shock and fluid replacement

Question 1

what is homeostasis

Answer 1

an attempt to return things to normal

Question 2

What is haemodynamic stability

Answer 2

a state where there is adequate tissue perfusion.

Question 3

what is shock

Answer 3

when the body does not get enough blood flow so there is reduced tissue perfusion, making someone not be able to function properly.

Question 4

how many people die from shock

Answer 4

1 in 5

Question 5

what are the 4 stages of shock

Answer 5

1. initial stage where the cells begin to be deprived of oxygen.
2. compensation stage- where the body triggers different mechanisms to try and maintain tissue perfusion.
3. progressive stage-where compensatory mechanisms start to fail with signs of inadequate tissue perfusion.
4. decompensated stage- irreversible damage occuring where death is inevitable and imminent.

Question 6

what are the causes of hypovolemic shock

Answer 6

haemorrhage, then burns, peritonitis and excessive diuresis (production of urine)

Question 7

what is hypovolemic shock

Answer 7

when you lose more then 20% of your bodys blood or fluid supply.

Question 8

when is cardiogenic shock associated with MI

Answer 8

when 40% or more of the myocardium is necrotic. carries a poor prognosis with hospital mortality of 70-90%

Question 9

following an MI, what gives rise to cardiogenic shock?

Answer 9

partial papillary muscle rupture and ventricular septal defects (hole in heart).

Question 10

what are the effects of gastro intestinal shock ?

Answer 10

mucosal ischemia, ileus (an obstruction in ileum) and gangrene (death of body tissue) of bowel can lead to perforation (rupturing) of the bowel with faecal contamination leading to peritonitis (inflammation of peritoneum).

Question 11

what can stagnation of blood within capilliaries lead to

Answer 11

disseminated intravascular co-agulation (a condition in which blood clots form throughout the bodys small blood vessels)

Question 12

what detects alterations in blood pressure

Answer 12

baro receptors stimulate the sympathetic nervous system in an attempt to restore the BP.

Question 13

what will renal hypotension trigger

Answer 13

renin release which will stimulate the renin angiotensin aldosterone mechanism.

Question 14

what does pulmonary hypoperfusion increase

Answer 14

pathological dead space and VQ mismatch (where perfusion and ventilation do not match).

Question 15

is respiratory shock, why does the respiratory rate increase?

Answer 15

in attempt to compensate for anaerobic metabolism and resulting metabolic acidocis

Question 16

what drug therapy will help manage respiratory shock

Answer 16

inotropic shock, diuretics, and sodium bicarbonate

Question 17

when and why were IV fluids first used

Answer 17

in 1830s for treatment of fluid loss due to chlorea

Question 18

whats the average requirement of IV fluid

Answer 18

1500mls per square metre of body area every 24hrs.

Question 19

what are the 5 r’s

Answer 19

resucitation, routine maintenance, replacement, redistribution, reasessment

Question 20

what do you give if a patient needs fluid resucitation

Answer 20

crystalloids that contain sodium in the range 130-154 mmol/l with a bolus of 500 ml over less then 15 minutes

Question 21

what would you restrict the prescription to for a patient who needs routine maintenance

Answer 21

25-30ml/kg a day of water and
approximately 1mmol/kg a day of potassium, sodium and chloride
and approximately 50-100g a day of glucose to limit starvation ketosis (when the body uses fat as a reserve for energy instead of carbs).

Question 22

how big are fluid compartments

Answer 22

as small as a cell or as large as a heart or blood vessel

Question 23

what separates fluid compartments

Answer 23

a selectively permeable membrane

Question 24

what is tonicity

Answer 24

used to describe the number of particles dissolved within a solution.
Isotonic means the number is the same as those within the cells.
Hypertonic means there are a greater number of particles then within the cells .
Hypotonic means that there are less particles then in the cells.

Question 25

what causes filtration

Answer 25

hydrostatic pressure exerted by contraction of the left ventricle.

Question 26

how does intravascular volume be maintained

Answer 26

colloid osmotic pressure draws fluid back

Question 27

what is crystalloid fluid

Answer 27

balanced salt soloutions with water soluble molecules.

Question 28

what is colloid fluid

Answer 28

salt solutions containing larger soluble molecules/active particles i.e protinate, synthetic polymers and polysaccharides .blood itself is a colloid.
increase circulating blood volume
increase blood osmotic pressure
increase in BOP draws fluid back from the intersistial compartment into the intravascular compartment (10mls of albumin, 25% will draw back 350mls).

Question 29

when is hartmans crystalloid fluid for

Answer 29

hypertonic soloution
for maximum fluid and electrolyte replacement
contraindicted in renal or liver disease

Question 30

when is Dextrose 5% soloution used

Answer 30

isotonic soloution

used to maintain volume, replace mild loss and provide minimal calories

Question 31

when is normal saline crystalloid fluid used

Answer 31

isotonic soloution.
used to maintain volume, replace mild loss and correct hyponatraemia (a condition when the level of sodium in your blood is abnormally low).

Question 32

what does fresh frozen plasma colloid do

Answer 32

contains all the co agulation factors including factor VIII, XI and Fibrinogen.
used to correct coagulation defects.

Question 33

what does gelofusine colloid do

Answer 33

its a gelatin based plasma expander.
it has a short intravascular half life of 2-3 hours.
It is isomotic with plasma (does not draw fluid in)
carries a high risk of anaphylaxis.

Question 34

what does blood as a colloid fluid do

Answer 34

given as packed cells-contains half the fluid volume of whole blood.
will raise the packed cell volume and haemogoblin without giving excessive volume.

Question 35

what does albumin 4.5% colloid do?

Answer 35

can be given to replace moderate protein loss.

very rarely used following cochrane reviews.

Question 36

what are starch based plasma expanders

Answer 36

complex molecular structures
very high molecular weights, i.e Hespan-450,000 or Pentaspan- 200,000
long half life

Question 37

what kind of research is helping to develop manufactured blood

Answer 37

stem cell

Question 38

what is a new method of fluid delivery

Answer 38

intraosseal needle which injects directly into marrow of bone.

Question 39

what is sodium

Answer 39

an elcectrolyte that helps regulate the amount of water in and around your cells.