Cardiovascular System: Shock
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Questions and Answers

What are some key monitoring parameters required during continuous intravenous infusion?

Blood pressure, heart rate, urine output, signs of ischemia

What are some complications related to critical bleeding?

  • Hemodynamic instability
  • Coagulopathy
  • Organ dysfunction
  • Transfusion complications
  • All of the above (correct)

    • Volume overload, including transfusion-associated circulatory overload (TACO), is a complication of massive blood transfusion.

    True

    _______ is a common metabolic disturbance associated with a massive blood transfusion.

    <p>Hypocalcaemia</p> Signup and view all the answers

    Match the following components of nursing care with the scenario of a patient undergoing massive blood transfusion:

    <p>Preparation and Setup = Verify blood products, baseline assessment. Monitoring = Vital signs, cardiac monitoring, signs of reaction. Fluid and Electrolyte Management = Monitor for overload, replace electrolytes. Coagulopathy Management = Monitor coagulation, administer blood products. Temperature Management = Use blood warmers, monitor core temperature. Documentation = Record details, monitor input and output.</p> Signup and view all the answers

    What are some causes of hypertensive crisis?

    <p>Medication non-adherence, acute kidney injury, preeclampsia/eclampsia, pheochromocytoma, drug use</p> Signup and view all the answers

    What are the primary goals of oxygen therapy?

    <p>Correct Hypoxemia, Reduce Work of Breathing, Reduce Myocardial Workload</p> Signup and view all the answers

    What physiological dangers are associated with oxygen therapy?

    <p>All of the above</p> Signup and view all the answers

    What are the indications for non-invasive ventilation?

    <p>COPD Exacerbations, Acute Pulmonary Oedema, Hypoxemic Respiratory Failure, Ease of Use</p> Signup and view all the answers

    Match the following ventilation types with their indications: Non-Invasive Ventilation and Invasive Ventilation

    <p>Non-Invasive Ventilation = COPD Exacerbations, Acute Pulmonary Oedema, Hypoxemic Respiratory Failure, Ease of Use Invasive Ventilation = Acute Respiratory Failure, Severe Hypoxemia, Hypercapnic Respiratory Failure</p> Signup and view all the answers

    Define Positive End Expiratory Pressure (PEEP)

    <p>PEEP refers to the positive pressure maintained in the airways and alveoli at the end of expiration during mechanical ventilation.</p> Signup and view all the answers

    Which factors affect Cardiac Output?

    <p>All of the above</p> Signup and view all the answers

    The Sympathetic Nervous System causes vasoconstriction and increased heart rate.

    <p>True</p> Signup and view all the answers

    What are the properties of Cardiac Cells?

    <p>Automaticity, Excitability, Conductivity, Contractility, Rhythmicity, Ion Channel Regulation</p> Signup and view all the answers

    The _____ initiates the impulse in the heart's conduction pathway.

    <p>SA node</p> Signup and view all the answers

    What is the normal range for PR interval on an ECG?

    <p>0.12 - 0.20 seconds</p> Signup and view all the answers

    Which type of AV block is characterized by progressive prolongation of the PR interval until a QRS complex is dropped?

    <p>Second-Degree AV Block (Type I - Mobitz Type I)</p> Signup and view all the answers

    Junctional rhythms involve impulses coming from the SA node.

    <p>False</p> Signup and view all the answers

    Bundle Branch Block (BBB) refers to a delay or blockage in the conduction of electrical impulses down one of the ______ branches of the heart's electrical system.

    <p>bundle</p> Signup and view all the answers

    Match the following leads with their corresponding coronary territories:

    <p>Anterior Leads (V1-V4) = LAD territory (anterior wall) Lateral Leads (I, aVL, V5-V6) = LCx territory (lateral wall) Inferior Leads (II, III, aVF) = RCA or LCx territory (inferior wall) Right Ventricular Leads (V1-V2) = RCA territory (right ventricle)</p> Signup and view all the answers

    What is the defining ECG feature of right bundle branch block (RBBB)?

    <p>Wide QRS complex</p> Signup and view all the answers

    Which type of Acute Coronary Syndrome (ACS) is characterized by persistent ST-segment elevation in at least two contiguous leads?

