CUES :- Car crash :rural : 3 pt- 1 male(mark b) 2 female: 1 F vomitting: Airbag inflated: M bleeding from left thigh, spurting.
Mark: conscious, thirst is a fundamental symptom of hypovolemic . Groaning in pain, cloudy by conscious, complaining of difficulty breathing. Systolic BP 70. Pulse 135. RR 30. Airway intact. Chest bruised and sore but no ribs through the skin, or signs of trauma. Deformity of left thigh with substantial haemorrhage. several brusies and lacerations. After time slowly develops pallor, conjunctiva and palmar creases, cold sweaty extremeties. No obvious head injury, no neck pain, pupils equal and reactive to light (if not be worried about intracranial pressure which put pressure on optic nerve- could be caused by bleed. BP goes up, HR down)
Thirst mechanism
Forces: oncotic (pulling water in), hydrostatic (pressure pushing out of vessels). If blood pressure goes down- baroreceptors (aortic arch and kidneys, cartoid bodies, great vessels and heart detect change in pressure/ volume. Send message to hypothalamus. Increase ADH- prevents passing urine. From posterior pituitary. Vasoconstriction happens by adrenaline from adrenal glands - sympathetic nervous system is fired up and releases adrenaline- increases heart rate. Noradrenaline does more the vasoconstriction. Plasma proteins (ie. albuminis one of most important ones). Osmolality: per unit weight osmolarity:per unit volume per L- used in bedside setting. Ion concentration affects the osmolarity of extracellular fluid- can pass freely accross the membrane.
Inflammatory response: make proteins leaky so lose fluid (ie. burns)
Aquaporins become more permiable to water to absorb more water in.
Kidneys produced renin which produces Angiotensin receptors in kidney-
Cold mechanism:
Sympathetic system shuts down peripheral blood flow by vasoconstriction to increase blood pressure to vital organs. This makes them cold.
-
-
-
Total Circulating Volume: 5L. tennis scoring of shock.
Blood loss <15% stage 1
Blood lose 15-30% stage 2
Blood loss 30-40% Stage 3
Blood loss >40% stage 4
MAP: more time relaxing than contracting. = 1/3 systolic pressure + 2/3 diastolic pressure. Not a normal ratio because spend more time in diastolic than systolic.
-
-
Ambulance officers:
Oxygen therapy- to compensate O2 loss
IVC
administer bolus of IV fluid + commence Saline infusion.
-
Investigations:
compound fracture of left femur with partial laceration of left formal artery.
Blood alcohol = 0.09g/dl (0.05 is limit). No PMX, negative for HIV, Hep B and Hep C.
Chest xray clear
-
Partial lacertion- bleeds more because held open. Where as full laceration might contract (vasospasm) and lessen the bleeding.
History: 26 years old, lives on fam farm until boarded at ag school. Farm life: financial stressors, lack of services, high rates of suicide and depression. Pressures of taking over the farm? Lots of responsibility.
Mental health, cancer, etc. higher
-
Social history: marks income that keeps family going, no smoker, drinks occassionally with mates, recently working long hours because of tough times in drought, plays football,