Week 4 --Hypovolemic Shock Flashcards Preview

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Flashcards in Week 4 --Hypovolemic Shock Deck (41)
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31

 

Measurement of blood pressure in the

thoracic vena cava, near the right atrium

Central Venous Pressure (CVP)

  • Measures:
    • ​Amount of blood returning to the heart
    • ability of the heart to pump the blood into the arterial system
    • Hemodynamics
      • ​PRELOAD
      • VOLUME OVERLOAD
      • CARDIAC OVERLOAD
      • SEPSIS
    • Normal values for CVP
      • ​2 - 8 cm H20   (or)
      • 2 - 6 mm Hg

 

32

what does CVP measure

--Indicated mean right atrial pressure --frequently used as an estimate of right ventricular preload __does NOT measure blood volume-only estimates it

33

what lab is best for detecting blood loss?

  • HEMOGLOBIN
    • Loss >2 gm/dL indicates active blood loss

34

 

HYPOVOLEMIC SHOCK FLUID....???

Initial FluidTreatment:

First-Line Agent(s):.....

Second-Line Agent(s).....

 

  • INITIAL FLUID TX:
    • IV FLUID-2L of Crystalloid
  • 1st LINE AGENT
    • blood products for blood loss (or)
    • further IV crystalloids
  • 2nd LINE AGENT
    • Norepinephrine (Levophed)
    • Dopamine (Intropin)
    • Epinephrine 

35

 

Stimulation of ALPHA RECEPTORS does what?

INITITATES PERIPHERAL VASOCONSTRICTION

*increased PRELOAD

*increased CARDIAC OUTPUT

*increased BP

36

Disadvantages of taking meds that

stimulate the ALPHA receptors (2)

1) increased workload of heart

2) increased O2 demands of heart

**r/t increased afterload --not good for damaged heart

37

Disadvantages of taking meds that

stimulate the BETA receptors (2)

1) increased workload of heart

2) increased O2 demands of heart

**r/t increasing HR and contractility

38

 

Central Venous Pressure (CVP)

  •  Measure blood pressure in the thoracic vena cava (near the right atrium)
    • hint:  this is where all the returning blood from the body goes through and it is measuring pressures in the right side of the heart.  Anything that would decrease pressure in the right side of the heart is going to result in low CVP.  
    • most common reason for decreased pressure—>is decreased volume
  • Measures:
    • Amount of blood returning to the heart
    • Ability of the heart to pump the blood into the arterial system
    • Hemodynamics
      • PRELOAD
      • VOLUME OVERLOAD
      • CARDIAC FAILURE
      • SEPSIS
  • NORMAL VALUES2-8 cm H2O  or  2-6 mm Hg

39

STIMULATION OF THE ALPHA RECEPTORS:

Advantages

►Results in _________ which increases ______ ...which increases CO & BP

Disadvantages:

Increased______and _______ demands of heart by increasing afterload

Medications:

►____________, ___________ & _____________

 

  • Advantages:
    • peripheral vasoconstriction
    • Preload
  • Disadvantages:
    • increases workload
    •  O2
  • Medications:
    • Phenylephrine
    • Norepinepherine
    • Epinepherine

40

STIMULATION OF THE BETA RECEPTORS:

Advantages

►Results in _________ and / or ______ of mycardial contraction

Disadvantages:

►Increases______and _______ demands of heart by increasing rate and contractility

Medications:

►____________, ___________ & _____________

Advantages:

increased force

rate

Disadvantages:

workload

O2

Medications:

Dobutamine (inotrope)

Dopamine (ino and chronortrope)

Epinepherine (Ino and Chronotrope)

41

Best position for patient in hypovolemic shock

Trendelenburg