Fluid & Shock -exam 1 Flashcards
Edema
- excess interstitial fluid
- may be localized or systemic
Types of edema
- Transudate
- exudative
Transudate edema
- salt water, little to no protein content
- results from alterations in starling forces or lymphatic failure
ex: heart failure, cirrhosis, renal failure, salt-indulgence
Causes of transudate edema
- excess total body water
- salt/fluid overloading
- excess aldosterone (tumor, hepatic failure)
- kidney failure
- systemic vein: right heart failure
- pulmonary veins: left heart failure
- leg veins: prolonged standing, pregnancy
- portal vein: cirrhosis
- cerebral capillaries: brain trauma
- lymphatic obstruction
Exudate edema
- protein rich salt water
- results from overly leaky cappilaries
- leaked proteins draw water into interstitial space
- inflammation, spesis, burns
Hemorrhage
- loss of whole blood from blood vessels
- may be external, into tissues, or into “third” spaces
- significance depends on where and how much
Causes of hemorrahge
- trauma
- disease of blood vessels
- disease around blood vessels
- lack of clotting factors
- lack of platelets
Class I hemorrhage
- up to 750 ml (1-15%) blood loss
- clinical signs: minimal to none
Class II hemorrhage
- 750-1500 mL (15-30%) blood loss
- clinical signs: tachycardia, tachypena, anxiety
Class III hemorrhage
- 1500-2000 mL (30-40%) blood loss
- clinical signs: tachycardia, tachypena, hypotension, altered mental status
Class IV hmorrhage
- 2000 mL (40%) blood loss
- clinical signs: tachycardia, hypotension, cold, clammy, severely altered mental status
Shock
- widespread hypoperfusion of body tissues - not localized
- hypoperfusio leads to organ malfunction/failure
Types of shock
- hypovolemic
- cardiogenic
- distributive
- obstructive
Hypovolemic shock
- decreased in blood volume
- ex: hemorrhage, vomiting diarrhea, burns, third-spaces losses
Cardiogenic shock
- pump failure
- ex: massive infarction, rupture of ventricle or valve, some rhythm disturbances
Distributive shock
- warm shock
- profound vasodilation, lack of venous return
- ex: sepsis, anaphylaxis, high spinal cord injury, profound anesthesia, vasovagal, newer war gasses
Obstructive shock
- external compression of heart or its outflow
- tension pneumothorax, larege pericardial effusion, massive PE
Stages of shock
- compensated
- progressive
Compensated shock
- blood shunted from kidneys, salivary glands, gut, skin
- maintains perfusion to heart and brain
- oliguria, dry mouth, and skin
- BP is maintained
Progressive shock
- sympathetic compensatory mechanism fail
- BP and cardiac output drop
- lung and kidney damage occurs
- survival becomes unlikely
Goals for shock
- tx is to restore tissue perfusion
- tx is NOT to simply raise the BP
- control of bleeding
- fluids, fluids, fluids
- address underlying cause
