HFD HEMORAGE AND SHOCK
Terms
undefined, object
copy deck
- PRE-LOAD
- AMOUNT OF BLOOD AVAILABLE TO FILL THE VENTRICLES. END DIASTOLIC VOLUME, END DIASTOLIC PRESSURE
- HOW MUCH BLOOD VOLUME IS HELD IN THE VENOUS SYSTEM
- 64%
- FRANK-STARLING-MECHANISM
- GREATER THE PRE-LOAD=GREATER THE STRETCH=GREATER THE FORCE OF CONTRACTION
- AFTER-LOAD
- RESISTANCE OR PRESSURE THE VENTRICLES CONTRACT OR PUMP AGAINST
- CARDIAC OUTPUT
- AMT OF BLOOD PUMPED IN ONE MINUITE, C.O.=S.V. X RATE
- STROKE VOLUME
- BLOOD EJECTED IN ONE CONTRACTION
- BLOOD PRESSURE
- PERIPGERAL VASCULAR RESISTANCE (AFTERLOAD) B/P=C.O. X P.V.R.
- HOW DOES THE BODY COMPENSATE FOR BLOOD LOSS
- BARORCEPTORS-SNS NERVES-ADRENAL MEDULA-NE AND EPINEPHRINE RELEASED-VASOCONSTRICTION-SVR AND PRELOAD INCREASE
- HOW MUCH BLOOD VOLUME DO ARTERIES CONTAIN
- 13%
- HOW MUCH BLOOD VOLUME DO CAPILLARIES CONTAIN
- 7%
- HOW MUCH BLOOD CAN THE VENULES COMPENSATE FOR
- 500-1000 ML BLOOD LOSS, 15-20% OF VOLUME
- AEROBIC METABOLISM
- 1.GLUCOSE BREAKDOWN YIELDS PYRUVIC ACID, 2.PYRUVIC ACID ENTERS THE KREB OR CITRIC ACID CYCLE, 3.PYRUVIC ACID IS DEGRATED TO CO2,H2O,ENERGY
- ANAEROBIC METABOLISM
- 1.GLYCOLYSIS OCCURS AND PYRUVIC ACID IS PRODUCED, 2.PYRUVIC ACID DOES NOT ENTER KREB OR CITRIC ACID CYCLE, 3.PYRUVIC ACID DEGRADES INTO LACTIC ACID AND SMALL AMOUNT OF ENERGY
- INADEQUATE PERFUSION LEADS TO:
- BARORECEPTORS NOT BEING STRETCHED-STROKE VOLUME DECREASED-CNS ALERTED
- RENIN
- RELEASED FROM KIDNEYS DUE TO LOW PRESSURE. RENINACTS AS AN ENZYME TO CONVERT PLASMA PROTIEN ANGIOTENSIN TO ANGIOTENSIN 1 WICH IS CONVERTED TO ANGIOTENSIN 2 BY ANGIOTENSIN-CONVERTING ENZYME
- ANGIOTENSIN 2
- STIMULATES VASOCONSTRICTION THAT LAST ABOUT ONE HOUR, AND PRODUCES ALDOSTERONE
- ALDOSTERONE
- CAUSES KIDNEYS TO REABSORB Na+, REDUCES Na+/H2O LOSS FROM SWEATING AND GI TRACT=INTRAVASCULAR VOLUME MAINTAINED
- POSTERIOR PITUITARY GLAND
- STIMULATED BY HYPOTHALAMUS WHEN BP IS LOW, THE GLAND RELEASES ADH WICH CAUSES KIDNEYS TO REABSORBE Na=FLUID VOLUME MAINTAINED
- SPLEEN
- STORES 300 ML OF BLOOD IN VENOUS SINUS, DROP IN PRESSURE=SNS STIMULATES CONSTRICTION OF SINUS=UP TO 200ML ADDED TO CIRCULATION
- WHAT % BODY FLUID IS IN INTERSTITIAL SPACE
- 88%
- EYRTHROPOIETIN
- RELEASED BY KIDNEYS IN RESPONSE TO HYPOXIA, ANEMIA ECT. CAUSES INCREASE PRODUCTION AND MATURATION OF RBC. CAN INCREASE BY 10 OVERTIME
- COMPENSATED SHOCK HEART-
- INCREASES RATE AND FORCE OF CONTRACTIONS
- COMPENSATED SHOCK BLOOD VESSELS-
- CONSTRICT=BP MAINTAINED
- COMPENSATED SHOCK SKIN-
- GETS COOL, CLAMY, PALE
- COMPENSATED SHOCK RESPIRATIONS-
- INCREASE TO GET RID OF CO2 AND INCREASE O2
- COMPENSATED SHOCK URINARY SYSTEM-
- PITUITARY RELEASES ADH/ADRENAL CORTEX RELEASES ALDESTRONE=DECREASED URINATION=MAINTAIN FLUID VOLUME
- COMPENSATED SHOCK GI SYSTEM-
- DIGESTION SLOWES DUE TO DECREASES BLOOD FLOW AND DECREASED GUT MOBILITY
- DECOMPENSATED SHOCK
- AKA:PROGRESSIVE SHOCK, MEDICAL INTERVENTION MAY STILL HELP, BODT CAN NO LONGER COMPENSATE, HEART NO LONGER PERFUSED VESSELS DIALATE=BP DROBS
- IRREVERSABLE SHOCK
- SELF NOR MEDS CAN CORRECT CONDITIONMULTIPLE ORGAN DISFUNCTION SYNDROME DUE TO MICRO EMBOLI, MASSIVE RELEASE OF NEURTROPHILS
- HEART, LUNGS, BRAIN CAN LIVE
- 4-6 MIN WITH OUT O2
