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Hypotension - Coggle Diagram
Hypotension
Management
Volume replacement
Indications
Hypovolaemia
Blood loss (aburption / aph)
Fluid loss (diarrhoea, polyuria, vomiting)
Insensible losses
Skin (prematurity / humidity)
Inadequate intake
Relative hpoyvolaemia third spacing
Risks
Overload
PDA
IVH
Fluids
Saline
Albumin
4% Albumin
20% Albumin
Hypoalbuminaemia
Extremely preterm
Nutritional
Liver failure
Hydrops / chylothorax
Surgical
Blood
FFP
Inotropes
Dobutamine
Beta 1 agonist
Inotrope
Vasolidate
Chronotrope
Dopamine
Dopamine recepters -> Beta -> Alpha
Low doses - Renal perfusion
Medium - Inotrope, chronotrope
high dose - Vasoconstriction
Noradrenaline
+++Alpha > Beta
Increasing vascular tone (Afterload)
Vasoconstriction
Adrenaline
Alpha = Beta
Tachycardia
Lactic acidosis
Milirinone
Lusitrope (increased contractility / reduces afterload)
Phosphodiesterase inhibitor
Hypotension
Vasopressin (ADH)
Physiological
Kidney
Increases aquaporin expression
Increases water reabsorption
Alpha / vasopressin receptors
++++++ SVR
Hyponatraemia / Oliguria
Pulmonary vasolidation
Steroids
Hydrocortisone
Anti inflammatory
Mineralocorticoid
Glucocorticoid
Upregulates a / b recepter expression
Fludrocortisone
Adrenal crisis
CAH
Prolonged steroid use
Assessment
? Normal
Gestational Age
Systolic
Afterload
Vascular tone
Systemic vascular resistance
cardiac output
Stroke volume
Filling
Contractility
Heart rate
Diastolic
Filling
Resting vascular tone
Cardiac perfusion
Physical exam
Capillary refill
Hypothermia
Dark skin
Polycythaemia
Vasodilated
Immature skin
Pulses
Monitoring
Heart rate
False positive
Early
Tachycardia
Limited compensation
Less time diastole
Urine output
Measuring errors
Late finding
Preterms
ATN
Non-invasively
Cuff side
Placement
Movement artifact
Invasive
Access
Limb perfusion
Set up
Bloods
Lactate
Creatinine / Urea
Echocardiography
Training
Handling
Interobserver agreement