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CSI Exam 4 > Shock and Pericarditis > Flashcards

Shock and Pericarditis Flashcards

1
Q

Pericardium layers

A

visceral (lies on epicardium) and parietal (dense fibrous outer layer)

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2
Q

Pericadial sac holds (what V)

A

15-50mL

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3
Q

Pericarditis - pericardium may contain

A

exudates, adhesions, blood, or serous type fluid.

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4
Q

Fibrinous Pericarditis is caused by

A

Dressler’s Syndrome, Uremia, Radiation

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5
Q

Dressler’s Syndrome

A

Delayed pericarditis 2-10 wks after mi due to antibodies

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6
Q

Treatment for Dressler’s Syndrome

A

Corticosteroids

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7
Q

Sx of Fibrinous Pericarditis

A

Loud friction rub, “bread and butter” appearance

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8
Q

Serous Pericarditis

A

Noninfectious inflammatory disease

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9
Q

Serous Pericarditis is caused by

A

rheumatic fever, SLE, viral infections (Coxsackie)

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10
Q

Suppurative Pericarditis is caused by

A

bacterial, fungal, and parasitic agents

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11
Q

Mortality is greatest for which type of pericraditis

A

Suppurative Pericarditis

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12
Q

Pericarditis is more common in what pt pop

A

Male, adults

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13
Q

Most common symptom of pericarditis

A

chest pain

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14
Q

Sx of pericarditis

A

substernal, stabbing/burning chest pain, SOB, dysphagia, radiation to back/neck/shoulder/arm, pain referral to left trapezius ridge

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15
Q

Pericarditis Sx - pain referral to left trapezius ridge bc

A

Inflammation of the joining diaphragmatic pleura

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16
Q

Chest pain w/ pericarditis is worsened by

A

lying down, inspiration, swallowing; improved by sitting or leaning forward

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17
Q

Other Sx of pericarditis

A

pericradial friction rub, low fever, dysphagia, dyspnea, Beck’s Triad

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18
Q

Beck’s Triad for Pericarditis

A

Hypotension, JVD, muffled heart sounds

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19
Q

Causes of Pericarditis

A

Idiopathic, Malignancy, Drug-induced, rheumatic, Radiation, uremia, post-MI

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20
Q

What drugs can cause pericarditis

A

Hydralazine, Isoniazid, Procainamide

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21
Q

Bacterial Causes of Pericarditis

A

Staph, Strep, Pneumococcus, Neisseria, Legionella (low Na+)

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22
Q

Most common bacterial agent of pericarditis

A

Staph

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23
Q

Most common viral agent of pericarditis

A

Coxsackie

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24
Q

Pericardial friction rub

A

sit/lean forward, diaphragm of stethoscope, LLSB, leather on leather

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25
Q

4 Stages on EKG of pericardits

A

Stage 1: PR depression, ST elevation
Stage 2: PR depression
Stage 3: inverted T wave
Stage 4: normal

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26
Q

Stage 1 EKG of Pericarditis

A

acute phase - diffuse ST elevation and PR depression

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27
Q

Stage 2 EKG of Pericarditis

A

PR depression, but ST segments return to normal

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28
Q

What should be present on EKG w/ STEMI

A

reciprocal changes, ST depression of T inversion on other leads

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29
Q

Stage 3 EKG of Pericarditis

A

T-wave inversions (also seen w/ ischemic changes)

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30
Q

Stage 4 EKG of Pericarditis

A

Normal EKG

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31
Q

Complications of Pericarditis

A

Pericardial effusion leading to cardiac tamponade

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32
Q

Acute Sx of Pericardial effusion appear at (what V)

A

80mL

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33
Q

Chronic Pericardial effusion can accumulate (what V)

A

1-2 L

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34
Q

EKG findings w/ Pericardial effusion

A

low voltage, electrical alternans, pendular motion of beating heart of heart in fluid-filled sac

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35
Q

electrical alternans

A

QRS amplitude alternates (tall, short, tall)

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36
Q

Elevated T-wave indicates

A

hyperkalemia

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37
Q

Tx hyperkalemia w/

A

Calcium to stabilize membrane, no effect on K+

38
Q

Can you give Ca2+ if patient is on Digoxin?

A

No, stone heart results

39
Q

Radiography of pericarditis

A

CXR - no value

40
Q

Pericardial fat pad sign

A

Epicardial fat allows the silhouette of two layers of pericardium to appear separate from the heart - seen on lateral CXR

41
Q

What imaging modality is best to diagnose Pericardial effusion

A

Cardiac ECHO

42
Q

Water bottle/Flask heart on

A

CXR indicating pericardial effusion

43
Q

Treatment for pericardial effusion

A

pericardiocentesis

44
Q

Labs for pericarditis

A

elevated WBC, uremia, +Strep tests, +blood cultures, UA, ESR, TSH, ANA/RF, Troponin

