Shock and Stabilization

  1. What type of catheters have potential for increased damage to vessel walls?
    Larger, rigid catheters
  2. Common materials for catheters (4)
    • 1. Teflon
    • 2. Polypropylene
    • 3. Polyurethane
    • 4. Silicone
  3. Less common IVC placement sites (3)
    • 1. Dorsal common digital veins
    • 2. Auricular veins
    • 3. Lingual veins
  4. What catheter placement sites may reach the heart faster?
    IVC placed centrally or in the cephalic region
  5. Movement of IVC within vein potentially causes what? (3)
    • 1. Increased damage to vessel wall
    • 2. Risk of thrombus formation
    • 3. Phlebitis
  6. Complications of surgical cut-down for IVC placement (6)
    • 1. Perforation of vascular wall
    • 2. Hematoma
    • 3. Thrombosis
    • 4. Venous transection
    • 5. Infection
    • 6. Cellulitis
  7. Advantages of central venous catheter over peripheral catheter (4)
    • 1. Longer dwell time
    • 2. Safer administration of hyperosmolar solutions such as TPN
    • 3. Measurement of CVP
    • 4. Blood sampling
  8. Why are certain catheters contraindicated in patients with head trauma or other CNS disturbances?
    Jugular vein catheters contraindicated, occlusion for placement may increase intracranial pressure
  9. Seldinger technique
    Placing catheter over guide wire
  10. Advantage of polyurethane catheters in central venous placement
    They are antithrombic and last longer
  11. What will thrombosis feel like around a catheter site
    "Ropey" feel to vessel
  12. Important thing to remember about parenteral nutrition connection
    Parenteral nutrition lines should NEVER be disconnected to decrease the risk of infection
  13. Ionized calcium levels should  be / not be  measured on heparanized samples
    Not be
  14. What vein closely approximates oxygenation of arterial blood, and how should sample be collected?
    Sublingual veins in anesthetized patients, should be punctured with 25 gauge needle and 5 minutes of pressure should be applied after
  15. Arterial catheter sites (5)
    • 1. Dorsal metatarsal (dorsal pedal)
    • 2. Radial
    • 3. Coccygeal
    • 4. Femoral
    • 5. Auricular
  16. What are the only things that should be injected into an arterial line? (2)
    • 1. Heparanized flush
    • 2. Sterile flush
  17. Ischemic complications are more common in what species, and why?
    Cats - they have poorer collateral circulation compared to dogs
  18. Nosocomial infection:
    Hospital-acquired
  19. Risks linked to nosocomial infections (3):
    • 1. Increased morbidity and mortality
    • 2. lengthen hospital stays
    • 3. added cost to pt. care
  20. Types of IVC material (4) and preferred materials*:
    • 1. Teflon*
    • 2. Polyurethane*
    • 3. polyvinyl chloride
    • 4. polyethylene
    • *Per CDC - reduces risk of infection
  21. Increased/Decreased IVC diameter increases risk of thrombi
    Increased
  22. What inactivates povidone-iodine
    Alcohol
  23. Topical antibiotic ointment Should/Should Not be applied to insertion site for IVC
    should not
  24. Thermoregulatory center
    Hypothalmus
  25. Why shouldn't topical antibiotic ointment be applied to insertion sites?
    • Promotes fungal growth
    • Encourages bacterial resistance
  26. How often should insertion sites be cleaned and with what?
    Cleaned with chlorhexidine and allowed to dry every time dressings are changed
  27. Phlebitis
    Inflammation of vessel
  28. Signs of Phlebitis (4)
    • 1. Redness around site
    • 2. Heat
    • 3. Swelling
    • 4. Pain on palpation of site or when flushing IVC
  29. Thrombosis
    • Thrombus formation at tip or along outer length of catheter.
