Removed by liver, but only with oxygen
Where blood is shunted away from during shock
GI, Liver, Kidneys, Lungs
Extreme edema in lower extremities
Anaphylactic shock treatment
Depends on the severity
Cardiogenic shock classic manifestation
Pink, frothy sputum
Cardiogenic shock definition
Systolic or diastolic disfunction
Cardiogenic shock diagnostics
Increased cardiac markers
Increased BUN and blood glucose
Echo (left ventricular dysfunction)
Cardiogenic shock treatmetn
Discover cause and treat
Diuretic effect on preload
Vasodilator effect on afterload
Why CCB is not given with decreased contractility?
Contractility will be reduced even further
Beta blocker effect on heart
Reduces myocardial oxygen demand
Hypovolemic shock treatment
3ml of isotonic crystalloid for every 1ml of estimated blood loss
Results is loss of sympathetic tone.
Occurs with spinal cord injury
Neurogenic shock effect on HR and BP
Heart rate and Blood pressure both decrease. Neurogenic shock is the only shock where this occurs.
Neurogenic shock effect on nervous system
Sympathetic system impacted. Parasympathetic system not impacted and it takes over.
Blocks parasympathetic nervous system.
Basically hypovolemic shock
Changes capillary permiability
Oncontic pressure disrupted
Manage for hypovolemic shock
Caused by flame, flash, scald, or contact with hot objects.
Most common type of burn.
Same as body temperature
Inhalation of hot air or noxious chemicals.
Cause damage to respiratory tract.
Why bright cherry red skin color with smoke inhalation?
Carbon monoxide replaces oxygen on hemoglobin.
Damage above epiglottis
Hot air, steam, or smoke.
Painful swelling is cue.
Damage below epiglottis
Related to length of exposure to smoke.
Pulmonary edema (12 to 24 H after) (ARDS)
Progression of pulmonary edema
After 1 hour: clear lung sounds.
After 6 to 10 hours: wheezes heard.
After 12 to 24 hours: NO lung sounds heard.
Iceberg effect of electrical burns
Most damage is under the skin.
Difficult to assess.
Used to assess percentage of body burned.
Based on capillary bed.
Face, Neck, and Chest burn
Increased risk for respiratory obstruction.
Monitor for complications
Phases of burn management
Remove from source of burn.
Stop burning process.
Lasts 24 to 48 hours.
Begins with fluid loss and edema formation and continues until fluid mobilization and diuresis begins.
Normal insensible loss
30 to 50 ml/H
Severely burned patient fluid loss
200 to 400 ml/H
Begins with mobilization of extracellular fluid and subsequent diuresis
Acute Phase classic manifestations
Bowel sounds return.
Necrotic tissue begins to slough.
Partial thickness heal from edges.
Full thickness burn needs a graft.
Risk factors for hypothermia
Less than 95 degrees
Leading cause of unintentional death in children.
IV fluids with large bore (200 to 400ml/hour)
Monitor CVP (will be low or zero)
HOB kept low
Refractory stage Assessment
Decreased peristalsis (No bowel sounds)
Decreased blood pressure
Liver enzymes elevated
Progressive stage Assessment
Decreased blood pressure
Decreased urine output
Compensatory stage assessment
Warm, flushed skin
CVP about zero
WBC > 12,000 or < 4,000
Compensatory stage treatment
Give bolus of NS until CVP > 8, unless Na is elevated.
Why Frothy, Pink Sputum with Cardiogenic Shock?
Left ventricle is not pushing forward and everything is backing up into lungs.
Electrical Burns treatment
Spine precautions (assume they fell)
Protect from further shock injury
Central lines with burns
Not the subclavian, due to pneumothorax
Why give epinephrine?
MODS succussfully resuscitated:
Increased urine output
Increased blood pressure
Primary survey Burn care
A = Airway
B = Breathing
C = Circulation
D = Disability
E = Exposure
Compensatory stage goal
Restore cadiac output and tissue perfusion to vital organs.
Why is early recognition of Compensatory Stage important?
With Progressive or Irreversible stage, the mortality rate increases.
Neurogenic Shock treatment
Treat underlying problem
Neurogenic shock manifestations
Absence of reflexes
Loss of temperature regulation
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