Shock + Flashcards
components of stroke volume
Preload, Myocardial contractility, Afterload
Venous capacitance, Volume status, Venous flow
- Preload
- Myocardial contractility
- Afterload
- Preload
Mean venous systemic pressure- right atrial pressure
- Preload
- Myocardial contractility
- Afterload
- Preload
Peripheral vascular resistance
- Preload
- Myocardial contractility
- Afterload
- Afterload
in shock blood flow is preserved to
kidneys, heart and brain
progression of vasoconstriction in shock
Progressive vasoconstriction of cutaneous, muscular and visceral circulation
Poorly oxygenated cells will shift to anaerobic metabolism, hence formation of
lactic acid leading to metabolic acidosis
most common type of shock
HEMORRHAGIC SHOCK
suspect blunt cardiac injury in rapid deceleration
a. Cardiogenic
b. Cardiac tamponade
c. Tension pneumothorax
d. Neurogenic shock
e. Septic shock
a. Cardiogenic
tachycardia, Becks triad, insufficient response to fluid
a. Cardiogenic
b. Cardiac tamponade
c. Tension pneumothorax
d. Neurogenic shock
e. Septic shock
b. Cardiac tamponade
acute respiratory distress, subcutaneous emphysema, absent unilateral breath sounds, hyperesonance in percussion and tracheal shift
a. Cardiogenic
b. Cardiac tamponade
c. Tension pneumothorax
d. Neurogenic shock
e. Septic shock
c. Tension pneumothorax
brainstem injuries; hypotension without tachycardia and cutaneous vasoconstriction
a. Cardiogenic
b. Cardiac tamponade
c. Tension pneumothorax
d. Neurogenic shock
e. Septic shock
d. Neurogenic shock
can occur in patient’s arrival to ED is delayed for several hours
a. Cardiogenic
b. Cardiac tamponade
c. Tension pneumothorax
d. Neurogenic shock
e. Septic shock
e. Septic shock
normal adult blood volume is what percent of body weight?
7% of body weight
normal pediatric blood volume is what percent of body weight?
8-9% of body weight
Equation for male EBW
50 kg + 2.3 kg for every inch over 5 feet
Male: 50 kg + 2.3 kg for every inch over 5 feet
Female: 45.5 kg + 2.3 kg for every inch over 5 feet
1-11 months: (0.5 x age in months) + 4
1-5 years: (2 x age in years) + 8
6-12 years: (3 x age in years) + 7
Equation for female EBW
45.5 kg + 2.3 kg for every inch over 5 feet
Male: 50 kg + 2.3 kg for every inch over 5 feet
Female: 45.5 kg + 2.3 kg for every inch over 5 feet
1-11 months: (0.5 x age in months) + 4
1-5 years: (2 x age in years) + 8
6-12 years: (3 x age in years) + 7
Equation for 1-11 months EBW
(0.5 x age in months) + 4
Male: 50 kg + 2.3 kg for every inch over 5 feet
Female: 45.5 kg + 2.3 kg for every inch over 5 feet
1-11 months: (0.5 x age in months) + 4
1-5 years: (2 x age in years) + 8
6-12 years: (3 x age in years) + 7
Equation for 1-5 years EBW
(2 x age in years) + 8
Male: 50 kg + 2.3 kg for every inch over 5 feet
Female: 45.5 kg + 2.3 kg for every inch over 5 feet
1-11 months: (0.5 x age in months) + 4
1-5 years: (2 x age in years) + 8
6-12 years: (3 x age in years) + 7
Equation for 6-12 years EBW
: (3 x age in years) + 7
Male: 50 kg + 2.3 kg for every inch over 5 feet
Female: 45.5 kg + 2.3 kg for every inch over 5 feet
1-11 months: (0.5 x age in months) + 4
1-5 years: (2 x age in years) + 8
6-12 years: (3 x age in years) + 7
(< 15%)
Class I Hemorrhage
Class II
Class III
Class IV
Class I Hemorrhage
the condition of an individual who has donated 1 unit of blood
Class I Hemorrhage
Class II
Class III
Class IV
Class I Hemorrhage
(15- 30%)
Class I Hemorrhage
Class II
Class III
Class IV
Class II
Uncomplicated hemorrhage for which crystalloid fluid resuscitation is required
Class I Hemorrhage
Class II
Class III
Class IV
Class II
Tachycardia, tachypnea and decreased pulse pressure
Class I Hemorrhage
Class II
Class III
Class IV
Class II
Subtle CNS changes: anxiety, fear, hostility
Class I Hemorrhage
Class II
Class III
Class IV
Class II
(31 to 40%)
Class I Hemorrhage
Class II
Class III
Class IV
Class III
which at least crystalloid infusion is required and most will blood products to reverse shock state
Class I Hemorrhage
Class II
Class III
Class IV
Class III
marked tachycardia and tachypnea and measurable fall in systolic blood pressure
Class I Hemorrhage
Class II
Class III
Class IV
Class III
significant changes in mental status
Class I Hemorrhage
Class II
Class III
Class IV
Class III
what is classic sign of inadequate perfusion:
marked tachycardia and tachypnea, significant changes in mental status and measurable fall in systolic blood pressure
(> 40%)
Class I Hemorrhage
Class II
Class III
Class IV
Class IV
Blood transfusion is required
Class I Hemorrhage
Class II
Class III
Class IV
Class IV
very narrow pulse pressure
Class I Hemorrhage
Class II
Class III
Class IV
Class IV
Which is the most severe?
Class I Hemorrhage
Class II
Class III
Class IV
Class IV
The most effective method of restoring CO, end-organ perfusion and tissue oxygenation is restoring VR to normal by
locating and stopping source the source of bleeding
Most desirable sites for vascular access
forearms and antecubital veins
initial warmed fluid bolus for adult
is 1 liter
initial warmed fluid bolus for pediatric patients weighing less than 40 kg
20 ml/kg
Early administration of blood products must be considered
Class I Hemorrhage
Class II
Class III
Class IV
Class III
Class IV
adequate volume replacement for adult
0.5 ml/kg/hr (adult)
adequate volume replacement for pedia
1 ml/kg/hr (pedia)
adequate volume replacement for infant
2ml/ kg/ hr (under 1)
If crossmatched blood is unavailable, what is indicated for exsanguinating hemorrhage?
type O PRBC
What blood replacement is preferred for female of childbearing age?
Rh- negative PRBC
Define massive transfusion
as > 10 units of PRBC within the first 24 hours of admission or more than 4 units in 1 hour
what can be given in the first 3 hours of hemorrhagic shock to improve survival
what is dose?
Tranexamic Acid
First dose: 1gram over 10 minutes
Follow-up dose: 1 gram over 8 hours
