國外休克課件

SHOCKJeremyMaddux,NREMTP..SHOCKJeremyMaddux,NREMTP..1DefinitionsShock:“Thebody’sresponsetopoorperfusion”AKA:HypoperfusionPerfusion:“Theprocessbywhichoxygenatedbloodisdeliveredtothebody’stissueandwastesareremovedfromthetissue”..DefinitionsShock:“Thebody’s2DefinitionsAerobicMetabolism:“Metabolismwithoxygen”AnaerobicMetabolism:“Metabolismwithoutoxygen”Decreasedperfusionleadsto:ShockAnaerobicmetabolismBuildupoftoxins..DefinitionsAerobicMetabolism:3FluidsandElectrolytesWater60%MixedwithproteinsandelectrolytesSenttovariouscompartmentsinthebodyIntracellularfluid-75%Extracellularfluid-25%Interstitialfluid-17.5%Intravascularfluid-7.5%..FluidsandElectrolytesWater..4ElectrolytesSubstancesthatdissociateintoelectricallychargedparticleswhenplacedintowater.Chargedparticlesarecalled“ions”.Positivecharge=“cation”Negativecharge=“anion”..ElectrolytesSubstancesthatdi5CationsandAnionsCations-positivelychargedSodiumNa+PotassiumK+CalciumCa++MagnesiumMg++Anions-negativelychargedChlorideCl-BicarbonateHCO3-PhosphatePO4-..CationsandAnionsCations-po6CationsSodium(Na+)MostprevalentcationintheextracellularfluidPlaysamajorroleinregulatingthedistributionofwaterPotassium(K+)MostprevalentcationintheintracellularfluidTransmissionofelectricalimpulses..CationsSodium(Na+)..7“NextofKin”“N”extSodium(Na+)Mostprevalentcationintheextracellularfluid“K”inPotassium(K+)Mostprevalentcationintheintracellularfluid..“NextofKin”“N”ext..8CationsCalcium(Ca++)MusclecontractionNervousimpulsetransmissionMagnesium(Mg++)SeveralbiochemicalprocessesCloselyassociatedwithphosphateinmanyprocesses..CationsCalcium(Ca++)..9AnionsChloride(Cl-)MostprevalentanionintheextracellularfluidFluidbalanceandrenalfunctionBicarbonate(HCO3-)PrinciplebufferofthebodyNeutralizeshighlyacidichydrogenion(H+)..AnionsChloride(Cl-)..10AnionsPhosphate(HPO4-)MajorintracellularanionImportantinbodyenergystoresHelpsmaintainacid-basebalance..Anions..11CellularMembranesPermeabilityThedegreetowhichasubstanceisallowedtopassthroughacellmembraneSemipermeableCellmembranesthatallowonlycertainsubstancestopassthroughthem..CellularMembranesPermeability12DiffusionMovementofsolutesfromanareaofgreatersoluteconcentrationtoanareaoflowersoluteconcentration..DiffusionMovementofsolutesf13OsmosisMovementofwaterfromanareaoflowersoluteconcentrationtoanareaofhighersoluteconcentration..OsmosisMovementofwaterfrom14ActiveTransportMovementofasubstanceacrossthecellmembraneagainsttheosmoticgradientFasterthandiffusionRequiresenergyExample:Sodium-PotassiumPump..ActiveTransportMovementofa15FacilitatedDiffusionRequirestheassistanceof“helperproteins”Proteinbindstomoleculechangingit’sconfigurationMayormaynotrequireenergyExample:Insulin&Glucose..FacilitatedDiffusionRequires16CrystalloidsIsotonicFluidsLactatedRingersNormalSalineHypotonicFluidsD5W?NSHypertonicFluids3%NS10%NS..CrystalloidsIsotonicFluidsHyp17IsotonicSolutionsStateinwhichsolutionsonoppositesidesofasemi-permeablemembraneareequalinconcentrationThereisNOfluidshift!..IsotonicSolutionsStateinwhi18HypotonicSolutionsStateinwhichasolutionhasalowersoluteconcentrationononesidethantheotherThereisashiftintotheintracellularfluid!..HypotonicSolutionsStateinwh19HypertonicSolutionsStateinwhichasolutionhasahighersoluteconcentrationononesidethantheotherThereisafluidshiftintotheinterstitialfluid!..HypertonicSolutionsStateinw20ColloidsContainproteinsorotherhigh-molecular-weight-moleculesTendtostayinvasculatureforextendedperiodsoftimeHave“colloidosmoticpressure”Tendtoattractwaterintotheintravascularspaces..ColloidsContainproteinsorot21ColloidsPlasmaProteinFractionContainsalbumin&salineSalt-PoorAlbuminContainsonlyhumanalbuminDextranLargesugarmoleculeHetastarch(Hespan)Sugarmolecule..ColloidsPlasmaProteinFractio22BloodComponentsPlasma54%RedBloodCells45%WhiteBloodCells1%Platelets1%..BloodComponents..23BloodComponentsPlasmaFluidportionofbloodContainsproteins,carbohydrates,aminoacids,lipids,&mineralsaltsErythrocytesMostnumerouscellsinbloodCarryhemoglobin..BloodComponentsPlasma..24BloodComponentsLeukocytesFightinfectionProduceantibodiesPlateletsEssentialforclotformation..BloodComponents..25HematocritPercentageofredbloodcellsinwholebloodWomen42(+/-5)Men45(+/-7)..HematocritPercentageofredbl26BloodTyping..BloodTyping..27BloodDonorCompatibility..BloodDonorCompatibility..28Let’sLookatPerfusionTheFickPrinciple..Let’sLookatPerfusionTheFic29FickPrincipleAdequateconcentrationofinspiredoxygenOn-loadingofoxygentoredbloodcellsatlungsDeliveryofredbloodcellstotissuecellsOff-loadingofoxygenfromredbloodcellstotissuecells..FickPrincipleAdequateconcent30Adequateperfusionrequiresthat