    <p>ST-Elevation Myocardial Infarction (STEMI)</p> Signup and view all the answers

    What are the common symptoms of Left-Sided Heart Failure?

    <p>Dyspnea, orthopnea, pulmonary congestion</p> Signup and view all the answers

    Define shock.

    <p>Shock is a life-threatening circulatory failure that results in cellular and tissue hypoxia.</p> Signup and view all the answers

    What are the clinical manifestations of shock?

    <p>All of the above</p> Signup and view all the answers

    What is the relationship between alveoli and lung capillaries?

    <p>Alveoli are where oxygen diffuses into the blood stream and carbon dioxide diffuses out. Lung capillaries facilitate gas exchange between alveolar air and blood.</p> Signup and view all the answers

    Match the following terms with their definitions:

    <p>Hypoxemia = Low oxygen levels in arterial blood Hypoxia = Condition where tissues are deprived of adequate oxygen supply V/Q Mismatch = Imbalance between ventilation and perfusion in the lungs</p> Signup and view all the answers

    Hypoxemia specifically refers to low oxygen levels in tissues.

    <p>False</p> Signup and view all the answers

    What do elevated blood lactate levels typically indicate?

    <p>Anaerobic metabolism due to inadequate oxygen supply, tissue hypoxia, hypoperfusion, or impaired lactate clearance.</p> Signup and view all the answers

    What is the function of the pulmonary circulation?

    <p>Facilitates gas exchange in the lungs</p> Signup and view all the answers

    What is oxygen delivery (O2 delivery)?

    <p>The amount of oxygen transported to tissues per unit of time.</p> Signup and view all the answers

    What does an elevated PaCO2 indicate?

    <p>Inadequate alveolar ventilation</p> Signup and view all the answers

    Type 1 respiratory failure is characterized by elevated arterial partial pressure of carbon dioxide.

    <p>False</p> Signup and view all the answers

    Study Notes

    Week 1: Shock

    • Definition of Shock: Life-threatening circulatory failure resulting in cellular and tissue hypoxia, characterized by insufficient blood flow and an imbalance of oxygenated and non-oxygenated blood in the body.
    • Impact on Cardiac Output:
      • Decreased stroke volume due to fluid loss
      • Increased heart rate as the heart tries to compensate
      • Overall decrease in cardiac output
      • Impaired tissue perfusion leading to organ dysfunction and failure
    • Clinical Manifestations of Shock:
      • Hypotension
      • Altered mental state
      • Tachycardia
      • Elevated respiratory rate
      • Decreased urine output
      • Hypoxia
      • Delayed capillary refill
      • Elevated lactate levels
      • Mottled, clammy skin
      • Metabolic acidosis

    Types of Shock and Treatment

    • Distributive Shock:
      • Causes: sepsis, anaphylaxis, neurogenic
      • Characterized by vasodilation, decreased systemic vascular resistance, and redirected blood flow away from vital organs
      • Treatment: Sepsis 6, treat underlying cause, and provide pain relief
    • Cardiogenic Shock:
      • Causes: heart damage or dysfunction (MI, arrhythmias, myocarditis, cardiomyopathy)
      • Treatment: reperfusion therapy, cardioversion
    • Hypovolemic Shock:
      • Causes: decreased circulating blood volume (bleeding, trauma, dehydration)
      • Treatment: haemorrhage control, surgical intervention, IV fluids, blood products, and TXA
    • Obstructive Shock:
      • Causes: physical obstruction to blood flow (PE, pneumothorax, cardiac tamponade, aortic stenosis)
      • Treatment: thrombolytic, decompression, removal of pericardial fluid

    Week 2: Respiratory Anatomy, Physiology, and Assessment

    Systemic vs Pulmonary Circulation

    • Pulmonary Circulation:
      • Function: facilitates gas exchange in the lungs
      • Pathway: pulmonary arteries, capillaries, and pulmonary veins
      • Operates under lower pressure to prevent lung damage and facilitate gas exchange
    • Systemic Circulation:
      • Function: delivers oxygenated blood to body tissues and returns deoxygenated blood to the heart
      • Pathway: arteries, arterioles, capillaries, venules, and veins
      • Operates under higher pressure due to the pumping action of the left ventricle and peripheral resistance

