BGEN 3020 Lecture Notes - Eugenius Warming, Angiotensin, Collateral Circulation

34 views4 pages

lilacgiraffe554

24 Feb 2013

School

University of Manitoba

Department

Biochem. and Medical Genetics

Course

BGEN 3020

Professor

Jason Leboe- Mcgowan

For unlimited access to Class Notes, a Class+ subscription is required.

Document Summary

Causes of hypovolemic shock diarrhea, blood loss, cholera, sweating, not di (b/c losing pure water, and not losing na, total body na is normal! Losing water from icf; no signs of dehydration; when you lose salt, show signs of dehydration). Example: lady with hypovolemic shock when she was lying down, her bp and pulse were normal; when they sat her up, the bp decreased and pulse went up. Normal bp when lying down b/c there is no effective gravity, therefore normal blood returning to the right side of the heart, and normal. However, when you sit the patient up, and impose gravity, you decrease the venous return to right heart. So, if you are hypovolemic, it will show up by a decrease in bp and an increase in pulse. Cardiac output is decreased, and the catecholamine effect causes this scenario. Example: pt collapses, and you do a tilt test: 100/80 and pulse of 120 while lying down.

Related Questions

Shock Case Study (15 pts)

HPI. Mrs. K is a 22 y/o college student, rushed to the ED 35 minutes after sustaining multiple stab wounds to the chest and abdomen by an unidentified assailant. A witness called 911. Paramedics arriving at the scene found the victim to be in severe acute distress.

Vital signs were as follows: HR 128 (baseline 80), BP 80/55 (baseline 115/80), RR 37 and labored. Chest auscultation revealed decreased breath sounds in the R lung consistent with basilar atelectasis (ie. collapsed R lung). Pupils were equal, round, reactive to light, and accommodation. Her LOC was reported as âawake, slightly confused, and complaining of severe chest and abdominal pain.â Pedal pulses were absent, radial pulses were weak, and carotid pulses were palpable. The patient was immediately started on IV Lactated Ringerâs solution at a rate of 150 mL/hr.

An ECG monitor placed at the scene of the attack revealed that the patient has developed sinus tachycardia. She was tachypneic, became short of breath with conversation and reported her heart was pounding out of her chest. She appeared to be very anxious and continued to c/o pain. Her skin was cool and nail beds were pale but not cyanotic. Skin turgor was poor. Peripheral pulses were absent with the exception of a thread, brachial pulse. Capillary refill time was 7-8 seconds. Doppler ultrasound had been required to obtain an accurate BP reading. The patientâs skin was cool and clammy. There was a significant amount of blood on her dress and on the pavement where she was lying.

Question 2. What is the pathophysiologic sequence of events for shock? (2pts)

Question 3. What type of shock does this patient seem to have? What is your rationale? (2 pts)

Question 4. Does this patient need a blood transfusion? Provide rationale for your answer. (2pts)

During transport to the hospital, vital signs were reassessed: HR 138, BP 75/50, RR 38 with confusion. Patient was diagnosed with hypovolemic shock and IV fluids were doubled. Oxygen was started at 3L/min by nasal cannula. ER physicians chose not to start a central venous line. An indwelling foley catheter was inserted with return of 180mL of amber colored urine. Urine output measured over the next hour was 14mL. Patient was taken to the OR for surgical correction of lacerations to the right lung, liver and pancreas. In total, patient received 1L of Lactated Ringers.

Table 1.

Class

Parameter	I	II	III	IV
Blood loss (ml)	<750	750â1500	1500â2000	>2000
Blood loss (%)	<15%	15â30%	30â40%	>40%
Pulse rate (beats/min)	<100	>100	>120	>140
Blood pressure	Normal	Decreased	Decreased	Decreased
Respiratory rate (breaths/min)	14â20	20â30	30â40	>35
Urine output (ml/hour)	>30	20â30	5â15	Negligible
CNS symptoms	Normal	Anxious	Confused	Lethargic

Molly is a 75yr old widow who lives alone. For 2 days she had a fever and chills and mainly stayed in bed. On rising to go to the bathroom, she felt dizzy, fainted, and fell to the floor. Molly quickly regained consciousness and managed to call her son, who took her to the emergency room, where a physical diagnosed orthostatic hypotension.
Orthostasis literally means " to stand"
and hypotension refers to low blood pressure; thus, orthostatic hypotension is a significant drop in blood pressure upon standing. when a person moves from lying down to standing, blood "pools" within the veins below the heart because of gravity, and less blood returns to the heart. Consequently, blood pressure drops because the heart has less blood to pump.
Predict -Although orthostatic hypotension has many causes, in the elderly it can be due to age related decrease in neural and cardiovascular responses. Decreased fluid intake while feeling I'll and sweating due to a fever can result in dehydration. Good
Dehydration can decrease blood volume and lower pressure, increasing the likelihood of orthostatic hypotension.

1 Describe the normal response to a decrease in blood pressure on standing?

2 what happened to Molly heart rate just before she fainted? why did Molly faint?

3 How did Molly's fainting and falling to the floor help establish homeostasis ( assuming she was not injured)?

BGEN 3020 Lecture Notes - Eugenius Warming, Angiotensin, Collateral Circulation

Document Summary

Get access

Related Documents

BGEN 3020 Chapter Notes - Chapter 1: Shortness Of Breath, Hemoglobin, Glycolysis

BIOM3010 Lecture Notes - Lecture 14: Orthostatic Hypotension, Neurogenic Shock, Pulse Pressure

NUR 424 Lecture Notes - Lecture 6: Abdominal Compartment Syndrome, Pulse Pressure, Shortness Of Breath

Related Questions