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What is anaphylaxis?
- Hypersensitivty Type 1 reaction to already exposed sensitized person to a antigen that may cause respiratory arrest, vascular collapse, shock, accompanied with urticuria, angioedema, etc
What is the main mediator in the bodyt hat causes anayphylaxis?
What happens cardio in anaphylaxis?
- cardiac arrest
What local anestheics is more likely to have a rxn?
What is the epi dose for anaphylaxis?
0.3-0.5 ml of epi (1:1000 dilution)
What are the signs of shock?
- Increase venous pressure
- Pulmonary Edema
What do you do if the pt is in intense pain or dyspnea but no shock?
- IV and infuse D5W
- IV Morphine 2-5 mg every 10-20 min
- Blood gases
How do you know if you have a extopic pacemaker in the ventricle?
QRS is wider and the p wave will be absent
What causes torsades de pointes?
- STAT blood for toxins, electrolytes, ca, bun, creatinine, liver function
What can you give a comatose pt that won't hurt them?
- Glucose (D50)
- Thiamin- but give with glucose
- Corticosteriods- decrease cerebral edema
- Mannitol- reduce intracranial pressure
- Naloxone- 0.4-2.0 mg IV narcotic overdoes
- Valium 5-10 mg IV- Stop seizures
- Flumazenil IV- Reverse benzos overdose
What is the most important element in treating shock?
Organ perfusion with oxygenated blood
What are the signs of shock?
- Tachycardic: Earliest sign
- RR increases b/c of tissue perfusion decreases less oxygen so more lactic acid build up causing metabolic acidosis
- Capillary filling will decrease causing cold extremities
- Pulse pressure (difference between systolic and diastolic) will decrease because of raise in diastolic pressure b/c of catecholamines released during shock state increases peripheral resistance
- Change in metnal status: Early on
- Fall in systolic pressure with blood loss of 1500-2000ml
- Decrease in urinary output (20-30ml/hr in adult) shoudl return with fluids. Is sign that it is working 50ml/hr
- Hematocrit normal is 45% in males- low is significant blood loss or anemia
How much blood in the body?
5 liters (7% of body weight)
How much blood loss until you see mental stasus change?
How much blood loss can your body replace?
Greater than 40% or 2000 ml is life threatening?
Yes. No urine output, intervention needed
How much blood loss with a tibia fx?
750 ml (15% of blood)
How much in femoral blood loss?
3 units or (1500 ml)
What is the ratio of electrolyte replacement needed with blood loss?
- 300ml electrolyte for each 100ml of blood
What is initial management of hemorragic shock?
- 1- Airway (wanted >95%)
- 2- Hemorrhage control
- 3- Gastric decompression: Danger of aspiration b/c GI stops working
- 4- Vascular access: lare bore 16 gauge IV
- 5- Initial fluid replacement: Crystalloid isotonic electrolyte solution are used for resuscitation only. Ringers lactate is first choice follow by normal saline.
- 1-2 liters bolus in adults
- 6- Blood replacement: must cross match. Type O rh negative is the universal donor.
- 7-Peumatic antishock Garmet: device raises systolic pressure by increasing peripheral resistance and cardial afterload.
When is Bicarb indicated?
Metabolic acidosis and pH drops below 7.2