| A | B |
|---|
| total body water (TBW) | accounts for 60 percent of teh body weight, or about 42 liters in the 70 kg person; dividied between two major compartments (intracellular and extracellular) |
| intracellular fluid (ICF) | account for 75 percent of body fluid |
| extracellular fluid (ECF) | accounts for 25 percent of body fluid; subdivided into two compartments (interstitial and intravascular) |
| interstitial fluid | accounts for about 17.5 percent of body fluid; remains outside the cells, yet not within the vascular space |
| intravascular fluid | acounts for 7.5 percent of body fluid; contained within the circulatory system |
| sodium | cheif extracellular cation (postively charged particle); plays a role in regulating the distribution of water |
| potassium | chief intracelluar cation; plays a major role in the transmission of electrical impulses |
| chloride | body's chief anion (negatively charged particle); plays an important role in kidney function and fluid balance |
| diffusion | tendency of molecules within a solution to move toward an equilibrium; keeps the fluids within each body compartment consistent in mixture |
| osmosis | movement of solvent (body water) from an area of lesser particle concentration to one of greater concentration; causes body water to follow the various electrolytes into the intracellular, intravascular, and interstitial spaces |
| active transport | biochemically powered movement of a substance across a cell's membrance often against an osmotic gradient; essential activity of the cell membrane, which allows the body to control movement of electrolytes and essential molecules; faster than osmosis or diffusion, but it requires cell energy |
| facilitated diffision | assisted transport across the cell membrance; mechanism by which blucose is brought into the body's cells |
| dehydration | net loss of body fluid may be caused by vomiting,. idarrhea, disorders of absorption, fever states, diaphoresis, seeping wounds, or third space losses; can leave the cardiovascular system without the medium (plasma) to transport essential body materials effectively |
| overhydration | net accumulation of fluid casued by the inability of teh person to eliminate fluid (as in kednet failure) or an excesive intake of fluids (as in aggressive intravenous fluid administration), excess fluid flows out of the vascular space into the interstitial spaces and lungs causing peripheral edema or pulmonary edema |
| whole blood | ideal fluid replacement when blood is lost; precious commodity and carries with its administration the risk of reaction or disease transmission |
| blood products | valuable in resuscitation of the patient who has lost fluid; carry the risk of reaction or transmission of disease |
| colloids | solutions containing proteins or other large molecules that tend to remain in the vascular space for extended periods of time; draw water from the interstitial space and expand the vascular volume; tend to be expensive and have a relatively short shelf life |
| crystalloids | solutions of electrolytes that have hypertonic (greater) isotonic (the same), or hypotonic (lesser) osmotic concentrations; remain in the vascular space for a relatively short time, but are inexpensive and practical to store; isotonic fluids most widely used in field becasue of limited side effects; commonly used isotonic fluids - lactated Ringer's solution, normal saline, and 5 percent dextrose in water |
| respiratory alkalosis | causd by hyperventilation resulting from anxiety or head injury |
| respiratory acidosis | caused by hypoventilation due to chest injury, head injury, or drug overdose |
| metabolic acidosis | results from the accumulation of metabolic acids due to hypoxia at the cellular level; may be caused by hypoxia, hypoperfusion, diabetic ketoacidosis, poisonings, and serious infections |
| metabolic alkalosis | results from an excess of bicarbonate ions; may be caused by ingestion of antacids or by prolonged vomiting and diarrhea |
| shock | inadequate tissue perfusion; inability of the hyman system, through the cardiovascular system, to supply the body's cellular needs |
| increased peripheral resistance | caused by constriction of blood vessels; provides two mechanisms to combat shock; first, constriction of the arterioles maintains blood pressure; second, it diverts blood to critical organs |
| increased preload | occurs when the veins constrict and reduce their volume; because veins account for about 60 percent of the blood volume, a reasonable effective response may result in modest to moderate blood loss |
| increased heartrate | response to lowering blood pressure; in the presence of low preload, may not be effective |
| peripheral vascular shunting | directs blood away from the skin, conserves body heat, and reduces fluid loss through evaporation; also redirects blood to more critical areas |
| fluid shifts | result of drawing fluid from the interstitial and cellular spaces into the vascular space; although a slow process, can provide the vascular system with several liters of fluid |