allcomponentsofthe

“FickPrinciple”areinplace!..Adequateperfusionrequiresth31FickPrinciple1.

Adequateconcentrationofinspiredoxygenrequires:AdequateventilationHighconcentrationofinspiredoxygenUnobstructedairpassages..FickPrinciple1.Adequatecon32FickPrinciple2.

On-loadingofoxygentoredbloodcellsatlungsrequires:Minimalobstructionacrossalveolar-capillarymembraneandAppropriatebindingofoxygentohemoglobin..FickPrinciple2.On-loadingo33FickPrinciple3.

Deliveryofredbloodcellstotissuecellsrequires:NormalhemoglobinlevelsCirculationofoxygenatedcellstotissuesAdequatecardiacfunctionAdequatevolumeofbloodflowProperroutingofbloodthroughvasculature..FickPrinciple3.Deliveryof34FickPrinciple4.

Off-loadingofoxygenfromredbloodcellstotissuecellsrequires:CloseproximityoftissuecellstocapillariesIdealpHIdealtemperature..FickPrinciple4.Off-loading35Removeanycomponent

fromthe“FickPrinciple”

andshockwillfollow!..Removeanycomponent

fromthe36NutritionCellsrequireacontinuoussupplyofnutrientsEx:Glucose,OxygenWorkloaddemandsdeterminetherateofneedThebodyautomaticallyadjusts..NutritionCellsrequireaconti37CellularRespirationBreakdownoffoodintoenergyAerobicAnaerobic..CellularRespirationBreakdown38AerobicMetabolismRequiredfuelsGlucoseOxygenWasteproductsPyruvicacidLacticacidCarbondioxideMethodofexcretionRespirationUrination..AerobicMetabolismRequiredfue39AnaerobicMetabolismUsesglucoseonlyAlmost20timeslessefficientthanaerobicCausesdramaticincreaseinlacticacidproduction,andthereforemetabolicacidosisVasculardilationfollows,causingafurthershiftinfluidsoutofthevascularspaceandintotheinterstitialspaceFurther,potassiumshiftsoutofthecell,andsodiumin,whichcausescellmembraneinstability..AnaerobicMetabolismUsesgluco40DeathComethBrainandLungsDiewithin4to6minuteswithoutoxygenOrgansDiewithin45to90minuteswithoutoxygenSkinandmuscleDiewithin4to6hourswithoutoxygen..DeathComethBrainandLungs..41TheCardiovascularSystem’sRoleThePump,TheFluid,&TheContainer!..TheCardiovascularSystem’sRo42ThePump,TheFluid,

