hypotension Flashcards
def. of hypotension
- no specific number
- 90/60 could be
def. shock
inadequate perfusion of tissues
def. hypoxemia
- less o2 in blood
def. hypoxia
- less o2 in tissues
what 3 things infulence BP
- CO
- HR
- SV (preload, afterload, contractility)
how to assess BP
cuff pulses - carotid - 60mm - femoral - 70 - radial - 80
assessment of pulse
- rate
- strength
assessment of organ perf
skin - cool clammy
other organs - mental status, urine outsput
what must be managed in C
BP and hemmorarge control
4 steps to pt with hypotension
- determin cause and correct
- assess severity og blood loss
- resusictate
- assess rescitations
4 possible causes of low BP
- hypovolemic - in trauma assume until proven otherwise
- obstructive
- tension pneumo
- tamponade - distributive
- vasodilation (sepsis, cord) - cardiogenic
pneumonic approach
S- spinal cord/sepsis H- hemorrage O - obastruction C - cardiogenic K - anaphylaXis
4 types of cardiogenic
- percardial
- myocardial
- endocardial
- coronary As
5 causes of hemorrage
- external
- Chest
3 abdo
4 pelvis
5 long bones - femur
2 cats for treating in hypotens
- non-hemorragic causes
2. hemorragic causes
2 treats for non-hemor causes
- need or chest tube
2. surg. for tamponade
2 steps for hemo
- stop the bleed (surg or IR)
2. restore tissue perfusion
keys to volume resussitation
- 2 large bore IVs
- in upper extremities
- peripheral IV best
what is traditional approach to fluid types
- start with crystalloid (RL or saline) - warm
- 3:1 fluid to blood loss
- switch to blood after 3l of crystal
- associated with coagulopathy
what is damage control resus
aggresive resuscitation with blood products
reason for damage contrl
- permissive hypotension
- SBP of 80-90
- stop clots from breaking off
keys to damage control
- start with RBC, not crystal
- aggressive use of coag products
- tranexamic acid - anti-fibrolytitics
3 types of blood can give
- fully crossmatched - 45 min
- type specific - 10 min
- uncrossmatched
- O+ in womn
- O- in men
3 classes of response to vol. resus
- normalized
- transient- replaced but ongoing bleeds
- no/min. response - need def. treatment
6 traditional causes of coagulopathy
- bleeding
- consumption of pruducts
- dilution
- hypothemia
- acidosis
- hypocalcemia
what is acute coag. of trauma (ACT)
- severe tissue trauma and hypoperfusion BOTH required
3 reasons ACT is important
- incr. transfusion required
- incr. mortality
- incr. morbidity
mech of ACT
need balance of: coag - endo thelium, - platelets - reduced - factors - low levels of fibrinogen anti-coag - fibrinolysis - get hyperfibrinolysis - anticoag factos (C and S) - C gets activated by trauma and shock
