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Hypovolemic Shock
Hypovolemic shock is a form of shock caused by severe hypovolemia (insufficient blood volume or extracellular fluid in the body). It could be the result of severe dehydration through a variety of mechanisms or blood loss. Hypovolemic shock is a medical emergency; if left untreated, the insufficient blood flow can cause damage to organs, leading to multiple organ failure. In treating hypovolemic shock, it is important to determine the cause of the underlying hypovolemia, which may be the result of bleeding or other fluid losses. To minimize ischemic damage to tissues, treatment involves quickly replacing lost blood or fluids, with consideration of both rate and the type of fluids used. Tachycardia, a fast heart rate, is typically the first abnormal vital sign. When resulting from blood loss, trauma is the most common root cause, but severe blood loss can also happen in various body systems without clear traumatic injury. The body in hypovolemic shock prioritizes getting ox ...
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Interstitial Fluid
In cell biology, extracellular fluid (ECF) denotes all body fluid outside the cells of any multicellular organism. Total body water in healthy adults is about 60% (range 45 to 75%) of total body weight; women and the obese typically have a lower percentage than lean men. Extracellular fluid makes up about one-third of body fluid, the remaining two-thirds is intracellular fluid within cells. The main component of the extracellular fluid is the interstitial fluid that surrounds cells. Extracellular fluid is the internal environment of all multicellular animals, and in those animals with a blood circulatory system, a proportion of this fluid is blood plasma. Plasma and interstitial fluid are the two components that make up at least 97% of the ECF. Lymph makes up a small percentage of the interstitial fluid. The remaining small portion of the ECF includes the transcellular fluid (about 2.5%). The ECF can also be seen as having two components – plasma and lymph as a delivery syst ...
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Capillary Refill
Capillary refill time (CRT) is defined as the time taken for color to return to an external capillary bed after pressure is applied to cause blanching. It can be measured by holding a hand higher than heart-level and pressing the soft pad of a finger or fingernail until it turns white, then taking note of the time needed for the color to return once pressure is released. In humans, CRT of more than three seconds indicates decreased peripheral perfusion and may indicate cardiovascular or respiratory dysfunction. Assessment In adults CRT can be measured by applying pressure to the pad of a finger or toe for 5–10 seconds. It became popularized in the 1980s when Champion et al. proposed a CRT of less than 2 seconds be deemed normal and included CRT in the Trauma Score. The value of 2 seconds for a normal CRT that was proposed by Dr Champion had been arbitrarily chosen by his nurse, and no evidence supporting that value has subsequently been found. CRT has been shown to be influen ...
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Muscle Cramp
A cramp is a sudden, involuntary, painful skeletal muscle contraction or overshortening associated with electrical activity; while generally temporary and non-damaging, they can cause significant pain and a paralysis-like immobility of the affected muscle. A cramp usually goes away on its own over a period of several seconds, or minutes. Cramps are common and tend to occur at rest, usually at night (nocturnal leg cramps). They are also often associated with pregnancy, physical exercise or overexertion, age (common in older adults), in such cases, cramps are called idiopathic, because there is no underlying pathology. In addition to those benign conditions cramps are also associated with many pathologic conditions. Skeletal muscle cramps may be caused by muscle fatigue or a lack of electrolytes such as sodium (a condition called hyponatremia), potassium (called hypokalemia), or magnesium (called hypomagnesemia). Some skeletal muscle cramps do not have a known cause. Motor neuro ...
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Thirst
Thirst is the craving for potable fluids, resulting in the basic instinct of animals to drinking, drink. It is an essential mechanism involved in fluid balance. It arises from a lack of fluids or an increase in the concentration of certain osmolites, such as sodium. If the water volume of the body falls below a certain threshold or the osmolite concentration becomes too high, structures in the brain detect changes in blood constituents and signal thirst. Continuous dehydration can cause acute and chronic diseases, but is most often associated with kidney, renal and neurological disorders. Excessive thirst, called polydipsia, along with excessive urination, known as polyuria, may be an indication of diabetes mellitus or diabetes insipidus. There are Sensory receptor, receptors and other systems in the body that detect a decreased volume or an increased osmolite concentration. Some sources distinguish "extracellular thirst" from "intracellular thirst", where extracellular thirst i ...
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Acid–base Disorder
Acid–base imbalance is an abnormality of the human body's normal balance of acids and bases that causes the plasma pH to deviate out of the normal range (7.35 to 7.45). In the fetus, the normal range differs based on which umbilical vessel is sampled (umbilical vein pH is normally 7.25 to 7.45; umbilical artery pH is normally 7.18 to 7.38). It can exist in varying levels of severity, some life-threatening. Classification An excess of acid is called acidosis or acidemia, while an excess in bases is called alkalosis or alkalemia. The process that causes the imbalance is classified based on the cause of the disturbance (respiratory or metabolic) and the direction of change in pH (acidosis or alkalosis). This yields the following four basic processes: Mixed disorders The presence of only one of the above derangements is called a ''simple'' acid–base disorder. In a ''mixed'' disorder, more than one is occurring at the same time. Mixed disorders may feature an acidosis and al ...
