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Fluids and Shock

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Tramua-AIMS study material

AB
shocka state of inadequate tissue perfusion
waterthe universal solvent. Approximately 60 percent of the weight of the human body is due to water
intracellular fluid (ICF)portion of the body fluid inside the body's cells
extracellular fluid (ECF)portion of the body fluid outside the body's cells
intravascular fluidportion of the body fluid outside the body's cells and within the circulatory system
interstitial fluidportion of the body fluid found outside the body's cells, yet not within the circulatory system. Interstitial fluid is that fluid found within the interstitial space between the cells
electrolyteschemical substances that dissociate into charged particles when placed in water
iona charged particle
cationa postively charged ion. It is attracted to the negative pole of an electrode (cathode), hence the name.
aniona negatively charged ion. It is attracted to the positive pole of an electrode (anode), hence the name.
soduimIs the most prevalent cation in the extracellular fluid. It plays a major role in regulating water distribution
potassiumIs the most prevalent cation in the intracellular fluid. It is also important in electrical impulse transmission
calciumhas many physiological functions. It plays a major role in muscle contraction as well as nervous impulse transmission
magnesiumnecessary for several biochemical processes. It is also closely associated with phosphate in many body processes
chlorideis an important anion. It also plays a major role in fluid balance and renal function
bicarbonateis the principle buffer of the body. It neutralizes the highly acidic hydrogen ion and other organic acids
phosphateis important in body energy stores. It also acts as a buffer, primarily in the intracellular space
buffersubstance that neutralizes or weakens a strong acid or base
semi-permeable membranespecialized biological membrane, such as that which encloses the body's cells, that allows the apssage of certain substances and restricts the passsage of others
solutea substance that dissolves in a solvent
solventa liquid that dissolves a solute
isotonica state where solutions on opposite sides of a semi-permeable membrane are in equal concertration
hypertonica state where a solution has a higher solute concentration on one side of a semipermeable membrane compared to the other side
hypotonica state where a solute has a lower solute concentration on one side of a semipermeable membrance compared to the other side
diffusionthe movement of solutes (substances dissolved in a solution) from an area of greater concentration to an area of lesser concentration
osmosisthe movement of a solvent (water) across a semi-permeable membrance from an area of lesser (solute) concentration to an area of greater (solute) concentration. Osmosis is a form of diffusion
active transportbiochemical process where a substance is moved across a cell membrane, often against a gradient, using energy
facilitated dissusionbiochemical process where a substance is slectively transported acrosee a membrane, using "helper proteins" and energy
hemoglobinthe iron-containing substance in blood responsible for transport of oxygen
hematocritthe percentage of the blood consisting of the red blood cells, or erythrocyes (usually 35-45 percent)
ABO systemsystem of blood typing based on the presence of proteins on the surgace of the red blood cells.
homeostasisthe body's natural tendency to keep the internal environment constant
dehydrationan abnormal decrease in total body water
overhydrationan excess of total body water
fluid replacement therapyintravenous therapy is the introduction of fluids and other substances into the venous side of the circulatory system. Intravenous therapy is used for fluid replacement, for electrolyte replacement, and for the introduction of medications directly into the cardiovascular system
colloidscontain proteins, or other high molecular weight molecules, that tend to remain in the intravascular pace for an extended period of time
colloid osmotic pressurepressure generated by the presence of colloids in the vascular system or interstitial space
plasma protein fraction (plasmanate)is a protein containing colloid
salt-poor albumincontains only human albumin. Each gram of albumin holds approximately 18 milliliters of water in the blood stream
dextranis not a protein, but a large sugar molecule with osmotic properties similar to albumin
hetastarch (hespan)is a sugar molecule with osmotic properites similar to protein. It does not appear to share many of Dextran's side-effects
albuminprotein found in almost all animal tissues hat constitutes one of the major proteins in human blood
crysalloidsare the primary solutions used in prehospital intervenous fluid therapy
tonicitythe number of particles present per unit of volume
isotonic solutionshave an electrolyte composition similar to blood plasma. When placed into a normally hydrated patient, they will not cause a significant fluid or electrolyte shift
hypertonic solutionshave a higher solute concentration than plasma. When administered to a normally hydrated patient, these fluids will tend to casue a fluid shift out of the intracellular compartment into the extracelluar compartment. Later, there will be a dissusion of solute in the opposite direction
hypotonic solutionshave less of a solute concentration when compared to plasma. When administered to a normally hydrated pateint, they will cause movement of fluid from the extracellular compartment into the intracellular compartment. Later, sloutes will move in an opposite direction
selection of replacment fluidnormal saline and lactated ringer's solution are the most commonly-used fluids in prehospital care.
lactated ringer'sis an isotonic, electrolyte solution. It contains sodium chloride, potassium chloride, calcium chloride, and sodium lacate in water
