Fluid and Hemodynamics

• Transport gases, nutrients, and wastes.
• Help generate the electrical activity needed to power body functions.
• Take part in the transforming of food into energy.

• Body fluids distributed between intracellular and extracellular compartments.
• ICF- fluid contained w/in the cells of body.
• ECF- fluid contained outside the cells including water in interstitial tissue or spaces and bl. vessel.
• Cell membrane- main barrier to the mov't of substances between the ECF & ICF compartments

• the mov't of charged or uncharged particles along a concentration [] gradient.
• all molecules & ions including h2o & dissolved molecules, are in constant random motion.

• The mov't of H2O across a semipermeable membrane.
• H2O moves from area of higher concentration of H2O to lower like diffusion.

• Tension or effect that effective osmotic pressure of a solution w/ impermeable solutes exert on cell size b/c of water mov't across the cell membrane.
• isotonic, hypotonic, hypertonic.

• Body H2O:
• 40% of body weight from ICF
• 20 % of body weight from ECF
• -Plasma compartment 5% of body wt. Interstitial fluid compartment about 14% of body wt. Transcellular compartment about 1 % of body wt.

• Palpable swelling produced by an increase in interstitial volume.
• Doesn't become evident until interstitial volume has increased by 2.5-3 liters.

• Localized is caused by dialation of precapilary sphincters and aterioles that supply that swollen lesion.
• Generalized- reult of increased vascular volume seen in CHF or Rt. sided heart failure.

• Plasma proteins exert the osmotic needed to pull fluid back into the capillary from the tissues.
• Result in inadequate production or abnormal loss of plasma protein mainly albumin.

• When capillary pores become enlarged or the integrity of the capillary wall is damaged, capillary permeability is increased.
• Plasma protein and active particles leak into the interstitial spaces, increasing the tissue collidal osmotic pressure and thereby contributing to the accumulation of interstitial fluid.

• Plasma proteins and other large particles that can't be reabsorbed throgu the pores in the capillary membrane rely on the lymphatic systems for movement back into the circulatory system.
• Lymphedema- edema due to imparied lymph flow often caused by cancer w/ lymph node involvement, infection and lymph trauma.

• Increases distance for diffusion of O2, nutrients, and wastes.
• Increased risk of pressure ulcers and can compress bl. vessels.

Exceeds absortive capacity of tissue gel, tissue H2O is mobile and can be translocated w/ pressure

reflects on a condition where plasma protein have accumulated in the tissue spaces and coagulated

• Congestion
• An unusual amt of bl. in a part increase in quantity of bl. flowing through any part of the body shown by redness of skin

• Sudden obstruction of bl. vessel by debris.
• Bl. clots, cholesterol containing plaques, masses of bacteria, cancer cells, amniotic fluid, fat from broken bones, and injected substances may lodge in the bl. vessels and ocstruct circulation

• Formation or pressure of a bl. clot w/in the vascular system.
• Clot can occlude vessels, block bl. flow and O2 supply to part of an organ.
• If detaches, can travel and occlude a vessel at a distance from original site.

• Bl. loss.
• Episodes of bleeding that last more than a few mintues.
• Compromise organ or tissue perfusion.

• Clinical syndrome marked by inadequateperfusion and oxygenation of cells, tissues, and organs, usually as a result of marginal or markedly lowered bl. pressure.
• 4 types of shock: cardiogenic, hypovolvemic, Obstructive, and Distributive.

• Heart fails to pump bl. sufficiently enought to meet the body's demands.
• Decrease in cardiac output, hypotension, hyperfusion, and indications of tissue hypoxia despite an adequate intravascular volume.

• Dreases bl. volume so that there is inadequate filling of the vascular compartment.
• From accute bl. loss of 15-20 % of circulating volume.
• s/s- depend on severity, thirst, increased HR, cool, clammy skin, decreased BP, dec. urine output, change in mental status.

• Shock from mechanical obstruction of the flow of bl. through the central circulation.
• Caused by dissecting aortic aneurysm, cardiac tamponade, pneumothorax, atrial myxoma, and evisceration of abdominal contents into thoracic cavity from ruotured diaphragm, pulmonary embolism.

• Vasodialatory shock- loss of bl. vessel tone, enlargement vascular compartment, and displacement of vascular volume away from the heart and central circulation.
• 2 main causes result in vesssel tone: Decrease in sympathetic control of vasomotor tone, release of extensive vasodialator substances.

• Neurogenic shock- caused by decreased sympathetic control of bl. vessel tone.
• Anaphylactic shock- immunilogically mediates reaction in which vasodialator substance such as histamine are released.
• Septic shock- vessel dialates systemic responseto serious problem.

• acute lung injury/ acute respiratory distress syndrome.
• acute renal failure
• GI complications.
• disseminated intravascular coagulation.
• multiple organ dysfunction syndrome.

• stoppage of bl. flow.
• normal process is regulated by complex array of activators and inhobitors that maintain bl. fluidity and prevent bl. from leaving the vascular compartment.
• normal when seals bl. vessel toprevent bl. loss and hemorrhage.
• abnormal when it causes inappropriate bl. clotting or when clotting is insufficient to stop the flow of bl. from vascular compartments.

• Platelets- platelet production is controlled by thrombopoeitin which are found in liver, kidney, smooth muscle, and bone marrow.
• Coagulation- use of plasma proteing that are present as inactive procoagluation factors.
• Endothelium- endothelial cells line vessels that modulated several, and frequently opposite, stages of normal hemostasis.

• Hemostasis 5 stages:
• vessel spasm, platelet plug formation, bl. coagulation or development of an insoluble fibrin clot, clot retraction, and clot dissolution.

• Thermal hemostatic mechanism- ESU, Laser Unit, and Harmonic scapel.
• Chemical Hemostatic agents- Gel foam, avitene, surgicel or oxycel, and epinephrine.

Mechanical hemostatics- clamps, ligatures, clips, spnges, pladgets, bone wax, suction, pressure devices or tourniquets, and drains.