Distributive Shock
Pressor of Choice for Neurogenic shock
NE
Patient presents following an ATV accident. HR 135, BP 80/50. He is combative on scene. What class of hemorrhagic shock does this likely represent
Class 3
Maximum amplitude is 45mm.
What do they need ?
Platelets
What patients should get stress dose steroids ?
20 mg prednisone for > 3 weeks
Neurogenic shock typically occurs with spinal injuries above what level ?
T6
First hemodynamic parameter to change in hypovolemic shock
Decreased pulse pressure
R time is 15 minutes
What do they need ?
FFP
Nutritional deficiencies in Refeeding Syndrome
HypoMg
HypoPhos
HypoK
1 . Measure a lactate
2. Blood cultures
3. Bolus if hypotensive /lactate > 4 with 30 mg/kg IVF
What class of hemorrhagic shock is there decreased urine output ?
Class 3
How many Calories do most patients need per day in a non stress state ?
25 Kcal/kg/day
Difference between Cryo and FFP
Cryo is a precipitate derived from FFP.
FFP contains a wide range of clotting factors, while Cryo is a concentrated source of specific clotting factors like fibrinogen, Factor VIII, and von Willebrand factor
CO , CVP and SVR in Neurogenic shock
dec CO, SVR
unchanged / inc CVP
CO , CVP and SVR in hypovolemic shock
dec CO , CVP
inc SVR
MAP target in neurogenic shock
85-95
Difference between neurogenic shock and spinal shock
neurogenic shock is a cardiovascular problem, while spinal shock is a neurological one.
Spinal shock - neurologic issue below the level of the injury
List SIRS criteria (4)
–Temperature < 36°C or > 38°C
–Heart rate > 90 beats per minute
–Respiratory rate > 20 breaths per minute or PaCO2 < 32 mm Hg
–White blood cell count > 12,000 or < 4,000 or > 10% bands
How much fluid must be present on CXR to see an effusion?
250-600cc before visible on CXR
How much blood can the thigh contain
3L
Difference between PPN and TPN
PPN : has higher concentration of fat because carbohydrates are caustic to veins