    • Intravascular coagulation of blood in circulatory system
  30. Signs of thrombosis (5)
    • 1. Pain on palpation or when flushing IVC
    • 2. Vessel feels hard or "ropey"
    • 3. Vessel appears distended without being occluded
    • 4. Edema above or below site
    • 5. Becomes difficult to flush or aspirate
  31. Thrombosis increases risk of what?
    Pulmonary embolism
  32. Why may generalized edema be present when administering IVF?
    Due to compromise in vascular retention status due to low colloid osmotic pressure
  33. PICC
    Peripherally Inserted Central Catheter
  34. Why should multiple attempts not be made to place IO catheter in same site?
    • Fluid may leak from hole if replacing or attempting multiple placements in same bone.
    • Increases risk of compartment syndrome
  35. Compartment Syndrome IO catheter
    Fluids extravasate from IO site over long period of time. Pocket is formed in muscle, can cause necrosis
  36. What should be done with feeding tubes before feeding
    • Should be aspirated and checked for negative pressure
    • Gas aspirate back may be sign of line being in airway
  37. .
    .
  38. Hypotension
    Reduction in systemic arterial blood pressure
  39. Why does hypotension develop
    • Results from disruption of normal cardiovascular homeostasis
    • Only develops secondary to dz that has negatively affected regulation
  40. Systemic arterial blood pressure
    Force exerted by blood against any unit area of the vessel wall
  41. MAP
    Mean Arterial Blood Pressure
  42. What value plays biggest role in tissue perfusion (Systolic, Diastolic, MAP)
    MAP
  43. CO
    Cardiac Output
  44. SVR
    Systemic Vascular Resistance
  45. MAP is determined by what two functions
    CO and SVR
  46. Cardiac Output is function of
    SV times HR
  47. SV
    Stroke Volume
  48. Stroke Volume is
    volume of blood ejected with each contraction of heart
  49. HR
    Heart Rate
  50. Determinants of SV (3)
    • 1. Preload
    • 2. Contractility
    • 3. Afterload
  51. Preload
    Stretching of ventricle before contraction - function of venous return
  52. Contractility
    Force of ventricular contraction
  53. Afterload
    Force needed to overcome aortic pressure and achieve L ventricular outflow
  54. SV is directly related to
    Preload and Contractility
  55. SV is inversely related to
    Afterload
  56. HR is dictated by what
    balance between SNS and PNS
  57. SNS
    sympathetic nervous system
  58. PNS
    Parasympathetic nervous system
  59. Regulation of what is major factor in determining MAP?
    SVR
  60. Hypoxia
    Decrease in level of oxygen supplies to tissue
  61. Hypoxemia
    • Inadequate oxygenation of arterial blood. 
    • PaO2 <80 mm Hg (at sea level)
  62. Cao2
    Oxygen concentration of arterial blood
  63. Causes of hypoxemia (5)
    • 1. hypoventilation
    • 2. ventilation-perfusion mismatch
    • 3. diffusion impairment
    • 4. decreased oxygen content of inspired air
    • 5. intrapulmonary shunt
  64. Global oxygen delivery is often decreased with systemic disease processes like (4)
    • 1. sepsis
    • 2. SIRS
    • 3. anemia
    • 4. acid-base imbalances
  65. Arterial oxygen concentration is dependent on
    concentration of hemoglobin and degree of oxygen saturation of hemoglobin present
  66. SaO2
    oxygen saturation - how much hemoglobin is saturated with oxygen
  67. Majority of arterial oxygen delivered to tissues while bound to what
    hemoglobin
  68. "unbound" oxygen
    oxygen dissolved in plasma, small fraction delivered to tissue this way
  69. oxygen supplementation indicated when (2)
    • 1. PaO2 <70 mm Hg
    • 2. SaO2 <93% on room air
  70. PaO2
    This measures the pressure of oxygen dissolved in the blood and how well oxygen is able to move from the airspace of the lungs into the blood.
