Lesson 4 circulation Flashcards
How many mmHg can most clots withstand?
80mmHg
BP over this you risk “popping” the clot
Give fluid bolus cautiously or avoid altogether
Why should an occlusive dressing be placed over a neck wound?
To prevent air embolism
How could a trauma cause a distributive shock?
High spinal cord injury
Vasodilation with warm peripheries and normal capillary refill
In a trauma setting, what are the causes of cardiogenic shock?
Tension pneumothorax
Pericardial tamponade
Cardiac contusion
What volume or % of blood loss would result in Class II haemorrahge (HR 100 - 120, BP normal but narrowed pulse pressure, RR 20 - 30, mildly anxious) ?
Would you give this person blood products or cystalloid?
750 - 1500ml
15 - 30%
Crystalloid
What volume or % of blood is lost in a patient with class III haemorrhage (HR 120 - 140, BP decreased, pulse pressure decreased, RR 30 - 40, anxious and confused) ?
Would you give them blood products or crystalloid?
1500 - 2000 ml
30 -40%
Crystalloid and blood products
What volume or % of blood has been lost in Class IV haemorrhage (HR > 140, BP decreased, pulse pressure decreased, RR > 35, confused &lethargic)?
Would you give them crystalloids or blood products?
> 2000ml
40%
Crystalloid and blood products
What volume or % of blood loss results in decompensated shock?
1500 - 2000 ml
30 - 40%
Also known at Class III hameorrhage
What volume or % of blood loss results in compensated shock?
750 - 1500ml
15 - 30%
Also known as class II haemorrhage
Name four special populations of patients that may have shock but present different to the usual shocked patient
Children- very good compensatory mechanisms
Geriatirc - beta blockers and pace markers and baseline hypertension make signs of shock harder to se
Pregnant - up to 50% extra blood volume, can lose more before obvious
Athletles - normal HR 30 -40, HR of 90 may be tachycardic for them
What is your first preference of a dressing for a penetrating chest injury?
What would a markshift back up be?
Chest seal drain or occlusive dressing taped on 3 sides
Alternatively apply paraffin to gauze and cover
A trauma patient does not have a radial pulse. You don’t have blood products yet. What volume will your normal saline bolus be and what is your end goal?
250ml bolus until radial pulse or systolic BP 80- 90mmHg
MAP 65mmHg
What BP do you target for a patient with a head injury?
Systolic > 90 - 100 mmHg or MAP 90mmHg
What should a fluid warmer be used in trauma patients?
Large volume of cold products will drop core temperature
Hypothermia causes coagulopathy
What volume of fluid to you give someone with type 1 or 2 haemhorragic shock (compensated shock)
40 ml/hr to maintenance only
