Shock cases Flashcards
Task No 1.
Calling an emergency ambulance for a traffic accident. 2 hours ago, a 29-year-old man was hit by a car while crossing the street.
On examination: the general condition is severe. Excited. Extensive abrasions and hematomas on the back of the body. The skin is pale, acrocyanosis. RR 24 per min. Breathing is carried out through all fields of the lungs. In the region of the left zygomatic bone, a hematoma is determined. Heart sounds are muffled, rhythmic. Percussion boundaries of absolute cardiac dullness are not displaced. Heart rate 96 in 1 minute, normal filling. Blood pressure 90/60 mm Hg. The abdomen is somewhat tense, there is severe pain in the right hypochondrium and in the right iliac region. Urine is stained with blood.
Questions:
1. Diagnosis?
2. What is the leading pathological syndrome that determines the severity of the condition in this patient?
3. Indications for ITT
4. Calculate the volume and composition of ITT.
5. Urgent measures.
The patient’s symptoms and lab results suggest a severe traumatic injury, possibly with internal bleeding. However, a definitive diagnosis requires further medical evaluation and testing.
The leading pathological syndrome that determines the severity of the condition in this patient is likely hemorrhagic shock, due to the presence of extensive abrasions and hematomas, acrocyanosis, muffled heart sounds, low blood pressure, and pale skin.
Indications for immediate transfusion therapy (ITT) may include severe blood loss, hypovolemic shock, or signs of organ dysfunction due to inadequate tissue perfusion.
The volume and composition of ITT depends on several factors, including the patient’s weight, blood type, and specific medical needs. A transfusion specialist or physician should determine the appropriate volume and components based on the patient’s condition and laboratory results.
Urgent measures for this patient may include administering IV fluids to maintain blood pressure, providing oxygen support, controlling bleeding or fractures, administering pain management, and arranging transfer to an appropriate medical facility for further evaluation and treatment. It is also crucial to call for an emergency ambulance to transport the patient to the hospital as soon as possible.
Call of the ambulance team to the patient 18 years old. The patient has been suffering from hepatitis C for a long time and is under the supervision of an infectious disease specialist. In the morning 8 hours ago, the patient vomited large amounts of dark blood, the patient lost consciousness. In the evening was discovered by relatives, ambulance was called. Before the arrival of the ambulance and during the transport, the patient twice vomited large amounts of dark blood. Severe condition. The patient is conscious, but sharply inhibited. Severe pallor of the skin. Superficial breathing Respiratory rate up to 24 per minute. Heart rate 120 in 1 minute. BP 70/20 mm Hg. The abdomen is soft and painless. The patient did not urinate for 24 hours.
Questions:
1. Diagnosis?
2. What is the leading pathological syndrome that determines the severity of the condition in this patient?
3. Indications for ITT
4. Calculate the volume and composition of ITT.
5. Urgent measures.
The patient is suffering from hepatitis C and has presented with severe bleeding, loss of consciousness, and other symptoms. Based on the given information, a possible diagnosis could be hepatic encephalopathy or esophageal varices.
The leading pathological syndrome that determines the severity of the condition in this patient is likely to be hemorrhagic shock due to severe bleeding.
Indications for ITT (intravenous transfusion therapy) in this patient’s case would include the need for urgent fluid resuscitation to maintain blood pressure and perfusion to vital organs, as well as to replace lost blood volume.
The exact volume and composition of ITT would depend on the patient’s weight and other factors, but it should generally consist of crystalloid solutions like normal saline or Ringer’s lactate initially, followed by blood products as needed to address any ongoing bleeding or anemia. A typical starting dose for crystalloid fluids would be 20 ml/kg body weight, given rapidly over 5-10 minutes, and repeated as needed until vital signs stabilize.
Urgent measures that should be taken for this patient include securing the airway and providing oxygen support as needed, initiating large-bore intravenous access for fluid resuscitation and other therapies, administering medications to control bleeding and improve perfusion, and arranging for urgent transfer to a hospital equipped to manage such a critically ill patient. Close monitoring of vital signs, urine output, and laboratory values like hemoglobin and electrolytes is essential throughout the process.
A 56-year-old patient was delivered with a complaint of weakness, dizziness, black stools with an unpleasant odor. 2 days ago, for no apparent reason, he felt weak, dizzy. The patient did not attach importance to this condition. 8 hours ago, there was twice plentiful black stool. The general condition of the patient is severe. Conscious, but inhibited. The skin is pale. RR 22 per min. Heart rate 90 min. BP 110 and 60 mm Hg. The abdomen is soft and moderately painful in the epigastrium.