  71. Why does oxygen supplementation need to be humidified (4)
    • non-humidified O2 longer than several hours causes:
    • 1. drying of nasal mucosa
    • 2. respiratory epithelial degeneration
    • 3. impaired mucociliary clearance
    • 4. increased risk of infection
  72. Flow by oxygen should be how far from the nose
    2 cm
  73. 02 flow rate of 2-3L/min flow by = FiO2 of
    25%-40%
  74. How to measure nasal catheter
    Tip of nose to level of lateral canthus of eye
  75. Nasopharyngeal catheter measurement
    Tip of nose to ramus of mandible
  76. Flow rate of 50-150 ml/kg/min = FiO2 for nasal catheter
    30%-70%
  77. What is hyperbaric Oxygen
    Administration of 100% oxygen under supra-atmospheric pressure (>760 mm Hg)
  78. Why use hyperbaric oxygen
    • Can increase percentage of dissolved oxygen in patient's bloodstream by 10%-20%
    • Dissolve oxygen can readily diffuse into damaged tissues that lack adequate circulation
  79. Uses for hyperbaric oxygen (7)
    • 1. Severe soft tissue lesions
    • 2. Burns
    • 3. Shearing injuries
    • 4. Infection
    • 5. Osteomyelitis
    • 6. Ruptured tympanum
    • 7. Pneumothorax
  80. When does O2 toxicity occur
    >60% O2 for 24-72 hours
  81. Cardiogenic shock:
    Inadequate cellular metabolism secondary to cardiac dysfunction, despite adequate intravascular volume
  82. Aim of treatment for cardiogenic shock
    Restore cardiac output to normalize tissue perfusion
  83. 3 main causes of cardiogenic shock
    • 1. Systolic dysfunction
    • 2. Diastolic dysfunction
    • 3. Arrhythmias
  84. Most common cause of systolic dysfunction
    DCM
  85. Less common causes of systolic dysfunction (4)
    • Secondary to mechanical failure:
    • 1. subaortic stenosis
    • 2. hypertrophic obstructive cardiomyopathy
    • 3. Acute mitral regurge secondary to ruptured chordae tendinae
  86. Common causes of diastolic dysfunction (3)
    • 1. Secondary to cardiac tamponade
    • 2. hypertrophic cardiomyopathy
    • 3. tachyarrhythmias
  87. Common causes of severe bradyarrhythmias (2)
    • 1. 2nd and 3rd degree AV block
    • 2. Sick Sinus Syndrome
  88. Sick Sinus Syndrome
    sinus node (pacemaker) doesn't work properly, abnormally paced signals
  89. Shock
    inadequate cellular production
  90. Most common type of shock
    hypovolemic shock
  91. Forward flow failure = ___________ intravascular volume + Increased/decreased                  
    Forward flow failure = Adequate intravascular volume + decreased cardiac output
  92. ___ X ___ = CO
    SV X HR = CO
  93. Decreased SV = Increased/decreased HR in compensation
    Increased
  94. Clinical signs of cardiogenic shock
    • Consistent with global hypoperfusion
    • Change in mentation (depression, unresponsiveness, disorientation)
    • Cold peripheral extremeties
    • Pale MM
    • Increased CRT
    • Increased HR (Unless caused by bradyarrhythmia or pt moribund)
  95. Should tachycardia be treated with antiarrhythmics
    • Malignant tachycardia due to tachyarrhythmia should be treated to improve CO
    • Therapy for compensatory tachycardia contraindicated, fix underlying cause
  96. Compensatory respiratory Alkalosis/Acidosis can be seen in response to _________ with cardiogenic shock
    • alkalosis
    • lactic acidosis
  97. Reasons why cardiac sounds may be difficult to auscult (3)
    • 1. Pericardial effusion
    • 2. Severe hypovolemia
    • 3. Obesity
  98. What will you auscult with CHF
