hypotension in the trauma patient

Question 1

what happens to pulse pressure when you are hypovolemic?

Answer 1

it will decrease

diastolic pressure goes up, then systolic drops later

Question 2

First thing that happens in shock after you’ve lost 15-30% blood volume (~750cc)

Answer 2

1) Hrt rate increases

2) Pulse pressure decreases

Question 3

Systolic blood pressure will drop after how much blood is lost

Answer 3

30-40%

Question 4

decreased BP in trauma is due to

Answer 4

hypovolemia until proven otherwise

Question 5

4 causes of decreased BP

Answer 5

• hypovolemic
• distributive - vasodilation
• obstructive - obstruct return
• cardiogenic

Question 6

mnemonic for causes of decreased BP

Answer 6

SHOCK

• spinal cord/sepsis
• hemorrhagic
• obstructive
• cardiogenic
• anaphylaxis

Question 7

in a spinal cord injury with vasodilation how will patient’s present

Answer 7

• no sympathetics for example

- patients warm, normal color no pallor

Question 8

resistance varies with 3 variables

Answer 8

length
viscosity
radius

Question 9

how much ringer’s lactate or saline do you give for 1ml of blood loss

Answer 9

3-4 mls of saline

Question 10

if a patient is severely ill, bleeding, etc. how should you resuscitate?

Answer 10

with RBCs and coagulation products

Question 11

what should SBP be after resuscitation?

Answer 11

80-90

Question 12

antifibrinolytic that can be used to attenuate hyperfibrinolysis associated with severe trauma is

Answer 12

tranexamic acid

Question 13

women of child bearing age receive what blood type RBC

Answer 13

O negative

Question 14

what is required for the development of acute coagulaopathy of trauma?

Answer 14

Tissue trauma AND

hypoperfusion

Question 15

manage treatment of a patient in shoch

Answer 15

1- 2 large bore IVs - 
warm fluid
2 - Give blood, RBCs/plasma/fibrinogen
3- tranexamic acid
4- hemorrhage control