A cellular disease due to either the inadequate perfusion (oxygen demand is greater than oxygen delivered) or inability of cells to utilize the delivered oxygen (oxygen utilization, consultation).
Shock
What are the 3 phases of all types of shock?
- Compensatory
- Progressive
- Refractory
How is BP maintained during the compensatory phase of shock?
- Stimulation of the sympathetic nervous system
2. Activation of the RAAS
What are the internal causes of hypovolemic shock?
Third spacing, pooling in intravascular compartments.
What are the external causes of hypovolemic shock?
Hemorrhage, GI or renal losses, burns, excessive diaphoresis.
How does hypovolemic shock effect blood pressure?
NARROWs pulse pressure
When do you want to consider using a fluid warmer?
When repalcing >2L in 1 hour and in all trauma patients.
What are the consequences of hypothermia during blood administration?
- Impairment of red cell deformity
- Platelet dysfunction
- Increase affinity oh hgb to hold onto O2
Why does Ca and Mg decrease with blood administration?
The citrate in transfused blood binds ionized Ca and Mg.
What are the consequences of inadequate 2,3-DPG in transfused blood?
Oxyhemoglobin-dissocation curve shifts to the left (increases affinity of hgb to hold onto O2).
What is considered the triad of death?
Hypothermia, acidosis, coagulopathy
SIRS criteria:
Must have 2 or more of the following:
- Temp >38 or <36
- HR >90
- Resp rate >20 or PaCO2<32
- WBC >12 or <4 or bands >10 (shift to the left)
Examples of SIRS without sepsis: traumatic injury, pancreatitis, burns
Criteria for severe sepsis?
Sepsis plus markers for organ dysfunction
Criteria for septic shock?
Systemic MAP <65 after fluid resuscitation thus requiring pressers.
What is the initial fluid resuscitation for sepsis?
30 ml/kg.
Goal to keep MAP >65, urine output >0.5 ml/hr/hr, decrease tachycardia.
What are the oxygenation goals with septic shock?
- Maintain SpO2 >95%
- SvO2 >65% or ScvO2 >70%
IgE medicated hypersensitivity reaction to protein substances.
Anaphylactic Shock
What is the difference between anaphylactic and anaphylactoid response?
Anaphylactoid is not IgE mediated and does not require a previous exposure.
Treatment for anaphylactic shock?
- IM epi
- Aggressive fluid resuscitation (1-4L)
- Anti-histamines
- Inhaled B-adrenergic agents
- IV steroids (the sooner given, the better)
What is the 1st line trauma assessment?
A: airway B: breathing C: circulation D: disability (neuro exam, GCS) E: expose/environment
What is the 2nd line assessment?
F: full set of vitals, family presence
G: give comfort measures
H: history
I: inspect posterior, turn the patient over
What are the inclusion criteria for therapeutic hypothermia?
- Cardiac arrest with ROSC
- Unresponsive and not following commands
- Witnessed arrest with downtime <60 min
What are exclusion criteria for therapeutic hypothermia?
- Pregnancy
- Core temp <35c
- Age <18, >85
- Chronic renal failure
- Refractory ventricular arrhythmias
- Active bleeding
- Shock
- Drug intoxication
What is the temp goal with therapeutic hypothermia?
33 degree which is maintained for 24 hours.
