Hypotension Flashcards
Hypotension in pts under GA:
drop in blood pressure greater than 20% from baseline
Pulmonary causes of Hypotension: (3)
hypoxia
hypercarbia
tension pneumothorax
Hypovolemia causes of hypotension: (2)
fluid deficit, acute blood loss
Cardiac causes of hypotension: (9)
rate/rhythm abnormality inotropic failure myocardial ischemia contusion tamponade rupture congestive heart failure cardiomyopathy valvular injury
Shock causes of hypotension: (3)
hypovoleia, cardiogenic, septic
Surgical causes of hypotension: (2)
Surgical compression of the heart, aorta, inferior vena cava, or abdominal contents
Laparoscopy: hypercarbia, dysrhytia, increased vagagl tone from excessive stretching of peritoneum
Electrolyte and hormonal abnormalities for hypotension: (5)
hypoglycemia hypocalcemia adrenal insufficiency ADH supression hypermagnesemia
Anaphylaxis reasons for hypotension: (3)
Meds (abx, muscle relaxants especially esters, opioids, ACEI’s)
Latex
Transfusion
Anesthesia causes for hypotension:
deep analgesia
drug overdose
Temp causes for hypotension
hypothermia
When a patient is hypotensive, always administer what?
100% Oxygen
Whenever a patient is hypotensive-always confrim what?
Confirm the pressure!!!!
Things to KIM and say when pt is hypotensive:
Validate pressure ask about sxs physical exam palpate pulse look at mucus membranes check temp provide supplemental oxygen IV fluids 12 lead EKG ABG
Review anesthesia record
check rates and rhythm
NOrepi works on which receptors? Causes an increase in what? Reflex decrease in _____
alpha 1, alpha 2, beta 1
causes an increase in SVR, contractility, and afterload
reflex decrease in HR
Dopamine for hypotension-moderate doses vs high doses and what they cause?
moderate (2-10 mcg/kg/min) cause B1 receptor stimulation Higher doses (10-20 mcg/kg/min) cause Alpha 1 recepotr defect
Dobutamine: how does it work:
B1 agonist
Milrinone: how does it work, what happens to SVR?
decrease in SVR
Phosphodiesterase inhibitor=increase in cAMP=increase in myocardial contractility and cardiac output
Hypotension Causes: Decreased preload: Decreased afterload Rate Rhythm Contracitlity
Decreased preload: hypovolemia, hemorrhage, decreased venous return due to PTX, PEEP, tamponade, gravid uterus, PE, VAE, fat emboli
Decreased afterload: sepsis, anaphylaxis, vasodilating drugs, or unclamping the aorta
Rate: too fast or too slow
Rhyth: a fib, a flutter, v fib, v tach, PEA
Contractility: Myocardial depression from ischemia or volatiles
What rhythms provide the most perfusion?
Sinus>A aced>A-V paced>V paced
