Cardio deck

Question 1

What is systole?

Answer 1

The contraction of the right and left ventricles, which creates the maximum arterial pressure

Question 2

What is diastole?

Answer 2

The relaxation of the heart while the ventricles fill with blood, which produces the minimum arterial pressure

Question 3

At what rate do the ventricles pump blood into the arteries?

Answer 3

Between 60-80 times/minute

Question 4

What is a pulse?

Answer 4

The force of ventricular contraction starts a wave of increased pressure that begins at the heart and travels along the arteries, which is known as the pulse

Question 5

Where can you find pulses along the surface of the body?

Answer 5

Carotid pulse
Radial pulse
Femoral pulse - felt in the groin in the anterior crease between the leg and abdomen at a point approximately at the middle of the crease
dorsal pedis pulse - felt on the top of the foot
Posterior tibialis pulse - felt on the inside of the foot, behind the ankle

Question 6

What is blood pressure?

Answer 6

It is the force exerted by the blood against the walls of the arteries as it passes through them. The repeated ejection of blood from the left ventricle of the heart into the aorta is transmitted through the arteries as a series of pressure waves

Question 7

How is blood pressure measured?

Answer 7

Two measurements are taken:
1. Systolic pressure: the maximum pressure occurring at the peak of the left ventricular contraction
2. Diastolic pressure: the minimum pressure during relaxation of the left ventricle.

Question 8

What factors control arterial blood pressure?

Answer 8

The blood volume, the state of the arteries and arterioles (dilated or constricted), and the capacity of the heart muscle to contract normally

Question 9

Is venous blood pressure greater or weaker than arterial blood pressure? And what factors control venous blood pressure?

Answer 9

Venous blood pressure is weaker than arterial blood pressure.
Venous blood pressure is affected by blood volume and the capacity of the veins.

Question 10

How much blood volume does the average adult body have?

Answer 10

6L (10 pints) of blood. However, the capacity of all the body’s blood vessels is much larger than 6L.

Question 11

What does loss of normal blood pressure indicate?

Answer 11

It can indicate that the blood cannot circulate efficiently to the body’s organs, resulting in inadequate perfusion of the body’s organs. The state of inadequate perfusion is called shock.

Question 12

What is the primary objective in the treatment of shock?

Answer 12

To increase tissue perfusion

Question 13

What transport category is someone with shock in?

Answer 13

RTC

Question 14

What is the main cause of shock in injured patients?

Answer 14

Shock is almost always caused by blood loss (hypovolemic shock) in injured patients

Question 15

What are the 3 main causes of inadequate perfusion?

Answer 15

1. The volume of blood in circulation becomes inadequate, resulting in hypovolemic shock:
   - Blood loss
   - Fluid loss i.e. burns, vomiting, diarrhoea
2. The heart is damaged and fails to function properly:
   - cardiogenic shock (MI)
3. The blood vessels dilate excessively. In this situation, the normal blood volume is insuccient to fill the dilated blood vessels to capacity. This leads to inadequate tissue perfusion:
   - Anaphylactic shock
   - Septic shock
   - Neurogenic shock (spinal)

Question 16

Which 2 factors control blood pressure? What regulates these factors?

Answer 16

1. The resistance to flow of the circulating blood by the arterioles (arteriolar or peripheral resistance)
2. The volume of blood pumped by the heart into the systemic circulation (cardiac output)
   The autonomic nervous system matches CO to peripheral resistance to maintain the blood pressure and ensure adequate perfusion of the cells as their needs change

Question 17

What are the 2 key hormones in the cardiovascular system that regulate blood pressure and how do they work?

Answer 17

Any change in CO will tend to cause a reduction in systolic pressure. This change in pressure is detected by special pressure receptors. The receptors trigger the ANS, which attempts to restore CO and BP to normal. The 2 key hormones in this system are adrenalin and noradrenalin?
Adrenaline and noradrenalin cause:
- An increase in heart rate and a more forceful contraction. These increase CO and BP.
- Vasoconstriction (constriction of arterioles) in non-vital organs, decreasing blood flow to these organs, which redistributes blood flow to the vital organs
- Diaphoresis (sweating). This can increase fluid loss and aggravate shock. The OFA attendant must watch for this effect as it is a key sign in the detection of shock.

