Norepinephrine Medication Quiz

Fluid Management and Shock Treatment in Emergency Medicine

• Hypovolemic and hemorrhagic shock result from absolute hypovolemia, causing decreased intravascular volume, venous return, ventricular filling pressure, stroke volume, and cardiac output, leading to inadequate tissue perfusion.
• Causes of hypovolemic and hemorrhagic shock include trauma, non-traumatic blood loss, gastrointestinal, genitourinary, and vascular causes, dehydration, vomiting, diarrhea, diuresis, sweating, third space losses, pancreatitis, peritonitis, and bowel obstruction.
• Signs and symptoms of hypovolemic and hemorrhagic shock include agitation/anxiousness, nausea/vomiting, decreased urine output, tachycardia, tachypnea, weak pulses, cool and diaphoretic skin, altered mental status, and hypotension.
• Initial management of non-bleeding hypovolemic shock involves maintaining oxygenation, ventilation, and administering IV fluid to maintain a mean arterial pressure (MAP) of 65, typically with a 20 ml/kg fluid bolus 2-3 times prior to vasopressors.
• Vasopressors, such as norepinephrine, are recommended for hypovolemic and hemorrhagic shock treatment, along with addressing the underlying cause of fluid loss, such as antiemetics and treatments for osmotic losses like DKA/HNKS.
• The 4-2-1 method is used for calculating maintenance fluid from dehydration in pediatrics, with specific fluid volumes based on the child's weight.
• In hypovolemic shock with bleeding, identifying the source of bleeding, controlling bleeding, and administering tranexamic acid (TXA) when indicated are crucial, along with keeping the patient warm and promptly initiating fluid therapy with lactated Ringer's or 0.9% normal saline.
• Massive transfusion protocols typically involve a 1:1:1 ratio of packed red blood cells (PRBC), platelets, and fresh frozen plasma, and the administration of blood must be accompanied by monitoring calcium levels due to citrate-induced hypocalcemia.
• Transfusion therapy considerations include using type O RH- blood as a universal donor and the administration of 1 unit of PRBCs raising hemoglobin by approximately 1 gram/dL or 10 gram/L.
• Transfusion reactions, which may include fever, back pain, bloody urine, chills, flushing, fainting, or dizziness, require immediate management, including stopping the transfusion, flushing the line with normal saline, and contacting medical direction for further care.
• Excess catecholamines can lead to a hypertensive crisis, caused by abrupt discontinuation of clonidine medication, pheochromocytoma, sympathomimetic drug toxicity, or MAOI and tyramine interactions.
• Treatment for catecholamine excess involves managing airway, oxygenation, and ventilation, avoiding

Understanding Hypovolemic Shock and Cardiogenic Shock

• Hypovolemic shock occurs due to loss of blood volume from exogenous (hemorrhage) or endogenous (fluid loss contained inside the body) causes, leading to low blood pressure and inadequate tissue perfusion.
• Adult females have 65ml/kg and males have 70ml/kg of blood volume, and significant changes in vital signs occur with blood loss of 1L or more.
• Compensation for blood loss is related to the speed of blood loss, and infants and children have less blood volume than adults.
• Relative hypovolemia can lead to distributive shock, such as neurological, anaphylactic, or sepsis shock, due to fully dilated vascular system causing low blood pressure.
• Shock occurs with inadequate tissue perfusion, leading to compensatory mechanisms including vasoconstriction, release of hormones, and increased cardiac output.
• Impaired cellular metabolism results from inadequate tissue perfusion, causing lactic acid production, metabolic acidosis, and changes in electrolytes.
• Shock can be compensated (early) or decompensated (late), with symptoms including weakness, altered mental status, tachycardia, and cardiac arrest.
• Late shock can lead to multi-organ dysfunction syndrome and relative bradycardia, especially in patients taking specific medications or with internal bleeding.
• Hypotensive blood pressure for pediatrics is determined by age, and any decrease in systolic blood pressure of 10mmHg from the baseline should prompt assessment for shock.
• Hypotensive patients with bradycardia may be experiencing cardiogenic shock, characterized by decreased cardiac output and vital organ perfusion.
• Clinical presentation of cardiogenic shock includes reduced cerebral and renal perfusion, pulmonary or pedal edema, and hypotension, and treatment involves oxygenation, ventilation, and possible vasopressors.
• In a trauma scenario, chest trauma can lead to cardiogenic shock, presenting with shortness of breath, cyanosis, and distended neck veins, requiring assessment and appropriate treatment.

Understanding Shock in Cardiac Patients

• Hypovolemic shock occurs when blood volume loss leads to low blood pressure, affecting tissue perfusion.
• Females have 65ml/kg blood, males have 70 ml/kg blood, and children have 80-80 ml/kg blood volume.
• Inadequate tissue perfusion leads to compensation mechanisms such as vasoconstriction and release of hormones.
• Impaired cellular metabolism due to inadequate tissue perfusion results in anaerobic metabolism and metabolic acidosis.
• Shock can be classified as compensated (early), decompensated (late), and relative bradycardia can occur.
• Late shock can lead to multi-organ dysfunction syndrome, including renal, respiratory, and liver failure.
• Hypotensive shock is characterized by weak peripheral pulses, altered mental status, and decreased urinary output.
• Cardiogenic shock is caused by reduced cardiac output and can lead to decreased LOC, peripheral vasoconstriction, and pulmonary edema.
• Treatment for cardiogenic shock includes oxygenation, ventilation, IV fluid therapy, and vasopressors.
• Hypotension in pediatric patients is defined using age-specific blood pressure percentiles.
• A hypotensive patient with pale, cool skin and diaphoresis may be experiencing cardiogenic shock.
• In cases of chest trauma, such as from an MVC, symptoms like SOB, cyanosis, and distended neck veins should prompt immediate assessment for cardiogenic shock.