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Flashcards in Circulatory Deck (35):
1

Coronary artery disease/heart attack: 9 risk factors

1- congenital defect
2- family history
3- smoking
4- sedentary life style
5- diet
6- obesity
7- hypertension
8- diabetes
9- drug use

2

4 main causes of circulatory shock (Wikipedia)

1- Hypovolemic: most common; primary cause is hemorrhage (internal or external) or loss of fluid (e.g. vomiting, diarrhea, excess urine loss, burns)
2- Cardiogenic: failure of heart to pump effectively.
3- Obstructive: obstruction of flow outside of heart (e.g. cardiac tamponade, pulmonary embolism)
4- Distribution: due to impaired utilization of O2 (e.g. septic, anaphylactic, neurogenic)... abnormal distribution of blood flow, vasodilation.

3

Vascular Shock: definition

Inadequate perfusion pressure due to systemic vasodilation.

4

Vascular Shock: 4 mechanisms?

1- toxins
2- systemic infection (sepsis)
3- anaphylaxis (most common)
4- spinal cord injury

5

Vascular Shock: 3 S/Sx

1- flushed skin (no shell/ core comp)
2- increased pulse, respiration
3- altered MS if brain perfusion impaired

6

Vascular Shock: 4 Rx

1- reverse vasodilation (cause): meds for anaphylaxis, vasoconstrictors, + antibiotics for infection
2- high fluid volume: IV or electrolyte solution, or water + food
3- PROP: keep horizontal, A' = hypothermia
4- Evac as needed

7

CPR: when not to begin (3)

1- obviously dead from lethal injury
2- submerged under H2O >1 hr
3- trauma w/ no pulse

(Effective only with intact critical system... lightning injury, submersion, reversible cardiac arrhythmia)

8

Stop CPR when: (4)

1- spontaneous pulse resumes
2- authorized medical professional pronounces Pt dead
3- Rescuers exhausted or at risk
4- After 30 min of sustained cardiac arrest

9

Cardiac Arrest: what is it?

Loss of effective heart contractions indicated by absence of pulse

10

Cardiac Arrest: How to check?

1- results in immediate respiratory arrest + complete LOC
2- If Pt is at all responsive, breathing, or moving, NOT in cardiac arrest.
3-pulse can be difficult to detect, esp in extremities (shock, hypothermia). Easiest places to check: carotid or temporal (front of ear)

11

Stroke: Act F.A.S.T.

F= Face (ask to smile, one side droop?)
A= Arm (ask to raise arms, does one drift downwards?)
S= Speech (ask to repeat simple phrase, slurred/strange speech?)
T= Time (if have any os these signs, call 911)

Other S/Sx: sudden numbness or weakness, confusion, trouble seeing, difficulty walking, or severe headache with no known cause... act FAST

12

CPR: adults + children (not infants)... ratio of compressions:breaths

30:2

13

CPR: adults + children (2 rescuers)... ratio of compressions:breaths

15:2 (ck)

14

CPR: infants... ratio of compressions:breaths

15:2

15

CPR: breathes - how to...

Breaths given over 1 sec until chest rises. Don't blow too hard, can make vomit. Every 6-8 sec, or 7-10 breaths/min

16

Stroke: MOI (2)

1- Blockage: clot or embolus (can be transient but still warning of danger)
2- Hemorrhage

17

Stroke: Assessment (3)

1- Impaired brain function
2- Increasing ICP
3- No History of Trauma

18

Stroke: S/Sx (7)

1- Severe headache
2- Focal neurological deficit
3- Unilateral weakness
4- Speech deficit
5- Altered MS
6- Visual field deficit
7- S/Sx of increasing ICP

"Cincinnati stroke protocol" = hold arms out w/ eyes closed... 1-sided drift

19

Stroke: Rx (3)

1- Urgent Evac! Time matters!
2- PROP
3- No Drugs!