&TheContainer!..ThePump,TheFluid,

&TheCo43ThePumpBloodPressureCardiacOutputSystemicVascular

ResistanceStrokeVolumeHeartRatePreloadMyocardialContractilityAfterload..ThePumpBloodPressureCardiac44StrokeVolumeAmountofbloodejectedfromtheheartwitheverycontractionAffectedby:PreloadContractilityAfterloadStrokeVolumePreloadMyocardialContractilityAfterload..StrokeVolumeAmountofbloode45StrokeVolumeNormal60-100ccperbeatforaverageadultEjectionFractionPercentageofbloodintheventriclethatisejectedduringsystole,>50%,orawaytomeasurethe“efficiency”ofthe“fuelpump”..StrokeVolumeNormal..46PreloadHeartmuscleisstretchedaschambersfillwithbloodbetweencontractions.Stretchingmusclefibersbeforecontractionincreasesstrengthofcontraction...Preload..47PreloadInfluencedbyvolumeofbloodreturningtoheart.Morebloodreturningincreasespreload;lessbloodreturningdecreasespreload.Morestretchofmusclesmeansmoreforcefulcontraction.FrankStarling’sLaw..PreloadInfluencedbyvolumeof48FrankStarling’sLawMoretheheartisfilledduringdiastole,thegreaterthequantityofbloodthatwillbepumpedduringsystoleIncreaseinvolumestretchestheheartmuscleandincreasesstrokevolumeandthusincreasescardiacoutputThinkofa“rubberband”..FrankStarling’sLawMoretheh49ContractilityContractilityisextentandvelocityofmusclefibershortening.Influencedby:OxygensupplyanddemandSympatheticstimulationElectrolytebalanceCalcium..ContractilityContractilityis50AfterloadPressureventricularmusclesmustgeneratetoovercomehigherpressureinaorta.Greaterafterloadmeansharderworkforventriclestoejectbloodintoarteries.Dictatedtolargedegreebybloodpressure...AfterloadPressureventricular51CardiacOutputAmountofbloodejectedfromthehearteachminuteAffectedby:StrokeVolumeHeartRateCardiacOutputStrokeVolumeHeartRateCardiacOutput

=

StrokeVolume

X

HeartRate..CardiacOutputAmountofblood52BloodPressureForcethatbloodexertsagainstarterialwallsAffectedby:CardiacOutputSystemicVascularResistanceBPCardiacOutputSystemicVascular

