外科急诊创伤(英文)-休克及出血.ppt

Hemorrhage Shock Sections Introduction to Hemorrhage  Shock Hemorrhage Shock Introduction to Hemorrhage Shock Hemorrhage Abnormal internal or external loss of blood Homeostasis Tendency of the body to maintain a steady and normal internal environment Shock INADEQUATE TISSUE PERFUSION Transition between homeostasis and death SHOCK “a momentary pause in the act of death” 1800’s Injury to one part of the body results in often fatal effect Strychnine to stimulate NS; seizures Electrical current alcohol Treatment Goals Recognition of early shock Appropriate airway management Rapid transportation to appropriate facility Hemorrhage Circulatory System Hemorrhage Classification Clotting Factors Affecting Clotting Hemorrhage Control Stages of Hemorrhage Hemorrhage Assessment Hemorrhage Management Cardiovascular System Delivery of nutrients and O2 to tissues and cells Transportation of waste products produced by metabolism to liver and kidneys Delivery of CO2 to lungs Components Heart or pump Blood vessels or pipes Blood or fluid Circulatory System Heart Parasympathetic Nervous System Slows rate Vagus Nerve Sympathetic Nervous System Increases rate Cardiac Plexus Cardiac Output Volume of blood pumped in 1 minute = 4-6L SV x HR SV = amount of blood ejected from left ventricle with each contraction Blood Pressure Directly proportional to the product of the CO multiplied by SVR BP = CO x SVR SVR, resistance to flow in the system (systemic vascular resistance) Stroke Volume Preload Represents filling of the ventricle Volume of blood delivered to atria prior to ventricular diastole Dependent on venous return Afterload Amount of resistance heart must overcome to eject blood Contractility Ability to contract, inotropy Frank Starling’s Law Inotropy Negative Scar tissue, CHF Beta adrenergic blockers Calcium channel blockers Positive Beta adrenergic agonists, B1 List some B blockers, Ca channel blockers, B agonists Names Indications Contraindications What would you expect to see