Physiology of Muscle Breakdown and Shock

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Questions and Answers

What is a likely cause of Hg's symptoms, given his heart rate and distended neck veins?

  • Acute myocardial infarction
  • Pericardial tamponade (correct)
  • Hypertension
  • Pulmonary embolism

Which of the following is a possible consequence of delaying treatment for Hg's condition?

  • Decreased heart rate
  • Cardiac arrest (correct)
  • Increased blood pressure
  • Improved cardiac function

What is the primary function of the treatment option listed as 'B. Subxiphoid pericardiotomy'?

  • To increase blood volume
  • To strengthen the heart muscle
  • To relieve pressure on the heart (correct)
  • To regulate heart rate

Why might administering Ringer's lactate solution be considered in Hg's case?

<p>To increase blood pressure (C)</p> Signup and view all the answers

Which of the following is NOT a typical symptom of pericardial tamponade?

<p>Bradycardia (C)</p> Signup and view all the answers

What percentage of body weight does the plasma volume represent?

<p>10% (D)</p> Signup and view all the answers

If an individual weighs 70 kg, what is the approximate volume of their extracellular fluid?

<p>28 L (B)</p> Signup and view all the answers

Which cation is primarily found in the intracellular fluid?

<p>Potassium (B)</p> Signup and view all the answers

What is the approximate volume of plasma in an individual with 20 L of extracellular fluid?

<p>5 L (B)</p> Signup and view all the answers

Which of the following statements regarding extracellular fluid is TRUE?

<p>Extracellular fluid includes plasma and interstitial fluid. (C)</p> Signup and view all the answers

What is the primary purpose of the testing described in the content?

<p>To detect a wide range of bleeding disorders (D)</p> Signup and view all the answers

Which of these statements is TRUE about glucose production in the context of wound healing?

<p>Glucose production increases to provide fuel for healing processes. (B)</p> Signup and view all the answers

For which patients are studies of platelet aggregation specifically recommended?

<p>Patients suspected of having qualitative platelet function defects (D)</p> Signup and view all the answers

In addition to wound healing, which other tissues are mentioned as utilizing glucose?

<p>Nerve tissue and renal medulla (C)</p> Signup and view all the answers

What does the information suggest about the limitations of the described testing?

<p>It may not identify all possible causes of perioperative bleeding (C)</p> Signup and view all the answers

What is the primary function of glucose in wound healing?

<p>To provide energy for the repair and regeneration of tissues (D)</p> Signup and view all the answers

Which of the following is NOT a consequence of increased glucose production during wound healing?

<p>Improved tissue oxygenation (C)</p> Signup and view all the answers

Which of the following is NOT mentioned as a potential cause of perioperative bleeding?

<p>Underlying medical conditions (D)</p> Signup and view all the answers

What type of bleeding disorder is specifically mentioned as a reason to perform platelet aggregation studies?

<p>von Willebrand's disease (A)</p> Signup and view all the answers

What is the significance of the renal medulla utilizing glucose?

<p>To filter waste products from the blood (A)</p> Signup and view all the answers

Which of the following is NOT specifically mentioned as a crucial step in handling specimens and blood products?

<p>Storage (A)</p> Signup and view all the answers

What does the content suggest is the most common outcome of mishandling specimens or blood products?

<p>Allergic reactions (C)</p> Signup and view all the answers

Based on the information provided, what is the severity of reactions due to mishandling specimens or blood products?

<p>Potentially fatal but usually less severe (C)</p> Signup and view all the answers

What is the primary purpose of emphasizing careful handling of specimens and blood products?

<p>To minimize the risk of adverse reactions (D)</p> Signup and view all the answers

What is the main implication of the statement "Allergic and other reactions are common but rarely fatal"?

<p>Mishaps are frequent, but serious consequences are uncommon. (B)</p> Signup and view all the answers

What is the recommended course of action for patients scheduled for a major surgical procedure?

<p>All of the above. (D)</p> Signup and view all the answers

What is the primary purpose of a history and physical examination in the context of bleeding problems?

<p>To identify potential risk factors for bleeding. (D)</p> Signup and view all the answers

Which of the following laboratory tests is NOT commonly used to assess bleeding risk in patients scheduled for major surgery?

<p>Liver Function Test (LFT) (A)</p> Signup and view all the answers

What is the significance of performing a Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) test on patients scheduled for major surgery?

<p>To evaluate the coagulation cascade and clotting factors. (D)</p> Signup and view all the answers

What is the most likely outcome if a patient with a bleeding problem undergoes a major surgical procedure without proper assessment and management?

<p>Increased risk of excessive bleeding during and after surgery. (B)</p> Signup and view all the answers

Flashcards

Glucose production in healing

Increased glucose is produced to meet fuel needs during wound healing.

Wound healing fuel

The fuel requirements of healing wounds are primarily met by glucose.

Nerve tissue glucose use

Nerve tissue utilizes glucose as a substrate for energy.