ResistanceBP

=

CardiacOutput

X

SystemicVascularResistance..BloodPressureForcethatblood53TheFluidSignificantfluidlossAdult=1literChild=?literInfant=100to200mLDecreasedHematocritHemoglobinRememberthe“FickPrinciple”..TheFluidSignificantfluidlos54TheContainerContinuous,closed,pressurizedpipelinethatmovesbloodthroughbody.Elasticbloodvesselsadjustfluidvolumeofcontainer.SystemicControlLocalControlAffectsamountofbloodreturningtoheartandamountoftissueoxygenation...TheContainerContinuous,close55TheNervousSystem&It’sRole!..TheNervousSystem&It’sRole56ReceptorsSensorynerveendingsthatsensechangesinbloodpressureorcarbondioxideBaroreceptors(pressure)locatedin:AorticarchWallsoftheatriaVenacavaCarotidsinusChemoreceptors(CO2)locatedin:BrainandspinalcordNotifythesympatheticnervoussystem..ReceptorsSensorynerveendings57SympatheticNervousSystem“FightorFlight”responseIncreasesheartrateStimulatesthehearttobeatmoreforcefullyRespirationsIncreaseReleaseofnorepinephrine“Clampsdown”onbloodvesselsKidneysdecreaseurinaryoutputtoconservewater..SympatheticNervousSystem“Fig58TheStagesofShockCompensatedShockAKA:NonprogressiveShockUncompensatedShockAKA:ProgressiveShockIrreversibleShock..TheStagesofShockCompensated59CompensatedShockEarliestphaseUpto15-25%bloodlossBodycompensatesActivatesthesympatheticnervoussystem..CompensatedShockEarliestphas60CompensatedShockSigns/SymptomsAlteredLOCIncreasedpulserateIncreasedrespiratoryratePale,coolskin..CompensatedShockSigns/Sympt61....62DecompensatedShockBloodvolumedropgreaterthan15-25%MechanismsnolongerabletomaintainEvenmorenorepinephrineisreleasedCardiacoutputdrops..DecompensatedShockBloodvolum63DecompensatedShockSigns/Symptomsmoreobvious,plusAdditionalincreaseinpulseandbreathingCool,clammyskinDecreasedcapillaryrefillNarrowingofpulsepressureSweatingIncreasedanxietyandconfusionNauseaandvomiting..DecompensatedShockSigns/Sym64....65IrreversibleShockRapiddeteriorationofthecardiovascularsystemGreaterbloodshuntingtoheartandbrainCelldeathbeginsMaydevelopoverseveraldays..IrreversibleShockRapiddeteri66IrreversibleShockSigns/SymptomsMarkeddecreaseinlevelofresponsivenessDecreasedrespiratoryrateandeffortProfoundhypotensionDecreaseinpulseratePatienthasfeelingsofimpendingdoom..IrreversibleShockSigns/Symp67....68TypesofShockHypovolemicshockCardiogenicshockNeurogenicshockAnaphylacticshockSepticshock..TypesofShockHypovolemicshoc69HypovolemicShockMostcommonformofshockLossofbloodorfluidfrombodyInternalorexternalhemorrhageBurnsSeveredehydrationAllpatientsinshockshouldbeconsideredashypovolemicuntilprovenotherwise..HypovolemicShockMostcommonf70CardiogenicShockCausedbyprofoundfailureoftheheartSevereMISevereheartfailureTraumatotheheartThereisgoodperipheralvascularresistanceandadequatebloodvolume,buttheheartisnotpumpingproperly..CardiogenicShockCausedbypro71NeurogenicShockThenervoussystemisnolongerabletocontrolthediameterofthebloodvesselsLeadstorelativehypovolemiaUsuallyfromseverebrainorspinalcolumninjuryMayhaveunusualSigns/Symptoms..NeurogenicShockThenervoussy72AnaphylacticShockCausedbyexposuretoasubstancetowhichthepatientishighlyallergicSkincontact–poisonivy,poisonoakInjections–medications,insects,stingsInhalation–molds,pollen,perfumesIngestion–chocolate,shellfish,peanuts..AnaphylacticShockCausedbyex73AnaphylacticShockHistaminereleasecauses:Sudden,severebronchoconstrictionIntensevasodilationLeakingoffluidfromvesselsduetoachangeinpermeability..AnaphylacticShockHistaminere74AnaphylacticShock:

Signs&SymptomsSenseofuneasinessoragitationSwellingHands,tongue,orpharynxSkinflushingandhivesTachycardiaCoughing,sneezing,orwheezingTingling,burning,oritchingAbdominalpainProfoundhypotensionDecreasedLOC..AnaphylacticShock:

Signs&Sy75SepticShockCausedbyaninfectionresultinginmassivevasodilationBloodplasmalostthroughvesselwallsResultsinarelativehypovolemiaS/SMaybefebrileMayhavewarmtrunk,coolextremitiesWholebodycoolisBAD..SepticShockCausedbyaninfec76Managementofthe

PatientinShockWorktomaintainadequatebloodpressureandperfusevitalorgans.Rapidassessmentandimmediatetransportationareessentialforpatientsurvival...Managementofthe

Patientin77Managementofthe

PatientinShockEvaluationdirectedatassessingoxygenationandperfusionofbodyorgansGoalsofpre-hospitalcareinclude:EnsuringapatentairwayProvidingadequateoxygenationandventilationRestoringperfusion..Managementofthe

