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TNCC shock
| Question | Answer |
|---|---|
| systolic blood pressure represents? | SBP is representative of the combined factors: cardiac output (which is stroke volume x heart rate), and ejection velocity..... |
| diastolic blood pressure represents: | total peripheral resistance: (TPR) which is the total resistance of the entire blood vessel sytem and which is readily modified by the peripheral system ie: the cappiliries, venules, arterioles and ateriorvenous anastemoses |
| how to calculate MAP: | first figure out pulse pressure (the difference between SBP and DBP) and find 1/3 or pulse pressure. Add this number to the DBP = MAP. |
| what should MAP be to maintain adequate perfusion? | |
| effects of SNS on some organs/systems... that will be activated in shock and other stress states: | heart: increased force and rate of contraction (positive inotropy and chronotropy) / peripheral vessels: vasoconstriction / pupils: dilation / sweat glands: increased secretion / adrenal glands: increased secretion of adrenal hormones / bronci: dilation |
| baro-receptors: | located: walls of carotid/aortic. these pressure receptors r triggered by BP stretching vessles = send inhibitory impulses to vasomotor centre (brain stem). when SBP falls, less stretch, fewer inhibitory impulses = increased vasomotor activity and >SBP |
| Define shock | a syndrome resulting from insufficient tissue perfusion, leading to decreased 02/nutrient supply and waste removal |
| hypovolemic shock: define + causes | most common shock in trauma pt. may be caused by decreased circulating volume due to either: haemorrhage (internal or external) or loss of sin integrity etc in burns with shifts from intravascualr to interstitial spaces |
| cardiogenic shock: define + causes | inadequate perfusion as the result of inadequate contractions of cardiac muscle. can be caused by MI, blunt cardiac injury, cardiac failure. blunt cardiac injury can cause shock by decreasing the heart contractions through cardiac muscle injury |
| obstructive shock: define + causes | is inadequate circulating volume due to obstruction or compression of the great veins, aorta, pulmonary arteries, or the heart itself. eg: cardiac tamponade, tension pneumo, air embolus |
| distributive shock definition | neurogenic shock is the most likely distributive shock in trauma. It occurs when C-spine or T-spine trauma injure the spinal cord, leading to disruption to the ANS: leading to mal distribution of blood thorugh vasodilation |
| distributive shock: pathophysiology | C-spine/T-spine trauma injures spinal cord = disruption to ANS: SNS functions of: vasomotor control: massive vasodilation/ loss of sweat glad control: loss of thermporegulation: warm dry skin/ Increased parasympathetic outflow to the heart: bradycardia |
| at what mmhg SBP dot he chemo receptors kick in? what are the efefcts? | ay about 80 Systolic the chemoreceptors will notice reduced flow through the main arteires and be stimulated: this stimulates the vasomotor centre to send out sns vasocnstruction of the peripheral vessels |
| why might a mildly hypostensive pt have a rising distolic BP? | stimulation of chemo receptors by < atrerial blood flow (<02 and >C02) = peripheral vasoconstriction = >TPR = >DBP |
| at what BP does cerebral ischemia occur despite autonomic compensatatory measures? | 50mmhg |
| why is decreased urine output an indicator of hypoperfusion? | when the kidneys recieve reduced blood supply, renin released from JGA. renin= acts on angiotensin= to form: angiotensin 1= which makes= angiotensin 2 (via ACE: lungs) A2 = vasoconstriction, SNS stimulation, H20 retention at kids, aldosterone (na++/H20) |
| what might muffled heart sounds indicate in the trauma pt with suboptimal perfusopn? | blood collecting in pericardial sack: pericardial tamponade |
| what might hypoactive bowel sounds indicate int he trauma pt with low BP/shock/Abdo trauma | may indicate intraabdominal bleeding, may indicate severe shock: in severe shock, bowel hypoperfused, there may be absent or reduced bowel sounds |
| pulse qualities in shock, and what to palpate for: | pulses tachycardic due to pos chronotropic effect (SNS: chemo/baroreceptors), peripheral pulses may be weak/thready (hypoperfusion), central pulses may be bounding due to positive inotropic effect (SNS: chemo/baro receptors) |
| what pos for pts in shock? | consider reverse trendelenburg/legs elevated |
| what might you see on CCM in shock pts? | early: sinus tachy. Later may see ST changes due to hypoperfusion, reduced preload, reduced coronary aretery filling > reduced myocardial perfusion and ischemia |
| what is the usual minimum U/O for an adequetely perfused pt? | 1ml/kg/hr |
| why is it important to prevent hypothermia in shock pt? | hypothermia is related to: decreased 02 extraction from haemoglobin, impaired cardiac contractility and |
| why to monitor coagulation in shock pt? | haemodilution may occur when larghe amounts of crystaloids and packed cells are transfused, leading to low plt and clotting factors/ coagulopathies may occur esp when there is concomitant hypothermia |
| 2 reasons why a shock pt might have tachypnoea | 1) body trie sto maintian acid base balance, blows off etxra H+ (generated as byproduct of anerobic metabolism) as Co2 / 2to maintain adequete 02 supply to hypoxic tissues |
| why does cardiac function decrease as shock worsens? | initially, blood is prefebntially diverted to brain and heart. as venous return decreases, less preload, coronary arteries dont fill up during dyastole, decreased myocardial perfusion and decreased cardiac function |
| observe central jugular veins for what when assessing circulatory innadequecy? | flattness: eg' hypoperfusion / distended: eg. cardiac tamponade or tension pneumothorax |
| what is narrowing pulse pressure, what might it indicate in the trauma pt? | the difference between SBP and DBP. if the pulse pressure progressively narrows it may indicate worsening shock: as CO falls, vessels constrict, TPR increases leading to a higher DBP and a stable to normal SBP. |
Created by:
jessharries