Fluid and Hemodynamics
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Fluid and Electrolytes
- Transport gases, nutrients, and wastes.
- Help generate the electrical activity needed to power body functions.
- Take part in the transforming of food into energy.
Composition and Compartmental Distribution of Body Fluids
- Body fluids distributed between intracellular and extracellular compartments.
- ICF- fluid contained w/in the cells of body.
- ECF- fluid contained outside the cells including water in interstitial tissue or spaces and bl. vessel.
- Cell membrane- main barrier to the mov't of substances between the ECF & ICF compartments
- the mov't of charged or uncharged particles along a concentration  gradient.
- all molecules & ions including h2o & dissolved molecules, are in constant random motion.
- The mov't of H2O across a semipermeable membrane.
- H2O moves from area of higher concentration of H2O to lower like diffusion.
- Tension or effect that effective osmotic pressure of a solution w/ impermeable solutes exert on cell size b/c of water mov't across the cell membrane.
- isotonic, hypotonic, hypertonic.
Compartmental Distribution of Body Fluids
- Body H2O:
- 40% of body weight from ICF
- 20 % of body weight from ECF
- -Plasma compartment 5% of body wt. Interstitial fluid compartment about 14% of body wt. Transcellular compartment about 1 % of body wt.
- Palpable swelling produced by an increase in interstitial volume.
- Doesn't become evident until interstitial volume has increased by 2.5-3 liters.
Edema from increased capillary filtration pressure
- Localized is caused by dialation of precapilary sphincters and aterioles that supply that swollen lesion.
- Generalized- reult of increased vascular volume seen in CHF or Rt. sided heart failure.
Edema from decreased capillary osmotic pressure
- Plasma proteins exert the osmotic needed to pull fluid back into the capillary from the tissues.
- Result in inadequate production or abnormal loss of plasma protein mainly albumin.
Edema from increased capillary permeability
- When capillary pores become enlarged or the integrity of the capillary wall is damaged, capillary permeability is increased.
- Plasma protein and active particles leak into the interstitial spaces, increasing the tissue collidal osmotic pressure and thereby contributing to the accumulation of interstitial fluid.
Edema from obstruction lymph flow
- Plasma proteins and other large particles that can't be reabsorbed throgu the pores in the capillary membrane rely on the lymphatic systems for movement back into the circulatory system.
- Lymphedema- edema due to imparied lymph flow often caused by cancer w/ lymph node involvement, infection and lymph trauma.
More about edema
- Increases distance for diffusion of O2, nutrients, and wastes.
- Increased risk of pressure ulcers and can compress bl. vessels.
Exceeds absortive capacity of tissue gel, tissue H2O is mobile and can be translocated w/ pressure
Non- Pitting edema
reflects on a condition where plasma protein have accumulated in the tissue spaces and coagulated
- An unusual amt of bl. in a part increase in quantity of bl. flowing through any part of the body shown by redness of skin
- Sudden obstruction of bl. vessel by debris.
- Bl. clots, cholesterol containing plaques, masses of bacteria, cancer cells, amniotic fluid, fat from broken bones, and injected substances may lodge in the bl. vessels and ocstruct circulation
- Formation or pressure of a bl. clot w/in the vascular system.
- Clot can occlude vessels, block bl. flow and O2 supply to part of an organ.
- If detaches, can travel and occlude a vessel at a distance from original site.
- Bl. loss.
- Episodes of bleeding that last more than a few mintues.
- Compromise organ or tissue perfusion.
- Clinical syndrome marked by inadequateperfusion and oxygenation of cells, tissues, and organs, usually as a result of marginal or markedly lowered bl. pressure.
- 4 types of shock: cardiogenic, hypovolvemic, Obstructive, and Distributive.
- Heart fails to pump bl. sufficiently enought to meet the body's demands.
- Decrease in cardiac output, hypotension, hyperfusion, and indications of tissue hypoxia despite an adequate intravascular volume.
- Dreases bl. volume so that there is inadequate filling of the vascular compartment.
- From accute bl. loss of 15-20 % of circulating volume.
- s/s- depend on severity, thirst, increased HR, cool, clammy skin, decreased BP, dec. urine output, change in mental status.
- Shock from mechanical obstruction of the flow of bl. through the central circulation.
- Caused by dissecting aortic aneurysm, cardiac tamponade, pneumothorax, atrial myxoma, and evisceration of abdominal contents into thoracic cavity from ruotured diaphragm, pulmonary embolism.
- Vasodialatory shock- loss of bl. vessel tone, enlargement vascular compartment, and displacement of vascular volume away from the heart and central circulation.
- 2 main causes result in vesssel tone: Decrease in sympathetic control of vasomotor tone, release of extensive vasodialator substances.
3 Shock states of distributive shock
- Neurogenic shock- caused by decreased sympathetic control of bl. vessel tone.
- Anaphylactic shock- immunilogically mediates reaction in which vasodialator substance such as histamine are released.
- Septic shock- vessel dialates systemic responseto serious problem.
Complications of shock
- acute lung injury/ acute respiratory distress syndrome.
- acute renal failure
- GI complications.
- disseminated intravascular coagulation.
- multiple organ dysfunction syndrome.
- stoppage of bl. flow.
- normal process is regulated by complex array of activators and inhobitors that maintain bl. fluidity and prevent bl. from leaving the vascular compartment.
- normal when seals bl. vessel toprevent bl. loss and hemorrhage.
- abnormal when it causes inappropriate bl. clotting or when clotting is insufficient to stop the flow of bl. from vascular compartments.
Components of Hemostasis
- Platelets- platelet production is controlled by thrombopoeitin which are found in liver, kidney, smooth muscle, and bone marrow.
- Coagulation- use of plasma proteing that are present as inactive procoagluation factors.
- Endothelium- endothelial cells line vessels that modulated several, and frequently opposite, stages of normal hemostasis.
Clot formation and dissolution
- Hemostasis 5 stages:
- vessel spasm, platelet plug formation, bl. coagulation or development of an insoluble fibrin clot, clot retraction, and clot dissolution.
Hemostatic surgical agents/ devices
- Thermal hemostatic mechanism- ESU, Laser Unit, and Harmonic scapel.
- Chemical Hemostatic agents- Gel foam, avitene, surgicel or oxycel, and epinephrine.
Mechanical hemostatics- clamps, ligatures, clips, spnges, pladgets, bone wax, suction, pressure devices or tourniquets, and drains.
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