Crawford - Ill-Appearing Flashcards
What is done in primary survey?
ABCDE = airway, breathing, circulation, disability, expose
Address only what’s going to kill them in the next 5 minutes?
What is Sellick’s maneuver in airway treatment?
pinch cricoid cartilage to decrease gastric insufflation
Two components of breathing that need to be assessed in primary survey?
oxygenation: O2 sat
ventilation: end tidal CO2
How to optimize oxygen content in hypoxic patient?
- supplemental oxygen
- increase PEEP with mechanical ventilation or needle decompression
- increase hemoglobin
What treatments can keep BP low even if circulation needs to increase?
beta blockers
pacemaker
Hypotension following injury is due to _________ until proven otherwise.
hypovolemia
CO = ____ x _____
SV x HR
What medications will increase heart rate? (chronotropy)
Non-selective adrenergic agonists - epinephrine
Anticholinergics - atropine
What medications will increase stroke volume? (inotropy)?
Adrenergic agonists – epinephrine, dobutamine
What medications will increase stroke volume without increasing heart rate? (pure inotropy)
Digoxin
What medications will constrict blood vessels?
Adrenergic agonists
Epinephrine
Norepinephrine
Vasopressin
What medications will dilate blood vessels?
Nitroglycerin
Nitroprusside
Calcium channel blockers
What is assessed in the D (disability) of the primary survey?
LOC: determine cause (hypoxia, cerebral injury, med/drug), GCS
Neurologically intact?: sensation and movement along dermatomes
What is important during E (exposure) step of primary survey?
Keep patient warm to prevent hypothermia (trauma triad)
Normal urine output that indicates adequate renal perfusion?
0.5 - 1 mL/kg/hr
End organ signs of shock
Altered mental status High HR and RR Low urine output Low arterial pH Low BP (specifically MAP)
Basic pathophysiology of shock and why it occurs
inadequate tissue perfusion; not enough oxygen
3 components: blood (fluid), heart (pump), blood vessels (pipes)
“warm” vs “cold” shock
early/compensated shock is warm - sympathetic activation (vasoconstriction, high HR and RR)
later decompensated shock patient becomes cold/clammy and hypotensive
Different classifications of shock
Distributive
Hypovolemic
Obstructive
Cardiogenic
Causes of obstructive shock
Massive PE
Tension pneumothorax
Cardiac tamponade
Constrictive pericarditis
BP = _____ x ______
BP = SVR x CO
Pathophysiology of Low SVR
things that cause vasodilation - septic, neurogenic, and anaphylactic shock
BVs are big and leaky, so blood sits in periphery and heart overworks to compensate
Signs of low SVR
WARM
pink
bounding pulses
hyper dynamic heart (fast and pounding)
Signs of high SVR
Cool extremities
Pale
Poor cap refill
Thready pulses (narrow pulse pressure due to high diastolic BP)
Stroke volume depends on what 3 factors? How do they cause shock?
preload = hypovolemic shock if too low
afterload (aortic resistance) = obstructive shock if too high
contractility = cardiogenic shock
Management priorities in hypoperfused states
1) Volume: Fluids to get to CVP 10
2) BP: Vasopressors to get to MAP 60 and SBP 90
3) Flow: inotropes for improved signs of perfusion
Why must you improve circulating volume before adding a vasopressor?
Vasopressors risk tachycardia and increased myocardial oxygen consumption if used too soon
Signs of 15-35% blood loss
Increased HR and DBP (narrow pp), prolonged cap refill, flat neck veins
Symptoms of cardiogenic shock
- Skin: cool, moist, pale with mottling
- CHF signs: JVD, HJR, APE, pedal edema
- Heart: murmurs, S3 or S4
- Pulse: rapid and thready/weak
- Decreased BP
- Decreased urine output
Treatment of cariogenic shock
Increase oxygen: mechanical ventilation, reperfusion
Maximize cardiac output: dysrhythmics, pacing, cardioversion, vasopressors, inotropes
Decrease afterload: intra-aortic balloon pump
Vascular changes in anaphylactic shock
- Diffuse vasodilation from histamine and bradykinin release
- Bronchoconstriction
Treatment of anaphylactic shock
1) ABCs
2) Epinephrine
3) Steroids, H2 blockers, Albuterol, etc.
What is septic shock?
multiple organ system inflammation causing hypoperfusion
SIRS -> sepsis -> severe sepsis -> septic shock
SIRS criteria + source of infection + hypotension
Septic shock treatment
Prompt volume replacement
Early antibiotic administration
If MAP