20

Volume Shock: MOI (2+ 6)

1- Bleeding (internal or external)

2- Dehydration
* sweating
* diarrhea
* vomiting
* excessive urination
* fluid restriction
* burns (only if severe)

21

Volume Shock: S/Sx - Compensated, Early Stage (6-8)

1- tachycardia w/ strong distal pulses *
2- Increased respirations *
3- ETCO2 normal, bet 35-45 (End-tidal CO2, requires equipment)
4- Nausea/vomiting (+ dizzy, faint, anxiety, lethargy) *
5- Thirst *
6- Skin cool/ moist *
7- Normal BP
8- Tachypnea/hyperpnea (any rapid breathing, more rapid, deep than at rest)

* Wilderness context = more obvious

22

Volume Shock: S/Sx - Compensated/Decompensated, Middle Stage (8)

1- Tachycardia with weak distal pulses
2- Feeling of impending doom
3- Postural blood pressure (low BP when stand up... dizzy, lightheaded, maybe faint)
4- Increased or decreased ETCO2
5- Skin: pale, cold, wet
6- Local cyanosis
7- Decrease in urinary output
8- Tachypnea w/ decrease in tidal (lung) volume (fast, shallow breathing)

23

Volume Shock: S/Sx - Decompensated, Late Stage (6)

1- BP drops
2- Weak rapid carotid pulses w/ absent distal pulses *
3- Profound hypoventilation *
4- Global cyanosis *
5- No urinary output
6- MS

* Most obvious in wilderness context

24

Volume Shock: Rx (6)

1- STOP FLUID LOSS
2- REPLACE FLUID VOLUME
3- PROP
4- Maintain body core temperature (protect from heat loss - add heat in all but warmest conditions)
5- Evac as needed
6- Supplem O2

25

Shock: 3 types

1- Volume: Low blood volume
2- Vascular: Poor vascular tone
3- Cardiac: Poor cardiac output

26

Shock: define

Inadequate perfusion pressure in circulatory system

27

Chest Pain: MOI (7)

1- myocardial ischemia
2- stable angina
3- Respiratory infection
4- chest wall muscle strain
5- chest wall contusion
6- esophageal spasm
7- pulmonary embolus

28

Chest Pain: Red Flags (6)

1- multiple risk factors for cardiac ischemia
2- persistent pain unrelieved by rest position
3- S/Sx of heart attack
4- S/Sx of Shock
5- Persistent respiratory distress
6- Persistent pain after trauma
-----
Can be due to ASR, indigestion, altitude adjustment, respiratory infection:
* Shortness of breath
* Sweating
* Nausea

29

Stable angina: S/Sx, Rx

= chest Pain with exertion that resolves with rest.
Pt has history of it usually
Temporary
May not be emergency

Rx: nitroglycerin

30

Cardiogenic Shock: Define

Inadequate perfusion pressure due to poor cardiac output

31

Cardiogenic Shock: MOI

1- Coronary artery disease
Heart Attack:
* myocardial ischemia + infarction (part of heart muscle dies)
* dysthymia

2- Trauma
* cardiac contusion
* cardiac tamponade

(Differs from cardiac arrest)

32

Cardiogenic Shock: S/Sx

Severe or subtle
Chest pain (angina) or pressure-> radiating to jaw or left arm
Other S/Sx of vol shock, except pulse may be variable
- trouble breathing, shortness of breath
- pale, diaphoretic (super sweaty)
Left arm pain
🚺= pain between shoulder blades, lower back (may not have other classic symptoms)
🚺= indigestión, heartburn

33

Cardiogenic Shock: Rx

BLS, PROP, gentle, no high exertion/stress
Aspirin = heart attack, not for trauma (makes blood more "slippery", not needed if someone already takes, chew)
Nitroglycerin = heart attack, not for trauma (vasodilator, clear blockage)

34

Shock: High Risk Problems (6)

1- cannot stop fluid loss
2- cannot replace fluids
3- Persistent chest pain
4- coexisting major problems
5- cannot maintain core body temperature
6- Persistent S/Sx of Shock despite Rx

35

Volume Shock: S/Sx Trends (7)

Blood volume ↘️
Skin perfusion ↘️
Urine output ↘️
Pulse ↗️
Respiration ↗️
BP ➡️↘️
LOC ➡️↘️

(Children compensate until blood volume is very low; can die before showing decompensated period.)