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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
4 Stages on EKG of pericardits
Stage 1: PR depression, ST elevation Stage 2: PR depression Stage 3: inverted T wave Stage 4: normal
26
Stage 1 EKG of Pericarditis
acute phase - diffuse ST elevation and PR depression
27
Stage 2 EKG of Pericarditis
PR depression, but ST segments return to normal
28
What should be present on EKG w/ STEMI
reciprocal changes, ST depression of T inversion on other leads
29
Stage 3 EKG of Pericarditis
T-wave inversions (also seen w/ ischemic changes)
30
Stage 4 EKG of Pericarditis
Normal EKG
31
Complications of Pericarditis
Pericardial effusion leading to cardiac tamponade
32
Acute Sx of Pericardial effusion appear at (what V)
80mL
33
Chronic Pericardial effusion can accumulate (what V)
1-2 L
34
EKG findings w/ Pericardial effusion
low voltage, electrical alternans, pendular motion of beating heart of heart in fluid-filled sac
35
electrical alternans
QRS amplitude alternates (tall, short, tall)
36
Elevated T-wave indicates
hyperkalemia
37
Tx hyperkalemia w/
Calcium to stabilize membrane, no effect on K+
38
Can you give Ca2+ if patient is on Digoxin?
No, stone heart results
39
Radiography of pericarditis
CXR - no value
40
Pericardial fat pad sign
Epicardial fat allows the silhouette of two layers of pericardium to appear separate from the heart - seen on lateral CXR
41
What imaging modality is best to diagnose Pericardial effusion
Cardiac ECHO
42
Water bottle/Flask heart on
CXR indicating pericardial effusion
43
Treatment for pericardial effusion
pericardiocentesis
44
Labs for pericarditis
elevated WBC, uremia, +Strep tests, +blood cultures, UA, ESR, TSH, ANA/RF, Troponin
45
If you suspect purulent pericarditis, then you must
do periocardiocentesis for culture and sensitivity
46
Treatment if pericarditis is viral or idiopathic
NSAIDS 1-3 wk
47
If you suspect purulent pericarditis, treat w/
> 4 wks of ABX
48
Poor prognostic indicators for pericarditis
immunosuppression, myocarditis, pericardial effusion, fever, trauma, NSAID failure, anticoagulant use
49
Constrictive Pericarditis
result of pericardial injury | Fibrous thickening of pericardium
50
Causes of Constrictive Pericarditis
Cardiac trauma/intrapericardial bleeding, Open heart surgery | Fungal, tb, or uremic pericarditis
51
Sx of Constrictive Pericarditis
dyspnea (worse w/ exertion), PND, orthopnea, LE edema, JVD, chest pain
52
Heart sounds w/ Constrictive Pericarditis
Pericardial knock
53
Cardiac Tamponade
Compression of heart by fluid in pericardium, equal pressure in all 4 chambers -> death
54
Sx for Cardiac Tamponade
Beck's Triad, tachycardia, pulsus paradoxus
55
Do steroids typically treat pericarditis?
No, only in the case of Dressler’s Syndrome!
56
Sx of Shock
hypotension, tachycardia (1st), oliguria, altered mental status, peripheral hypoperfusion
57
Shock physiology
arterial BF cannot meet tissue demands -> hypoxia of tissues -> anaerobic metabolism & lactic acidosis
58
Lactic serves as
diagnostic and prognostic indicator
59
Hypovolemic Shock physiology
decreased volume, compensation by vasoconstriction after 15% loss, TPR increases, but CO, PCWP and venous return decreases = shock
60
Causes of Hypovolemic Shock
trauma, blood loss, fluid/electrolyte imbalance, GI bleed, vomiting/diarrhea
61
Sx of Hypovolemic Shock
Oliguria, AMS, cool extremities, diaphoresis, pale
62
Pulmonary Capillary Wedge Pressure
reflects left atrial filling pressure- tells us if there is enough fluid to fill the heart
63
Treatment for hypovolemic shock
Isotonic Saline (.9) Lactate Ringers, Transfusion
64
Cardiogenic Shock
cardiac failure and heart can't maintain CO = tissue hypoxia
65
What is seen on ECHO of heart during Cardiogenic Shock
Wall motion abnormality due to decreased left ventricular contractility
66
Sx of Cardiogenic Shock
Oliguria, mental status changes, diaphoresis, cool extremities, jugular venous pressure is elevated, pulmonary edema
67
Cardiogenic Shock is associated w/ what type of HF
Low-ouput
68
Findings w/ Cardiogenic Shock
elevated PCWP
69
How do you differ b/w cardiogenic and hypovolemic shock?
Hx & ECHO: Cardiogenic: decreased left ventricular contractility Hypovolemic: small LV d/t poor filling, contractility is okay
70
Obstructive Shock Causes
Cardiac tamponade, tension pneumothorax, saddle embolus
71
The mediastinum gets shifted _____ form the side w/ tension pneumothorax
away; heart/lungs get squeezed
72
Tx for tension pneumothorax
needle pneumothorax
73
Tx for pneumothorax
chest tube
74
Distributive shock causes
septic, SIRS, neurogenic, anaphylaxis
75
Distributive shock
decreases in systemic vascular resistance
76
SIRS
occurs before sepsis
77
SIRS causes
infectious cause, or noninfectious (burns, pancreatitis, trauma, ischemia)
78
Need to have at least two of the following criteria for SIRS
Temp >100.4 or 90 | RR > 20 or abg 12 or < 4
79
ABG <32 may indicate
SIRS
80
Sepsis
SIRS + a source (UTI, pneumonia, cellulitis, meningitis)
81
Risks of sepsis:
age, DM, immunosuppression, recent invasive procedures
82
Most common cause of sepsis
gram negative agents
83
Neurogenic shock
Loss of sympathetic tone and systemic vascular resistance
84
Neurogenic shock causes
by traumatic spinal cord injury or by effects of an epidural, or spinal anesthetic
85
Sx of Neurogenic shock
Hypotension WITHOUT a compensatory tachycardia
86
S/S of shock
hypotension, tachycardia, vasoconstriction, cool/mottled extremities, oliguria, bowel ischemia, hepatic dysfunction, MSOF, altered mental status
87
Labs during shock, must order
Lactate & Procalcitonin
88
High lactate indicates
low prognosis
89
Hemorrhagic shock should be treated w/
FLUIDS + blood
90
Treatment for Septic shock
initial bolus of .9 normal saline, if that doesn’t work use pressors

CSI Exam 4 (11 decks)

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