normal salineis an electrolyte solution containing sodium chloride in wahter. It is isotonic with extracellular fluid
five percent dextrose in water D5Wis a hypotonic, glucose solution used to keep a vein open and to supply calories necessary for metabolism
pHscientific method of expressing the acidity or alkalinity of a solution. It is the logarithm of the hydrogen ion concentration divided by one. The higher the pH, the more alkaline the solution. The lower the pH, the more acidic the solution
acidosisa state where the pH is lower than normal to an increased hydrogen ion concentration
alkalosisa state where the pH is higher than normal due to the decreased hydrogen ion concentration
acid-base balanceis a dynamic relationship that reflects the relative concentration of hydrogen ions in the body
bicarbonate buffer systemis a fast-acting biochemical system that minimizes any significant shift in the body's pH.
respiratory systemhelps control the body's pH by retaining or eliminating carbon dioxide
kidneysplays a role in maintaining acid-base balances. when the hydrogen ion concentraton varies from normal, the kidneys excrete either an alkaline or acidic urine
disorders of acid-base balancein some cases, the pH of the body will move beyond the normal range of 7.35 to 7.45. This may be due to eight respiratory or metabolic casues. The acid-base disorder is named according to its origin.
respiratory alkalosisis caused by hyperventilation. Carbon dioxide is eliminated, resulting in the lost of hydrogen ions and an increased pH.
respiratory acidosisis due to hproventilation and the retention of carbon dioxide. The condition increses the concentration of hydrogen ions, which in turn lowers the pH.
metabolic acidosisis a condition that results from the accumulation of metabolic acids, such as lactic acid. In low perfusing states, such as shock, oxygen is not supplied to the tissues in adequate quantities to meet the metabolic demands of the cells. In the absence of oxygen, cells use alternate sources of energy to survive. This results in incomplete metabolism and an accumulation of acids and toeht toxic by-products
metabolic alkalosisis result of the accumulation of an excess of bicarbonate ions. This can occur throught he intake of excessive bicarbonate through the ingestion of large amounts of antacids. It also occurs in prolonged vomiting and diarrhea
perfusionfluid passing through an organ or a part of the body
physiology of perfusionall body cells require a constant supply of oxygen and otehr essential nutrients. At the same time, waste products, cush as carbon dioxide, must be constantly removed.
pathophysiology of shockshock is defined as inadequate tissue perfusion. It can occur for many reasons such as trauma, fluid loss, heart attack, infection, spinal cord injury, and other causes. Although casues differ, all forms of shock have the same underlying pathophysiology at the tissue level.
preloadthe pressure within the ventricles at the end of the diastole
cardiac contractile forcethe force generated by the heart during each contraction
afteloadthe resistance against which the heart must pump
peripheral vascular resistancethe resistance to blood flow due to the peripheral blood vessels. This pressure must be overcome for the heart to pump blood effectively
cardiac outputthe amount of blood pumped by the heart in one minute
the pumpthe heart is the pump of the cardiovascular system
the fluidblood is the fluid of the cardiovascular system
the containerblood vessels serve as the contain of the cardiovascular system
oxygen transportperipheral tissue oxygenation is also essential. Oxygen is brought into the body via the respiratory system
"fick principle"adequate concentration of inspired oxygen; appropriate movement of oxygen across the alveolar/capilary membrane into the pulmonary bloodstream; adequate number of red blood cells to carry the oxygen; proper tissue perfusion; effecient off-lading of oxygen at the tissue level
stages of shockshock can be divided into three distinct stages: Compenstated shock; decompensated shock and irreversible shock
compensated shockAs serious hemorrhage, fluid loss, or dehydration occurs, vascluar volume decreases. Several compensatory mechanisms ave activated to mantain adequate perfusion to critical organs. If volume loss continues, the body will be unable to maintain blood pressure and perfusion. The patient will then move into decompensated shock
decompensated shockthe hallmark of decompensated shock is a fall in the blood pressure
irreversible shockwhen enough cells in vital organs are disrupted, shock becomes irreversible and death is inevitable, even if perfusion and vital signs are restored
types of shockalthough all types of shock result in inadequate tissue perfusion, the causes are different. Shock is commonly classified based on the cause.
hypovolemic shockshock due to a loss of intravascular fluid volume - internal or external hemorrhage, trauma, severe dehydration from vomiting or diarrhea, plasma loss from burns, diabetic ketoacidosis with resultant osmotic diuresis, excessive sweating
cardiogenic shockan inability of the heart to pump enough blood to supply all body parts. Usually the result of severe left ventricular failure, secondary to acute myocardial infarction or congestive heart failure.
neurogenic shockinadequate peripheral resistance due to widespread vasodilation. With this inappropriate vasodilation, a disproportionate amount of blood collects in the capillary bed. This reduces venous return, cardiac output, and arterial blood pressure. This type of shock is most commonly due to an injury that resluts in severe spinal cord injury or total transection of the cord. Other causes are head injury, septicemia from bacterial nfection, anaphylactic reaction, insulin overdose and addisonian crisis (a disorder of the adrenal glands) With neurogenic shock, there is an absence of the "compensatory response".

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