Duke PA Surgery-Shock, Transfusion, and infection
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| show | Shock
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| show | mental status changes, acidosis, oliguria, and poor cutaneous perfusion (cool, pale skin).
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| a function of the cardiac output and the oxygen carrying capacity of the blood | show 🗑
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| divisions of shock | show 🗑
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| hemodynamic responses to compressive cardiac shock | show 🗑
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| show | large decrease in cardiac output, increase in filling pressures
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| hemodynamic responses to hypovolemic shock | show 🗑
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| hemodynamic responses to septic shock | show 🗑
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| shock due to pump failure can be due to | show 🗑
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| show | cardiac compressive shock
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| examples of cardiac compressive shock | show 🗑
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| With cardiac compressive shock,in addition to general signs of shock, physical exam reveals | show 🗑
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| rise in JVP with inspiration | show 🗑
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| show | pulsus paradoxus
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| show | correction of the mechanical abnormality
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| show | cardiogenic shock
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| Physical exam of a patient in cardiogenic shock may reveal | show 🗑
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| in cardiogenic shock due to inadequate pumping, improve pump function with | show 🗑
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| in cardiogenic shock due to excessive afterload, reduce afterload with | show 🗑
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| in cardiogenic shock due to arrhythmias, optimize heart rate and rhythm with | show 🗑
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| in cardiogenic shock optimize volume status by | show 🗑
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| one of the most common causes of shock encountered in the practice of surgery | show 🗑
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| Hypovolemic shock may be due to blood loss as well as from | show 🗑
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| show | third spacing
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| hypovolemia leads to | show 🗑
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| show | preload
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| show | <20% blood volume loss-decreased pulse pressure, postural hypotension, cutaneous vasoconstriction, collapsed neck veins, concentrated urine, hemoconcentration
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| show | 20-40% blood volume loss-thirst, tachycardia, moderate hypotension, oliguria
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| severe hypovolemia | show 🗑
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| show | pulse pressure
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| show | Large-bore IV. Resuscitation should always begin with crystalloid infusion—30 cc/kg (2 liters for most adults) as fast as possible then titrate against signs of clinical improvement. Blood products may be appropriate in situations of blood loss.
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| show | venous pooling with decreased blood return to the heart (preload) and decreased cardiac output
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| loss of arterial tone results in | show 🗑
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| neurogenic shock | show 🗑
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| injury above the level of __ results in a loss of sympathetic tone and adrenergic stimulation | show 🗑
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| physical signs of neurogenic shock may include | show 🗑
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| in neurogenic shock the loss of venous tone is exacerbated by | show 🗑
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| treatment of neurogenic shock | show 🗑
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| show | gram negative bacteria
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| In early septic shock, the response is __ | show 🗑
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| show | the cardiovascular system decompensates and progresses to a hypodynamic state
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| Early clinical manifestations of septic shock include __ | show 🗑
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| show | Hypothermia, coagulopathy, pulmonary failure (ARDS), and renal failure
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| show | clearance of the offending infection (surgical debridement or resection, appropriate antibiotic therapy)
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| Potential indications for the transfusion of blood products | show 🗑
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| effect of administration of one unit of PRBC's | show 🗑
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| effect of administration of one unit of platelets increases platelets county by __ | show 🗑
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| show | increase in fibrinogen by 3%
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| indication for administration of PRBC's | show 🗑
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| indication for administration of platelets in the presence of bleeding | show 🗑
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| show | bleeding + coagulopathy, coumadin reversal
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| show | fibrinogen <100 mg/dL
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| platelets are given for the correction of | show 🗑
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| show | plts <15,000
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| show | six_pack
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| show | vitamin K dependant clotting factors
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| show | serum clotting factors (except VIII, and V), antithrombin III, fibrinogen, and proteins C and S
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| is a plasma component that is enriched for high-molecular-weight proteins | show 🗑
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| is a plasma componenet that is enriched for fibrinogen, factor VIII, factor XIII, and von Willebrand's factor | show 🗑
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| show | Hemolytic reactions
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| show | 20,000
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| delayed(minor) hemolytic reactions occur at the rate of 1/__ units | show 🗑
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| symptoms of hemolysis | show 🗑
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| show | donor WBC's
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| show | is a rare but real phenomenon
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| show | 50
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| show | 1/400,000-1/600,000
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| rate of Hep C transmission from blood products | show 🗑
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| show | 1/50,000-1/200,000
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| show | Hypocalcemia