Patientin78LevelofConsciousnessAssessedthroughoutinitialsurvey.Betterindicatoroftissueperfusionthanmostothervitalsigns.Assumealteredmentalstatusisduetodecreasedcerebralperfusion...LevelofConsciousnessAssessed79LevelofConsciousnessRestlessnessoragitationDisorientationConfusionInabilitytorespondBelligerentorcombativebehaviorUnresponsive..LevelofConsciousnessRestless80AirwayOpeningtheairwayHead-tilt,chin-liftModifiedjawthrustSoundsthatmayindicateairwayobstructioninclude:Snoring(tongue)Gurgling(liquidssuchasbloodorvomitus)Stridor(foreignbody/swelling)..AirwayOpeningtheairway..81AirwayUseairwayadjunctsifnecessary.Endotrachealintubationispreferredtopreventaspirationofblood.Clearbloodorfluidswithsuction.Removelargeforeignobjectswithfingersweep...AirwayUseairwayadjunctsifn82Breathing&OxygenationLOOK,LISTEN&FEEL,forairexchange.RATE,DEPTH,andQUALITYofrespirations...Breathing&Oxygenation..83Breathing&OxygenationProvide100%oxygenwithnonrebreathermaskat10to15L/min.Ensurereservoirremainsinflatedatendofeachinspiration.Forassistedventilations,supply100%oxygenviabag-valve-mask...Breathing&OxygenationProvide84CirculationLookforandcontrolobviousexternalbleeding.AssessRATE,RHYTHM,&QUALITYofpulse.Palpablepulselocationmayprovideestimateofsystolicpressure.Notecolor,appearance,andtemperatureofskin...CirculationLookforandcontro85CirculationAfast,weak,orthreadypulsesuggestsdecreasedcirculatoryvolumeColor,appearance,andtemperatureoftheskinPaleMottledCyanoticCapillaryrefill..CirculationAfast,weak,orth86CirculationControlanyobviousexternalbleedingDirectpressureElevationPressurepointsTourniquetPASGRemembercompensatorymechanismscanmaintaina10to15%volumeloss..CirculationControlanyobvious87CirculationElevatepatient'slegs.Apply,andifnecessaryinflatethepneumaticanti-shockgarment.Place2largeboreIVlines...CirculationElevatepatient'sl88PneumaticAnti-ShockGarmentTooltocareforhypotensionandshock.Helpscontrolbleedingbyapplyingpressuretobloodvessels...PneumaticAnti-ShockGarment..89PASGIndicationsHypovolemicshockfromanycause.Hypotensionsecondarytodecreasedcardiacoutput.Fracturestabilization.CriteriaforPASGincludesystolicbloodpressurebelow90mmHgwithobvioussignsandsymptomsofshock...PASGIndicationsHypovolemicsh90PASGContraindicationsPulmonaryedema(absolutecontraindication).Abdominalcompartmentinflationiscontraindicatedin:PregnancyRespiratorydistressofanynatureEviscerationCasesofimpaledobjectsinabdomen..PASGContraindicationsPulmona91PASGComplicationsUseinpresenceofchestinjuries.Mayincreasebleedinginintrathoraciccavityleadingtotensionhemopneumothorax.Willincreasebreathingdifficultyinpatientwithflailsegment...PASGComplicationsUseinprese92PASGPneumaticAnti-ShockGarmentBPto100mmHg,orvelcrocrackles..PASGPneumaticAnti-ShockGarm93FluidReplacementIVlinesareusedtocounterbloodlossbyintroducingfluidintointravascularspace.Fluidshelprestorecirculatingvolumeuntilbodycanmanufacturemoreblood.PatientinhypovolemicshockneedsatleasttwoIVlines...FluidReplacementIVlinesare94MaintainBodyTemperatureMaintainbodytemperatureasclosetonormalaspossible.Payattentionto:Environmental/WeatherConditionsTemperatureofoxygenandIVfluidsLocationofpatientProtectpatientfromelements...MaintainBodyTemperatureMaint95MaintainBodyTemperatureRemovewetclothing.Coverpatienttopreventheatloss.Toomuchheatproducesvasodilation,counteractingbody'svasoconstrictivecompensatoryefforts...MaintainBodyTemperatureRemov96KeystoSuccess!MaintainahighlevelofsuspicionAnticipatethepotentialforshockDonotget“tunnelvision”EnsureapatentairwayProvideadequateoxygenationandventilationRestoreperfusion..KeystoSuccess!Maintainahig97Questions?..Questions?..98SHOCKJeremyMaddux,NREMTP..SHOCKJeremyMaddux,NREMTP..99DefinitionsShock:“Thebody’sresponsetopoorperfusion”AKA:HypoperfusionPerfusion:“Theprocessbywhichoxygenatedbloodisdeliveredtothebody’stissueandwastesareremovedfromthetissue”..DefinitionsShock:“Thebody’s100DefinitionsAerobicMetabolism:“Metabolismwithoxygen”AnaerobicMetabolism:“Metabolismwithoutoxygen”Decreasedperfusionleadsto:ShockAnaerobicmetabolismBuildupoftoxins..DefinitionsAerobicMetabolism:101FluidsandElectrolytesWater60%MixedwithproteinsandelectrolytesSenttovariouscompartmentsinthebodyIntracellularfluid-75%Extracellularfluid-25%Interstitialfluid-17.5%Intravascularfluid-7.5%..FluidsandElectrolytesWater..102ElectrolytesSubstancesthatdissociateintoelectricallychargedparticleswhenplacedintowater.Chargedparticlesarecalled“ions”.Positivecharge=“cation”Negativecharge=“anion”..ElectrolytesSubstancesthatdi103CationsandAnionsCations-positivelychargedSodiumNa+PotassiumK+CalciumCa++MagnesiumMg++Anions-negativelychargedChlorideCl-BicarbonateHCO3-PhosphatePO4-..CationsandAnionsCations-po104CationsSodium(Na+)MostprevalentcationintheextracellularfluidPlaysamajorroleinregulatingthedistributionofwaterPotassium(K+)MostprevalentcationintheintracellularfluidTransmissionofelectricalimpulses..CationsSodium(Na+)..105“NextofKin”“N”extSodium(Na+)Mostprevalentcationintheextracellularfluid“K”inPotassium(K+)Mostprevalentcationintheintracellularfluid..“NextofKin”“N”ext..106CationsCalcium(Ca++)MusclecontractionNervousimpulsetransmissionMagnesium(Mg++)SeveralbiochemicalprocessesCloselyassociatedwithphosphateinmanyprocesses..CationsCalcium(Ca++)..107AnionsChloride(Cl-)MostprevalentanionintheextracellularfluidFluidbalanceandrenalfunctionBicarbonate(HCO3-)PrinciplebufferofthebodyNeutralizeshighlyacidichydrogenion(H+)..AnionsChloride(Cl-)..108AnionsPhosphate(HPO4-)MajorintracellularanionImportantinbodyenergystoresHelpsmaintainacid-basebalance..Anions..109CellularMembranesPermeabilityThedegreetowhichasubstanceisallowedtopassthroughacellmembraneSemipermeableCellmembranesthatallowonlycertainsubstancestopassthroughthem..CellularMembranesPermeability110DiffusionMovementofsolutesfromanareaofgreatersoluteconcentrationtoanareaoflowersoluteconcentration..DiffusionMovementofsolutesf111OsmosisMovementofwaterfromanareaoflowersoluteconcentrationtoanareaofhighersoluteconcentration..OsmosisMovementofwaterfrom112ActiveTransportMovementofasubstanceacrossthecellmembraneagainsttheosmoticgradientFasterthandiffusionRequiresenergyExample:Sodium-PotassiumPump..ActiveTransportMovementofa113FacilitatedDiffusionRequirestheassistanceof“helperproteins”Proteinbindstomoleculechangingit’sconfigurationMayormaynotrequireenergyExample:Insulin&Glucose..FacilitatedDiffusionRequires114CrystalloidsIsotonicFluidsLactatedRingersNormalSalineHypotonicFluidsD5W?NSHypertonicFluids3%NS10%NS..CrystalloidsIsotonicFluidsHyp115IsotonicSolutionsStateinwhichsolutionsonoppositesidesofasemi-permeablemembraneareequalinconcentrationThereisNOfluidshift!..IsotonicSolutionsStateinwhi116HypotonicSolutionsStateinwhichasolutionhasalowersoluteconcentrationononesidethantheotherThereisashiftintotheintracellularfluid!..HypotonicSolutionsStateinwh117HypertonicSolutionsStateinwhichasolutionhasahighersoluteconcentrationononesidethantheotherThereisafluidshiftintotheinterstitialfluid!..HypertonicSolutionsStateinw118ColloidsContainproteinsorotherhigh-molecular-weight-moleculesTendtostayinvasculatureforextendedperiodsoftimeHave“colloidosmoticpressure”Tendtoattractwaterintotheintravascularspaces..ColloidsContainproteinsorot119ColloidsPlasmaProteinFractionContainsalbumin&salineSalt-PoorAlbuminContainsonlyhumanalbuminDextranLargesugarmoleculeHetastarch(Hespan)Sugarmolecule..ColloidsPlasmaProteinFractio120BloodComponentsPlasma54%RedBloodCells45%WhiteBloodCells1%Platelets1%..BloodComponents..121BloodComponentsPlasmaFluidportionofbloodContainsproteins,carbohydrates,aminoacids,lipids,&mineralsaltsErythrocytesMostnumerouscellsinbloodCarryhemoglobin..BloodComponentsPlasma..122BloodComponentsLeukocytesFightinfectionProduceantibodiesPlateletsEssentialforclotformation..BloodComponents..123HematocritPercentageofredbloodcellsinwholebloodWomen42(+/-5)Men45(+/-7)..HematocritPercentageofredbl124BloodTyping..BloodTyping..125BloodDonorCompatibility..BloodDonorCompatibility..126Let’sLookatPerfusionTheFickPrinciple..Let’sLookatPerfusionTheFic127FickPrincipleAdequateconcentrationofinspiredoxygenOn-loadingofoxygentoredbloodcellsatlungsDeliveryofredbloodcellstotissuecellsOff-loadingofoxygenfromredbloodcellstotissuecells..FickPrincipleAdequateconcent128Adequateperfusionrequiresthat

