RRAPID - C Flashcards
Causes of circulatory problems
Primary cardiac = MI, ischaemia, HF, tamponade
Secondary = asphyxia, hypoxia, hypothermia, sepsis, shock
How do circulatory problems kill?
Cardiac arrest
Definition of shock
State of tissue hypoperfusion
What is stroke volume?
Volume of blood ejected by ventricle per heartbeat
What is preload?
Volume of blood returning to ventricle during diastole
What is Starling’s law?
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
What is myocardial contractility?
Force with which myocardium contracts
What increases contractility?
Increasing preload or sympathetic nervous system activity
Adrenaline or inotropic drugs
What decreases contractility?
Hypovolaemia, cardiac disorder, hypoxia, hypercapnoea, acidosis, electrolyte disturbances
What is afterload + what is the consequence of increased afterload?
Tension in L ventricle during systole. 1 component is systemic vascular resistance
Increased afterload = increased myocardial work = decreased stroke volume
What is systemic vascular resistance?
Resistance of arteries to flow of blood
Directly proportional to BP
Increases with age leading to HTN
What is cardiac output?
SV X HR
What is MAP?
Mean arterial pressure = CO X SVR
5 categories of shock
Hypovolaemic Vasodilatory (septic, anaphylactic) Cardiogenic Obstructive (PE, tamponade, tension pneumothorax) Neurogenic
What type of shock affects preload?
Hypovolaemia
What type of shock affects cardiac contractility?
Arrhythmias
Congestive HF
Obstructive causes
What type of shock affects afterload?
Sepsis
Anaphylaxis
Neurogenic
Early signs of septic shock
Hypotension
Bounding pulse
Low urine output
Presentation of cardiogenic shock
Hypotension
Raised JVP
Raised SVR
Signs of pulmonary oedema
Signs of neurogenic shock
Due to spinal transection
Raised JVP
Hypotension + bradycardia
S+S shock (+ which are early + late)?
Tachycardia - EARLY
SOB - EARLY
Cold peripheries Prolonged CRT Reduced JVP Poor urine output Agitation
Hypotension - LATE
Lactic acidosis - LATE
presentation + signs of hypovolaemic shock
Thirsty Cold + clammy Decreased CRT Raised HR, low BP Reduced JVP
How to assess C
Feel peripheries CRT PR BP O2 sats RR Urine output ABG
How to assess fluid status?
CRT PR BP JVP Skin turgor (over clavicle) Heart sounds Lungs (pulmonary oedema) Peripheral oedema Urine output
What 5 questions to consider for cause of circulatory disease?
1) Are they shocked?
2) Signs of hypovolaemia?
3) Cause of hypovolaemia?
4) evidence of sepsis?
5) evidence of cardiogenic cause?
What to give in a fluid bolus?
500ml (250ml for HF) of Hartmanns or saline if K >5.5, rhabdomyolysis, AKI
What is the definition of SIRS?
Temp <36 or >38
HR >90
RR >20 or CO2 <4.3
WCC <4 or >12
What is the definition of sepsis + severe sepsis?
Sepsis = SIRS secondary to infection
Severe sepsis = sepsis + organ dysfunction, hypotension or hypoperfusion
What is the definition of septic shock?
Sepsis + hypotension despite fluids
What is the definition of narrow + broad complex tachycardias
QRS <0.12
QRS >0.12
What are the signs that indicate patients with arrhythmia are unstable?
Shock
Syncope
MI
HF
