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21 Cards in this Set
- Front
- Back
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What value is considered to be low blood pressure?
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Not specific value, depends on individual (90/60 is a rough guide)
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What is the definition of shock, hypoxemia and hypoxia?
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Shock: Inadequate oxygen delivery to tissues causing a switch to anaerobic metabolism
Hypoxemia: decreased oxygen in blood Hypoxia: decreased oxygen in tissues |
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How do you assess circulation (C) ?
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Blood Pressure: measure with cuff, estimate by pulses
Pulse: Rate and strength Organ perfusion: skin (colour, temperature, perspiration), mental status, urnie output, etc. |
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How do you estimate BP using pulses?
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Carotid only: SBP = 60
Carotid + femoral: SBP = 70 Carotid + femoral + radial: SBP = 80+ |
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What is pulse pressure and what is its significance when assessing circulation?
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Pulse pressure = SBP - DBP
If it is decreased it means that >15% of blood loss has occured even though SBP may not be decreased |
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What are the 4 classes of shock and how do they help estimate blood loss?
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Class 1 = 0-15% loss, no physical findings
Class 2 = 15-30% loss, HR >100, Pulse pressure decreased, RR 20-30, anxious Class 3 = 30-40% loss, HR>120, BP and PP decreased, RR 30-40, confused Class 4 = >40% loss, HR >140, BP and PP decreased, RR >35, lethargic |
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How do you manage a trauma patient with decreased BP
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Assess: determine cause of decreased BP, assess severity of blood loss
Treat: Correct cause(s) of decreased BP, resuscitate, assess response to resuscitation *Assessment and Treatment simultaneous |
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What are causes of low blood pressure using a physiologic categorization?
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Hypovolemia (assume this until proven otherwise): blood loss
Obstructive: tension PTX, pericardial tamponade Distributive: vasodilation (spinal cord injury, sepsis, anaphylaxis) Cardiogenic: MI, arrhythmia, etc |
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What are the causes of low blood pressure using the pneumonic?
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S - spinal cord, sepsis
H - horrhage O - obstructive C - cardiogenic K - "anaphylaksis" |
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What are possible causes/sources of hemorrhage?
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External
Chest Abdomen (peritoneum, retroperitoneal) Pelvis Long bones |
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How do you assess for hemorrhage in the chest?
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Physical, CXR, Chest tube output, CT
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How do you assess for hemorrhage in the abdomen?
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Physical, FAST, CT with contrast
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How do you assess for hemorrhage in the retroperitoneum?
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Physical
Pelvic radiograph CT with contrast Angiography |
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How do you assess for hemorrhage in the long bones?
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Physical, plain xrays
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How do you manage low BP due to hemorrhage in a trauma patient?
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1. stop the bleeding
2. resore tissue perfusion (resuscitate) |
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What kind of IV access do you need for volume resuscitation?
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Two large IV's in antecubital fossae
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What kind of fluids do your resuscitate with?
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1. Crystalloid (ringer's lactate or normal saline) - give 3:1 (crystalloid:blood loss)
2. Switch to blood after 3L of crystaloid |
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What kinds of blood can you give?
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Fully crossmatched: ABO and Rh + no antibodies (takes 45min)
Type-specific: ABO and Rh matched (takes 10min) Uncrossmatched: O+ or O- if women of childbearing age |
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What do you need to do to blood before you give it?
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Heat it up
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What do you do if there is no response to volume resuscitation?
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Definitive treatment (surgery)
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What are causes of coagulopathy in massively resuscitated patients?
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Blood loss
Dilution Consumption (plateletts, etc.) Hypothermia Acidosis Shock |
