Med Surg 2 Final Exam Review
Shock - 13
1. Main goal is to prevent shock from occuring
2. Dec tissue perfusion and impaired cellular metabolism
a. Lack of O2 or imbalance in supply/demand leads to build up in lactic acid =
metabolic acidosis
3. Distrubutive Shock: mast cell release and fluid release around aveoli and tissues.
a. Swollen lips
4. Manfestations of shock:
a. Tachypnea
b. Hypotension
c. Hypoxia
i. Signs of hypoxia = cool and clammy
d. Decreased CO
5. Priorities for shock:
a. Improve perfusion to tissues = remove/treat cause & stabilize volume with normal
saline
i. Could be catheter, central line, burn, surgery, mi, sepsis etc.
b. Oxygenate
6. MODs = multuple organ dysfunction only needs 2 or more failing organs
7. SIRS = severe inflammatory response syndrome = suspect sepsis
a. Manifestations:
i. HIGH (>100.4) OR LOW TEMP (95.8>)
ii. Pulse > 90
iii. Resp > 20
1. Can also look at CO2
8. SIRS vs. Sepsis vs. Septic shock
a. Sepsis = SIRS is caused by an infection
b. Spetic shock = ICU
i. Hemodynamically unstable despite fluide replacement = MAP is < 65
mmHg/hypotensive
ii. Temp & HR are still elevate
9. Shock TX goals:
a. Within 1 6 hours
i. MAP above 65 mmHg
ii. CVP 8-12
iii. U/O more that 30 ml/hr
1. Assure we are not overloading
iv. Normalize lactate level
1. Done with a bicarbonate IV drip
v. Maintain glucose less than 150
, Burns - 5
1. Priorty care order: CABD
a. Circulation = replace fluid
i. Due to massive shift of fluid from intravascular to interstitial space = NO
BP
b. Airway = are they able to get air in? Burns on chest or neck?
c. Breathing = are they
d. (Neurological) Disability =
i. Oriented?
ii. Can they follow commands?
iii. Are they responding or know someone is in the room?
2. TX is based on rule of 9’s
a. Front & Back (so x2)
i. Head = 4.5% (so in total its 9%)
ii. Right arm = 4.5%
iii. Left arm = 4.5%
iv. Torso = 18%
v. FRONT PUBIC AREA ONLY = 1%
vi. Right leg = 9%
vii. Left leg = 9%
3. Parkland Formula = 4ml/kg/%TBSA
Ex: if someones left arm only on the front was totally burned and they weighed
50kg it would look like = 4ml/50kg/4.5%TBSA
If total arm 4ml/50kg/9%TBSA
GI - 5
1. Ulcerative colitis = bleeding in rectum
a. HOLD = heparin and nepracin
b. NO NSAIDS
c. Loosing volume and electrolytes = LOW platelets and Hgb
i. Monitor for bleeding
ii. Replace volume and electrolytes =
1. D5 normal saline with 20 K (potassium) = maintenance
2. Cholecyitis = Gallbladder ⇒ cholecytectomy (remove gall bladder)
a. Usually outpatient
b. Post-op = start on full liquid diet and advance after
3. Treat decreased LOC with cirrhosis with lactulose 3-4x a day to decrease ammonia levels
to decrease/prevent acidosis.
Shock - 13
1. Main goal is to prevent shock from occuring
2. Dec tissue perfusion and impaired cellular metabolism
a. Lack of O2 or imbalance in supply/demand leads to build up in lactic acid =
metabolic acidosis
3. Distrubutive Shock: mast cell release and fluid release around aveoli and tissues.
a. Swollen lips
4. Manfestations of shock:
a. Tachypnea
b. Hypotension
c. Hypoxia
i. Signs of hypoxia = cool and clammy
d. Decreased CO
5. Priorities for shock:
a. Improve perfusion to tissues = remove/treat cause & stabilize volume with normal
saline
i. Could be catheter, central line, burn, surgery, mi, sepsis etc.
b. Oxygenate
6. MODs = multuple organ dysfunction only needs 2 or more failing organs
7. SIRS = severe inflammatory response syndrome = suspect sepsis
a. Manifestations:
i. HIGH (>100.4) OR LOW TEMP (95.8>)
ii. Pulse > 90
iii. Resp > 20
1. Can also look at CO2
8. SIRS vs. Sepsis vs. Septic shock
a. Sepsis = SIRS is caused by an infection
b. Spetic shock = ICU
i. Hemodynamically unstable despite fluide replacement = MAP is < 65
mmHg/hypotensive
ii. Temp & HR are still elevate
9. Shock TX goals:
a. Within 1 6 hours
i. MAP above 65 mmHg
ii. CVP 8-12
iii. U/O more that 30 ml/hr
1. Assure we are not overloading
iv. Normalize lactate level
1. Done with a bicarbonate IV drip
v. Maintain glucose less than 150
, Burns - 5
1. Priorty care order: CABD
a. Circulation = replace fluid
i. Due to massive shift of fluid from intravascular to interstitial space = NO
BP
b. Airway = are they able to get air in? Burns on chest or neck?
c. Breathing = are they
d. (Neurological) Disability =
i. Oriented?
ii. Can they follow commands?
iii. Are they responding or know someone is in the room?
2. TX is based on rule of 9’s
a. Front & Back (so x2)
i. Head = 4.5% (so in total its 9%)
ii. Right arm = 4.5%
iii. Left arm = 4.5%
iv. Torso = 18%
v. FRONT PUBIC AREA ONLY = 1%
vi. Right leg = 9%
vii. Left leg = 9%
3. Parkland Formula = 4ml/kg/%TBSA
Ex: if someones left arm only on the front was totally burned and they weighed
50kg it would look like = 4ml/50kg/4.5%TBSA
If total arm 4ml/50kg/9%TBSA
GI - 5
1. Ulcerative colitis = bleeding in rectum
a. HOLD = heparin and nepracin
b. NO NSAIDS
c. Loosing volume and electrolytes = LOW platelets and Hgb
i. Monitor for bleeding
ii. Replace volume and electrolytes =
1. D5 normal saline with 20 K (potassium) = maintenance
2. Cholecyitis = Gallbladder ⇒ cholecytectomy (remove gall bladder)
a. Usually outpatient
b. Post-op = start on full liquid diet and advance after
3. Treat decreased LOC with cirrhosis with lactulose 3-4x a day to decrease ammonia levels
to decrease/prevent acidosis.