Question 18

How does the body compensate for hypovolemic shock?

Answer 18

Releasing large amounts of adrenaline and noradrenalin to increase blood volume, as well as redistribute blood flow to vital organs and away from non-vital organs through vasoconstriction

Question 19

Describe the cascade of effects of hypovolemic shock:

Answer 19

1. Decreased blood volume
2. Inadequate venous return
3. Decreased CO (Cardiogenic shock)
4. Blood pressure falls
5. ANS stimulated
6. Peripheral blood vessels constrict - leading to cool skin, pallor, and sweating (identify these)
7. Increased CO (increased HR) - sign of ANS activation
8. BP rises briefly, the lowers - evident through weak/absent limb pulses
9. Inadequate perfusion of vital organs - altered LOC, air hunger, increased respiratory rate
10. Death

Question 20

What are the 5 types of shock

Answer 20

1. Hypovolemic
2. Cardiogenic
3. Anaphylactic
4. Septic/Bacteremic
5. Neurogenic

Question 21

What are the signs and symptoms of hypovolemic shock?

Answer 21

Hypovolemic shock is primarily caused by excessive blood loss through a traumatic injury, but can also be due to excessive fluid loss due to prodound diarrhoea, vomiting, or when a patient has extensive burns.
The symptoms include:
- COOL SKIN - when warm blood is re-routed from the skin as a consequence of vasoconstriction
- PALLOR - with vasoconstriction, blood is no longer flowing to the body’s surface, giving a more ‘white-ish’ appearance
- SWEATING - This develops as a direct effect on the sweat glands because of ANS response to shock
- INCREASED HR (usually >100 BPM) - due to ANS activation and release of adrenaline and noradrenalin, indicating more severe shock
- LOW BP (HYPOTENSION) - defined as systolic pressure less than 100 mmHg measured on a blood pressure cuff. Alternatively, the absence of radial pulses indicates a BP reading of less than 90 mmHg. Weak or absent pulses indicate hypotension, which is a late sign of shock and indicates a massive loss of blood volume with inability to compensate
- ALTERED LOC - in its early stages, shcok is often associated with anxiety, restlessness, or combativeness. This is due in part to the release of adrenalin. As shock increases and hypoxia become smore pronounced, the patient may become very agitated and restless. As perfusion of the brain decreases, LOC increases.
- TACHYPNEA - increased respiratory rate of between 20-30 breaths/min - usually a patient in shock breathes more rapidly and can gasp for breath with ‘air hunger’ as a consequence of hypoxia and acidosis. This may also be present with associated chest injuries. The OFA attendant must be very concerned about an associated chest injury if the respiratory rate is greater than 30 breaths/min
- THIRST - owing to a reduced blood volume, patients in shock often complain of intense thirst. The patient should be given nothing by mouth in case surgery is needed

Question 22

Which patients with hypovolemic shock must receive special consideration?

Answer 22

1. Athletes - Athletes have a well-conditioned heart muscle and CV system, which means their HR may be below 50 BPM. Despite significant blood loss, their body may compensate for shock and not display an increased HR or diminished BP until either a large volume of blood has been lost or shock state has become advanced
2. Pregnant women - During pregnancy, a woman will have up to 20% increase in blood volume. Consequently, following trauama, she may not initially exhibit signs of shock. The fetus, however, will experience profound shock as the maternal vasoconstrictive response to shock shunts the blood from the fetus to the maternal vital organs. Any pregnant woman who has received trauma, even if insignificant, should be referred to a physician for assessment
3. Cardiac patients: There are 2 major complications with cardiac patients
   a) Cardiac patients are at higher risk of developing shock from trauma because of their weaker hearts, and hence are more likely to have chest pain and/or dyspnea
   b) Patients on heart medication may not exhibit the early signs of shock because these medications dampen the body’s normal vasoconstrictive response+