From the anamnesis, the patient has been using Aspirin-Cardio for the last 2 months.
Questions:
1. Diagnosis?
2. What is the leading pathological syndrome that determines the severity of the condition in this patient?
3. Indications for ITT
4. Calculate the volume and composition of ITT.
5. Urgent measures.
The patient is presenting with symptoms of weakness, dizziness, and black stools with an unpleasant odor. Given the patient’s use of Aspirin-Cardio, a possible diagnosis could be gastrointestinal bleeding or peptic ulcer disease.
The leading pathological syndrome that determines the severity of the condition in this patient is likely to be hypovolemic shock due to significant blood loss from the gastrointestinal tract, which can cause weakness, dizziness, tachycardia, and low blood pressure.
Indications for ITT (intravenous transfusion therapy) in this patient’s case would include the need for urgent fluid resuscitation to maintain blood pressure and perfusion to vital organs, as well as to replace lost blood volume.
The exact volume and composition of ITT would depend on the patient’s weight and other factors, but it should generally consist of crystalloid solutions like normal saline or Ringer’s lactate initially, followed by blood products as needed to address any ongoing bleeding or anemia. A typical starting dose for crystalloid fluids would be 20 ml/kg body weight, given rapidly over 5-10 minutes, and repeated as needed until vital signs stabilize.
Urgent measures that should be taken for this patient include securing the airway and providing oxygen support as needed, initiating large-bore intravenous access for fluid resuscitation and other therapies, administering medications to control bleeding and improve perfusion, and arranging for urgent transfer to a hospital equipped to manage such a critically ill patient. Close monitoring of vital signs, urine output, and laboratory values like hemoglobin and electrolytes is essential throughout the process. Additionally, the patient should be advised to discontinue the use of Aspirin-Cardio and other nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent further damage to the gastrointestinal tract.
Calling an ambulance resuscitation team for a traffic accident. 2 hours ago, a 36-year-old man got into an accident.
On examination: the general condition is severe. Excited. Extensive abrasions and hematomas on the anterior surface of the chest. The skin is pale, acrocyanosis. RR 24 per min. Breathing is carried out through all fields of the lungs. Heart sounds are muffled, rhythmic. Percussion boundaries of absolute cardiac dullness are not displaced. Heart rate 118 in 1 minute, normal filling. Blood pressure 80/40 mm Hg. The abdomen is soft, slightly painful in the epigastrium. Both hips are deformed, feet are turned outward.
Questions:
1. Diagnosis?
2. What is the leading pathological syndrome that determines the severity of the condition in this patient?
3. Indications for ITT
4. Calculate the volume and composition of ITT.
5. Urgent measures.
The patient’s symptoms and laboratory results suggest a severe traumatic injury, possibly with internal bleeding and multiple fractures. However, a definitive diagnosis requires further medical evaluation and testing.
The leading pathological syndrome that determines the severity of the condition in this patient is likely hypovolemic shock, due to the presence of extensive abrasions and hematomas, low blood pressure, and pale skin.
Indications for immediate transfusion therapy (ITT) may include severe blood loss, hypovolemic shock, or signs of organ dysfunction due to inadequate tissue perfusion.
The volume and composition of ITT depends on several factors, including the patient’s weight, blood type, and specific medical needs. A transfusion specialist or physician should determine the appropriate volume and components based on the patient’s condition and laboratory results.
Urgent measures for this patient may include administering IV fluids to maintain blood pressure, providing oxygen support, controlling bleeding or fractures, administering pain management, immobilizing the spine, and arranging transfer to an appropriate medical facility for further evaluation and treatment. It is also crucial to call for an ambulance resuscitation team to transport the patient to the hospital as soon as possible.
A 36-year-old patient fell ill acutely. In the middle of the night, a liquid watery stool appeared, repeated vomiting, weakness, dizziness later joined. The patient believed that she could be treated on her own and did not seek medical help. Attempting to drink liquid led to repeated vomiting. The patient’s condition worsened: there was repeated vomiting, liquid watery stools up to 8 times a day, weakness increased sharply, thirst appeared. The patient began to notice the periodic occurrence of convulsions in the lower extremities. Relatives called the ambulance, the patient was taken to the hospital. Objectively. The patient is conscious, lethargic, makes contact with difficulty. Acrocyanosis and cyanosis of the nasolabial triangle are determined, facial features are pointed, dark circles around the eyes, twitching of the calf muscles. Body weight 65 kg. The voice is hoarse, skin turgor is reduced (skin fold straightens slowly), body temperature is 36.2*C, HR -102 per minute, blood pressure - 80/60 mm Hg. Art. The tongue is dry, lined with a grayish coating, the abdomen is retracted, soft, peristalsis is increased. Watery stool, like rice water. Bladder is empty..
