CIRCULATION W2 Flashcards
(103 cards)
1
Q
What are the 4 bloodtypes?
A
A, B, AB, O
2
Q
Blood contains of
A
Plasma 55%
Formed elements 45%
3
Q
What are the layers of the heart called?
A
Pericardium (outer)
Myocardium (muscle)
Endocardium (inner)
4
Q
Name the 2 types of chambers in the heart
A
Atrium (right and left)
Ventricles (right and left)
5
Q
What is the “pacemaker center”in the heart called?
A
Sinoatrial node (sinus node)
6
Q
How does the pre capillary sphincters affect blood flow?
A
Regulates amount of blood going into the capillaries by constricting the entrances
7
Q
Name the 3 layers of the vessels
A
Tunica interna (in contact with blood)
Tunica media (with smooth muscle)
Tunica externa (connective tissue)
8
Q
What does the hydrostatic pressure accomplish in relation to fluid balance
A
Facilitates filtration of water out of the vessels into the interstitial space
9
Q
What does the coloid osmotic pressure accomplish in relation to fluid balance
A
Large molecules like Albumin (protein) draws water from the intertistial space into the vessels due to osmosis. This is called reabsorbtion
10
Q
What facilitates venous blood to flow against gravity?
A
Venous pumps (muscle movement)
Venous valves (prevents backflow)
11
Q
What is an embolism?
A
The condition were a blood clot, air bubble or foreign object has travled with the blood stream and is stuck in a vessel causing ischemia.
12
Q
How much blood is expected ind an average adult of 87kg
A
70 ml x 87kg = 6090ml
13
Q
How is the blood normally distributed anatomically between arterial and venous vessels?
A
75% in venous vessels
20% in arteries
5% in capillaries
14
Q
How does the sympathetic nervous system directly affect the heart?
A
Generally increases CO (cardiac output) via:
Increase in HR (Heart rate)
Increase in SV (Stroke volume)
15
Q
How does the parasymphatetic nervous system directly affect the heart
A
Decreases HR
16
Q
What do we call EDV-ESV
A
SV (stroke volume)
17
Q
The desaturated vessels running from the right ventricle to the lungs are called?
A
Pulmonary arteries
18
Q
Saturated vessel running from the left ventricle is called
A
Aorta
19
Q
The valve between the right atrium and ventricle is called
A
Tricuspid (AV-valve)
20
Q
The valve between the left atrium and the ventricle is called
A
Mitral / Bicuspid (AV-valve)
21
Q
What are the early signs of hemorrhagic shock
A
Hypotension (absent or weak radial pulse)
Altered mental status
22
Q
What are the compensative responses of shock
A
Increased RR (respiratory rate)
Increased HR (heart rate)
Decreased urine output
23
Q
You have treated a guy for hemorrhagic shock with TQ and blood infusion, but he is still having signs of shock. What should you consider?
A
Refractive shock
(e.g. obstructive shock - Tension pneumothorax)
24
Q
What are the early mechanics of hemorrhagic shock
A
- Vasocontriction in both veins and arteries
- Redistribution of blood from the GI-Tract to the other parts of the circulatory system
- Heart tries to maintain BP by increasing HR
- Respiration rate and depth increases resulting in increased venous return
25
What are the late mechanichal signs of hemorrhagic shock
1. Redistribution of fluids from extracellular space into vessels due to decreased hydrostatic pressure.
2. Urine retention
26
Name 4 types of shock
Obstructive shock
Cardiogenic shock
Distributive shock
Hypovolemic shock
27
Causes of obstructive shock
1. Tensionpneumathorax
2. Cardiac tamponade
28
Causes of cardiogenic shock
1. MI (myocardial infarction)
2. Arytmia
3. Valvedysfunction
4. Damage to heart muscle due to trauma
29
Causes of hypovolemic shock
1. Dehydration due to: Vomit, burns, diarrhea
2. Hemorrhage: loss of blood
30
Causes of distributive shock
1. Sepsis (systemic infection)
2. Analphylaxia (systemic allergic reaction
3. Neurogenic (spinal injury)
31
What can happen with the blood vessels caudal to an severe spinal injury around T4 and why?
The can dilate excessive due to injury to the sympathetic nervous system. Therefor the parasymphatetic nervous system controls vessels alone.
Bloodpressure may descrease and signs of shock may be present.
32
Desaturated blood collects in two big veins before entering the heart. They are called?
Superior Vena Cava
Inferior Vena Cava
33
What are the main arteries going towards the head called?
Carotid arteries
34
What is the artery on the top of the foot called?
Dorsalis pedis
35
What are the arteries supplying the heart muscle called?
