Rapid Cardiopulmonary Assessment

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Rapid Cardiopulmonary Assessment Recognition of Respiratory Failure and Shock


Objectives

At the end of this session, participants will be able to: • Perform a rapid cardiopulmonary assessment • Recognize signs of distress or respiratory failure and shock

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Respiratory failure and shock Variables

Respiratory failure

Shock

Cardiopulmonary failure Cardiovascular arrest

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Survival after cardiovascular arrest in children 100%

50%

0%

Respiratory arrest

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Cardiovascular arrest

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Rapid Cardiovascular Assessment

1. General assessment: neurological evaluation, muscle tone (mental status, tone, responsiveness) 2. Clinical examination: airways, breathing and circulation (ABCs) 3. Classification of the physiological state

A rapid cardiovascular assessment must be performed in less than 30 seconds!

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General evaluations

• Skin colour • Mental state and type of response • Activity, movements and muscle tone • Age-appropriate response

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Airways

• Patent and functional • Supported • Non-functional without intubation

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Breathing

• Respiratory rate • Respiratory mechanics: difficulty-effort • Breath sounds/inspiratory effort/volume • Inspiratory stridor • Expiratory wheezing • Skin colour and O2 saturation

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Classification of the pathophysiological state

• Respiratory distress Increased respiratory work • Respiratory failure Inadequate ventilation and/or oxygenation

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Effects on systemic perfusion

Volume Lower volume Cardiac output

Heart rate

Myocardial contractility Peripheral resistances

Blood pressure Vascular resistances

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Hemodynamic response to shock

Vascular resistance

Percent of control

140 100 60 Cardiac output

20

Compensated shock Rapid Cardiopulmonary Assessment

Blood pressure

Decompensated shock 11


Decompensated shock: characterized by hypotension

Compensatory mechanisms to maintain adequate blood pressure and cardiac output

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Circulatory examination

Cardiovascular function: • Heart rate • Peripheral pulses and capillary reperfusion • Blood pressure Perfusion and function: • Central nervous system • Skin • Kidneys

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Circulation

• Neurological assessment • Quality of peripheral pulses, skin temperature, capillary reperfusion • Blood pressure • Monitoring of urine quantity

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Circulation

Response assessment: • A — Active and alert • V — Responsive to verbal stimulation • P — Responsive to painful stimulation • U — Unresponsive

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Heart rate in children

Infant 85

220

300

Normal Sinus Tachycardia SVT

60

Child

180

200

Normal Sinus Tachycardia SVT

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Circulation

Assessment of tissue perfusion: • Temperature of the extremities • Capillary reperfusion • Colour • Pink • Pale • Blue • Mottled

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Assessment of peripheral pulses

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Capillary reperfusion

Capillary reperfusion >10 seconds in a three-month-old baby with cardiogenic shock

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Circulation

Ideal blood pressure: Age

Accepted pressure (5th percentile)

0 – 1 month

60 mm Hg

>1 month – 1 year

70 mm Hg

1 – 10 years

70 mm Hg + (2 x age in years)

>10 years

90 mm Hg

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Circulation

Cardiovascular function: • Heart rate • Pulses and capillary reperfusion • Blood pressure Tissue function and oxygenation: • Central nervous system • Skin • Kidneys

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Circulation

Assessment of tissue function and oxygenation Kidneys Urine quantity: Normal: 1 - 2 mL/kg per hour

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Shock classification

Early signs of compensation: • Tachycardia • Peripheral hypoperfusion

Late signs of decompensation: • Weak pulses • Neurological alterations • Hypotension

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Septic shock • Cardiac output can be normal, increased or decreased. NOT SIGNIFICANT • Hypotension is a sign of decompensation even with preserved tissue perfusion. • Other early signs of septic shock decompensation are: • Fever or hypothermia • Tachycardia and tachypnoea • Leukocytosis, leukopenia or thrombocytopenia

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Trauma • Airway and ventilation problems are more common than those related to shock • Use ABC • Airways + immobilization of the cervical spine • Respiration + pneumothorax • Circulation + blood loss control • Identification of life-threatening injuries

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Poisoning • Airway obstructions, respiratory depression, circulatory problems. • ABC approach • Airways: keep patent • Respiration: prevent respiratory depression • Circulation: arrhythmias, hypotension, myocardial ischemia • Early detection of reversible complications • Administer antidotes

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Cardiopulmonary failure

Cardiopulmonary failure is characterized by signs of respiratory failure and shock: • Dyspnoea • Bradycardia • Cyanosis and hypoperfusion

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Cardiopulmonary failure

• Stable • Respiratory distress • Respiratory failure • Shock • Compensated • Decompensated • Cardiopulmonary failure

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Summary

• General assessment • ABCs assessment • Classification of the respiratory status • Respiratory distress • Respiratory failure • Compensated shock • Decompensated shock • Cardiopulmonary failure • Initial management: ABCs support

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Case

Three-week-old infant taken to the ER History of vomiting and diarrhoea Respiratory gasping, bradycardia, cyanosis, and tissue hypoperfusion

What’s his/her status? What immediate action should you implement?

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Continuation

Intubated and ventilated with 100% FiO2 Heart rate: 180 bpm Blood pressure: 50 mm Hg systolic Centrally pink and peripheral cyanosis No peripheral pulses No response to pain What’s his/her status now? What’s the priority now?

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Treatment

• Improving vital signs • Better tissue perfusion

What would you do now?

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