Question 23

Describe cardiogenic shock, its most common causes, and the signs and symptoms:

Answer 23

In cardiogenic shock, the heart muscle does not pump enough blood to peripheral tissues.
The most common cause is acute MI. The strength and force of the left ventricular contraction is reduced because of the extensive structural damage to the ventricle wall. Congestive heart failure and chest trauma can also cause cardiogenic shock.
The signs and symptoms are the same as hypovolemic shock: cool skin, pallor, sweating, increased HR, hypotension, altered LOC, tachypnea, thirst

Question 24

Describe anaphylactic shock and its main causes

Answer 24

This condition is caused by a severe allergic reaction. It may be caused by the injection, ingestion, or inhalation of a roeign protein substance into a person sensitised to it. The allergic reaction may lead to a loss of the normal tone of the blood vessels. The shock state is caused by abnormal systemic dilation of the blood vessels (vasodilation), cause the blood pressure to drop and resulting in body-wide inadequate perfusion of the cells.

Question 25

What are the main agents that can cause anaphylactic shock?

Answer 25

Insect stings, antibiotics, seafood, nuts, and blood or other transfusion.

Question 26

What should you look for to determine if someone is predisposed for anaphylactic shock?

Answer 26

Some individuals wear medical alert bracelets or necklaces and may also carry an epinephrine auto-injector

Question 27

What is the main tell-tale sign of anaphylactic shock?

Answer 27

It's distinguished by its rapid onset. You cannot predict how severe the allergic reaction is likely to be, as severe reactions may occur immediately or be delayed for half an hour or more.

Question 28

What are the main signs and symptoms of anaphylactic shock?

Answer 28

- A medical alert bracelet/necklace indicating an allergy - Generalised itching - Numbness and tingling, especially about the face and mouth - Blotchy areas of raised reddish-oink swelling of the skin that are very itchy (hives) - Swelling of the tongue and face - Tightness in the throat or upper airway - Breathing difficulty, possibly with wheezing - A tight discomfort across the chest - General weakness, restlessness, dizziness, or anxiety - Abdominal cramps, diarrhoea, or vomiting - A rapid, weak pulse

Question 29

Describe septic shock

Answer 29

Profound circulatory collapse may result when certain bacteria invade the bloodstream. It is believed that these bacteria produce toxins. They ultimately affect the blood vessel walls, causing generalised vasodilation and, ultimately, diminished tissue perfusion. This is most often seen in a hospital setting.

Question 30

What are the signs and symptoms of septic shock?

Answer 30

- Confusion is often the earliest sign due in part to bacterial toxins - High fever with warm, flushed skin that later becomes cool and pale - Increased pulse rate - Increased respiration

Question 31

Describe neurogenic shock

Answer 31

In neurogenic shock, the blood vessels to the lower extremities, abdomen, trunk, and sometimes part of the upper extremities suffer impairment of their autonomic nerve control. As a consequence, the blood vessels dilate markedly, increasing their capacity. The patient's blood volume becomes pooled in these dilated blood vessels, resulting in a reduced return to the heart. Although there is no actual blood loss, the patients' normal blood volume is inadequate to maintain perfusion of the cells. Neurogenic shcok occurs only in the presence of a spinal cord injury with complete paralysis. It does not occur with spinal fractures alone.

Question 32

What are the signs and symptoms of neurogenic shock?