    Oxygen Delivery

    • Variables of O2 Delivery:
      • Cardiac output (CO)
      • Haemoglobin (Hb) concentration
      • SaO2 (percentage of haemoglobin bound to oxygen)
      • PaO2 (partial pressure of oxygen in arterial blood)
    • Steps of Oxygen Delivery:
      1. O2 available to breathe
      2. Airway - into the alveoli
      3. Transmembrane diffusion (A-a gradient)
      4. Vascular - red cells available for binding
      5. Cardiac output - blood moving to take O2 to tissues
      6. Hb releasing O2 adequately - tissue uptake
      7. Use of O2 by tissue

    Lactate Levels

    • Elevated lactate levels: indicate anaerobic metabolism due to inadequate oxygen supply, tissue hypoxia, hypoperfusion, or impaired lactate clearance

    Oxyhaemoglobin Dissociation Curve

    • Shift to the left:
      • Lungs: oxygen has a higher affinity for haemoglobin in alkalotic conditions
      • Lower temperature
      • Higher oxygen levels
      • More affinity - holds onto oxygen
      • Less 2,3 DPG
    • Shift to the right:
      • Muscles/placenta: oxygen has a lower affinity for haemoglobin in acidic conditions
      • Higher temperature
      • Higher CO2 levels
      • Less affinity - needs to unload oxygen
      • More 2,3 DPG

    Hypoxia vs Hypoxemia

    • Hypoxemia: low oxygen levels in arterial blood (measured by PaO2)
    • Hypoxia: condition where tissues are deprived of adequate oxygen supply

    V/Q Mismatch

    • Definition: imbalance between ventilation and perfusion in the lungs, leading to impaired gas exchange and hypoxemia
    • Consequences:
      • Shunting effect: blood passes through poorly ventilated alveoli without efficient gas exchange
      • Dead space: areas with adequate ventilation but reduced perfusion, contributing to wasted ventilation

    Week 3: Acute Respiratory Failure and Common Respiratory Disorders

    Definition of Respiratory Failure

    • Respiratory failure: respiratory system fails to perform gas exchange (oxygenation or elimination of carbon dioxide)
    • Type 1 Respiratory Failure: failure to oxygenate (PaO2 < 60 mmHg)
    • Type 2 Respiratory Failure: failure to ventilate (PaCO2 > 45 mmHg)

    Management of Respiratory Failure

    • Treatment: address underlying cause, improve gas exchange, and support respiratory function
    • Supplemental oxygen: improves oxygenation and reduces work of breathing
    • Mechanical ventilation: supports respiratory function in severe cases

    Causes of Respiratory Failure

    • Airway disease
    • Lung disease
    • Pulmonary circulation
    • Pulmonary oedema

    Clinical Features of Respiratory Failure

    • Dependent on the degree of:
      • Hypoxaemia
      • Hypercarbia
      • Acidosis

    Week 4: Invasive and Non-Invasive Ventilation

    Principles of Oxygen Therapy

    • Oxygen therapy: administration of oxygen as a medical intervention to maintain adequate tissue oxygenation
    • Primary goals:
      • Correct hypoxemia: increase oxygen levels in the blood
      • Reduce work of breathing: decrease effort required to breathe
      • Reduce myocardial workload: lower oxygen demand on the heart

    Delivery Systems

    • Low-flow systems:
      • Nasal specs
      • Simple face mask
      • Non-rebreather
    • High-flow systems:
      • Nasal high flow
      • NIV
      • IPPV

    Physiological Dangers of Oxygen Therapy

    • CO2 retention: high oxygen levels can reduce the hypoxic drive to breathe, leading to respiratory acidosis
    • V/Q mismatch: high oxygen levels can worsen ventilation-perfusion mismatch, leading to increased dead space