| compensated shock | initial response of the body to fluid loss; blood bessels constrictl the heart rate and strength of contraction increase, the blood is directed from less critical structures, such as the skin, to the internal and vital organs (Note: If the loss is not controlled, compensated should will progress to decompensated shock) |
| decompensated shock | state in which the cardiovascular system is not receiving enough oxygenated circulation to maintain the compensatory state; blood vessels relax, the heart can no longer forcibly contract. and blood pressure and circulatory flow drop precipitously (Note: If immediate aggressive intervention does not occur, the patient will move into irreversible shock) |
| irreversible shock | state in which cell death has begun and the cardiovascular sstem is not longer capable of sustaining life; even if the lost of fluid is replaced in its entiret (or the primary problem is corrected) damage is irreversible |
| blood pressure | falls late in the shock process, too late to be a useful tool |
| pulse | rises quickly as the patient loses blood and the body begins to compensate; pulse rises above 100, especially if it is weak, indictive of early shock |
| rate of respirations | increases while depth decreases |
| skin temperature | cool and clammy may relect shunting of blood to the core circulation |
| capillary refill time | greater than two seconds suggestive of shock |
| indications for intravenous therapy | include the meed for administration of intravenous medications, replacement of fluid loss, and obtaining venous blood samples for analysis |
| initiation of intravenous therapy | begns with identification of an appropriate site, followed by the application of a venous tourniquet and teh cleansing of the site for cannulation (Note: Steps then follow in this order. A catheter is selected, tape is torn to secure the catheter, and an IV solution and administration set are connected and prepared. The skin is pierced, the vein is entered [as denoted by flashback], and the catheter is advanced. The needle is withdrawn and the administration set is connected) |
| venous toruniquet | used to obstruct the venous return, thereby dilating the vein and making cannulation easier |
| cleansing agents | (such as alcohol or Betadine) used to cleanse the site, reducting the chance that infectious agents will enter the skin and blood vessel with cannulation |
| catheters | most commonly over-the-needle variety, ranging from 24 to 14 gauge (smallest to largest); needle and catheter inserted into the skin and vessel with cannulation |
| tape | torn prior to cannulation and used to secure the catheter, the connection between the catheter and the administration set, and the first few inches of administration set tubing |
| administration set | tubng that carries the fluid from the solution bag to the catheter, contains a drip chamber and control valve that allow for controlling the rate of fluid administration; sets normally come in 60 (mini) and 10 (marco) drops per milliliter versions |
| intravenous fluids | used to replace fluid a patient has lost and/or provide a carrier for drug administration; most common fluids for field use are lactated Ringer's solution, normal saline, and dextrose 5 percent in water |
| infiltration | due to extravasation of fluid; ensure that the catheter is within the vein and running properly |
| hematoma | internal hemorrhage due to needle movement damage or delicate veins; withdraw the catheter and apply direct pressure |
| pyrogenic reaction | reaction of agents within the solution with the patient's blood; results in fever, nausea, vomiting, chills, and backache; if suspected, discontinue IV immediately and save the solution |
| catheter shear | may occur when a catheter is drawn back over a needle that has been inserted into the vein; never withdraw the catheter over the needle |
| air embolism | occurs when air is allowed to enter the vein through the administration set and catheter; completely clear the administration set of air and ensure that your IV solution does not run out |
| indications for the PASG | indiated for any pateint who pisplays internal or external hemorrhage in the lower abdomen, pelvis, or lower extremities; recommended for the stabilization of any pelvic and/or femur fracture or for the signs and symptoms of shock |
| contraindications for the PASG | should not be used in the patient who is experiencing pulmonary edema or who has a head or penetrating chest injury; use with caution on any patient who is experiencing dyspnea due tot he pressure it may place aginst the diaphragm; do not employ the abdominal section if the patient is in the third trimester of pregnancy, has an abdominal evisceration, or has an impaled object in the abdomen |
| applicaton of the PASG | asses breath sounds and record the patient's blood pressure, pulse rate and strength, and level of consciousness; visualize the abdomen, lower back, and lower extermities to ensure aginst sharp debris that could harm either the patient or the garment; apply the garment wiht consideration of the patient's injuries and position; inflate lower extermity chambers prior to or simultaneously witht he abdominal chamber; follow local protocols for indications and contraindications |
