Shock and Resuscitation - SNguyen

Shock and Resuscitation - SNguyen - Shock and Resuscitation...

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Shock and Resuscitation Scott Nguyen, MD Elmhurst Hospital Center
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Definition of Shock Condition of inadequate delivery of oxygen and nutrients necessary for normal tissue and cellular function
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Types of Shock Hypovolemic Inflammatory Compressive Neurogenic Cardiogenic
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41M assaulted in street, stabbed in L side of chest. VS 90/60, HR 130, RR 40s, O2 Sat 85% Decrease BS on Left, Left JVD, tracheal shift toward Right
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Compressive Shock External forces compress the chambers of the heart or great veins (VC) resulting in decreased cardiac filling / cardiac output. Mechanism of Tension Pneumothorax?
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Tension Pneumothorax
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Other Method of Compressive Shock? Pericardial Tamponade Compression by fluid in pericardial sac obstructs contraction by heart Sx: Beck’s Triad
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Pericardial Tamponade
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ED Thoracotomy: Survival based on mechanism J Trauma. 1998 Jul;45(1):87-94
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22M s/p high speed car accident, head on collision, flipped restrained driver VS HR 140, BP 90/60, RR 15 Unresponsive Chest / Abdomen bruising all over surface, distended, tender diffusely
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Initial CXR negative Despite volume resuscitation w/ 2 L NS, no improvement in hemodynamics DPL - gross blood in abdomen
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Acute blood loss in trauma patient results in loss of circulatory volume SNS stimulation, Release of epinephrine and norepinephrine Vasopressin release Activation of Renin angiotensin cascade Vasosconstriction to maintain cerebral and coronary
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Shock and Resuscitation - SNguyen - Shock and Resuscitation...

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