3 - Grey Flashcards
What is hypothermia?
Core temp under 35 deg C
Transition between safe hypothermia when physiologic adaptations to heat loss are working to a danger zone of core temp between 30 and 33 deg
Shivering stops, metabolism slows, and head loss is passively accepted
What are the physiologic phases of response to hypothermia?
37-35: hyper-dynamic heart/lungs/metabolic response w/shivering & vasoconstriction
35-33: confusion, ataxia, amnesia, severe shivering
33-30: falling CO, bradycardia, hypoventilation, cold diuresis, spontaneous bleeding, muscle rigidity, complex acid-base status
31: shivering stops
<30: arrhythmias
23: apnea
21: asystole
What is the Bohr effect and how is it affected by hypothermia?
O2 - hbg association curve
Right shift:
- Increased H+, pCO2, temp, 2-3 DPG
- O2 unloading in peripheral capillaries
Left shift:
- decreased H+, pCO2, temp, 2-3 DPG
- decreased O2 unloading in capillaries
What are the contraindications to succinylcholine?
Recent trauma Burns Chronic abdo infection Extensive denervation of skeletal muscle Upper motor nerve injury Conditions causing degeneration of CNS SAH
What are proven strategies in sepsis?
Tidal volume 6-8 ml/kg
Activated progenitor C (shock + apache <25)
Early goal directed therapy (resus)
Low dose steroids (refractory to pressers)
Intensive insulin (controversial)
Daily HD better than q2days (prisma 24x7)
What are the physiologic effects of intra-aortic balloon pumping?
Increased
- MAP
- CO
- Coronary blood flow
- renal blood flow
++ increased
- aortic diastolic pressure
++ decreased
- aortic systolic pressure
- Cardiac afterload
Decreased
- left ventricular systolic pressure
- left ventricular end-diastolic pressure
- cardiac preload
- left ventricular wall tension
- left ventricular volume
- left ventricular stroke work
What are the major effects of intra-aortic balloon pumping?
Increase in LV afterload
Decreased coronary artery perfusion pressure
Increased CO
What are the contraindications to intra-aortic balloon pumping?
Severe aortic insufficiency Aortic aneurism (relative CI)
What are some general indications for an intra-aortic balloon pump?
Unstable angina - medically refractory or post-infarction Postcardiotomy cardiac failure Angioplasty - failure: precoronary surgery - complex angioplasty support Complications of myocardial infarction - acute mitral insufficiency - acute ventricular septal defect - refractory arrhythmias - ventricular aneurysm Cardiogenic shock - only before surgery or angioplasty Precardiac transplantation Occasional prophylactic use - poor ventricular function - severe left main coronary stenosis - very severe multivessel disease Rarely high-risk non cardiac surgery
What is the mortality for various degrees of organ failure?
Single organ 10-20%
Double organ 25-35%
Triple organ 50-60%
Quadruple organ 60-80%
What is commonly the first organ to fail in multiple organ failure?
Lungs
What is the common physiologic response of the heart seen in multiple organ failure?
Biventricular dilation with decrease RVEF + LVEF
Mechanism of RV dysfxn = LV dysfxn
What is SIRS?
Systemic inflammatory response syndrome 2+ of the following: T>38 or <36 HR>90 RR>30 or PaCO2 <32 WBC >12 or <4
Shock is an important risk factor
What is the most common cause of abdo compartment syndrome?
Intra-abdominal bleeding due to post-trauma coagulopathy
What type of patient does abdominal compartment syndrome occur?
Profound shock -> requires large volume resuscitation fluid/blood
Major abdominal visceral or vascular injury