    Week 5: Cardiovascular Anatomy and Physiology

    Properties of Cardiac Cells

    • Automaticity: cardiac cells can generate electrical impulses spontaneously
    • Excitability: cardiac cells respond to electrical stimuli by depolarizing and generating action potentials
    • Conductivity: cardiac cells can propagate electrical impulses rapidly through intercalated discs and gap junctions
    • Contractility: cardiac cells contract in response to depolarization, leading to the pumping action of the heart
    • Rhythmicity: synchronized action of cardiac cells ensures rhythmic beating of the heart
    • Ion channel regulation: specialized ion channels regulate the flow of ions across the cell membrane, crucial for action potential generation and contraction

    Cardiac Cycle

    • Atrial contraction (atrial systole):
      • Initiated by depolarization of the atria
      • Causes contraction, increasing atrial pressure and forcing blood into the ventricles
    • Ventricular filling (early diastole):
      • Ventricles relax, lowering pressure and allowing blood from the atria to fill them### Cardiac Function and Blood Pressure Regulation
    • Atrioventricular valves open due to higher atrial pressure than ventricular pressure, while semilunar valves remain closed
    • Ventricular contraction (systole) triggers atrioventricular valve closure, increasing ventricular pressure and opening semilunar valves to eject blood into the pulmonary artery and aorta
    • Ventricular relaxation (diastole) leads to semilunar valve closure, atrioventricular valve reopening, and refilling of ventricles

    Blood Pressure Regulation

    • Blood pressure (BP) is the force exerted by circulating blood against arterial walls
    • Autonomic nervous system (ANS) regulates BP through sympathetic nervous system (SNS) and parasympathetic nervous system (PNS)
      • SNS releases norepinephrine, causing vasoconstriction and increased heart rate
      • PNS releases acetylcholine, causing vasodilation and decreased heart rate
    • Renin-angiotensin-aldosterone system (RAAS) regulates BP through:
      • Renin release, triggered by low BP or SNS stimulation, converting angiotensinogen to angiotensin I
      • Angiotensin-converting enzyme (ACE) converting angiotensin I to angiotensin II, a potent vasoconstrictor
      • Aldosterone release, promoting sodium and water reabsorption by the kidneys, increasing blood volume and pressure
    • Kidneys regulate BP through renal regulation of sodium and water retention/excretion, influenced by RAAS and atrial natriuretic peptide (ANP)

    Cardiac Output and Cardiovascular Disease

    • Cardiac output (CO) is the volume of blood pumped by the heart per minute, calculated as CO = Heart Rate (HR) × Stroke Volume (SV)
    • Factors affecting cardiac output include:
      • Heart rate (HR)
      • Stroke volume (SV)
    • Cardiovascular disease can impact cardiac output, including:
      • Heart failure: reduced cardiac output due to impaired heart function
      • Hypertension: increased systemic vascular resistance leading to increased workload on the heart and potentially reduced cardiac output
      • Coronary artery disease (CAD): reduced blood flow to the heart muscle, impairing its ability to pump effectively and reducing cardiac output
      • Arrhythmias: abnormal heart rhythms affecting heart rate and cardiac output

    Myocardial Oxygen Supply and Demand

    • Coronary blood flow determines myocardial oxygen supply, influenced by:
      • Coronary artery diameter and resistance
      • Systemic blood pressure
      • Diastolic perfusion pressure
      • Autoregulation
    • Oxygen content of coronary blood depends on:
      • Systemic arterial oxygen content
      • Coronary venous oxygen extraction
    • Endothelial function maintains vascular tone and regulates coronary blood flow
    • Collateral circulation provides alternate pathways for blood flow to the myocardium in the presence of coronary artery occlusion
    • Factors affecting myocardial oxygen demand include:
      • Heart rate
      • Contractility
      • Preload (volume of blood in the ventricles at the end of diastole)
      • Afterload (resistance against which the heart must pump)

    Coronary Arteries and Conduction Pathway

    • Left coronary artery (LCA) branches into:
      • Left anterior descending (LAD) artery, perfusing the anterior wall and septum
      • Left circumflex (LCx) artery, perfusing the lateral wall
    • Right coronary artery (RCA) branches into:
      • Posterior descending (PDA) artery, perfusing the back wall
      • Right marginal artery, perfusing the right side
    • The conduction pathway includes:
      • SA node, initiating the impulse
      • AV node, delaying the impulse briefly
      • Bundle of His and its branches (right and left bundle branches, Purkinje fibers), ensuring coordinated contraction of the heart chambers

