Trauma Physiology and Care Flashcards
How much blood volume in a normal person?
70ml/kg
How much blood does the heart pump per minute?
5-6 L
What percent of blood is on venous side (low pressure)?
70%
How does blood maintain homeostasis?
Helps keep the body warm, transport waste and CO2
Blood components and functions
- 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
What is Von Willebrand factor?
Component of the clotting cascade that works by mediating the adherence of platelets to one another and to a site of injury.
Thrombin role in clotting cascade
Thrombin converts Fibrin into a net that traps more platelets and blood cells.
Vitamin K role in clotting
Necessary to make proteins for clotting
Calcium role in clotting
Responsible for complete activation of many clotting factors
Stage 1 of hemorrhagic shock
(Blood lost, BP, HR, RR, SpO2, Mentation, presentation, pH, Calcium, Temp)
- Blood lost
- <750
- 0 - 15%
- BP
- Systolic NORMAL
- Diastolic NORMAL
- HR
- Slightly INCREASED
- 100 ish
- Slightly INCREASED
- RR
- NORMAL
- SpO2
- 95%
- Mentation
- Alert, thirsty
- Blue hands, feet, shunting to core (acrocyanosis)
- Alert, thirsty
- pH
- WNL
- 7.35-7.45
- Temp
- WNL
- 98.6
- Ca
- 0-75 mg loss
- Capno
- WNL
- 35-45
Stage 2 of hemorrhagic shock
(Blood lost, BP, HR, RR, SpO2, Mentation, presentation, pH, Calcium, Temp)
- Blood loss
- 750 - 1500 mL
- 15 - 30%
- BP
- Systolic NORMAL
- Diastolic INCREASED
- 120/90
- PP narrowing
- HR
- Slightly INCREASED
- 100 - 120
- Slightly INCREASED
- RR
- NORMAL
- SpO2
- NORMAL
- 95%
- NORMAL
- Mentation
- Anxious, aggressive, alert
- More shunting of blood to the core, acrocyanosis
- pH
- Slight decrease
- 7.34ish
- Slight decrease
- Ca
- 75-150mg lost
- Temp
- Dropping
- 96 degrees
- Dropping
- Capno
- Rising
- 44
Stage 3 of hemorrhagic shock
(Blood lost, BP, HR, RR, SpO2, Mentation, presentation, pH, Calcium, Temp)
- 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
Stage 4 of hemorrhagic shock
(Blood lost, BP, HR, RR, SpO2, Mentation, presentation, pH, Calcium, Temp)
- 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
Temperatures and mortality rate in hemorrhagic hypovolemic shock
<90 degrees = 100% mortality rate
92 degrees = 90% mortality
Triad of Death components
Coagulopathy, acidosis, hypothermia
Exsanguination definition -
Draining of blood
Renin Angiotensin Aldosterone mechanism in response to shock
- 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
ADH response in shock
- 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.
Intracellular fluid shift in shock
- Fluid moves from the cells and tissues to the blood vessels.
- Increases blood volume
- Increases CO and BP
Types of shock
- Cardiogenic
- Hypovolemic
- Distributive
- Neurogenic
- Anaphylactic
- Septic
- Obstructive
- Tension pneumo
- Cardiac tamponade
- Pulmonary embolism
- Dissociative
Hypovolemic shock treatment
- 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
- Epinephrine (if you can correct the bleed first)
- Vasopressors
Obstructive shock (Tension Pneumo) S/S
- 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
Obstructive shock treatment (tension pneumo)
- ABC, decompress (if no external wound), IV, transport
Obstructive shock s/s (cardiogenic)
- Dyspnea, anxiety
- Increased RR, HR
- Becks Triad
- JVD, Hypotension, muffled heart sounds
- narrowing pulse pressures
- Diminished breath sounds to affected side
Obstructive shock Treatment (Cardiac Tamponade)
- ABC, IV
- NS if lung sounds clear
- Shock treatment, transport
Obstructive shock S/S (Pulmonary embolism)
- Dyspnea, clear breath sounds
- SOMETIMES pinpoint pain
- depends on size and location of PE
- Tachycardic, hypotensive, narrowing PP
Obstructive shock treatment (Pulmonary embolism)
- Shock treatment, IV, treat the BP, transport.
Cardiogenic Shock S/S
- 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
Cardiogenic shock treatment
- If rate is slow and BP low, fix the rate.
- Dopamine
- 2 - 10 mcg/kg/min
- 400mg in 250 mL bag
- 2 - 10 mcg/kg/min
Distributive shock (neurogenic) s/s
- 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
Distributive shock (neurogenic) treatment
- ABC, Fluid, check sugar.
- Dopamine 10 - 20 mcg/kg/min
Distributive shock (septic) s/s
- 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
Distributive shock (septic) treatment
- FLUID WIDE OPEN
- Vasopressor (if unable to control pressure)
- Dopamine 10-20 mcg/kg/min
Distributive shock (anaphylactic) s/s
- 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
Distributive shock (anaphylactic) treatment
- 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.
Dissociative shock S/S
- CO, Cyanide, Anemia
- Something not allowing oxygen to reach the cells
- S/s is decreased tissue perfusion
- Cyanosis, acrocyanosis, circumoral cyanosis, etc
Dissociative shock treatment
- ABC’s and OXYGEN
What part of the brain is responsible for temperature management?
Hypothalamus on top of brainstem
