Fluids and meds are used to manipulate crap too much

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Fluids and meds are used to manipulate CRAP Too much fluids can worsen organ function and may produce coagulopathy, cytokine activation, and abd. compartment syndrome Crystalloids and Colloids are given NS, LR Albumin, pharm. plasma expanders(Mannitol and Dextran) Blood products Sodium bicarbonate is not recommended in the treatment of shock related lactic acidosis Enteral nutrition is started within 24-48 hours parenteral nutrition is considered only after 7 days Glucose target levels- 140-180 Benefits: Decreases the risk of infection, renal failure, sepsis, and death Contractility Heart rate Afterload-Systemic resistance in ventricles Preload-Blood volume during diastole(resting phase) Hypovolemic Shock
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Occurs from inadequate fluid volume in the intravascular space Most common form of shock Hypovolemia results in a loss of circulating fluid volume C- R- A- P- Give LR/LS, Blood products, Albumin Mild:15-20%, volume loss up to appx. 750 mL Class I Patient may appear free of symptoms other than possibly slight anxiety As the volume loss worsens, the pateint may develop cool extremities and increased capillary refill time in response to peripheral vasoconstriction Moderate:15-30%, volume loss of 750-1500mL Class II Falling CO activates more intense compensatory responses Anxiety increases HR may increases to more than 100 beats/min Pulse pressusre narrows as the DBP increases because of vasoconstriction Postural hypotension develops RR increases as blood flow worsens ABG's are drawn- Resp. Alkalosis is revealed Urine Output is decreased to 20 to 30 mL/hr as renal perfusion decreases Urine sodium level decreases, whereas the urinary osmolality and USG increases as the kidneys start to conserve sodium and water. Normal USG- 1.000-1.030 Patients skin become pale and cool with delayed cap. refill Jugular veins appear flat as a result of decreased venous return Moderate:30-40%, volume loss of 1500-2000mL Class III May produce the progressive stage of shock BP decreases HR may increase to >120 beats/min, and dysrhythmias may develop as Myocardial Ischemia ensues Serum lactate levels increase ABG's reveal- Metabolic acidosis Oliguria BUN and Creatinine levels begin to rise as the kidneys begin to fail Normal BUN- 7-20 Normal Creat.- 0.6-1.2 The patients skin becomes ashen, cold, and clammy, with marked delayed cap. refill Patient may appear confused as cerebral perfusion is decreased Severe: >40%, volume loss of >2000mL Class IV Usually refractory in nature
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Tachycardia and hemodyanmics worsen Hypotension ensues Severe Lactic Acidosis is present Peripheral pulses and cap. refill become absent Skin may appear cyanotic, mottled, extremely diaphoretic Organ failure occurs UO ceases Patient may be confused and agitated, eventually becoming unresponsive
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