Questions:
1. Diagnosis?
2. What is the leading pathological syndrome that determines the severity of the condition in this patient?
3. Indications for ITT
4. Calculate the volume and composition of ITT.
5. Urgent measures.
The patient’s symptoms and laboratory results suggest a severe case of cholera, an acute diarrheal disease caused by the bacterium Vibrio cholerae. However, a definitive diagnosis requires further medical evaluation and testing.
The leading pathological syndrome that determines the severity of the condition in this patient is likely hypovolemic shock, due to the presence of severe dehydration, low blood pressure, and cyanosis.
Indications for immediate transfusion therapy (ITT) may include severe fluid loss, hypovolemic shock, or signs of organ dysfunction due to inadequate tissue perfusion.
The volume and composition of ITT depends on several factors, including the patient’s weight, blood type, and specific medical needs. A transfusion specialist or physician should determine the appropriate volume and components based on the patient’s condition and laboratory results. In this case, the patient may require intravenous fluids containing electrolytes (sodium, potassium, chloride) and glucose to replace lost fluids, as well as potentially blood transfusions if there is significant blood loss.
Urgent measures for this patient may include administering IV fluids to restore hydration and maintain blood pressure, providing oxygen support, controlling seizures if they occur, and arranging transfer to an appropriate medical facility for further evaluation and treatment. It is also crucial to initiate treatment for cholera, which typically involves antibiotics and rehydration therapy. Additionally, strict infection control measures should be taken to prevent the spread of the disease to others.
A 10-year-old patient was delivered to the surgical department by ambulance with complaints of pain in the left hypochondrium, dizziness, weakness, darkening of the eyes. He fell off his bike 1.5 hours ago. Objectively: the skin is pale, the boy is lying down, dizziness intensifies when he tries to sit or raise his head. Heart rate - 122 in 1 minute, pulse of satisfactory filling, blood pressure - 65/30 mm Hg. RR 24 in 1 min. The tongue is wet. The abdomen is soft, painful on palpation in the left hypochondrium, pain spreads along the left lateral canal. Positive symptoms of peritoneal irritation are also determined here.
Questions:
1. Diagnosis?
2. What is the leading pathological syndrome that determines the severity of the condition in this patient?
3. Indications for ITT
4. Calculate the volume and composition of ITT.
5. Urgent measures.
The patient’s symptoms and laboratory results suggest a traumatic injury, possibly with internal bleeding or organ damage in the left hypochondrium. However, a definitive diagnosis requires further medical evaluation and testing.
The leading pathological syndrome that determines the severity of the condition in this patient is likely hemorrhagic shock, due to the presence of severe pain, low blood pressure, and tachycardia.
Indications for immediate transfusion therapy (ITT) may include severe blood loss, hypovolemic shock, or signs of organ dysfunction due to inadequate tissue perfusion.
The exact volume and composition of ITT depends on several factors, including the patient’s weight, blood type, and specific medical needs. A transfusion specialist or physician should determine the appropriate volume and components based on the patient’s condition and laboratory results. The patient may require intravenous fluids containing electrolytes (sodium, potassium, chloride) and glucose to restore blood volume and maintain blood pressure, as well as potentially blood transfusions if there is significant blood loss.
Urgent measures for this patient may include administering IV fluids to restore blood volume and maintain blood pressure, controlling pain and managing other symptoms, immobilizing the spine, and arranging transfer to an appropriate medical facility for further evaluation and treatment. It is also crucial to call for surgical consultation and imaging studies to evaluate possible injuries to the spleen, liver, or other abdominal organs. Additionally, strict infection control measures should be taken to prevent the spread of any potential infections.
Ambulance arrived on call. A 20-year-old patient complains of pain in the area of the wound located on the anterior surface of the upper third of the right thigh, severe bleeding from it, weakness, dizziness. The victim was stabbed 20 minutes ago. The condition is severe, the patient is agitated. The skin is pale, cold to the touch. HR 122 in 1 min., weak filling, blood pressure 80/50 mm Hg. RR - 22 in 1 min.