    • inspiratory crackles secondary to pulmonary edema
    • Or lungs my be quiet ventrally due to pleural effusion
  99. Venous blood gas often shows what with cardiogenic shock
    • Metabolic acidosis
    • Decreased cellular oxygen may cause anaerobic metabolism and lactic acidosis
    • Prerenal or renal azotemia may also contribute
    • Often see compensatory respiratory alkalosis
  100. If there is concurrent pulmonary edema with cardiogenic shock, what may be increased on arterial blood gas
    alveolar-arteriolar (A-a) gradient
  101. EKG on cardiogenic shock may show
    • 1. Sinus tachycardia
    • 2. bradyarrhythmias (AV block)
    • 3. tachyarrhythmias (a-fib, v-fib)
  102. CHF CXR will show
    • 1. Enlarge pulmonary veins
    • 2. Alveolar or interstitial pattern in perihilar region (K9s)
    • 3. Infiltrates often patchy or diffuse in felines
    • 4. pleural effusion
  103. Why can pulmonary arterial catheters help with diagnosis of cardiogenic shock
    Decreased CO + Increase in preload parameters of central venous pressure, pulmonary arterial pressure, and pulmonary arterial occlusion pressure will be seen
  104. Systolic dysfunction
    Decrease in cardiac contractility or decrease in flow through left ventricular outflow tract (mechanical failure)
  105. Common causes of failure of contractility with systolic dysfunction (4)
    • 1. DCM
    • 2. Sepsis
    • 3. Endomyocarditis
    • 4. Myocardial infarction
  106. Most common cause of cardiogenic shock from systolic dysfunction
    DCM
  107. Breeds commonly affected by DCM (5)
    • 1. Dobermann
    • 2. Boxer
    • 3. Great Dane
    • 4. Labs
    • 5. American Cocker Spaniel
  108. What is DCM
    • Progressive decrease in myocardial contractility over months or years.
    • Activation of renin-angiotensin system and SNS in compensation, renal retention of Na and H2O,
    • Increased intravascular volume produces increase end-diastolic volume
    • Eccentric hypertrophy secondary to myocardial stretch
  109. Eccentric hypertrophy
    Dilation of L ventricular chamber
  110. CXR for DCM may show
    • Enlarged heart
    • CHF if present
  111. EKG for DCM may show
    • +/- sinus tachycardia
    • +/- arrhythmias - afib or vtach
  112. Aim of tx for DCM
    • Increase CO by increasing SV
    • Preload parameters monitored closely
    • IVF only if necessary
    • Diuretics only if CHF
  113. Drugs for DCM tx (3)
    • Titrated to optimize SV
    • 1. Positive inotropic agents - dobutamine
    • 2. Phosphodiesterase inhibitors - Amrinone, Pimobendan
    • 3. Cardiac glycosides - Digoxin
  114. Why would sepsis potentially cause cardiogenic shock
    • Dysfunctional myocardium sometimes seen in humans and dogs.
    • During hyperdynamic phase of septic shock my see increase in CO and possible decrease in Ejection fraction
  115. Ejection fraction
    Percentage of blood L ventricle pumps out with each contraction
  116. Dysfunctional myocardium with sepsis caused by (3)
    • 1. Decrease in ventricular compliance
    • 2. Biventricular dilation
    • 3. Decrease in contractile function
  117. When will you see myocardial dysfunction with sepsis
    Will peak within days of onset, will resolve within 7-10 days with survival
  118. Do you see a change in CO with septic shock?
    Decreases in CO are rare with septic shock, usually due to end-stage decompensated myocardial depression
  119. What is endomyocarditis
    • Rare condition of cats, often seen several days after routine procedure like neuter.