    Rhythm Analysis and Bundle Branch Block

    • Interpret a rhythm strip systematically, considering:
      • Calibration and patient details
      • Rhythm regularity or irregularity
      • Rate (atrial and ventricular)
      • P-wave presence and morphology
      • PR interval
      • QRS complex duration and morphology
    • Identify bundle branch blocks, including:
      • Right bundle branch block (RBBB): wide QRS complex with rSR' morphology in lead V1
      • Left bundle branch block (LBBB): wide QRS complex with W morphology in lead V1
    • Bundle branch blocks can indicate underlying cardiac pathology and may require management with devices like pacemakers

    Junctional and Ventricular Arrhythmias

    • Junctional rhythm originates from the AV node, resulting in:
      • Abnormal heart rhythm
      • No relationship between P waves and QRS complexes
      • QRS complex duration and morphology
    • Junctional escape rhythm has a rate of 40-60 bpm
    • Mechanisms of junctional and ventricular arrhythmias include:
      • Abnormal automaticity
      • Reentry
      • Triggered activity

    12-Lead ECG and Axis Deviation

    • Identify cardiac axis and axis deviation on a 12-lead ECG:
      • Normal cardiac axis: positive reflections in leads I and II
      • Right axis deviation: negative reflection in lead I, positive in lead III
      • Left axis deviation: positive reflection in lead I, negative in leads II and III
    • Relate ECG leads to coronary territories:
      • Anterior leads (V1-V4): LAD territory (anterior wall)
      • Lateral leads (I, aVL, V5-V6): LCx territory (lateral wall)
      • Inferior leads (II, III, aVF): RCA or LCx territory (inferior wall)
      • Right ventricular leads (V1-V2): RCA territory (right ventricle)

    Bundle Branch Block and Clinical Significance

    • Bundle branch block refers to a delay or blockage in conduction down one of the bundle branches
    • Right bundle branch block (RBBB) and left bundle branch block (LBBB) have distinct ECG features
    • Bundle branch blocks can indicate underlying cardiac pathology and may require management with devices like pacemakers

    Acute Coronary Syndrome and Sepsis

    • Acute coronary syndrome (ACS) refers to a spectrum of conditions associated with sudden, reduced blood flow to the heart
    • Categories of ACS include:
      • Unstable angina (UA)
      • Non-ST-elevation myocardial infarction (NSTEMI)
      • ST-elevation myocardial infarction (STEMI)
    • ACS is diagnosed based on symptoms, ECG findings, and biomarkers
    • Sepsis is a clinical syndrome characterized by life-threatening organ dysfunction
    • Causes of sepsis include infections, pathogens, and underlying conditions
    • Management of sepsis involves fluids, vasopressors, antibiotics, and supportive care

    Hemodynamic Monitoring and Vasoactive Medications

    • Inotropes, chronotropes, and vasopressors are used in critically ill patients
    • Inotropes increase cardiac contractility, chronotropes affect heart rate, and vasopressors cause vasoconstriction
    • Examples of inotropes include dobutamine, dopamine, and milrinone
    • Vasopressors include norepinephrine, epinephrine, vasopressin, and phenylephrine
    • Hemodynamic monitoring involves balancing cardiac output with peripheral resistance and blood pressure

    Massive Transfusion and Hypertensive Crisis

    • Critical bleeding is associated with hemodynamic instability, coagulopathy, and organ dysfunction
    • Massive transfusion can lead to complications such as coagulopathy, metabolic disturbances, volume overload, and transfusion reactions
    • Nursing care during massive transfusion involves monitoring, fluid and electrolyte management, coagulopathy management, and temperature management
    • Hypertension is a major public health burden, and hypertensive crisis requires prompt management to prevent end-organ damage

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    Learn about the definition of shock, its impact on cardiac output, and clinical manifestations. Understand the life-threatening circulatory failure that results in cellular and tissue hypoxia.

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