Triage, shock and fluids Flashcards
Shock
Inadequate cellular energy production.
Most commonly secondary to poor tissue perfusion (may be due to low/unevenly distributed blood flow)
Shock leads to critical decrease in oxygen delivery compared to oxygen consumption in tissues.
Signs consistent with shock
- Changes to mentation
- MM colour
- Changes to CRT
- Cold extremities
- Changes in pulse profile (hyperdynamic/bounding, weak or thready)
Systemic inflammatory response syndrome (SIRS)
Wide variety of severe clinical insults.
Sepsis
SIRS + an infectious agent identified or assumed
Multiple organ dysfunction syndrome (MODS)
presence of altered function in acutely ill patient such that haemostasis cannot be maintained witout intervention.
Refractory (septic) shock/SIRS shock
subset of severe sepsis; defined as sepsis-induced hypotension despite adequate fluid resuscitation.
Types of IV fluids available
- Crystalloids: may be hypotonic, isotonic, hypertonic
- There are also colloids
Example of hypotonic fluids
5% dextrose
Example of isotonic fluids
Hartmann’s
0.9% NaCl
Example of hypertonic fluids
Hypertonic saline
True/false: Hartmann’s is suitable in most (98% of) cases
True
True/false: some replacement fluids e.g. hypotonic fluids can lead to substantial haemodilution with large volumes.
False - all replacement fluids can cause this!
What are the possible effects of haemodilution with large volumes of replacement fluids?
- Anaemia
- Hypoproteinaemia
- Hypocoagulibility
What are the benefits of hypertonic saline
✅ Attractive if limited period of time for resuscitation
✅ Physiological benefits: arteriolar vasodilation and cardiac contractility
✅ Though to have positive ionotropic effects (i.e. help cardiac contracility)
✅ Immuno-modulatory effects e.g. inhibiton of neutrophil activation amongst others
When might hypertonic saline be appropriate?
- Intracranial hypertension (fluid of choice for traumatic brain injury)
- May be of value in trauma patients, those with sepsis, septic shock