    • Normal myocardial function pre-anesthesia, afterwards rapidly develop:
    • 1. Cardiac dysfunction
    • 2. Hypotension
    • 3. Pulmonary edema
    • 4. Interstitial pneumonia
  120. Echo with endomyocarditis
    Hyperechoic
  121. Histopath with endomyocarditis
    • Neutrophilic inflammation
    • Fibroplasia
  122. Prognosis with endomyocarditis
    Poor, even with PPV
  123. Two common causes of mechanical failure with cardiogenic shock
    • Forward flow decreased by obstruction to L ventricle outflow tract (aortic stenosis, Hypertrophic obstructive cardiomyopathy)
    • Severe acute retrograde bloodflow (Chordae tendinae rupture, causes acute and extensive MR)
  124. Diastolic failure
    Due to inadequate ventricular filling
  125. Common causes of diastolic failure (4)
    • 1. hypovolemia
    • 2. physical restriction (cardiac tamponade)
    • 3. Inability of myocardium to relax (HCM)
    • 4. inadequate time for filling (tachycardia)
  126. Most common cause of diastolic failure
    Hypovolemia - not truly cardiogenic shock
  127. Cardiac tamponade is secondary to
    pericardial effusion
  128. Cardiac tamponade
    pericardial effusion
  129. Most common causes of cardiac tamponade (5)
    • 1. neoplasia *most common
    • 2. coagulopathy
    • 3. trauma
    • 4. atrial tear
    • 5. idiopathic
  130. What may chronic pericardial effusion cause with bloodwork?
    increased potassium from reduced effective circulating volume induced pseudohypoadrenocorticism. Results from decreased preload
  131. Hypertrophic cardiomyopathy
    • Concentric hypertrophy of ventricular myocardium.
    • Failure of normal end-diastolic volume can occur secondary to inability of myocardium to relax
  132. concentric hypertrophy
    increased ventricular wall thickness
  133. what does decreased end-diastolic ventricular volume lead to
    decreased SV and decreased CO
  134. Pts with HCM typically have what flow failure
    backwards
  135. What happens to systolic function with end stage HCM
    May have severely impaired systolic function. Leads to decreased SV and cardiogenic shock
  136. Tx for HCM
    beta blockers or calcium channel antagonists. They enhance lusitropy and diastolic filling
  137. Lusitropy
    Rate of myocardial relaxation
  138. Increased heart rate affects ventricular filling how
    inadequate ventricular filling
  139. End diastolic volume is largely dependent on what?
    venous return
  140. How does atrial contraction contribute to preload
    Atrial contraction contributes little to normal preload
  141. How does tachycardia affect diastolic filling
    • Tachycardia leads to inadequate time for diastolic filling before systole.
    • Leads to decreased end diastolic filling which leads to decreased SV and decreased CO
  142. Most common cause of tachyarrhythmias that lead to cardiogenic shock
    Supraventricular tachycardia - caused by primary heart disease or cardiac manifestation of other systemic disease
  143. Tx for tachyarrhythmias
    • 1. vagal maneuvers
    • 2. calcium channel antagonists
    • 3. beta blockers to decrease HR
    • 4. management of underlying condition
  144. Most common bradyarrhythmias
    • 1. Severe high grade AV block
    • 2. Severe sick sinus syndrom
  145. 3rd degree AV block
    AV nodal conduction does not occur. Escape complexes from bundle of His, bundle branches, or purkinje fibers produce cardiac contractions
  146. HR with bundle of His escape complexes
    40-60 BPM
  147. HR with escape complexes from bundle branches or distal perkinje fibers
    20-40 BPM
  148. With 3rd degree AV block, what happens to SV
    SV increases secondary to increased preload (increased time for diastolic filling)
