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235 trauma > Trauma Physiology and Care > Flashcards

Trauma Physiology and Care Flashcards

1
Q

How much blood volume in a normal person?

A

70ml/kg

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2
Q

How much blood does the heart pump per minute?

A

5-6 L

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3
Q

What percent of blood is on venous side (low pressure)?

A

70%

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4
Q

How does blood maintain homeostasis?

A

Helps keep the body warm, transport waste and CO2

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5
Q

Blood components and functions

A
  • Plasma
    • Liquid portion, carries different blood cells and proteins for clotting
  • Platelets
    • Controls bleeding
    • Part of clotting cascade
    • Forms plug
  • RBC
    • Carry oxygen
  • WBC
    • Fight infection, disease
    • Immune system response
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6
Q

What is Von Willebrand factor?

A

Component of the clotting cascade that works by mediating the adherence of platelets to one another and to a site of injury.

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7
Q

Thrombin role in clotting cascade

A

Thrombin converts Fibrin into a net that traps more platelets and blood cells.

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8
Q

Vitamin K role in clotting

A

Necessary to make proteins for clotting

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9
Q

Calcium role in clotting

A

Responsible for complete activation of many clotting factors

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10
Q

Stage 1 of hemorrhagic shock

(Blood lost, BP, HR, RR, SpO2, Mentation, presentation, pH, Calcium, Temp)

A
  • Blood lost
    • <750
    • 0 - 15%
  • BP
    • Systolic NORMAL
    • Diastolic NORMAL
  • HR
    • Slightly INCREASED
      • 100 ish
  • RR
    • NORMAL
  • SpO2
    • 95%
  • Mentation
    • Alert, thirsty
      • Blue hands, feet, shunting to core (acrocyanosis)
  • pH
    • WNL
    • 7.35-7.45
  • Temp
    • WNL
    • 98.6
  • Ca
    • 0-75 mg loss
  • Capno
    • WNL
    • 35-45
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11
Q

Stage 2 of hemorrhagic shock

(Blood lost, BP, HR, RR, SpO2, Mentation, presentation, pH, Calcium, Temp)

A
  • Blood loss
    • 750 - 1500 mL
    • 15 - 30%
  • BP
    • Systolic NORMAL
    • Diastolic INCREASED
      • 120/90
      • PP narrowing
  • HR
    • Slightly INCREASED
      • 100 - 120
  • RR
    • NORMAL
  • SpO2
    • NORMAL
      • 95%
  • Mentation
    • Anxious, aggressive, alert
    • More shunting of blood to the core, acrocyanosis
  • pH
    • Slight decrease
      • 7.34ish
  • Ca
    • 75-150mg lost
  • Temp
    • Dropping
      • 96 degrees
  • Capno
    • Rising
    • 44
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12
Q

Stage 3 of hemorrhagic shock

(Blood lost, BP, HR, RR, SpO2, Mentation, presentation, pH, Calcium, Temp)

A
  • Blood lost
    • 1500 - 2000 mL
    • 30 - 40%
  • BP
    • Systolic and Diastolic DECREASED (diastolic no longer maintaining)
    • 100/70
  • HR
    • Increased, thready
    • 120, thready
  • RR
    • INCREASED
    • Above 20
    • Body trying to get rid of CO2
  • SpO2
    • Dropping
    • 90%
  • Mentation
    • Anxious, aggressive, drowsy
    • Cyanotic
  • pH
    • Low
    • 7.28
    • Metabolic acidosis due to blood loss
  • Calcium
    • 150 - 200 mg lost
  • Temp
    • Dropping
    • 94 degrees
  • Capno
    • Dropping, less and less CO2 making it to the lungs
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13
Q

Stage 4 of hemorrhagic shock

(Blood lost, BP, HR, RR, SpO2, Mentation, presentation, pH, Calcium, Temp)

A
  • 90% MORTALITY RATE
  • Blood loss
    • >2000mL
    • 40% +
  • BP
    • Dramatic drop in both
    • 80/palp
  • HR
    • >120, very thready
  • RR
    • HIGH
    • >20
  • SpO2
    • Low
    • <88%
  • Mentation
    • Drowsy, confused, unconscious
  • pH
    • Low
    • 7.20
    • Breathing so fast to fix metabolic acidosis, causing respiratory alkalosis
  • Capno
    • Low
    • 30ish
  • Calcium
    • >200mg lost
  • Temp
    • LOW
    • 92
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14
Q

Temperatures and mortality rate in hemorrhagic hypovolemic shock

A

<90 degrees = 100% mortality rate

92 degrees = 90% mortality

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15
Q

Triad of Death components

A

Coagulopathy, acidosis, hypothermia

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16
Q

Exsanguination definition -

A

Draining of blood

17
Q

Renin Angiotensin Aldosterone mechanism in response to shock

A
  • Blood flow to kidneys is decreased, JGC in the kidneys now stimulated, activating system.
    • Renin released
    • Angiotensinogen converts renin to angiotensin 1
    • Angiotensin 1 goes to lungs, reacts w/ACE, converts to angiotensin 2.
    • Angiotensin 2 = POWERFUL VASOCONSTRICTOR, short acting
    • Increases PRELOAD and AFTERLOAD
  • Angiotensin 2 stimulates production of aldosterone from adrenal cortex
    • Aldosterone causes kidneys to reabsorb sodium in renal tubules
    • Water follows sodium, so more water returns to body, less as urine.
      • INCREASES VOLUME IN BODY
18
Q