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Electrolyte Imbalance
Electrolyte imbalance, or water-electrolyte imbalance, is an abnormality in the concentration of electrolytes in the body. Electrolytes play a vital role in maintaining homeostasis in the body. They help to regulate heart and neurological function, fluid balance, oxygen delivery, acid–base balance and much more. Electrolyte imbalances can develop by consuming too little or too much electrolyte as well as excreting too little or too much electrolyte. Examples of electrolytes include: calcium, chloride, magnesium, phosphate, potassium, and sodium. Electrolyte disturbances are involved in many disease processes, and are an important part of patient management in medicine. The causes, severity, treatment, and outcomes of these disturbances can differ greatly depending on the implicated electrolyte. The most serious electrolyte disturbances involve abnormalities in the levels of sodium, potassium or calcium. Other electrolyte imbalances are less common and often occur in conjunction ...
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Volume Depletion
Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the loss of extracellular fluid and should not be confused with dehydration. Hypovolemia is caused by a variety of events, but these can be simplified into two categories: those that are associated with kidney function and those that are not. The signs and symptoms of hypovolemia worsen as the amount of fluid lost increases. Immediately or shortly after mild fluid loss (from blood donation, diarrhea, vomiting, bleeding from trauma, etc.), one may experience headache, fatigue, weakness, dizziness, or thirst. Untreated hypovolemia or excessive and rapid losses of volume may lead to hypovolemic shock. Signs and symptoms of hypovolemic shock include increased heart rate, low blood pressure, pale or cold skin, and altered mental status. When these sig ...
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Hemostasis
In biology, hemostasis or haemostasis is a process to prevent and stop bleeding, meaning to keep blood within a damaged blood vessel (the opposite of hemostasis is hemorrhage). It is the first stage of wound healing. This involves coagulation, which changes blood from a liquid to a gel. Intact blood vessels are central to moderating blood's tendency to form clots. The endothelial cells of intact vessels prevent blood clotting with a heparin-like molecule and thrombomodulin, and prevent platelet aggregation with nitric oxide and prostacyclin. When endothelium of a blood vessel is damaged, the endothelial cells stop secretion of coagulation and aggregation inhibitors and instead secrete von Willebrand factor, which initiate the maintenance of hemostasis after injury. Hemostasis involves three major steps: * vasoconstriction * temporary blockage of a hole in a damaged blood vessel by a platelet plug * blood coagulation (formation of fibrin clots) These processes seal the ...
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Systolic
Systole ( ) is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood. The term originates, via New Latin, from Ancient Greek (''sustolē''), from (''sustéllein'' 'to contract'; from ''sun'' 'together' + ''stéllein'' 'to send'), and is similar to the use of the English term ''to squeeze''. The mammalian heart has four chambers: the left atrium above the left ventricle (lighter pink, see graphic), which two are connected through the mitral (or bicuspid) valve; and the right atrium above the right ventricle (lighter blue), connected through the tricuspid valve. The atria are the receiving blood chambers for the circulation of blood and the ventricles are the discharging chambers. In late ventricular diastole, the atrial chambers contract and send blood to the larger, lower ventricle chambers. This flow fills the ventricles with blood, and the resulting pressure closes the valves to the atria. The ventricles now perform ...
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Perfusion
Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue. Perfusion is measured as the rate at which blood is delivered to tissue, or volume of blood per unit time (blood flow) per unit tissue mass. The SI unit is m3/(s·kg), although for human organs perfusion is typically reported in ml/min/g. The word is derived from the French verb "perfuser" meaning to "pour over or through". All animal tissues require an adequate blood supply for health and life. Poor perfusion (malperfusion), that is, ischemia, causes health problems, as seen in cardiovascular disease, including coronary artery disease, cerebrovascular disease, peripheral artery disease, and many other conditions. Tests verifying that adequate perfusion exists are a part of a patient's assessment process that are performed by medical or emergency personnel. The most common methods include eva ...
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Permissive Hypotension
Permissive hypotension or hypotensive resuscitation is the use of restrictive fluid therapy, specifically in the trauma patient, that increases systemic blood pressure without reaching normotension (normal blood pressures). The goal blood pressure for these patients is a mean arterial pressure of 40-50 mmHg or a systolic blood pressure less than or equal to 80. This goes along with certain clinical criteria. Following traumatic injury some patients experience hypotension (low blood pressure) that is usually due to blood loss (hemorrhage) but can be due to other causes as well (for example, blood leaking around an abdominal aortic aneurysms). In the past, physicians were very aggressive with fluid resuscitation (giving fluids such as normal saline or lactated Ringer's through the vein) to try to bring the blood pressure to normal values. Recent studies have found that there is some benefit to allowing specific patients to experience some degree of hypotension in certain settings. Thi ...
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Resuscitation
Resuscitation is the process of correcting physiological disorders (such as lack of breathing or heartbeat) in an acutely ill patient. It is an important part of intensive care medicine, anesthesiology, trauma surgery and emergency medicine. Well known examples are cardiopulmonary resuscitation Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spont ... and mouth-to-mouth resuscitation. Variables See also * * * * * * * * * * {{Shock Critical emergency medicine Emergency medicine Intensive care medicine ...
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