  149. Average cat HR with 3rd degree AV block
    • 100-140 BPM
    • Cardiogenic shock as a result rare in cats
  150. Fluid treatments for hypovolemic shock (5)
    • 1. Crystalloids
    • 2. Synthetic colloids
    • 3. Albumin
    • 4. Hypertonic saline
    • 5. Blood products
  151. Best route of administration for shock fluids (2)
    IV or IO
  152. Main con to isotonic crystalloids in shock tx
    Possible interstitial and pulmonary volume overload
  153. Synthetic colloids great for
    hypo-oncotic states
  154. Main con to synthetic colloids in shock tx
    Possible coagulopathies and AKI in higher doses
  155. Metabolic causes of shock (3)
    • 1. Hypoglycemia
    • 2. Various toxin exposure
    • 3. Cytopathic hypoxia
  156. Physical exam parameters to meet during fluid resuscitation (7)
    • 1. Improvement in HR
    • 2. Pulse quality
    • 3. CRT
    • 4. Temperature of extremities
    • 5. Brighter mentation
    • 6. Normalization of arterial blood pressure
    • 7. Improvement in key BW parameters
  157. BW parameters to improve with shock fluid resuscitation (2)
    • 1. Lactate
    • 2. Central venous oxygen saturation
  158. Isotonic crystalloids
    Fluids with composition similar to extracellular fluid
  159. Principal component of isotonic crystalloids
    • Inorganic salt NaCl
    • 0.9% NaCl - prototype isotonic crystalloid
  160. Most abundant solute in extracellular fluid
    • Sodium 
    • Distributed uniformly throughout extracellular space
  161. ___% extracellular fluids located in extravascular (interstitial) space
    75 %
  162. Exogenously administered Na follows what distribution?
    • 75% of total body Na in interstitial fluids with 75% of extracellular fluid. 
    • Administered Na follows same distribution, 75% of volume of Na-based IVF rapidly redistribute within interstitium
  163. To increase plasma volume by given amount, how much of desired volume of isotonic crystalloids needs to be administered?
    4 times desired volume
  164. Shock bolus administration rate
    • start 10-20 ml/kg over 15-30 mins
    • repeat PRN
  165. Adverse effects of isotonic crystalloid administration in shock resuscitation
    • 1. Fluids redistribute to interstitium - organ edema possible
    • 2. Pulmonary edema
    • 3. Acute lung injury
  166. Adverse effects of isotonic crystalloid administration in shock resuscitation more common with what?
    Increase vascular permeability secondary to systemic inflammation or sepsis
  167. Consequences of overzealous crystalloid administration (7)
    • 1. Change to GI tract resulting in decreased motility
    • 2. Increased intestinal permeability predisposing to bacterial translocation
    • 3. Increased rish for abdominal compartment syndrome
    • 4. Increased risk of ventricular arrhythmias
    • 5. Disruption of cardiac contractility
    • 6. Decreased CO
    • 7. Coagulation disturbances
  168. Abdominal compartment syndrome
    Organ dysfunction caused by intra-abdominal hypertension
  169. Coagulation disturbances caused by oversealous crystalloid administration
    • 1. Dilution of factors
    • 2. Decreased blood viscosity
  170. Typical bolus dose crystalloids
    10-20 ml/kg over 15-30 mins
  171. Total "shock" dose crystalloids
    • 60-90 ml/kg dogs
    • 45-60 ml/kg cats
  172. Typical bolus dose colloids
    2-5 ml/kg over 10-30 mins
  173. Total shock dose colloids
    • 10-20 ml/kg dogs
    • 5-10 ml/kg cats
  174. Total dose hypertonic solutions
    3-5 ml/kg 7%-7.5% NaCl solution
  175. Typical dose pRBC and FFP
    • 10-20 ml/kg over 2-3 hours
    • 1.5 ml/kg/min over 15-20 mins in rapidly decompensating patients
  176. Colloids are
    • Large molecules (>10,000 Daltons)
    • Do not readily cross diffusion barriers across normal blood vessels like crystalloids do, tend to remain in vascular space
  177. How do colloids retain fluid in vascular space
    Increase colloid onsmotic pressure of serum. Creates force that opposes hydrostatic pressure in vasculature, retains fluid in vascular space
  178. Hetastarch
    • Synthetic colloid 6% solution suspended in an isotonic crystalloid.
