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3| Haemostasis, shock, critical care, anaesthesia :check: (Shock (Types…
3| Haemostasis, shock, critical care, anaesthesia :check:
Shock
Types
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Crush syndrome:
- Crush muscle
- Hyperalbumin
- Increase load of kidney
- Transfuse normal saline
Anaphylataic shock tx :red_cross:
- Fluids
- Adrenaline
- Steroids
- Anti-histamines
First principles: :red_cross:
- Definition: Reduction in circulating vol, inadeq perfusion
- Detected by: Stretch receptors or JGA receptors
- Medically detected by: Central venous pressure (blood volume, SG ultrasound first)
Clinical manifestations :red_cross:
- Psychological: Anxiety, malaise
- Physiological: Thirst, clammy skin, decreased temp
- Neurological: Nausea, vomiting
Responses :red_cross:
- Hormonal: RAAS, epinephrine
- Haemodynamic: Inc CO, vascular resistance
- Body can compensate if loss <20%
Consequences: :red_cross:
- Inadequate perfusion
- Cell hypoxia
- Anaerobic metab dec pH
- Vasoconstriction (epinephrine)
- Inc peripheral blood resistance (epinephrine)
Positive feedback mech: Cell damage redirects supply there, but other parts start to lack blood as well
Brain tolerates 5-10mins of hypoxia
Mx: goals inc CO & Perf :red_cross:
- Treat primary: arrest bleed, drain pus
- Improve ventricular filling
Transfusion (Autologous/Homologous)
Saline
Plasma
- Improve myocardial contractility
- Correct acid-base imbalance
Mx: How to arrest bleed :red_cross:
- Pressure
- Position
- Ligation
- Operation
- Repair
- Excision
Mx: Indications for transfusion :red_cross:
- Trauma
- Operation
- Severe burns
- Anemic
Mx: Adverse effects of transfusions :red_cross:
- Incompatibility
- Pyrexial (fever)
- Allergic
- Ab production
Critical Care
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Breathing:
- Pulse oximeter
- Monitor RR
- Administer O2 or ventilator
Risk of pneumonia/infection
Circulation:
- ECG/EKG
- Monitor HR/BP
Atelectasis :red_cross:
Definition: Collapse of lung resulting in reduced/absent gas exchange
ARDS
Acute respiratory distress syndrome: respiratory failure due to inflammation of lungs
SIRS crieteria :red_cross:
Systemic inflammatory response syndrome (2 or more of)
- Variable Temperature <36deg or >38deg
- Inc HR > 90BPM
- Inc RR > 20BPM or PaCO2 < 32mmHg
- Variable WBC > 12,000 cells/uL or < 4000 cells/uL
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