ADH response in shock

A
  • Baroreceptors in carotid sinus and aortic arch activated w/BP drop
  • ADH (vasopressin) secreted from pituitary
    • Causes kidneys to reabsorb water in renal collecting ducts
    • Decreases urine output, increases volume in veins
  • INCREASES VOLUME TO R SIDE OF HEART, INCREASING BP AND CO.
19
Q

Intracellular fluid shift in shock

A
  • Fluid moves from the cells and tissues to the blood vessels.
  • Increases blood volume
  • Increases CO and BP
20
Q

Types of shock

A
  • Cardiogenic
  • Hypovolemic
  • Distributive
    • Neurogenic
    • Anaphylactic
    • Septic
  • Obstructive
    • Tension pneumo
    • Cardiac tamponade
    • Pulmonary embolism
  • Dissociative
21
Q

Hypovolemic shock treatment

A
  • C-AB. Stop bleeding first if seen.
  • Oxygen, intubate if needed
  • Place patient supine
  • If BS clear, give NS
  • Medications
    • Vasopressors
      • Epinephrine (if you can correct the bleed first)
        • 1 mg into 250 mL at 2-10 mcg/min, start at 30 drops/min
22
Q

Obstructive shock (Tension Pneumo) S/S

A
  • Restless, SOB, chest tightness
  • ABSENT/DIMINISHED LUNG SOUNDS on one side
    • Vena cavae can become kinked, decreasing venous return and CO.
  • Possibly JVD
  • Tracheal deviation (late)
  • Hypotensive
    • Pulse pressures narrow (diastolic compensates and holds initially)
  • Tachycardia
  • tachypnea
23
Q

Obstructive shock treatment (tension pneumo)

A
  • ABC, decompress (if no external wound), IV, transport
24
Q

Obstructive shock s/s (cardiogenic)

A
  • Dyspnea, anxiety
  • Increased RR, HR
  • Becks Triad
    • JVD, Hypotension, muffled heart sounds
    • narrowing pulse pressures
  • Diminished breath sounds to affected side
25
Q

Obstructive shock Treatment (Cardiac Tamponade)

A
  • ABC, IV
  • NS if lung sounds clear
    • Shock treatment, transport
26
Q

Obstructive shock S/S (Pulmonary embolism)

A
  • Dyspnea, clear breath sounds
  • SOMETIMES pinpoint pain
    • depends on size and location of PE
  • Tachycardic, hypotensive, narrowing PP
27
Q

Obstructive shock treatment (Pulmonary embolism)

A
  • Shock treatment, IV, treat the BP, transport.
28
Q

Cardiogenic Shock S/S

A
  • Crackles
  • restless, agitated, confused - unresponsive.
  • Pale, cool, diaphoretic
  • JVD (if not hypovolemic)
  • HR weak, bradycardia or tachycardia (160+) - progress to absent peripheral
    • Dysrhythmias can occur (V tach/a fib/flutter)
  • BP
    • Initially elevated, narrowing pulse pressures
29
Q

Cardiogenic shock treatment

A
  • If rate is slow and BP low, fix the rate.
  • Dopamine
    • 2 - 10 mcg/kg/min
      • 400mg in 250 mL bag
30
Q

Distributive shock (neurogenic) s/s

A
  • Spinal cord injury
  • WIDE PP
  • Injury down, vessels have dilated, BP low (80 - 100 systolic)
    • Warm dry above, pale and cool below
  • HR may be elevated, depending on if sympathetic response disrupted
31
Q

Distributive shock (neurogenic) treatment

A
  • ABC, Fluid, check sugar.
  • Dopamine 10 - 20 mcg/kg/min
32
Q

Distributive shock (septic) s/s

A
  • WIDE PP
  • Early
    • Vasodilation, warm, dry, flushed skin
    • Source of infection (i.e. pneumonia)
    • Wide PP, bounding pulses, rapid breathing
    • FEVER
  • Late (cold), decompensating
    • Diminished pulses
    • cold extremities
    • AMS
    • rapid HR
33
Q

Distributive shock (septic) treatment

A
  • FLUID WIDE OPEN
  • Vasopressor (if unable to control pressure)
    • Dopamine 10-20 mcg/kg/min
34
Q

Distributive shock (anaphylactic) s/s

A
  • Allergic reaction, involves 2+ body systems (one = allergic reaction)
  • Anxiety, AMS, decrease responsiveness
  • Stridor/wheezing, dyspnea, prolonged expiration, laryngeal edema, angioedema
  • Urticaria, flushing, diaphoretic
  • BP down, HR up, dysrhythmias
  • NVD
35
Q

Distributive shock (anaphylactic) treatment

A
  • ABC, O2, IV, supine, fluid challenge.
  • EPI FAST
    • 1:1000 0.3 - 0.5 mg IM
  • Diphenhydramine
    • 40 to 50 mg IVP or deep IM
  • Solumedrol
    • 125 mg SIVP over 2 minutes
  • Albuterol
    • Not necessarily required since B2 effects will happen w/Epi.
36
Q

Dissociative shock S/S

A
  • CO, Cyanide, Anemia
  • Something not allowing oxygen to reach the cells
  • S/s is decreased tissue perfusion
    • Cyanosis, acrocyanosis, circumoral cyanosis, etc
37
Q

Dissociative shock treatment

A
  • ABC’s and OXYGEN
38
Q

What part of the brain is responsible for temperature management?

A

Hypothalamus on top of brainstem

235 trauma (6 decks)

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