Coronary arteries
36
What is the most preferable fluid for resuscitation hemorrhagic shock per TCCC guideline?
Cold stored low titer whole blood
37
What can cause decreased venous return?
Positive pressure ventilation (bagging)
38
What is the goal of resuscitation?
Palpable radial pulse
Improved mental status
Stabile vital signs
"Deliver a live and warm body to the surgeon”
39
What does the MAP indicate?
General perfusion state of vital organs
40
What are the main physiological factors in BP?
1. CO (Cardiac output)
2. SVR (Systemic vascular resistance)
41
What are the steps of treating hemorrhagic shock?
1. Stop bleeding
2. Give blood
3. TXA and Calcium
4. Airway and respiration management
5. Hypothermia prevention
6. Pain management
7. Surgery
42
What are the preferred types of blood for infusion in prioritised order?
1. Cold stored low titer whole blood
2. Pre selected low titer whole blood
3. Blood products (RBC, Plasma, Platelets) 1-1-1 ratio
4. RBC and plasma 1-1 ratio
5. RBC or plasma alone
43
What is primary hemostasis
Plug of platelets
44
What is secondary hemostasis?
RBC form clots with fibrin strings
45
What are the formed elements in blood?
RBC 95,1%
WBC 0,1%
Platelets 4,8%
46
What determines the blood pressure?
BP = CO x SVR
BP is the result of cardiac output and systemic vascular resistance
47
What are the receptors that measure blood pressure called?
Baroreceptors in the aortic arch and carotid artery
48
What effect does TXA have on fibrinolysis?
TXA prevents the body's natural way of breaking down fibrin. This causes clots to "stay around for longer"
49
What are the 3 regulations of blood pressure?
1. Autoregulation
2. Nural
3. Hormonal
50
What is cardiac tamponade?
Blood surrounding the heart in the mediastinum (heart cavity) due to blunt or penetrating trauma causing the heart to pump ineffectively.
51
RIGHT heart failure causes what? (congestion)
Build up of fluids in the legs primarely
(systemic edeema)
52
LEFT heart failure causes what? (congestion)
Build up of fluid in the lungs
(pulmonary edeema)
53
Bradycardia is when...
HR is under 60 Bpm (for a person at rest)
54
Tachycardia is when...
HR is above 100 Bpm (for a person at rest)
55
A stroke volume (SV) of 50 ml and a Heartrate (HR) of 100 Bpm equals what cardiac output (CO)?
5000ml
CO = SV x HR
CO = 50ml x 100 Bpm = 5000ml
56
If end diastolic volume (EDV) is 80ml and end systolic volume (ESV) is 20ml how much is the stroke volume (SV)?
60 ml
SV = EDV - EST
SV = 80ml - 20ml = 60ml
57
Factors that increases end diastolic pressure (EDV)
1. Increased symphatetic activity
2. Increased blood volume (after fluid or blood infusion)
3. Increased skeletal muscle activity
4. Increased respiration (more venous return)
58
Normal CRT (Capillary refill time)
Under 2-3 seconds
59
Signs & symptoms of MI (myocardial infarction)
1. Central chest pain
2. Radiating pain to arm/neck/jaw
3. Signs of cardiogenic shock
4. Vomiting
60
What is the main concern about DVT (deep venous thrombosis)
The thrombosis might travel to the lungs via the bloodstream and cause a pulmonary embolism
61
What is the function of the lymphatic system?
Drains and transports excessive fluids from the intertistial space to lymph notes and back to the venous vessels. Plays an important role in the immunesystem.
62
Normal MAP (mean arterial pressure)
65-100 mmhg
63
Types of responsiveness to treatment
Non-responders
Transient-responders
Responders
64
Signs & symptoms of septic shock (field diagnostic criterias)
Proven infection +
RR >22
Altered mental state
BP <100 mmhg
65
The problem with systemic allergic reaction (analphylactic shock) is?
Systemic vasodialation and loss of fluid from vessels into extracellular space
66
TQ applied during CUF should be placed
High and tight
67
TQ replacement during TFC should be placed
Directly onto skin
5-6cm proximal to injury
68
Atrial fibrillation (AFIB) is when...
Cells in atriums do not contract coordinated causing an irregular heart rhythm
69
Ventrical fibrillation (VFIB) is when...
Ventricles do not contract coordinated causing no CO and no measurable BP.
70
Asystoli is when...
There is no activity of the heart muscles
71
When auscultating the heart the 1. sound you hear is
Closure of AV-valves marking the beginning of the systole
72
When auscultating the heart the 2. sound you hear is...
