6 hr. Sepsis Bundle - Repeat lactic
Start pressors if fluid bolus ineffective
Gain central access for pressors
Symptoms of Early Shock - Normotensive with NARROWING pulse pressure
Tachycardia
Weak and thready pulse
Tachypnea with DEEP respirations
Normal lactic
Cool and clammy
Anxiety, impending doom
Decreased urine output
Symptoms of Late Shock - Hypotension
Tachycardia
Tachypnea with shallow respirations
Elevated lactic
Cool, clammy, and mottled skin
Confusion, decreased LOC
SUPER decreased to no urine output
Stages of Shock - 1. Early (Compensatory)
2. Late (Decompensated)
3. Irreversible
Irreversible Shock Symptoms - MODS
Severe acidosis
Obtunded
Cardiac arrest
Trauma Triad of Death - Hypothermia
Acidosis
Coagulopathy
Symptoms of Hypothermia - Decreased cardiac output and HR (reduced perfusion)
Vasoconstriction
Depressed CNS
Bleeding due to decreased coagulation
Symptoms of acidosis - Decreased myocardial contractility
Prolonged PTT
Increased risk of dysrhythmias
SIRS
Explain the trauma triad of death - Hypothermia causes coagulopathies which worsen acidosis,
causing cardiac dysfunction and further worsening shock
,What blood product is administered for low fibrinogen levels? - Cryo
What blood product is used to address increased PT/PTT? - FFP
What blood product is used for thrombocytopenia? - Platelets
Where should tourniquets be placed in relation to the injury? - As close to the bleed as possible
to preserve as much limb as possible
Pneumoperitoneum - Air in the peritoneal cavity that is related to a ruptured hollow organ
Displays as abdominal distention
Cullen's sign -
Chance fractures - Lumbar spine fractures caused by hyperflexion over a seat belt
Indications for TXA - Indicated for SBP <90 or HR >110
Major hemorrhage (except in the head)
Indicated <3 hours from injury
Contraindications for TXA - Isolated brain bleeds
Known DVT/PE
Known clotting disorder
Transexamic Acid (TXA) - IV medication that inhibits the formation and binding of
plasmin/plasminogen to prevent degradation of clots
Dose of TXA - 1G in 100 cc in NS or LR given over 10 minutes
REBOA - Resuscitative endovascular balloon occlusion of the aorta
Provides balloon tamponade of the aorta to inhibit blood flow to the lower half of the body to
try and stop hemorrhage
Indications for REBOA - PEA arrest
Hypovolemia with SBP <70 mmHg related to bleeding below the diaphragm (Pelvic, severe
abdominal injuries, etc..)
**VERY invasive measure that should only be used for patients that would otherwise die of
hemorrhage extremely quickly
What is the current recommendation for initial fluid bolus in hypovolemic shock and why? -
500 ml, to maintain BP >90 systolic
Second 500 ml bolus can be administered if first is ineffective
, Because approximately 75% will third space after administration. More than 1L is not
recommended. Blood products are the preferred option.
What should be the ratio of blood product resuscitation in hemorrhagic shock? - 1:1:1
PRBC, FFP, Platelets
How much will 1 unit of PRBC increase the hemoglobin in a patient? - 1 unit= 1 g/dL
What is a "unit" of blood for a pediatric patient? - 10 ml/kg is considered a unit for kids
Pulse pressure - SBP-DBP
TIC (Trauma Induced Coagulopathy) - Coagulopathy cascade initiated by a traumatic insult
2 Stages:
1-Increased coagulopathy related to trauma triad of death, hypercoagulopathy
2- Excessive bleeding due to consumption of clotting factors, can result in DIC
Where are the primary access locations used for intraosseous cannulation? - Sternum, proximal
humerus, proximal tibia
Contraindications to an IO - Fracture, repeated attempts in same location
Average volume of one unit of blood - 250-300 ml
FFP (fresh frozen plasma) - Contains the majority of clotting factors
Frozen to preserve clotting factors that degrade quickly
AB is the universal donor
Cryoprecipitate - Plasma that has been spun a second time to further concentrate clotting
factors
What blood product does not require ABO testing? - Platelets
Permissive hypotension - Hypotension permitted in trauma patients to prevent the breakage of
new clots in high pressure
Better for penetrating trauma than blunt trauma
SBP 70-90 mmHg, MAP of 50
In what patient population is permissive hypotension contraindicated? - Head trauma
Normal CVP - 2-6 mmHg
Normal wedge pressure - 8-10 mmHg
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller smartzone. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $20.99. You're not tied to anything after your purchase.