Answer 32

- Paralysis ad numbness of the lower extremities and various portions of the trunk - Possible impaired breathing as a consequence of paralysis of the chest muscles - May have warm and dry skin in the extremities - May have a lack of a radial pulse

Question 33

What are the general principles of shock management

Answer 33

1. Conduct scene assessment and activate WERP as required 2. Assess the LOC. Perform primary survey, initiating CPR/AED protocols as needed 3. When the patient is not in cardiac arrest, ensure an open airway (with C-spine control if necessary) 4. Assess for signs of respiratory distress or signs of oxygen deficiency. Assist ventilation if needed, and train a helper to take over the assisted ventilation. IF the patient is unresponsive to verbal stimuli, insert an oral airway and administer 10 Lpm oxygen connected to the pocket mask 5. Assess for adequate breathing 6. Assess the adequacy of the patient's respiration and, if not effective, assist ventilations as in step 4 7. Check radial pulse and skin for signs of shock 8. Apply oxygen at 10 Lpm by face mask 9. Control life-threatening bleeding. Complete the rapid body survey and expose the patient's chest if there was a history of trauma to the chest 10. If the patient is suffering from anaphylactic shock and has an epinephrine auto-injector, assist them in using it or inject it if they are unresponsive 11. All patients in shock or suspected shock are RTC 12. Reassess ABCs every 5 mins 13. Avoid all unnecessary movement or rough handling because it will aggravate the shock state 14. Keep patient comfortably warm and give nothing by mouth 15. Conduct the secondary survey during, or while awaiting, transport 17. Monitor the patient's ABCs every 5 mins and vital signs every 10 mins to determine if there is deterioration

Question 34

What is hemorrhage?

Answer 34

Hemorrhage is the loss of blood from arteries, veins, or capillaries. It can be external or internal and can lead to shock or death if not controlled.

Question 35

How much blood loss is generally manageable for the average adult without severe consequences?

Answer 35

The average adult can comfortably lose 500 ml (approximately 1 pt.) of blood over 15 to 20 minutes, as the body adapts well to this loss.

Question 36

What are the Three Ps of Hemorrhage Control?

Answer 36

1. Pressure: Apply direct pressure on the wound. 2. Patient Position-At-Rest: Keep the patient lying down to lessen anxiety and slow bleeding. 3. Part Prevent Movement: Prevent unnecessary movement of the bleeding part to slow blood flow.

Question 36

What are the main differences between internal and external bleeding?

Answer 36

Internal bleeding involves blood loss that is not visible due to no break in the skin, whereas external bleeding involves blood escaping to the outside through a break in the skin.

Question 37

What are the characteristics of arterial bleeding?

Answer 37

Arterial bleeding involves blood that spurts or pulses out, is usually bright red, and can be very brisk if a large vessel is involved.

Question 38

How should pressure be applied to control bleeding?

Answer 38

Pressure should be applied directly on the wound using a gloved hand or a sterile pressure dressing. The dressing should be secured with a bandage, and additional dressings can be applied if soaked with blood.

Question 39

What is internal bleeding and how can it be identified?

Answer 39

Internal bleeding is associated with injury to internal organs or fractures and is not directly visible. It can be identified through signs like cool, pale, clammy skin, weak and rapid pulse, shortness of breath, dizziness, thirst, anxiety, and nausea.

Question 40

What should be done if external bleeding cannot be controlled with direct pressure alone?

Answer 40

A tourniquet should be applied proximal to the wound if direct pressure fails or if another life-threatening priority requires immediate attention.

Question 41

What are the general principles of managing external hemorrhage?

Answer 41

1. Conduct scene assessment and activate emergency response. 2. Assess consciousness, airway, breathing, and circulation. 3. Apply direct pressure to the wound. 4. Use tourniquets if necessary. 5. Immobilize the limb if required. 6. Reassess ABCs and monitor vitals regularly.

Question 42

What precautions should be taken when using a tourniquet?

Answer 42

- Avoid using belts, ropes, or wires. - Ensure the tourniquet is applied with sufficient pressure. - Do not release the tourniquet once applied. - Clearly mark the patient as having a tourniquet and note the application time

Question 43

How should hemorrhage from the neck be managed?

Answer 43

Immediate and continuous direct hand pressure should be applied to the wound. Monitor for airway problems due to swelling and treat accordingly. Transport rapidly if there is local swelling or penetration into muscles.