Closure of semilunar-valves (pulmonary and aortic) marking the beginning of diastole
73
The part of the aorta which is leading blood towards the legs are called the...
Descending aorta
74
The two arteries you can palpate by the rist are the ...
Radial artery
Ulnar artery
75
How long can an IV site normally be used before you should replace the IV catheter?
Maximum of 72 hours
76
Which anatomical part of the vessels distinguishes arteries from veins the most?
Tunica media.
Arteries are more capable of constricting due to more smooth muscle in this layer
77
What 3 types of surface antigens can be prescent on RBC?
A, B and D (rhesus)
78
If your blood type is AB Rhesus Negative you have...
Absence of antigen D on your RBC's
79
If your blood type is B Rhesus Positive you have...
Presence of antigen D on your RBC's
80
If you have B-antibodies in your plasma and receive blood transfusion with type B blood what will happen?
B-Antibodies (proteins) in your plasma will "kill" the transfused RBC's with the B-antigen on their surface. This might cause systemic inflammation (sepsis) if untreated.
81
Case: CAX was in MVA and presents as follows:
M: No massive bleeds
A: Airway patent
R: Tachypnea, auscultation +\+
C: Pale, clammy, sweaty, weak radial pulse that intensifyes with breath cycle. Auscultation cardiac: murmur
H: A(V)PU, Pearrl.
O: No other injuries
N: Has pain in the chest
What is your initial disgnosis?
Cardiac tamponade with signs of obstructive shock
82
What are the contents of plasma?
Proteins 7%
Water 92%
Waste
Nutrients
Gasses
83
What 3 types of protein do we have in plasma?
Albumin 60%
Globulin 35%
Fibrinogen 4%
84
Uncompensated or untreated shock leads to
Downwards spiral with:
-Decreased CO
-Decreased tissue perfusion
-Unconsciousness
-Ischemia in vital organs
Eventually: Multi organ failure and possible death
85
Case
CAX presents as follows:
M: No massive bleeds
A: Patent, speaking but feels discomfort in throat
R: Tachypnea, auscultation +/+
C: Tachycardia, sweaty warm skin, weak radial pulse
H: No injuries to head, A(V)PU, pearl,
O: Signs of snakebite on calf
N: No pain
What is your initial diagnosis? And what can you do to treat it?
CAX may suffer from analphylactic shock due to a systemic allergic reaction to the snakebite.
Treatment: Adrenaline I.M.
86
What are the function of WBC's?
They are a part of the immune system. They defend the body against pathogens (diseases) and assist in repairing damaged tissue.
87
RESTRICTIVE fluid therapy is preferable for...
Hemorrhagic shock. We do not want to give excessive fluids. Goal is to get a palpable pulse, increased mental status and BP around 80-90mmhg
88
Ways to die:
Blood on the floor (and 4 more)...?
Sites for fatal INTERNAL bleedings:
Thorax
Abdomen
Pelvis
Femur
89
What is the medical term for a bleeding in or near a joint?
Junctional hemorrhage
90
Name 2 other main anatomical sites for bleeding besides a junctional
Thruncal (the core of the body)
Extremity (arms & legs)
91
RBC’s are produced were?
In red bone marrow
92
Hematocrit (crit) is a measure of...
Percentage of RBC's in the blood
93
Anemia is the term for...
Lower levels of RBC's in the blood
94
What colours of PIVC (peripheral intravenous catheter) are preferable for fluid resuscitation?
Green 18G (90ml/m)
Grey 16G (180ml/m)
Orange 14G (240ml/m)
95
At what angle do you insert your needle in when doing IM injections
90 degrees
96
What do you control when you aspirate the plunger of a syringe under IM injection?
If there is blood flowing into the syringe
97
What is the reason blood might flow into the syringe when aspirating during IM injection?
If you have perforated a vessel. Withdraw the needle a bit and then administer the substance.
98
Low titer regarding blood products means
Low concentration of antibodies. Low titer usually equals less risk of reaction to infusion.
99
IO CENTRAL contraindications
1. Fractured manubrium
2. Adults <50kg
3. Children <12years
100
Important steps in placing humeral IO?
1. Rotate arm inwards
2. Attack the bone in 45 degrees from the saggital plane and 45 degrees above the transverse plane of the patient
101
How much tolerance does the brain have to ischemia?
Heart, lungs and Brain can survive 4-6 minutes with ischemia before taking damage
102
What’s “Fick principle”?
1. Onloading of oxygen to RBC’s in the lungs
2. Delivery or RBC’s to tissue cells
3. Off loading of oxygen from RBC’s to tissue
103
