hypotension and abdo pain Flashcards
a-e signs of hypotensive pts
airway swelling to anaphyais
trauma pt - chest truma , medical PO HF - high flow needed
circulation - get patient flat - preserve blood flow to the brain
check hr manually
3 lead
BP IV access
12 lead
tachycardia with hypotension is either a physiological repsonse or tachyArrhythmia causing hypotension
rates over 150 are patholgocal below physiological
consider bleeding souces - external and internal
feel pt perpheries
cool peripheries - hypovolaemai
warm/flsuhes suggests distributive shock
happy hr caue of hypotension give a fluid bolus or blood tranfusion
D- normally fine
consider neurogenic shock particulalty in truame
e - temp , hypothermai poor indicator
no hidden bleeding - role
abdomen - sepsis - or AAA
4 shcoks
distribtuiv
distrbutive shock
look flushes due to vasodilation - anayhlaxis and sepsis
hypovolaemi a
fluid or blood loss - peripeall y shut down
cardiogenic
pump failure or filling failure - LVSD , arrhythmias or valvular pathology
obstructive
mechnaical obstruction to filling or pumping
tension penumothorax or cardiac tamponade
gi bleed definition
any bleed from GI tract except colon
cx of gi bleed
peptic ulcer
varices
mallowry weis
oesphagitis
malignancies
rare - av fistulaor malforamt
rf gi bleed
alcohol nsaid use
increasing age
CKD - peptic ulcer disease
portal hypertension
haematemsis
projectile - high force and distance
variceal bleed
coffee ground vomit -grainy and black
melaena - black tarry sticky difficult to flush
pain or not pain
collapse/pre syncope is shock
consider activation of major haemorrhage protocol early
what blood tests need
FBC
COAG
cross match - confrim blood group
LFT
UandE
bone profile - transfusion can result in hypocalcamiae
PPi given if there is pain - imited evidence in acute bleeds
terlipressin is given in variceal bleeding only - constricts splanchci vessels
iv abx - - die from sepsis later if not from bleed so get them on early
redcue re-bleed rates in cirrhosis
endoscopy needed diagnossic
clip lesions - ulcer band ligation varicies
fibrin and adrenaline around bleeding points
common surgial complications post srugery
immediate - hours
early - days
late - week
replace blood with blood
if bleeding go back to surgery
MI type 2 due to physiolgoical stress - patietns anaesthesied wont complain of pain
pre op ecg
sepssi can occur immediate and early - montior site of surgery
beware of septi showers - surgery on infecte area
often get pneumonia uti etc
early complications
basal atelectiasis - collapse - common on ventilated patients
post op deliriiosu ptaitent = analgeisa, aneasthetic, sleep, meds
red flag for delirum - sepsis - spesisi 6 and drhaydrtion
bowel obstruction and paralyitc ileus - vomiting distenion BNO - no wind - causes post surgery, opiates, electrolyees, dehydration , adhesions
wound dehiscence 7-10 days post op - if large may need return
anastomotic leak - breakdon of wound connecting two parts of bowel - small elaks causes abcess formation which may be treated conservatively or require washout in theatre - peirotnsim quickly - reuire IV abx IV fluids
vte common post - thromboptolysis stockingmand penumaitc ocmpression
d-dimer always raised post op so go image
UR post op - catherterise - remove when reoslves
AKI - often due to drhdration UO
fever is probs the most common call to f1 post - physiologyi insult
day 2 onwards most likely infection look for chest urine adn lines treat with abx
late complications
bowel obstruction
incisional hernias - size and risk of strnagulation
pain and cosmic
post op pyrexia
Early causes of post-op pyrexia (0-5 days) include:
Blood transfusion
Cellulitis
Urinary tract infection
Physiological systemic inflammatory reaction- (usually within a day following the operation) after day 2 more liekly infective source
Pulmonary atelectasis - this if often listed but the evidence base to support this link is limited
Late causes (>5 days) include:
Venous thromboembolism
Pneumonia
Wound infection
Anastomotic leak
