Flashcards in 7. Fluid and Hemodynamics Deck (15):
What is the first step of treatment in hypovolemia?
Normal saline! to stabilize the BP
After you stabilize a hypovolemic patient with normal saline, what do you do now?
Figure out what kind of fluid they initially lost (isotonic vs. hypertonic vs. hypotonic) and replete with that kind of fluid
What is the most common cause of sepsis?
E. coli from indwelling catheter
Cardiogenic/hypovolemic shock - what does the skin feel like?
Cold and clammy because catecholamines have vasoconstriction to redirect blood to vital organs
What is the main factor controlling peripheral vascular resistance?
Radius of the vessel (to the 4th power)
What happens to peripheral vascular resistance in septic shock?
Decreases because we have vasodilation - makes skin warm because of increased blood pressure
What is cardiac output in septic shock vs. cardiogenic/hypovolemic shock?
Septic shock - increase because of vasodilation vs. cardiogenic/hypovolemic shock - decrease because of vasoconstriction
Is mixed venous oxygen content lower in septic shock or cardiogenic/hypovolemic shock?
Cardiogenic/hypovolemic shock because cardiac output is decreased and peripheral resistance is increased so tissues have lots of time to extract oxygen from the blood (opposite in septic shock - high mixed venous oxygen content)
Total peripheral resistance is determined mainly by which vessels?
How do we differentiate cardiogenic vs. hypovolemic shock?
Pulmonary capillary wedge pressure = measure of end diastolic pressure in left ventricle
Cardiogenic - high vs. Hypovolemic - low
Which organ suffers greatest from decrease in BP?
What's the most common cause of respiratory alkalosis?
Anxiety - hyperventilation
Why do all pregnant women have a little bit of respiratory alkalosis?
Estrogen and progesterone overstimulate the respiratory center
What are the acid-base disturbances in septic shock?
Respiratory alkalosis - from overstimulation of respiratory center by endotoxin
Metabolic acidosis - from anaerobic glycolysis (lactic acid build up)