Fluid Therapy

Originally posted by Surgicalcric
Loss of as little as 1/5th of circulating volume can cause Hypovolemia.

do all cases of hypovolemia cause hypotension? This leads into the 4 classes of shock and the symptoms of each...

guess that is the homework of the evening...

easy enough to find... amount of blood loss, percent of circulating volume, HR, RR, BP, pulse pressure, mental status, urine output and resuscitation for each...

post either here or the shock folder...

(I am intruding as usual)

doc t.

[NousDefionsDoc]

Intruding? No way. I'll work on it tomorrow if Cric boy doesn't beat me to it.

[Surgicalcric]

CARDIOGENIC: When the heart fails to pump enough blood.
Causes: MI when 40-50% of the myocardium is destroyed, or secondary to valve dysfunction or cardiomyopathies or cardiac arrest
S/S: Increased workload on ventricles from catecholamine release; Restlessness; weakness; alterations in mentation; Decreased urine output (oligouria); Alterations of peripheral perfusion; pallor; cyanosis; Tachycardia; hypotension; dysrhythmias; Deteriorated pulmonary status (congestion and/or edema) and eventually Cardiac arrest
TX: CPR and follow ACLS protocols, Vasopressors and diuretics, Intra-aortic balloon device or ventricular assist devices, Heart transplant

HYPOVOLEMIC: When volume of bloods loss is enough to inhibit tissue perfusion.
Causes: Hemorrhage, Vomiting and diarrhea, Burns, third space fluid loss.
S/S:
Mild: Volume loss is 10%;CO is decreased and SNS is activated; Skin is pale, cool and clammy; Mucosa is mildly dry; Skin turgor is decreased; Anxiety, restlessness, thirst, weakness
Moderate: Volume loss is 15-40%; CO and BP decrease dramatically; Tachycardia; tachypnea; pallor; Poor skin turgor; Thirst; restlessness; weakness; Decreased urine output
Severe: Volume loss exceeds 45%; Vital organ functions display effects of decreased perfusion; Decreased level of consciousness; confusion; agitation; Metabolic acidosis; and eventually death
TX: treat cause of loss and replace fluid loss 3:1 with an isotonic solution and packed RBC

DISTRIBUTIVE: When there is a loss is SVR.
Causes: Sepsis(TSS, SIRS), Neurological trauma, or Anaphylaxis from food, drugs, or insect stings
S/S:
Sepsis: Hypotension, Fever, Decreased CO, tachycardia, dysrhythmias, Clammy, pale skin, Pulmonary congestion, tachypnea
Anaphylaxis: Alterations in mentation; Urticaria; pruritus; Bronchoconstriction; tachypnea; wheezing; Warm and flushed skin;Tachycardia; angina; dysrhythmias; hypotension; Decreased CO
Neurologic: Alterations in LOC; Cool and clammy skin above lesion; Warm and dry below lesion; Bradycardia; Hypotension; Tachypnea
TX: IV fluids to fill container, Probably give vasopressors
Sepsis: ID and eliminate nidus of infection, ABX therapy
Anaphylaxis: benadryl 50mg IV, 1mg 1:10,000EPI IV(if patient is mearly having an allegic reaction .03mg 1:1000 EPI SQ)
Neurological: fix spinal dysfunction, steroids, vasopressors

OBSTRUCTIVE: When something permits the heart from pumping.
Causes: Cardiac Tamponade, Pneumothorax, or PE
S/S: b/p drop as tamponade becomes greater, pulse pressures narrow, Tachycardic, tachypnic, skin cool/clammy, LOC drops as CO decreases.
TX:
Cardiac Tamponade: Pericardialcentesis
Pneumothorax: Needle/tube Thorocotomy
PE: Systemic anticoagulation, possibly thrombolysis or surgical embolectomy.

those are the different types of shock...not the different classes but GREAT job....

now back to the drawing board for the real answer however....

doc t.

[Surgicalcric]

Sorry DocT. Somehow when I read "Classes of shock" I thought 4 types of shock.

JD

no need to apologize... it is a great piece for on here... but the question Sneaky has asked (sorry, cannot remember all those initials) was about percentage of losses to achieve hypotension...

the classes of shock spell this out very well. If you cannot find it and Sneaky doesn't respond soon I'll post the stuff later when I have a moment...

doc t.

[Surgicalcric]

For a 70kg male

Class 1
Blood Loss(ml) <750
Blood Loss(%BV) <15%
Heat Rate <100
Pulse Pressure(mmHg) Normal
Repiratory Rate 14-20
Urine Output(ml/hr) >30
CNS/Mental Status Slightly anxious
Fluid Replacement Crystalloid

Class 2
Blood Loss(ml) 750-1500
Blood Loss(%BV) 15-30%
Heat Rate >100
Pulse Pressure(mmHg) Normal
Repiratory Rate 20-30
Urine Output(ml/hr) 20-30
CNS/Mental Status Mildly Anxious
Fluid Replacement Crystalloid

Class 3
Blood Loss(ml) 1500-2000
Blood Loss(%BV) 30-40%
Heat Rate >120
Pulse Pressure(mmHg) Decreased
Repiratory Rate 30-40
Urine Output(ml/hr) 5-15
CNS/Mental Status Anxious & Confused
Fluid Replacement Crystalloid & Blood

Class 4
Blood Loss(ml) >2000
Blood Loss(%BV) >40%
Heat Rate >140
Pulse Pressure(mmHg) Decreased
Repiratory Rate >35
Urine Output(ml/hr) Negligible
CNS/Mental Status Confused & Lethargic
Fluid Replacement Crystalloid & Blood

[Sacamuelas]

................................Class I.........ClassII.....ClassIII.....ClassIV
Blood loss(%).......... <15.............15-30.......30-40........>40
Blood Loss(ml) ..........<750.......750-1500...1500-2000..>2000
Pulse rate ...............Normal........100-110...120............>120
Systolic....................Normal.........Normal. ....Low...........Very Low
Diastolic...................Normal.........High... ......Low...........Very Low
Capillary Refill..........Normal.........Slow........Slow... ........Absent
Mental State............Alert.............Anxious...Confu sed...Lethargic
Resp. Rate...............Normal.........Normal.....Tachy .........Tachy
Urine Output............>30 ml/hr.....20-30......5-20 ml .....<5 mls/hr

***above reference is for average adult with no medicines that could alter baselines

much better..

but not sure your source...most charts show a drop in pulse pressure with Class II shock, and ultimately SBP drops in Class III shock...

so to answer Sneaky's question....

Class III shock would typically be the level to START seeing hypotension...or a 30-40% blood volume loss....

[Sacamuelas]

Didn't mean to double post your info James...
I was copying my old post while you typed that out.

[Surgicalcric]

It is from my paramedic notes. Albeit they are now 13 years old.

I somehow missed B/P in my chart. I have it here but somehow missed adding it.

James D

[Surgicalcric]

Originally posted by Sacamuelas
Didn't mean to double post your info James...
I was copying my old post while you typed that out.

NP.

Welcome.

James D