Fluids & Shock Flashcards
what is edema?
excess interstitial (tissue) fluid-may be localized or systemic
what can edema include?
excess fluid in body cavities (“third spaces”)
what is edema in the peritoneal cavity?
ascites
what is edema in the pericardial cavity?
pericardial effusion
what is excess cerebrospinal fluid?
hydrocephalus
what is edema in the testicular cavity?
hydrocele
what is edema in the uterine tube?
hydrosalpinx
what is edema in the small intestine?
ileus
what is edema between the epidermis and dermis?
blister
what is edema in a surgically-created space (wound)?
seroma
what is edema in the pleural cavity (hemothorax, empyema)?
hydrothorax
what are transudates composed of?
salt water, little to no protein content
what do transudates result from?
alterations in starling forces or lymphatic failure
what can cause transudates?
heart failure cirrhosis renal failure salt-indulgence mechanisms can be complex
starling forces
things that contribute to fluid exchange across capillary walls
what causes fluid to go out of capillaries?
hydrostatic pressure (BP) is higher than the pressure in the tissues (osmotic/oncotic pressure) capillary hydrostatic pressure (BP), as fluid is lost BP goes down at venous end, capillary hydrostatic pressure drops on venous end positive at end
what causes fluid to go into capillaries?
osmotic pressure is greater than capillary hydrostatic pressure
causes of transudative edema
excess total body water salt/fluid overloading excess aldosterone (tumor, hepatic failure) kidney failure from any cause systemic veins (all)-R heart failure pulmonary veins-L heart failure leg veins-prolonged standing, pregnancy, valve failure portal vein-cirrhosis
causes of transudative edema 2
cerebral capillaries-brain trauma
systemic capillaries-decreased plasma proteins (liver failure, malnutrition, nephrotic syndrome)
lymphatic obstruction-inflammation/scarring-filariasis “elephant man”, cancer, radiation
is treatment needed for transduative edema?
varies depending on cause
what are exudates composed of?
protein-rich salt water
what causes exudates?
overly leaky capillaries
what are exudates seen with?
inflammation
sepsis
burns
abnormal capillaries in tumors
what happens when exudates are created?
leaked proteins draw water into interstitial space or “third” space
how would you tell transudate or exudate?
lab can distinguish from sample of fluid, protein content main determining factor
hemorrhage
loss of whole blood from blood vessels
where can hemorrhages be?
external, into tissues, or into “third” spaces
what are small hemorrhages?
petechiae <3mm
what are medium hemorrhages?
purpura 3-10mm
what are large hemorrhages?
ecchymosis >10mm “bruise”
hematoma
blood in tissues produces a mass
hematoma in thorax, pericardium, peritoneum
hemathorax
hemopericardium
hemoperitoneum
hemoptysis
coughing blood
hematemesis
vomiting lood
hematochezia
bright red blood per rectum
melena
black, tarry, digested blood per rectum
causes of hemorrhage
trauma diseases of blood vessels diseases around blood vessels lack of clotting factors lack of platelets
what determines significance of hemorrhage?
where and how much brain bleeds-devastating hemopericardium-rapidly fatal black eye-harmless 500mL in street no big deal, 500mL pericardial space means death
can hemorrhages be quantified?
yes if it is into tissues or external
class I hemorrhage blood loss
up to 750mL (1-15%)
class I hemorrhage clinical signs
minimal to none
class II hemorrhage blood loss
750-1500mL (15-30%)
class II hemorrhage clinical signs
tachycardia, tachypnea, anxiety
class III hemorrhage blood loss
1500-2000mL (30-40%)
class III hemorrhage clinical signs
tachycardia, tachypnea, hypotension, altered mental status
class IV hemorrhage blood loss
2000mL (>40%)
class IV hemorrhage clinical signs
tachycardia, hypotension, cold, clammy, severely altered mental status
what can class III and IV hemorrhages progress to?
irreversible shock
where can significant internal losses occur?
thoracic/abdominal cavities
thigh
shock
widespread hypoperfusion of body tissues
what does hypoperfusion lead to?
organ malfunction/failure
what can compensatory mechanisms do in hypoperfusion?
maintain blood pressure
what does anaerobic metabolism predominate in shock?
lactic acidosis
release of inflammatory mediators
further vasodilation
decreased perfusion
hypovolemic shock
decrease in blood volume
what can cause hypovolemic shock?
hemorrhage-internal or external vomiting diarrhea burns third-space losses
cardiogenic shock
pump failurs
what can cause cardiogenic shock?
massive infarction (heart attack)
rupture of ventricle or valve
some rhythm disturbance
distributive shock (“warm” shock)
profound vasodilation, lack of venous return
what can cause distributive or warm shock?
sepsis anaphylaxis high spinal cord injury profpund anesthesia vasovagal (pain, emotion) newer war gases
obstructive shock
external compression of heart or its outflow
what can cause obstructive shock?
tension pneumothorax
large pericardial effusion “cardiac tamponade”
massive pulmonary embolism
what happens during compensated stage of shock?
blood shunted from kidneys, salivary glands, gut, skin
maintains perfusion to heart and brain
oliguria, dry mouth and skin
BP is maintained
what happens during progressive stage of shock?
sympathetic compensatory mechanisms fail BP and cardiac output drop lung and kidney damage occurs survival becomes unlikely -tissue injury may not be reversible
what is the goal of treatment for shock?
restore tissue perfusion not simply raise BP control of bleeding fluids, fluids, fluids address underlying cause
how much fluid is adequate to treat shock?
1L in 5 minutes, repeat 2L over 10 mintes
