EMERGENCY AND CRITICAL CARE

CIRCULATORY SUPPORT

Introduction

5 min

Introduce yourself and the group

Provide rationale for the session and relevance to clinical practice

Outline learning objectives:

Revise knowledge of physiological mechanisms for BP control
Perform a clinical assessment of a patients perfusion status
Understand the mechanisms used in ITU for maintaining BP

Explain structure of session

Total time:

45 min

Number of students:

1-5

Grade of students:

3rd to 5th year medical students

Created by:

Dr Max Byrne

Uploaded:

7th February 2020

Last updated:

7th February 2020

Resources needed for this session:

Patient

Resources linked to this session:

Activity 1: Recap Cardiac Physiology

15 min

Discuss with students the mechanisms for BP homeostasis in the human body.

i.e BP= CO (SV x HR) x TPR

Encourage them to discuss around how these factors can be manipulated in ITU and the use of inotropes and vasopressors.

Activity 2: Causes of Shock

20 min

Ask students to define the term 'shock'. Feedback on accuracy and explain concepts of supply and demand if needed. Ask students how shock might present in an unwell patient:

What clinical symptoms might patients notice?
What clinical signs might be evident? Encourage a systematic approach e.g. ABCDE structure.

Discuss with the students possible causes of shock using a structured approach i.e cardiogenic, distributive etc. Ask them to suggest examples of each, if needed.

Discuss the initial/basic management of shock in the ward setting.

What factors might indicate intensive care support might be required?
When might it be appropriate to refer to intensive care?

Activity 3: Clinical Assessment

15 min

Ask the student(s) to clinically assess the fluid status of a patient on the intensive care unit requiring circulatory support. Encourage students to suggest additional clinical signs or parameters that may not be immediately evident e.g. fluid output, IV infusions of medications.

Following this, ask students to present their findings. Discuss the mechanisms of circulatory support relevant to this patient e.g. fluids, inotropes, vasopressors etc.