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| __ can be associated with multiple transfusions of PRBC’s. | show 🗑
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| show | potassium
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| show | “cell-saver”
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| • Autotransfusion is an option for elective operations where significant blood loss is expected. The patient should ideally donate more than __ week prior to operation | show 🗑
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| show | von Willebrand's disease
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| show | cardiogenic, hypovolemic, septic, neurogenic, anaphylactic
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| MI, cardiomyopathy, valvular disease, rhythm disturbances, Pulm HTN, cardiac tamponade, tension PNX, diaphragm rupture (heart is compresed), PPV | show 🗑
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| hemorrhage, severe dehydration, vomiting, diarrhea | show 🗑
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| show | Septic shock
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| show | Neurogenic shock
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| hypersensitivity reaction | show 🗑
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| initial treatment for cardiogenic shock | show 🗑
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| show | fluid resuscitation
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| show | vasoactive agents may be needed, use fluid cautiously (watch for non-cardiac pulmonary edema)
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| initial treatment for septic shock | show 🗑
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| show | plts <15,000
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| most common reason for ABO mismatch | show 🗑
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| show | Kell, Kidd, Duffy
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| show | immunocompromises
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| show | decreased cardiac contractility, increased bleeding
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| hyperkalemia in a transfusion patient can be due to | show 🗑
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| show | immunocompromised (HIV, on steroids, organ transplant)
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| signs and symptoms of anemia | show 🗑
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| show | FFP or Vitamin K
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| show | bleeding patients whose platelets have been impaired by aspirin or NSAIDs
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| bleeding after cardiopulmonary bypass may be due to inadequate neutralization of heparin. Giving __ in this setting may worsen the bleeding because __ provides antithrombin III | show 🗑
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| microvascular bleeding often indicates a | show 🗑
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| __ impairs platelet function and can prolong bleeding | show 🗑
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| blood should never __ | show 🗑
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| show | extensive tissue injury
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| show | increase in diastolic pressure
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| systolic hypotension is a sign of | show 🗑
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| agitation is another sign of | show 🗑
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| profound hypotension and apathy are signs of | show 🗑
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| a normal 70 kg man has about __L of blood volume | show 🗑
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| Humoral host defenses | show 🗑
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| show | macrophages
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| cellular host defenses | show 🗑
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| show | recruit macrophages
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| phases of wound healing-inflamation days __ | show 🗑
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| show | inflamation phase of wound healing
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| proliferation phase of wound healing days __ | show 🗑
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| show | proliferation phase of wound healing
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| remodeling phase of wound healing weeks __ | show 🗑
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| show | remodeling phase of wound healing
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| order of arrival of cells to wound | show 🗑
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| show | streptococcus viridans
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| organism from cat bites | show 🗑
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| show | tetanus, rabies, augmentin, cephalexin
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| show | clean wound
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| show | clean_contaminated wound
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| show | contaminated wound
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| old traumatic wounds with retained devitalized tissuethose that involve existing clinical infection or perforated visceraeg. Abscess | show 🗑
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| perioperative antibiotics are given | show 🗑
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| choice of antibiotics depends on | show 🗑
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| show | no anearobes are expected
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| surgical prophylaxis with second generation cephalosporin (Cefotetan) if | show 🗑
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| show | necrotizing fasciitis
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| necrotizing fasciitis can be caused by | show 🗑
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| aka. Strep gangrene, Fournier's gangrene, flesh eating disease | show 🗑
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| show | necrotizing fasciitis
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| mortality rate in patients with necrotizing fasciitis __% | show 🗑
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| show | necrotizing fasciitis
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| Must have high index of suspicion for __ whenSkin discoloration, necrosis, crepitus, drainage of thinWatery, grayish, foul-smelling fluid present. | show 🗑
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| antibiotics usually not helpful with | show 🗑
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| local infection of the dermis and subcutaneous tissue characterized by spreading redness, swelling and pain | show 🗑
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| blanching erythema | show 🗑
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| show | bed rest
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| show | UTI
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| show | wind, water, wound, wonder drugs
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| #1 cause of post op fever | show 🗑
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| show | 3
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| show | 3
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| show | 5
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| show | Empyema
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| show | clostridium difficile
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