Renal medulla glucose use

The renal medulla also requires glucose for metabolic processes.

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Glucose role in metabolism

Glucose serves as a primary energy source for various tissue functions in the body.

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Extracellular Fluid Volume

The total volume of fluid outside of cells, representing 40% of body weight.

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Plasma Volume

The volume of plasma which is one fourth of the total extracellular fluid volume.

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Potassium Cation

Potassium is the main positive ion found in extracellular fluid.

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Ratio of Plasma to Extracellular Fluid

Plasma volume is 25% of the total extracellular fluid volume.

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Cations in Extracellular Fluid

Potassium is the principal cation in the extracellular fluid; cations are positively charged ions.

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History and Physical Examination

A systematic evaluation to identify bleeding problems in patients.

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CBC (Complete Blood Count)

A blood test that evaluates overall health and detects disorders.

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Platelet Count

A test that measures the number of platelets in the blood.

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PT (Prothrombin Time)

A blood test that measures how long it takes blood to clot.

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APTT (Activated Partial Thromboplastin Time)

A blood test that assesses the intrinsic pathway of coagulation.

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Perioperative bleeding

Bleeding that occurs during or after surgery.

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Bleeding disorders

Conditions that affect the blood's ability to clot and stop bleeding.

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Platelet aggregation

The clumping together of platelets in the blood, crucial for clot formation.

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Qualitative defects of platelet function

Abnormalities in platelet behavior affecting their function, like in von Willebrand's disease.

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Von Willebrand's disease

A genetic disorder resulting in abnormal platelet function leading to excessive bleeding.

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Hg

Chemical symbol for mercury, a heavy metal.

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Heart Rate

The number of heartbeats per minute.

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Distended Neck Veins

Swollen veins in the neck indicating potential heart problems.

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Ringer's Lactate Solution

A sterile solution used for fluid and electrolyte replenishment.

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Subxiphoid Pericardiotomy

A surgical procedure to relieve pressure on the heart by draining fluid.

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Specimen handling importance

Proper labeling, transfer, and handling are critical for specimens and blood products.

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Reactions to blood products

Allergic and other reactions to blood products are common but usually not fatal.

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Cross-matched blood products

Cross-matching refers to testing compatibility between donor and recipient blood.

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Safe specimen transfer

Careful transfer procedures are essential to maintain specimen integrity.

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Importance of labeling

Precise labeling of specimens prevents identification errors and ensures safety.

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Study Notes

Skeletal Muscle Breakdown

  • Skeletal muscle breakdown primarily releases alanine and glutamine
  • Alanine is converted to glucose in the liver
  • Glutamine is involved in renal acid-base balance and cellular fuel

Glucose Production

  • Post-operative or post-traumatic glucose is used by the central nervous system, kidney, and healing tissues
  • Skeletal muscle primarily uses fatty acids
  • Bone primarily uses mineral substrates

Shock Definition

  • Shock is best defined as hypoperfusion of tissues
  • Hypoperfusion leads to tissue hypoxia (potential cause of hypoxemia)
  • Hypotension is a late indicator of shock

Neurogenic Shock

  • Neurogenic shock results from severe head injury, spinal cord injury, or high spinal anesthesia
  • These injuries cause sympathetic denervation, leading to vasodilation (arteriolar and venous) and increased venous capacitance
  • Characteristics include warm and dry extremities, tachycardia (sometimes bradycardia), and hypotension.
  • Volume replacement is typically the primary treatment

Cardiogenic Shock Treatment

  • Dobutamine, sodium nitroprusside, and Intra-aortic balloon pump (IABP) are useful in treatment
  • Pneumatic antishock garment (PASG) is not useful

Hemorrhagic Shock

  • Hemorrhagic shock causes an initial interstitial fluid contraction
  • The use of colloid solutions or hypertonic saline is not contraindicated and may be useful.
  • Decreased pulse pressure is an early indicator of hemorrhagic shock.

CNS Injury & Hyponatremia

  • Signs of increased intracranial pressure may be masked by hyponatremia
  • Hyponatremia may lead to oliguric renal failure
  • Rapid correction of hyponatremia may prevent central pontine myelinolysis

Extracellular Fluid

  • Extracellular fluid accounts for 20% of body weight.
  • Plasma volume is roughly 5% of total body weight
  • Sodium is the major cation in extracellular fluid

Bleeding Disorders

  • Acquired bleeding disorders are more frequent than congenital
  • Vitamin K deficiency reduces factors II, VII, IX, X, protein C, and protein S
  • Hypothermia can also disrupt platelet function, causing bleeding problems

Transfusion Reactions

  • Clerical errors are the most common cause of fatal transfusion reactions
  • ABO-incompatible transfusions are a primary danger of clerical error

Nutritional Support

  • The goal is maintaining body cell mass and preventing weight loss greater than 10%
  • Early nutritional support is crucial, prior to significant weight loss, in trauma patients to promote host defence mechanism

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