Edema and Shock --> includes Starling Forces (5 star!!!) Flashcards
what is Pc?
pulmonary capillary pressure–> pushes fluid out of capillary
what is Pi?
interstitial fluid pressure⇒ pushes fluid into capillary
What is πc?
plasma colloid osmotic pressure (in capillary) ⇒ pulls fluid into capillary
what is πi?
interstitial fluid colloid osmotic pressure ⇒ pulls fluid out of capillary
what is Kf?
filtration constant ➡ reflects capillary permeability
what four things can cause ↑ Kf?
- infections
- septic shock
- toxins
- burns
where does most filtration take place in the capillary
at the arterial side ⇒ higher Pc and πi pull fluid out; by the venous end, fluid has left the capillary and a higher relative πc serves to keep fluid in the capillary
what are three conditions ↑ Pc might be seen in
- CHF (congestion in capillaries)
- Venous thrombosis
- Compression of veins
4 conditions ↓ πc might be seen
- Nephrotic syndrome
- Liver Dz
- Protein malnutrition
- Protein losing enteropathy
what can cause ↑ πi
Lymphatic occlusion ⇒ (can be due to tumor, surgery, infection or radiation)
what happens to SVR and CO in hypvolemic shock
↓ CO w/ compens. ↑ SVR
Tx for hypovolemic shock
IV fluids/ transfusion
SVR and CO in cardiogenic shock?
↓ CO w/ compens. ↑ SVR
SVR and CO in sepsis/ anaphylaxis
↓ SVR w/ compens. ↑ CO (increased HR, sypathetic d.c fro drop in BP)
earliest sign of septic shock?
Tachycardia –> can be complicated by multiorgan failure; ischemia may lead to lactic acidosis
SVR and CO in neurogenic shock? causes?
both ↓; due to brain or spinal cord injury
Tx for cardiogenic shock? (1)
Dobutamine ⇒ inotropic agent (β1 agonist)
tx for septic shock (3)
- ABx
- IV fluids
- NE!
*remember, NE is the best vasopressor for spetic shock shock; Epi is for anaphylactic shock
what tx is needed for spinal cord injury other than IV fluids to maintain CO
high dose steroids
MCC of hypovolemic shock? what is another big cause
- MCC = blood loss
2. Burns - also cause massive fluid loss
7 causes of cardiogenic shock
- MI
- pulmonary embolism (PE)
- CHF
- tension pneumothorax
- cardiac tamponade
- cardiac contusion
- Arrhythmia ( v-tach or v-fib)
central line placement with highest risk of pneumothorax
subclavian
why do you not place a internal jugular central line in the left IJ
greater risk of perforating the left SC vein due to the angle at which the left IF and left SC meet
*risk of puncturing the carotid with these too
placement for Swan-Getz catheter
right IJ or left SC
what is a way to tell from physical exam if a pt is in cardiogenic or septic shock
Cardiogenic –> skin will be cold, clammy, cyanotic
Septic–> skin will be warm and red (due to increased vascular permeability/ vasodilation)
pitting edema is what kind of fluid
transudate (no colloid) ⇒ due to ↑Pc or ↓πc
non-pitting edema is what kind of fluid
exudate–> doesnt pit b/c protein rich ⇒ due to ↑Kf = infections, septic shock, toxins, burns
what is a potential issue with femoral central lines, although the easiest to place and least risk of complication
can only stay in for 5-7 days due to risk of infection