Question 44

What are the two primary mechanisms causing a cardiac (myocardial) contusion?

Answer 44

Compression of the heart between the sternum and vertebral column, and sudden deceleration of the body, causing the heart to be thrust against the chest wall.

Question 45

Which workers are at risk for a myocardial contusion?

Answer 45

All injured workers with blunt anterior chest trauma

Question 46

What can the extent of injury in myocardial contusion vary from and to?

Answer 46

It can vary from small areas of bruising to full-thickness contusion of the cardiac wall, which may result in immediate or subsequent cardiac rupture.

Question 47

What is the most common symptom of myocardial contusion?

Answer 47

Anterior chest pain, often indistinguishable from that of a heart attack (myocardial infarction)

Question 48

What are the potential complications of myocardial contusion?

Answer 48

Lethal cardiac rhythms and hemopericardium, which may present with signs of pericardial tamponade

Question 49

What is the management protocol for patients with suspected myocardial contusion?

Answer 49

Follow the Priority Action Approach and General Principles of Management of Chest Injuries, with rapid transport to a medical facility.

Question 50

What is pericardial tamponade and how does it affect the heart?

Answer 50

Pericardial tamponade is a condition where the pumping action of the heart is impaired due to compression from blood or fluid in the pericardial sac, requiring urgent drainage to prevent shock and death.

Question 51

List the signs of pericardial tamponade?

Answer 51

Restlessness, air hunger, rapid and weak or absent pulse, cyanosis, and distended neck veins

Question 52

What is the emergency management for pericardial tamponade?

Answer 52

Follow the Priority Action Approach, ensure rapid transport, and manage according to the General Principle of Management of Chest Injuries

Question 53

How can injury to major blood vessels in the chest be indicated?

Answer 53

Symptoms may include chest pain, dyspnea, back pain, inability to move extremities, shock, and absent pulse in any limb

Question 54

What is the recommended management for patients with major suspected major vessel injury?

Answer 54

Follow the Priority Action Approach, ensure rapid transport, and manage according to the General Principles of Management of Chest Injuries.

Question 55

What is coronary artery disease and its leading cause?

Answer 55

It is a condition where the coronary arteries are narrowed or obstructed, leading to reduced blood flow to the heart muscle, often caused by atherosclerosis.

Question 56

Identify risk factors for coronary artery disease and heart attacks.

Answer 56

Smoking, high blood pressure, high cholesterol, poor physical fitness, obesity, diabetes, family history of heart attacks, and prolonged stress.

Question 57

Describe atherosclerosis and its impact on arteries.

Answer 57

Atherosclerosis is the buildup of fatty deposits (plaque) in the artery walls, narrowing the arteries and restricting blood flow, potentially leading to heart attacks.

Question 58

What are the symptoms and management of angina pectoris?

Answer 58

Symptoms include chest pain or discomfort that may radiate to arms, neck, jaw, or back. Management involves rest, nitroglycerin administration, and oxygen. If symptoms persist, consider a heart attack and ensure rapid transport.

Question 59

What are the signs and symptoms of a heart attack?

Answer 59

Sudden chest pain, which may radiate to arms, neck, jaw or back, associated with apprehension, denial, weakness, shortness of breath, sweating, pallor, nausea, vomiting, and a weak and rapid pulse

Question 60

What are the three major complications that most often cause death from a heart attack?

Answer 60

Arrhythmia, congestive heart failure, and cardiogenic shock.

Question 61

What is congestive heart failure and its symptoms?

Answer 61

A condition where the left ventricle fails to pump effectively, causing blood to back up into the lungs. Symptoms include respiratory distress, chest pain, pallor, cold skin, cyanosis, tachycardia, frothy sputum, wheezing, and distended neck veins.

Question 62

How should congestive heart failure be managed in an emergency?

Answer 62

Keep the patient calm and upright, conduct a primary survey, provide oxygen, suction airway if necessary, assist ventilation if needed, and ensure rapid transport.