- LIVER, KIDNEYS, GI TRACT CAN LIVE
- 45-60 MIN WITH OUT O2
- MUSCLE, SKIN, BONE CAN LIVE
- 2-3 HOURS WITH OUT O2
- HYPOVOLEMIC SHOCK
- FLUID LOSS CAUSED BY HEMORRHAGE, BURNS, DEHYDRATION
- IF FLUID LOSS IS NONTRAUMATIC OR PT IS NOT SHOWING SIGNS OF SHOCK YOU SHOULD
- TAKE ORTHOSTATIC VITALS, POS. IF PULSE INCREASE OR BP DECREASES 10-20 = 500-1000 CC LOST
- CAPILLARY BLEEDING=
- OOZES, CLOTS QUICKLY,BRIGHT RED
- VENOUS BLEEDING=
- FLOWS STEADY, DARK RED
- ARTERIAL BLEEDING=
- RAPID, SPURTING, BRIGHT RED
- HEMOSTASIS VASCULAR PHASE
- VESSSEL CUT-SMOOTH MUSCLES AROUND VESSEL CONTRACT-REDUCING LUMEN SIZE AND BLOOD FLOW, SUSTAINED FOR UP TO 10 MIN. MAY NOT WORK IF CUT NOT CLEAN
- HEMOSTASIS PLATLET PHASE
- 1-5 SEC. POST INJURY, PLATLETS STICK TO COLLAGEN-PLATLETS STICK TO PLATLETS-RAPID CONTROL BUT CLOTS ARE UNSTABLE
- HEMOSTASIS COAGULATION PHASE
- DISRUPTION OF INTIMA EXPOSES COLLAGEN AND OTHER PROTEINS- THIS LEADS TO COAGULATION, IN 3-6 MIN. VESSES IS FILLED
- WHAT MEDS. LOWER COAGULATION PHASE
- COUMADIN, HEPARIN, FIBRONOLYTICS
- STAGE 1 BLEEDING
- NO RESPONSE, LOSS OF <15% VOLUME, 500-700 ML,
- STAGE 2 BLEEDING
- COMPENSATED, 15-25% LOSS OF VOLUME, 750-1,250 ML, TACHYCARDIC, NARROWING BP, COOL&CLAMMY, RESTLESS, THIRST
- STAGE 3 BLEEDING
- DECOMPENSATED, 25-35% LOSS, 1,250-1,750 ML, TACHYCARDIC, BP DROPSPULSE BARELY PALPABLE, ANXIETY, LOC DECREASE, COOL, PALE, LOW URIN OUTPUT
- STAGE 4 BLEEDING
- >35% LOSS, 2,000 ML, PULSE BARLEY PALPABLE, RR SHALLOW, UNRESPONSIVE, SKIN COLD-MOTTLED, URIN CEASES, SURVIVLE UNLIKELY
- PREGNANT WOMEN HAVE
- 50% MORE VOLUME, MAY NOT HAVE EARLY SIGNS
- ATHLETES HAVE
- MORE VOLUME AND CARDIAC NERVES, MAY MOVE SLOWER THROUGH STAGES
- OBESE PATIENTS HAVE
- LESS VOLUME, SMALL LOSS MAY BE SERIOUS
- INFANTS AND CHILDREN HAVE
- 20% MORE VOLUME THAN ADULTS, CAN COMPENSATE WELL-CRASH QUICKLEY
- ELDERLY HAVE
- LOWER VOLUME RESERVES, COMPENSATORY SYSTEMS LESS RESPONSIVE, LOWER PAIN PERCEPTIONS/MENTAL ACUITY
- NEUROGENIC SHOCK
- OCCURS AFTER SPINAL INJURY, CORD CUT BELLOW C-5= PHRENIC NERV INTACT=DIAPHRAGMATIC BREATHING
- ANAPHYLACTIC REACTION
- EXTREME SYSTEMIC REACTION, MASSIVE DUMPUNG OF HISTAMINE, PT HAVE SENSE OF IMPENDING DOOM
- ANAPHYLACTIC SHOCK
- COMPRISED OF HYPOVOLEMIC, CARDIOGENIC, NEUROGENIC, RESPIRATORY SHOCK, PT DIES FROM CIRCULATORY, RESPIRATORY FAILURE
- SEPTIC SHOCK
- PT HAVE HISTORY OF ILNESS/INFECTION, PT HAS HIGH FEVERS, PALE, INFECTS LUNGS, BRAIN
- CARDIOGENIC SHOCK
- DUE TO POOR CONTRACTILITY, AMI, USUALY RESULTS WHEN 40% OR MORE OF LEFT VENTRICLE IS DAMAGED, MORTALITY RATE OF 80-90%
- MULTIPLE ORGAN DYSFUNCTION SYNDROME
- due to irreversable shock,ischemia and infection of organs
- WHAT IS TACHY PULSE RATE DUE TO HYPOVOLEMIA
- >100-ADULTS, >120-SCHOOL AGE, >140-PRESCHOOLER, >160-INFANTS
- WHAT BP IS USUALY SUFFICIENT TO MAINTAIN LOC
- 88-100 mmHg
- CONTRAINDICATIONS OF PASG
- ABSOLUTE-PULMONARY EDEMA, CARDIOGENIC SHOCK, RELATIVE-PREGNANCY, EVISCERATION, IMPALED OBJECT IN ABD, SUSPECTED DIAPHRAGMATIC RUPTURE, DO NOT INFLATE UNLESS BP <90 OR LOSS OF PULSES
- IV COMPLICATIONS
- PYROGENIC REACTION, CATHETER SHEAR, ARTERIAL PUNCTURE, CIRCULATORY OVERLOAD, THROMBOPHLEBITIS, AIR EMBOLISM, PAIN, HEMATOMA, INFILTRATION, LOCAL INFECTION