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Kenny MD [ @heart_lung ] In part 1 , right atrial pressure [P ra ] and cardiac output/venous return [CO/VR] were considered as two hemodynamic measures bound at the operating point [OP] of the circulatory system. OP is operating point. Shows what happens when Ppc, Pmsf, Rcardiac and Rvr all vary [grey operating points].
Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. 6 Severe toxicity and shock are typically seen with serum iron concentrations above 500 g/dL and serum iron concentrations above 1000 g/dL are associated with significant mortality. 2 L/hr in adults.
Both have a range of detection limits, which can be greatly dependent on operator. You should consider ordering this in all febrile children with fever <30 days from travel to a malaria-endemic country (Forgie 2022) Thick smears are 10 x more sensitive for malaria then thin smears, but thin smears are used to identify species.
Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. In those with severe injury, you may note refractory hypotension secondary to cardiogenic shock. for pericardial effusion. Jeff: Not only is US accurate, it’s also quick. Jeff: Exactly.
These definitions include blood loss of 40 mL/kg over 24 hours, transfusion of ≥50% of total blood volume in 3 hours, transfusion of 100% of total blood volume in 24 hours, and bleeding with clinical signs of hypovolaemic shock that is unlikely to be controlled. What is the ‘diamond of death’?
4 Patients with pelvic fractures are considered unstable when systolic blood pressure < 90mmHg and heart rate >120bpm, or in those with dyspnea, altered mental status, or skin findings of shock. 12 Patients with pelvic fractures and concerning straddle mechanisms should be thoroughly evaluated for genitourinary injuries.
While transfusingblood can be beneficial to those who have lost it or continue to lose it quickly, blood may not always be immediately available. Or maybe the family does not desire bloodtransfusions. Enter TXA or tranexamic acid , The Clot Stabilizer! of IV form TXA [O’Neill 2020] Inexpensive !
Be careful if the patient has received a recent bloodtransfusion since it may be misinterpreted as sickle cell trait instead of sickle cell disease. In these cases, repeat the Hb electrophoresis three months after the last bloodtransfusion. Would you consider this patient for bloodtransfusion?
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