Car 6 - Edema And Shock Flashcards
What are the four starling forces affecting capillaries?
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).
What is Filtration constant (Kf)?
Measure of capillary permeability.
What things will cause increase in capillary hydrostatic pressure?
CHF (^ central venous pressure). Venous thrombosis (locally). Compression of veins. Na and H2O retention.
What three things can ^ capillary permeability?
Infections and septic shock. Toxins. Burns.
What things \/ plasma colloid osmotic pressure?
Nephrotic syndrome. Liver disease (no protein making). Protein malnutrition. Protein-losing enteropathy.
What things ^ interstitial colloid osmotic pressure?
Lymphathic obstruction.
What is the difference b/w pitting edema vs Non-pitting edema?
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).
What is the difference b/w Transudate vs Exudate?
Transudate is Protein-poor edema fluid. Exudate is Protein-rich edema fluid [exudate is Extra stuff].
What two things would cause transudate?
^ capillary pressure. \/ plasma protein.
What would cause exudate?
^ capillary permeability.
What would the SVR (systemic vascular resistance), CO (cardiac output) and Tx be for Hypovolemic shock?
SVR: ^. CO:\/. Tx: IV fluids/blood.
What would the SVR, CO and Tx be for Cardiogenic shock?
SVR:^. CO: \/. Tx: Dobutamine.
What would the SVR, CO and Tx be for sepsis/anaphylaxis?
SVR: \/. CO:^. Tx: Antibiotics, IV fluids, Norepinephrine.
What would the SVR, CO and Tx be for Neurogenic shock?
SVR: \/. CO: \/. Tx: IV fluids. If spinal cord injury: usually high dose steroids to reduce core edema.
What would be seven causes of Cadiogenic shock?
MI. Pulmonary embolism. CHF. Arrhytmias. Cardiac tamponade. Tension pneumothorax. Cardiac contusion.
What would be two causes of hypovolemic shock?
Loss of blood. Severe burns.
What are three sites where a central line can be placed?
Femoral. Subclavian. Internal jugular.
What are the advantages/disadvantages of placing a central line in the femoral vein?
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.
What are the advantages/disadvantages of placing a central line in the subclavian vein?
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.
What are the advantages/disadvantages of placing a central line in Internal jugular veins?
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.
What vascular structure are inside the femoral sheath?
Femoral artery and vein are inside the femoral sheath. The nerve is outside the sheath peripherally.
What are the preffered sites of Swan-Ganz catheter?
Right IJ. If not, left SC.
How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Heart failure.
^ in capillary hydrostratic pressure (^Pc).
How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Liver failure.
\/ plasma colloid osmotic pressure (\/ Pi-c).
How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Oliguric renal failure.
^ capillary hydrostatic pressure (^ Pc).
How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Infections and toxins.
^ capillary permeability (^ Kf).
How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Nephrotic syndrome.
\/ plasma colloid osmotic pressure (\/ Pi-c).
How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: lymphatic blockage.
^ interstitial colloid osmotic pressure (^ Pi-i).
How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Burns.
^ capillary permeability (^Kf).
How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Diuretic administration.
\/ decreased hydrostatic pressure (\/ Pc).
How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: IV infusion of albumin or clotting factors.
^ plasma colloid osmotic pressure (^ Pi-c).
How do the following circumstance impact the Starling forces of fluid movement thru the capillaries: Venous insufficiency.
^ capillary hydrostatic pressure (^ Pc).
How is the skin of a patient different in cardiogenic shock compared to septic shock?
Cardigenic shock: Cold and clammy, cyanotic and poorly perfused. Septic shock: Initially warm and flushed.