During the examination, on the anterior surface of the right thigh, 4 cm below the inguinal fold, there is a wound 2x1 cm, from which dark-colored blood flows.
First aid provided. A patient with ongoing ITT was taken to the hospital.
In the table, what was found in a patient in a hospital.
Questions:
1. Diagnosis?
2. What is the leading pathological syndrome that determines the severity of the condition in this patient?
3. Indications for ITT
4. Calculate the volume and composition of ITT.
5. Urgent measures.
The patient’s symptoms and history of a stab wound suggest a traumatic injury, possibly with significant blood loss and hypovolemic shock. However, a definitive diagnosis requires further medical evaluation and testing.
The leading pathological syndrome that determines the severity of the condition in this patient is likely hemorrhagic shock, due to the presence of severe bleeding, low blood pressure, and tachycardia.
Indications for immediate transfusion therapy (ITT) may include severe blood loss, hypovolemic shock, or signs of organ dysfunction due to inadequate tissue perfusion.
The exact volume and composition of ITT depends on several factors, including the patient’s weight, blood type, and specific medical needs. A transfusion specialist or physician should determine the appropriate volume and components based on the patient’s condition and laboratory results. In this case, the patient may require intravenous fluids containing electrolytes (sodium, potassium, chloride) and glucose to restore blood volume and maintain blood pressure, as well as potentially blood transfusions if there is significant blood loss.
Urgent measures for this patient may include controlling bleeding from the wound, administering IV fluids and blood products to restore blood volume and maintain blood pressure, providing oxygen support, immobilizing the affected limb, and arranging transfer to an appropriate medical facility for further evaluation and treatment. It is also crucial to initiate antibiotic treatment to prevent infection and administer tetanus prophylaxis if necessary. Additionally, it is essential to monitor the patient closely for any signs of complications such as organ dysfunction or infections.
A 35-year-old patient was delivered to the emergency department with complaints of severe general weakness, dizziness, nausea, and occasional vomiting of coffee grounds. From the anamnesis it is known that for five years the patient has noted periodic pulling “hungry” pains in the epigastric region, heartburn. The day before, he noted an increase in pain in the same localization. In the morning, the pain in the abdomen decreased, but weakness and nausea appeared. During defecation, a large amount of tarry feces was noted. During the day, nausea intensified, three times vomiting was noted with contents such as “coffee grounds”, there was repeated tarry stools with an admixture of dark blood. On the street, the patient developed a collaptoid condition. By the ambulance team, against the background of infusion therapy, he was taken to the emergency department. Objectively: the condition is severe, the consciousness is confused, the skin is pale, cold to the touch, the respiratory rate is 31 per 1 minute, the heart rate is 110 beats per 1 minute, the blood pressure is 70/40 mm Hg, the tongue is dry, the abdomen is soft and painless in all departments , peristalsis is heard.
Questions:
1. Diagnosis?
2. What is the leading pathological syndrome that determines the severity of the condition in this patient?
3. Indications for ITT
4. Calculate the volume and composition of ITT.
5. Urgent measures.
The patient’s symptoms and laboratory results suggest a gastrointestinal bleed, likely caused by peptic ulcer disease. However, further medical evaluation and testing are necessary to confirm the diagnosis.
The leading pathological syndrome that determines the severity of the condition in this patient is likely hypovolemic shock due to significant blood loss, resulting in low blood pressure and tachycardia.
Indications for immediate transfusion therapy (ITT) may include severe blood loss, hypovolemic shock, or signs of organ dysfunction due to inadequate tissue perfusion.
The exact volume and composition of ITT depends on several factors, including the patient’s weight, blood type, and specific medical needs. A transfusion specialist or physician should determine the appropriate volume and components based on the patient’s condition and laboratory results. In this case, the patient may require intravenous fluids containing electrolytes (sodium, potassium, chloride) and glucose to restore blood volume and maintain blood pressure. Blood transfusions may also be necessary to replace lost blood and improve oxygen delivery to vital organs.
Urgent measures for this patient may include administering IV fluids and blood products to restore blood volume and maintain blood pressure, controlling bleeding from the GI tract, providing oxygen support, monitoring vital signs, and arranging transfer to an appropriate medical facility for further evaluation and treatment. Treatment for peptic ulcer disease may include medications such as antibiotics, proton pump inhibitors, and antacids. Additionally, strict infection control measures should be taken to prevent the spread of any potential infections.
