C- Circulation Flashcards
(11 cards)
Causes of VF (9)
VF is the most common initial cardiac arrest rhythm.
Causes:
- Acute coronary syndrome
- Hypertensive heart disease
- Valve disease
- Drugs
- Inherited cardiac diseases
- Acidosis
- Electrolyte concentration
- Hypothermia
- Electrocution
Acute coronary syndromes (ACS) categories
STEMI
NSTE ACS
- NSTEMI (ST depression, T wave inversion, )
- Unstable angina
Acute MI presentation presentation
Typical
- Central crushing/ tight pain
- Indigestion like pain
- Radiation to the neck/ arms/ back/ epigastrium
Less often:
- Discomfort in other areas
ECG:
- ST elevation
- T wave inversion
- Troponin increase
Unstable angina
Type of NSTEMI
- No ECG changes
- No laboratory evidence
Presents with similar characteristics to STEMI:
- Central pain
- Radiation
etc
Immediate ACS treatment
Anti clot:
Aspirin 300mg orally
Vasodilator:
Sub-lingual GTN
Hypoxia:
O2 if sats are <94
Pain relief: IV opiate (morphine)
Refer to cardiologist
Further interventions for ACS
Percutaneous coronary intervention (PCI)
- Primary for STEMI
Antithrombotic agents (clopidogrel)
Anticoagulation
Features that indicate a high probability of arrhythmic syncope (5)
Syncoping when supine
Syncoping during or after exercise
Syncope with no or only brief warning signs (sudden collapse)
Repeated episodes of unexplained syncope
Syncope with family history of sudden or inherited cardiac death
Causes of sudden cardiac death
Coronary heart disease
- Most common
Non-ischaemic cardiomyopathy
Valvular disease
Hereditary
Congenital
Examples of secondary heart problems that cause problems in circulation (cardiac arrest)
Asphyxia from airway obstruction or apnoea
Acute, severe blood loss
Severe hypoxia
Severe anaemia
Hypothermia
Severe septic shock
Circulation assessment
- Look at the patient.
- Colour: pale? sweaty? pink, blue? - Feel the patient
- Warm? Cold? - Cap refil: central (sternum
- >2 secs= poor peripheral perfusion - Pulse: central and peripheral
- Rate, rhythm, character
- Bounding= sepsis
- Thready= poor CO - BP
- Low= sepsis, anaphylaxis
- Narrow pulse pressure (<35 between systolic and diastolic) = cariogenic, hypovolaemia - Heart
- Feel: thrills, heaves
- Auscultate: rate, murmurs, pericardial rub - Low urine output, decrease conscious level, blood loss
C treatment
Tailor according to cause.
Main treatment:
Cannula: large gauge,14/16G
- Give rapid bolus of warmed 500mL Hartmann’s (or saline 0.9%)
- 250mL for patients with heart failure, trauma
Reassess after fluid, repeat if no improvement
- Lack of further response= seek help, could indicate bleeding
- Cardiac failure=ionotropes or vasopressors
Suspected ACS (chest pain etc)
- ECG
- Aspirin, GTN, Morphine, O2 if sats are low.
