hypotension

Question 1

def. of hypotension

Answer 1

• no specific number

- 90/60 could be

Question 2

def. shock

Answer 2

inadequate perfusion of tissues

Question 3

def. hypoxemia

Answer 3

• less o2 in blood

Question 4

def. hypoxia

Answer 4

• less o2 in tissues

Question 5

what 3 things infulence BP

Answer 5

1. CO
2. HR
3. SV (preload, afterload, contractility)

Question 6

how to assess BP

Answer 6

cuff
pulses
- carotid - 60mm
- femoral - 70
- radial - 80

Question 7

assessment of pulse

Answer 7

• rate

- strength

Question 8

assessment of organ perf

Answer 8

skin - cool clammy

other organs - mental status, urine outsput

Question 9

what must be managed in C

Answer 9

BP and hemmorarge control

Question 10

4 steps to pt with hypotension

Answer 10

1. determin cause and correct
2. assess severity og blood loss
3. resusictate
4. assess rescitations

Question 11

4 possible causes of low BP

Answer 11

1. hypovolemic - in trauma assume until proven otherwise
2. obstructive
   - tension pneumo
   - tamponade
3. distributive
   - vasodilation (sepsis, cord)
4. cardiogenic

Question 12

pneumonic approach

Answer 12

S- spinal cord/sepsis
H- hemorrage
O - obastruction
C - cardiogenic
K - anaphylaXis

Question 13

4 types of cardiogenic

Answer 13

• percardial
• myocardial
• endocardial
• coronary As

Question 14

5 causes of hemorrage

Answer 14

1. external
2. Chest
   3 abdo
   4 pelvis
   5 long bones - femur

Question 15

2 cats for treating in hypotens

Answer 15

1. non-hemorragic causes

2. hemorragic causes

Question 16

2 treats for non-hemor causes

Answer 16

1. need or chest tube

2. surg. for tamponade

Question 17

2 steps for hemo

Answer 17

1. stop the bleed (surg or IR)

2. restore tissue perfusion

Question 18

keys to volume resussitation

Answer 18

• 2 large bore IVs
• in upper extremities
• peripheral IV best

Question 19

what is traditional approach to fluid types

Answer 19

• start with crystalloid (RL or saline) - warm
• 3:1 fluid to blood loss
• switch to blood after 3l of crystal
• associated with coagulopathy

Question 20

what is damage control resus

Answer 20

aggresive resuscitation with blood products

Question 21

reason for damage contrl

Answer 21

• permissive hypotension
• SBP of 80-90
• stop clots from breaking off

Question 22

keys to damage control

Answer 22

• start with RBC, not crystal
• aggressive use of coag products
• tranexamic acid - anti-fibrolytitics

Question 23

3 types of blood can give

Answer 23

1. fully crossmatched - 45 min
2. type specific - 10 min
3. uncrossmatched
   - O+ in womn
   - O- in men

Question 24

3 classes of response to vol. resus

Answer 24

1. normalized
2. transient- replaced but ongoing bleeds
3. no/min. response - need def. treatment

Question 25

6 traditional causes of coagulopathy

Answer 25

1. bleeding 2. consumption of pruducts 3. dilution 4. hypothemia 5. acidosis 6. hypocalcemia

Question 26

what is acute coag. of trauma (ACT)

Answer 26

- severe tissue trauma and hypoperfusion BOTH required

Question 27

3 reasons ACT is important

Answer 27

1. incr. transfusion required 2. incr. mortality 3. incr. morbidity

Question 28

mech of ACT

Answer 28

``` need balance of: coag - endo thelium, - platelets - reduced - factors - low levels of fibrinogen anti-coag - fibrinolysis - get hyperfibrinolysis - anticoag factos (C and S) - C gets activated by trauma and shock ```