects preload?

A

Hypovolaemia

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16
Q

What type of shock affects cardiac contractility?

A

Arrhythmias
Congestive HF
Obstructive causes

17
Q

What type of shock affects afterload?

A

Sepsis
Anaphylaxis
Neurogenic

18
Q

Early signs of septic shock

A

Hypotension
Bounding pulse
Low urine output

19
Q

Presentation of cardiogenic shock

A

Hypotension
Raised JVP
Raised SVR
Signs of pulmonary oedema

20
Q

Signs of neurogenic shock

A

Due to spinal transection
Raised JVP
Hypotension + bradycardia

21
Q

S+S shock (+ which are early + late)?

A

Tachycardia - EARLY
SOB - EARLY

Cold peripheries 
Prolonged CRT
Reduced JVP 
Poor urine output 
Agitation

Hypotension - LATE
Lactic acidosis - LATE

22
Q

presentation + signs of hypovolaemic shock

A 
Thirsty 
Cold + clammy 
Decreased CRT 
Raised HR, low BP 
Reduced JVP
23
Q

How to assess C

A 
Feel peripheries 
CRT
PR 
BP
O2 sats 
RR 
Urine output 
ABG
24
Q

How to assess fluid status?

A 
CRT 
PR 
BP 
JVP 
Skin turgor (over clavicle) 
Heart sounds 
Lungs (pulmonary oedema)
Peripheral oedema 
Urine output
25
Q

What 5 questions to consider for cause of circulatory disease?

A

1) Are they shocked?
2) Signs of hypovolaemia?
3) Cause of hypovolaemia?
4) evidence of sepsis?
5) evidence of cardiogenic cause?

26
Q

What to give in a fluid bolus?

A

500ml (250ml for HF) of Hartmanns or saline if K >5.5, rhabdomyolysis, AKI

27
Q

What is the definition of SIRS?

A

Temp <36 or >38
HR >90
RR >20 or CO2 <4.3
WCC <4 or >12

28
Q

What is the definition of sepsis + severe sepsis?

A

Sepsis = SIRS secondary to infection

Severe sepsis = sepsis + organ dysfunction, hypotension or hypoperfusion

29
Q

What is the definition of septic shock?

A

Sepsis + hypotension despite fluids

30
Q

What is the definition of narrow + broad complex tachycardias

A

QRS <0.12

QRS >0.12

31
Q

What are the signs that indicate patients with arrhythmia are unstable?

A

Shock
Syncope
MI
HF

Emergency Medicine (24 decks)

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