    • Hespan = 0.9% saline 
    • Hextend = lactated electrolyte solution
  179. Hetastarch clearance from intravascular space depends on (4)
    • 1. rate of absorption by tissues
    • 2. uptake by reticulendothelial system
    • 3. clearance through urine and bile
    • 4. enzymatic degradation to small particles by amylase
  180. Tissues that affect rate of absorption of hetastarch (4)
    • 1. Liver
    • 2. Spleen
    • 3. Kidney
    • 4. Heart
  181. Tetrastarch (Vetstarch)
    Particles slightly lower average molecular weight and higher number of hydroxyl residues than hetastarch. Likely responsible for fewer effects on coagulation
  182. Pentastarch
    Low-molecular-weight derivative of hetastarch. Not available in USA. Smaller but more numerous starch molecules than hetastarch
  183. Adverse effects of colloids
    • 1. High molecular weight starches may cause acute kidney injury in septic patients
    • 2. Interfere with physiologic mechanisms of hemostasis
    • 3. High molecular-weight starches can cause decrease in activity of von willenbrand's factor and associated factor VIII and ristocetin cofactor activities
    • 4. Cause some degree of platelet dysfunction
  184. What dose of colloids can cause coagulation derangements
    • > 20 ml/kg/day hetastarch
    • Tetrastarch possibly fewer side effects, higher doses up to 40 ml/kg/day may be administered
  185. Hypertonic crystalloid solutions
    • Any saline solution with effective osmolarity exceeding normal plasma
    • Available in concentrations of 3% - 23.4%
  186. Properties of hypertonic solutions that make it ideal for fluid rescucitation with septic shock, hemorrhagic shock, and traumatic brain injuries (7)
    • 1. Decreased neutrophil activation and adherence
    • 2. Stimulation of lymphocyte proliferation
    • 3. Inhibition of pro-inflammatory cytokine production by macrophages
    • 4. Rheologic properties of circulating blood improved
    • 5. Decreased endothelial cell swelling
    • 6. Decreased intracranial pressure with TBI
    • 7. POSSIBLY improves myocardial function and c auses coronary vasodilation - may improve overall cardiac function
  187. "Turbostarch"
    • Hypertonic solution combined wtih synthetic colloid
    • 23.4% hypertonic saline with 6% hetstarch 1:2 ratio
    • 3-5 ml/kg
  188. Adverse effects of hypertonic solutions (4)
    • 1. Hypernatremia - immediately after administration, usually transient
    • 2. RARELY hypernatremia-induced central pontine myelinolysis with patients with preexisting chronic hyponatremia
    • 3. Increased intravascular volume + increased hydrostatic pressure may lead to volume overload or pulmonary edema in patients with preexisting cardiac or pulmonary abnormalities
    • 4. May cause significant interstitial and intravascular volume depletion, especially in dehydtrated patients
  189. Albumin physiologic effects on body (5)
    • 1. Maintenance of colloid osmotic pressure and endothelial integrity
    • 2. Wound healing
    • 3. Metabolic and acid-base functions
    • 4. Coagulation
    • 5. Free radical scavenging
  190. Albumin often low in critically ill patients due to (4)
    • 1. Loss
    • 2. vascular leak
    • 3. third-spacing
    • 4. Decreased production due to shifting of hepatic production toward acute-phase proteins
  191. Hypoalbuminemic patients requiring IVF at increased risk of
    Interstitial edema after large-volume crystalloid administration
  192. Benefits of fresh whole blood compared to component therapy (3)
    • Increased:
    • 1. clotting factors
    • 2. Fibrinogen levels
    • 3. Platelet levels
  193. Hypotensive resuscitation
    Coservative resuscitation in active hemorrhage, increased survival rates. Crystalloid, colloid, and blood product transfusions to achieve systolic BP of 80-90 mm Hg. TEMPORARY SOLUTION for cases like non-traumatic hemoabdomens before sx.
  194. Long term treatment risks of hypotensive resuscitation
    Risk of complications resulting from impairement of tissue perfusion
Author
anubis_star
ID
352220
Card Set
Shock and Stabilization
Description
VTS week 2-3 Shock and stabilization
Updated