NSE 22A/B Lecture : Shock Managment
16 Dec 2011
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100 % o2 administration ( hbo- hyperbarric oxygenation)to increase o2 saturation and tissue perfusion. Tracheostomy may be done to assist with breathing. Shock position: legs elevated to promote venous return body flat to increase cardiac output head slightly elevated to avoid icp. Anti-shock suit( mast military anti-shock trouser) used primarily in managing massive blood loss. Fluid replacement: to correct f & e imbalance & protein deficiencies to correct acidosis extra fluid is required as microvascular space is expanded due to microvascular pooling; extra fluid to fill the capillaries. Flow to veins co bp during fluid shift blood. Vasoconstriction capillary blood flow tissue perfusion + coagulation . Dic extra fluid decreases the catecholamine concentration in extra fluid to replace the intracellular fluid mobilized. Crystalloids : isotonic & hypotonic sodium to increase intravascular volume. Ringers lactate ( lactate is converted to bicarbonate by liver . l metabolic acidosis. Colloid solutions contain molecules large enough to remain within vascular compartment.
