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DIT Cardiology > Car 6 - Edema And Shock > Flashcards

Car 6 - Edema And Shock Flashcards

1
Q

What are the four starling forces affecting capillaries?

A

Pc: Capillary pressure (the hydrostatic pressure of blood in the capillary; pushes fluid out of the cap). Pi: Interstitial pressure (pushes fluid into the cap). Pi-c: Colloid osmotic pressure of the plasma inside the cap (absorbs fluid into the cap.) Pi-i: Colloid of the interstitium (absorbs fluid into the intersti).

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2
Q

What is Filtration constant (Kf)?

A

Measure of capillary permeability.

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3
Q

What things will cause increase in capillary hydrostatic pressure?

A

CHF (^ central venous pressure). Venous thrombosis (locally). Compression of veins. Na and H2O retention.

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4
Q

What three things can ^ capillary permeability?

A

Infections and septic shock. Toxins. Burns.

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5
Q

What things \/ plasma colloid osmotic pressure?

A

Nephrotic syndrome. Liver disease (no protein making). Protein malnutrition. Protein-losing enteropathy.

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6
Q

What things ^ interstitial colloid osmotic pressure?

A

Lymphathic obstruction.

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7
Q

What is the difference b/w pitting edema vs Non-pitting edema?

A

Pitting edema: excess amount of fluid in absence of additional colloid (a gravity phenom, leaves indentation mark after pressing in). Non-pitting edema: Colloid in interstitial fluid (doesn’t leave indentation after pressing).

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8
Q

What is the difference b/w Transudate vs Exudate?

A

Transudate is Protein-poor edema fluid. Exudate is Protein-rich edema fluid [exudate is Extra stuff].

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9
Q

What two things would cause transudate?

A

^ capillary pressure. \/ plasma protein.

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10
Q

What would cause exudate?

A

^ capillary permeability.

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11
Q

What would the SVR (systemic vascular resistance), CO (cardiac output) and Tx be for Hypovolemic shock?

A

SVR: ^. CO:\/. Tx: IV fluids/blood.

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12
Q

What would the SVR, CO and Tx be for Cardiogenic shock?

A

SVR:^. CO: \/. Tx: Dobutamine.

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13
Q

What would the SVR, CO and Tx be for sepsis/anaphylaxis?

A

SVR: \/. CO:^. Tx: Antibiotics, IV fluids, Norepinephrine.

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14
Q

What would the SVR, CO and Tx be for Neurogenic shock?

A

SVR: \/. CO: \/. Tx: IV fluids. If spinal cord injury: usually high dose steroids to reduce core edema.

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15
Q

What would be seven causes of Cadiogenic shock?

A

MI. Pulmonary embolism. CHF. Arrhytmias. Cardiac tamponade. Tension pneumothorax. Cardiac contusion.

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16
Q

What would be two causes of hypovolemic shock?

A

Loss of blood. Severe burns.

17
Q

What are three sites where a central line can be placed?

A

Femoral. Subclavian. Internal jugular.

18
Q

What are the advantages/disadvantages of placing a central line in the femoral vein?

A

The femoral is the easiest site w/ the least risk; however, it cannot stay in place more than 5-7 days due to risk of infection.

19
Q

What are the advantages/disadvantages of placing a central line in the subclavian vein?

A

The subclavian (SC) is preferred by some because it is easy to find, can remain longer (3-4 wks), and is not as uncomfortable to the patient; howeverm it has the highest risk of pneumothorax. Not such a great choice in those w/ COPD (barrel-chested) or lung tumors.

20
Q

What are the advantages/disadvantages of placing a central line in Internal jugular veins?

A

The internal jugular (IJ) is a good choice because there are good landmarks, can remain long (3-4 wks); however it can be uncomfortable to the patient, and there is a risk of puncturing the carotid or causing pneumothorax. Do not place a left IJ w/o discussing it w/ staff, due to a greater risk of perforating the left SC vein due to the angle at which the left IJ and left SC meet.

21
Q

What vascular structure are inside the femoral sheath?

A

Femoral artery and vein are inside the femoral sheath. The nerve is outside the sheath peripherally.

22
Q

What are the preffered sites of Swan-Ganz catheter?

A

Right IJ. If not, left SC.

23
Q

How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Heart failure.

A

^ in capillary hydrostratic pressure (^Pc).

24
Q

How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Liver failure.

A

\/ plasma colloid osmotic pressure (\/ Pi-c).

25
Q

How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Oliguric renal failure.

A

^ capillary hydrostatic pressure (^ Pc).

26
Q

How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Infections and toxins.

A

^ capillary permeability (^ Kf).

27
Q

How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Nephrotic syndrome.

A

\/ plasma colloid osmotic pressure (\/ Pi-c).

28
Q

How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: lymphatic blockage.

A

^ interstitial colloid osmotic pressure (^ Pi-i).

29
Q

How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Burns.

A

^ capillary permeability (^Kf).

30
Q

How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Diuretic administration.

A

\/ decreased hydrostatic pressure (\/ Pc).

31
Q

How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: IV infusion of albumin or clotting factors.

A

^ plasma colloid osmotic pressure (^ Pi-c).

32
Q

How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Venous insufficiency.

A

^ capillary hydrostatic pressure (^ Pc).

33
Q

How is the skin of a patient different in cardiogenic shock compared to septic shock?

A

Cardigenic shock: Cold and clammy, cyanotic and poorly perfused. Septic shock: Initially warm and flushed.

DIT Cardiology (22 decks)

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