allcomponentsofthe

“FickPrinciple”areinplace!..Adequateperfusionrequiresth129FickPrinciple1.

Adequateconcentrationofinspiredoxygenrequires:AdequateventilationHighconcentrationofinspiredoxygenUnobstructedairpassages..FickPrinciple1.Adequatecon130FickPrinciple2.

On-loadingofoxygentoredbloodcellsatlungsrequires:Minimalobstructionacrossalveolar-capillarymembraneandAppropriatebindingofoxygentohemoglobin..FickPrinciple2.On-loadingo131FickPrinciple3.

Deliveryofredbloodcellstotissuecellsrequires:NormalhemoglobinlevelsCirculationofoxygenatedcellstotissuesAdequatecardiacfunctionAdequatevolumeofbloodflowProperroutingofbloodthroughvasculature..FickPrinciple3.Deliveryof132FickPrinciple4.

Off-loadingofoxygenfromredbloodcellstotissuecellsrequires:CloseproximityoftissuecellstocapillariesIdealpHIdealtemperature..FickPrinciple4.Off-loading133Removeanycomponent

fromthe“FickPrinciple”

andshockwillfollow!..Removeanycomponent

fromthe134NutritionCellsrequireacontinuoussupplyofnutrientsEx:Glucose,OxygenWorkloaddemandsdeterminetherateofneedThebodyautomaticallyadjusts..NutritionCellsrequireaconti135CellularRespirationBreakdownoffoodintoenergyAerobicAnaerobic..CellularRespirationBreakdown136AerobicMetabolismRequiredfuelsGlucoseOxygenWasteproductsPyruvicacidLacticacidCarbondioxideMethodofexcretionRespirationUrination..AerobicMetabolismRequiredfue137AnaerobicMetabolismUsesglucoseonlyAlmost20timeslessefficientthanaerobicCausesdramaticincreaseinlacticacidproduction,andthereforemetabolicacidosisVasculardilationfollows,causingafurthershiftinfluidsoutofthevascularspaceandintotheinterstitialspaceFurther,potassiumshiftsoutofthecell,andsodiumin,whichcausescellmembraneinstability..AnaerobicMetabolismUsesgluco138DeathComethBrainandLungsDiewithin4to6minuteswithoutoxygenOrgansDiewithin45to90minuteswithoutoxygenSkinandmuscleDiewithin4to6hourswithoutoxygen..DeathComethBrainandLungs..139TheCardiovascularSyste