45
Q

If you suspect purulent pericarditis, then you must

A

do periocardiocentesis for culture and sensitivity

46
Q

Treatment if pericarditis is viral or idiopathic

A

NSAIDS 1-3 wk

47
Q

If you suspect purulent pericarditis, treat w/

A

> 4 wks of ABX

48
Q

Poor prognostic indicators for pericarditis

A

immunosuppression, myocarditis, pericardial effusion, fever, trauma, NSAID failure, anticoagulant use

49
Q

Constrictive Pericarditis

A

result of pericardial injury

Fibrous thickening of pericardium

50
Q

Causes of Constrictive Pericarditis

A

Cardiac trauma/intrapericardial bleeding, Open heart surgery

Fungal, tb, or uremic pericarditis

51
Q

Sx of Constrictive Pericarditis

A

dyspnea (worse w/ exertion), PND, orthopnea, LE edema, JVD, chest pain

52
Q

Heart sounds w/ Constrictive Pericarditis

A

Pericardial knock

53
Q

Cardiac Tamponade

A

Compression of heart by fluid in pericardium, equal pressure in all 4 chambers -> death

54
Q

Sx for Cardiac Tamponade

A

Beck’s Triad, tachycardia, pulsus paradoxus

55
Q

Do steroids typically treat pericarditis?

A

No, only in the case of Dressler’s Syndrome!

56
Q

Sx of Shock

A

hypotension, tachycardia (1st), oliguria, altered mental status, peripheral hypoperfusion

57
Q

Shock physiology

A

arterial BF cannot meet tissue demands -> hypoxia of tissues -> anaerobic metabolism & lactic acidosis

58
Q

Lactic serves as

A

diagnostic and prognostic indicator

59
Q

Hypovolemic Shock physiology

A

decreased volume, compensation by vasoconstriction after 15% loss, TPR increases, but CO, PCWP and venous return decreases = shock

60
Q

Causes of Hypovolemic Shock

A

trauma, blood loss, fluid/electrolyte imbalance, GI bleed, vomiting/diarrhea

61
Q

Sx of Hypovolemic Shock

A

Oliguria, AMS, cool extremities, diaphoresis, pale

62
Q

Pulmonary Capillary Wedge Pressure

A

reflects left atrial filling pressure- tells us if there is enough fluid to fill the heart

63
Q

Treatment for hypovolemic shock

A

Isotonic Saline (.9) Lactate Ringers, Transfusion

64
Q

Cardiogenic Shock

A

cardiac failure and heart can’t maintain CO = tissue hypoxia

65
Q

What is seen on ECHO of heart during Cardiogenic Shock

A

Wall motion abnormality due to decreased left ventricular contractility

66
Q

Sx of Cardiogenic Shock

A

Oliguria, mental status changes, diaphoresis, cool extremities, jugular venous pressure is elevated, pulmonary edema

67
Q

Cardiogenic Shock is associated w/ what type of HF

A

Low-ouput

68
Q

Findings w/ Cardiogenic Shock

A

elevated PCWP

69
Q

How do you differ b/w cardiogenic and hypovolemic shock?

A

Hx & ECHO:
Cardiogenic: decreased left ventricular contractility
Hypovolemic: small LV d/t poor filling, contractility is okay

70
Q

Obstructive Shock Causes

A

Cardiac tamponade, tension pneumothorax, saddle embolus

71
Q

The mediastinum gets shifted _____ form the side w/ tension pneumothorax

A

away; heart/lungs get squeezed

72
Q

Tx for tension pneumothorax

A

needle pneumothorax

73
Q

Tx for pneumothorax

A

chest tube

74
Q

Distributive shock causes

A

septic, SIRS, neurogenic, anaphylaxis

75
Q

Distributive shock

A

decreases in systemic vascular resistance

76
Q

SIRS

A

occurs before sepsis

77
Q

SIRS causes

A

infectious cause, or noninfectious (burns, pancreatitis, trauma, ischemia)

78
Q

Need to have at least two of the following criteria for SIRS

A

Temp >100.4 or 90

RR > 20 or abg 12 or < 4

79
Q

ABG <32 may indicate

A

SIRS

80
Q

Sepsis

A

SIRS + a source (UTI, pneumonia, cellulitis, meningitis)

81
Q

Risks of sepsis:

A

age, DM, immunosuppression, recent invasive procedures

82
Q

Most common cause of sepsis

A

gram negative agents

83
Q

Neurogenic shock

A

Loss of sympathetic tone and systemic vascular resistance

84
Q

Neurogenic shock causes

A

by traumatic spinal cord injury or by effects of an epidural, or spinal anesthetic

85
Q

Sx of Neurogenic shock

A

Hypotension WITHOUT a compensatory tachycardia

86
Q

S/S of shock

A

hypotension, tachycardia, vasoconstriction, cool/mottled extremities, oliguria, bowel ischemia, hepatic dysfunction, MSOF, altered mental status

87
Q

Labs during shock, must order

A

Lactate & Procalcitonin

88
Q

High lactate indicates

A

low prognosis

89
Q

Hemorrhagic shock should be treated w/

A

FLUIDS + blood

90
Q

Treatment for Septic shock

A

initial bolus of .9 normal saline, if that doesn’t work use pressors

CSI Exam 4 (11 decks)

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