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Acute Care_


what is CO? CO is the product of heart rate and stroke volume. CO (ml/min) = HR (beats/min) x SV (mls)
what is SV determined by? Preload that depends on Ventricular end diastolic volume and is govetrnd by the vo and pressure of blood returning to heart
what are the common causes of inadequate ventricular preload? hemorrhage, sepsis, anaphylaxix, raised intrathoracic pressure (severe asthma)
Describe afterload: load, resistance or "impedence" against which the ventri cl works
what increases afterload? valve stenosis, hypertension, high setemic vascular resistance, low intrthoracic pressure and ventricular dilation
what is defined as the hearts's ability to perform work independently of pre- or afterload. Failure is ither dut to systolic dysfuntion or poor diastolic filling. Myocardial contractility
what circuit factor is as important as myocardial contractility in maintaining CO? Peripheral vascular regulation that conducts venous capacitance accounts for ~ 70% of total blood volume, that can increase venous return by 30% from neurohormonal factors, systemic adrenergic, reninaldosterone, vasopressinergic, and steroid systems
Name several features of reduced CO upon inspection: Confusion, reduced UOP, delayed cap refill, peripheral cyanosis, pale cool limbs,
what may be heard upon auscultation? leaking heart valves, compensatory mechanisms (tachycard, increased SVR), hypovolemia= narrowing pulse pressure, sepsis = low diastolic bp
what are the main diagnosis for emergency treatment? hemorrhage, cordiac tampnade, massive pulmonary embolism
what is the difference in treatment for Left sided heart failure and hypovolemia? fluid restriction is meant to reduce the overall blood volume to prevent more fluid back up to the lungs in left sided heart failure vs fluid resuscitation for hemorrhage
how do rate and rhythm affect CO? keep K+ > 4.5 mmol/L, and Mg2+ > 1.2 mmol/L and withdraw arrhythmogenic drugs. (restore sinus rhythm and normal HR) treatment consider antiarrhythmic drugs and pacemaker
what is assessed for in a fluid challenge? in the absence of cardiac failulre a fluid challenge is given and assesses HR, BP, and chest Auscultation. A transient response indicates fluid resusitation, a sustained increase in CVP would risk pulmonary edema and should not receive fluid
what is the next step in treatment of reduced CO if fluid resuscitaiton fails to achieve adequate circulation or precipitates cardiac failure? inotropic or vasopressor drugs and mechanical ventricular support devices must be considered.````````````````````````````````````````````````````````````
describe the difference between oncotic and osmotic pressures: osmotic deals with cellular ion pumps (extracellular for sodium and chloride, & Intracellular for Potassium and phosphate) while oncotic pressure deals with an albumin cycle in the ability of vascular plasma proteins to bind to water in circulation
what factors cause critically ill patients to inability to maintain normal fluid volume? dehydration and hyperglycemia cause ADH release = reduced UOP and causing water/sodium retent; renin angiotensis system; catecholamine release, inflammation increases vascular permeability= edema, impaired gas exchange
Assessing fluid balance leads to choice of fluid between what types? crystalloid, colloid, blood, bicarb, maintenance fluid, post major surgery, major hemorrhage, sepsis/septic shock, and head injury
How do crystalloid solutions disperse in the intravascular system? rapidly to other fluid compartments (ECF, ICF); large volumes may cause interstitial edema. hypertonics draw ICF water to ECF. Small fluid resuscitation vol and hypertonic osmotic effects may reduce cerebral edema for head trauma.
How are colloid solutins dispersed? large molecules dont easily diffuse out blood vessels/remain longer,pulling water/expands intravascular volume 4-5x crystalloid. Benefits hypoalbuminaemic pts, severe sepsis, ARDS. may induce clotting prob, allergic rxs, renal impairment
why is blood given? to maintain hemoglobin concentration of > 80 g/L or 8g/dl.
Why is bicard given? used to correct ph < 7.2, or metabolic acidosis due to renal or GI loss.
what is the normal maintenance required for a euvolemic pt who cannot drink? 2-3L water, 70-150mmol/L Na+, 40 mmol/L K+, = 1L of 0.9% Saline, 2L 5% dextrose with 20 mmol K+ added for each L 5% D.
what is Hartman's solution? for Hypernatremic pts use 5% dextrose, for hyponatremic pts use 0.9% Saline
what is to be given for hypovolemia in Post surgical pts? double the infusion rate from 1-1.5 ml/kg/hr to 2-3ml/kg/hr, maintain hemoglobin > 8 g/dl, or in cardiac pts >10 g/dl
How does aggressive fluid resuscitation in major hemorrhage increase blood loss? Dilutional coagulopathyacidosis and hypothermia. Blood is the ideal replacement fluid, but usually begins with 20-30 ml/kg Hartman's solution, 1-1.5 L Gelofusin(1-1.5L Vovulen) infusion rate determined by repeated assessment, inlcudes plasma/platelets
what is monitored for sepsis and septic shock? UOP, Lactate, fluid challenges
what is treatment for elevated lactate and hypotension after initial 20-40 ml/kg Hartmans aliquots of .5 to 1 L? CVP line, metrics of 8-12 mmHg, MAP >65 mmHG, UOP >0.5 ml/kg/hr and Svo2 > 70%
what type of natremia aggravates brain edema? a degree of nypernatremia is benficial and saline 0.9% is fecommended for fluid resuscitation. avoid 5% dextrose except in diabetes insipidus.
Created by: redhawk101