KCP Flashcards
(112 cards)
Where and what is pain from myocardial ischaemia felt?
Centre on the chest.
It may radiate to the neck, jaw, upper or lower arms
Occasionally, in the back
Dull, constricting, choking and is described as burning, aching or squeezing
takes several minutes to develop.
Accompanied by sweating, nausea, breathlessness or vomiting
Where and what is the pain of myocarditis or pericarditis felt?
To the left of the sternum, or in the left or right shoulder
Felt as sharp, and may ‘catch’ during coughing
Where is the pain of aortic dissection felt?
central, with radiation to the back.
severe, and ‘tearing, usually sudden onset
What is pleurisy?
a condition in which the pleura — two large, thin layers of tissue that separate your lungs from your chest wall — becomes inflamed
a sharp or catching chest pain aggravated by deep breathing,
What is angina caused by?
Occurs during exercise and is relieved by rest. Can be exacerbated by emotion, a large meal or cold wind.
What is pain caused by gastro-oesophageal reflux like?
central, dull and burning
can elicit a history relating chest pain to eating drinking or oesophageal reflex.
How can you tell the difference between ischaemic cardiac and non-cardiac chest pain?
What should clinicains investiagte if a patient presents with chest pain?
- 12 lead electrocardiogram (ECG)
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What does chest pain accompanied by clinical evidence of increased intracardiac pressure indiacte?
Myocarial ischaemia or massive pulmonary embolism.
Legs should be examined for clinical evidence of deep vein thrombosis.
What is coronary heart disease usually caused by?
atherosclerosis (buildup of fats, cholesterol and other substances in and on your artery walls)
rarely, aortitis (inflammation of the aortia)
What are the risk factors for coronary heart disease?
Age
Genetics
Smoking
Hypertension
type 2 diabtetes
physical activity levels
obesity
Alcohol
social deprivation
What are risk factors for myocardial infarct?
Age, gender, obesity, lack of exercise, bad diet, smoking, blood pressure, family history, diabetes,
What is myocardial ischemia?
Myocardial ischemia occurs when blood flow to the heart muscle is obstructed by a partial or complete blockage of a coronary artery. A sudden, severe blockage of one of the heart’s artery can lead to a heart attack. Myocardial ischemia may also lead to abnormal heart rhythms (atrial fibrillation).
Why is troponin released into the blood during a myocardial infarction?
When the cell does not get enough oxygen, aerobic pathways cannot continue and ATP cannot be made. Anaerobic respiration takes place and lactic acid is produced. This leads to components of the cell being released, called troponins.
What are the steps of an ECG?
What happens when a trauma patient arrives at the hospital?
- hospital get a warning call- includes vital signs, injury, age and time of injury
- role allocation occurs, organise equipement and a room for the patient
- Once patient arrives, check for life threatening injuries
- May need to remove head blocks, stretcher, pelvic scoop and clothes.
- Aim to get a CT scan 20 mins after arriving in the hospital.
What initiative should emergency doctors follow?
ATLS (advanced trauma life support) which involves a primary and secondary check and the ABCDE checklist
What is the airway section of managing trauma patients?
If uncounscious, patients airway should be checked and cleared.
If the patient is vomiting, either log roll them or if chance of a spinal injury, head tipped bacl and vomit sucked away
Once airway checked, very patient should receive 100% oxygen at a flow rate of 15 L/min, and neck and cervical spine must be checked for injuries.
What does the breathing section of trauma patient managment include?
Check for tension pneumothorax, cardiac tamponade, open chest wound, massive haemoxthroax or flail chest
Respiratory rate must be measured
Chest x-ray crucial
Chest should be visually examined and listened to as well
What does the circulation and haemorrhage control section of managing trauma patients involve?
Look for clinical signs of shock, such as fast HR and poor capillary refill
Control any external haemorrage by pressure- torniquets only used when limb is unsalvagable
Blood should be taken to determine blood type, electrolyte concentrations, pH and blood gas analysis
The type of fluid given to patients differs in each region. To reduce the chance of hyperthermia, fluids must be warmed before use. If the vital signs do not improve at all, the patient has lost >40% of blood.
Whata are the D and E sections of managing a trauma patient?
D= disability, spinal cord and brain function tested by reflexes. The glasgow coma scale should be used
E=exposure and environment control- keep patient warm, continue to measure vital signs. Only after the main problems have been solved can move onto secondary survery.
What is hypovolaemic shock?
- Hypovolaemic shock is a clinical state in which loss of blood, extracellular fluid, or plasma causes inadequate tissue perfusion.*
- Hemorrhagic shock is hypovolemic shock from blood loss*
How much blood needs to be lost until a healthy adult’s systolic blood pressure decreases?
30-40% of blood volume
What happens in haemorrhagic shock?
Haemorrhagic shock causes a significant lactic acidosis; pyruvate is unable to enter the Krebs cycle. Instead, pyruvate undergoes anaerobic metabolism in the cytoplasm, a process that is relatively inefficient for adenosine triphosphate (ATP) generation. ATP depletion causes cell membrane pump failure and cell death. The aim of resuscitation is to deliver oxygen rapidly to stop death.
