Perfusion Is Basic

1
Perfusion Is Basic

• A patient without perfusion is not a patient for
  long

2
Tonights Schedule

• Admin stuff
• Presentation perfusion is basic
• Guided practice vital signs and urgent body
  survey
• Review whole body survey
• Scenarios assessment scenarios

3
Admin Stuff

• Hep B shots
• Assessment scenario format
• Books, roster, web page access?

4
The Great OEC Instructor Said

• Good evening ladies and gentlemen. Maintain
  perfusion. Good day. And then he left

5
Perfusion What Is It?

• Delivery of oxygen and nutrients to the tissues
  and organs of the body

6
Perfusion Why Is It So Important?

• The vital organs will survive only minutes
  without oxygen and nutrients

7
Perfusion What Does It Require?

• Effective respiration
• Effective circulation
• Brain stem function

8
Same Thing Said Pooh

• Its a shocking affair

9
Focus Tonight Is on Circulation

• How can effective circulation fail?

10
The Big Three

• Fluid loss
• Pump failure
• Vessel failure

11
And Some More

• Respiratory
• Anaphylaxis
• Chemical failure
• Fainting
• Septic

12
Hypovolemic - Fluid Loss

• External bleeding
• Internal bleeding
• About one quart loss causes shock
• Metabolic - diarrhea, vomiting, dehydration
• S/S - low BP, rapid, weak pulse, skin pale,
  clammy, cold

13
Cardiogenic - Pump Failure

• Heart attack - loss of blood to cardiac muscles
• Physical blockage
• Electrical failure
• Blunt trauma
• S/S - low BP, rapid, weak pulse, skin pale,
  clammy, cold, diaphoretic

14
Neurogenic - Vessel Failure

• Giving blood. Are we then 90 full
• Three muscle layers
• Substantial ability to expand and contract
• Controlled by brain stem/spinal cord
• S/S - low BP, normal to slow pulse, normal to dry
  skin

15
Signs of Circulatory Health

• Pulses
• Blood pressure
• Capillary refill
• Skin signs

16
Pulses

• Carotid
• Radial
• Brachial - used most frequently with infants
• Femoral
• Posterior tibial
• Dorsalis pedis

17
Blood Pressure

• Systolic - maximum pressure
• Diastolic - heart at rest pressure
• Written as 120/80

18
How Do We Take Blood Pressure?

• Measured by constricting upper arm
• Two methods
• Palpation - feeling radial pulse (systolic only)
  120/P
• Auscultation - listening for maximum/minimum

19
Capillary Refill

• Ability of circulatory system to refill vessels
  at skin surface
• Two seconds or less
• Cold restricts it
• Nail bed, web of thumb, inside of lip

20
Skin Signs

• Temperature - cold, warm, hot
• Color - red, pink, pale, cyanotic
• Moisture - dry, moist, diaphoretic
• Normal is warm, pink and moist

21
Perfusion?

• What is perfusion?
• Why is it important?
• What does it require?

22
Shock?

• Big three causes?
• How much effective volume loss?

23
Signs of Circulatory Health?

• Pulses
• Blood pressure
• Capillary refill
• Skin signs

24
Pulses? Head to Foot.

• Carotid
• Radial
• Brachial - used most frequently with infants
• Femoral
• Posterior tibial
• Dorsalis pedis

25
Blood Pressure

• Systolic?
• Diastolic?
• How do we write it?

26
How Do We Take Blood Pressure?

• Measured by ..
• Two methods
• Palpation
• Auscultation

27
Capillary Refill

• Ability of circulatory system ...
• How long?
• What about cold
• How do we check it?

28
Skin Signs

• What are the three signs
• Normal is?

29
Perfusion Is Basic

• A patient without perfusion is not a patient for
  long

30
Guided Practice

• Pulses
• Blood pressure
• Skin signs
• Whole body survey review
• Urgent body survey
• Focused body survey

31
How do we do vitals in scenarios?

• Measure them
• Report what you measure
• Monitor will tell you the scenario values

32
Pulses

• Carotid - find Adams apple, slide to notch, use
  multiple fingers
• Radial thumb side, use multiple fingers
• Brachial - infants - raise arm
• Femoral - used most often as pressure point
• Posterior tibial - outside - hard to find.
• Dorsalis pedis - between first two metacarpals

33
Blood Pressure

• Apply cuff one inch above elbow
• Not over clothing, sung fit, tubing clear
• Arrow over artery
• Find pulse
• Inflate 20 mm over loss of pulse
• Deflate slowly
• Listen for first and last sound

34
Skin Signs

• Temperature - cold, warm, hot
• Color - red, pink, pale, cyanotic
• Moisture - dry, moist, diaphoretic
• Normal is warm, pink and moist

35
Continuing Practice

• Whole body survey review
• Urgent body survey
• Focused body survey

36
Scenario Practice

• Sticks, marbles, pads, washers, cardboard
• Remember listen, look, feel
• Feel everything, all around
• Check for medic alert
• Remember to smell