cardiac Flashcards
The principal objectives of fluid and blood resuscitation in traumatic shock are
to restore intravascular volume
to prevent or correct derangements in coagulation
what is the pathophysiology of haemorrhagic shock
creates a state of impaired oxidative metabolism and homeostasis
produces global insult to the vascular endothelium that activates the coagulation and inflamatory system
mechanisms of coagulopathy in trauma and its characterstics
combination of factors tissue hypoxia ,loss of coagulation factors and exacerbated by acidosis and hypothermia
characterstics are anticoagulation and hyperfibrinolysis modulated through the protein c pathway
what is oxygen debt
develops in tissues or organs when tissue demand is not met and represents the amount of extra oxygen that is needed to metabolize the accumulated products of anaerobic metabolism once perfusion is restored.
Total oxygen debt is the accumulation of multiple oxygen deficits over time and is a measure of whole-body ischemia.
is the only physiologic measure that has clearly been linked to both mortality and morbidity in the form of multiple organ failure after shock
measurements used to detect occult shock are and their drawbacks
what is the earlier finding?
what are oxygen consumption surrogates and their normal value
lactate
base defecit
they are late findings
indicators of oxygen extraction like mixed or central venous oxygen saturation
invasive oximetric catheters measuring central venous oxygen saturation (ScvO2) and tissue oxygen saturation (StO2)
what are the priorities in haemorrhagic shock management and how to achieve them
ensuring adequate ventilation and oxygenation
controlling external bleeding
protecting the spinal cord
restore intravascularar volume
maintain oxygen-carrying capacity
limit ongoing blood loss
prevent the development of coagulopathy and hypothermia
what are hemostatic hypotensive resuscitation and its contraindications
what are the concerns regarding crystalloids
limiting intravascular volume expansion and avoiding normalization of blood pressure
contraindications are …coronary artery dx …cerebrovascular dx …TBI ..hypertension
concerns are
infusion of large amounts can cause increased activation of neutrophil
RL can increase cytokine release and may increase lactic acidosis
NS exacerbates intracellular potassium depletion and cause hyperchloremic acidosis.
what is massive transfusion protocol ??
what are the tools used to predict the need for massive transfusion
the requirements of >10 units of PRBCS within the first 24 hours of injury, replacement of 50% of blood volume within 3 hours, or ongoing transfusion during a period of rapid bleeding, such as >150 mL/min.
penetrating mechanism of injury, positive FAST examination, blood pressure <90 mm Hg (<12.0 kPa), and pulse rate >120 beats/min.
The presence of two or more variables has a sensitivity for massive transfusion of 76% to 90%, with a specificity of 67% to 87%.
what are the adjuncts of 1:1:1 mtp
what are thromboelastography and thromboelastometry
tranexamic acid
calcium (calcium chloride prefered because the well-perfused liver is required to liberate calcium from calcium gluconate)
