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GEMC - Medical Student - Trauma - Shock
 

GEMC - Medical Student - Trauma - Shock

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This is a lecture by Dr. Patrick Carter from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the ...

This is a lecture by Dr. Patrick Carter from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.

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    GEMC - Medical Student - Trauma - Shock GEMC - Medical Student - Trauma - Shock Presentation Transcript

    • Project: Ghana Emergency Medicine Collaborative Document Title: Shock Author(s): Patrick Carter (University of Michigan), MD 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers. !"
    • Attribution Key for more information see: http://open.umich.edu/wiki/AttributionPolicy Use + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation License Make Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. #" To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
    • $%&'()*'+" •  •  •  •  •  •  ,-.(/"0'123).2" 4.5678"9-:+3.8.;:" 97<-.=-:+3.8.;:" >8323(78"95'+'2<7).2" ?5'7<6'2<".@",-.(/"97)'2<+" ?:='+".@",-.(/" A"
    • ,-.(/"0'123).2" B  C27D'EF7<'".G:;'2"D'83*'5:"<."6''<" 6'<7%.83("D'672D+"" B  H'+F8<+"32";8.%78")++F'"-:=.='5@F+3.2"72D" 6'<7%.83("7(3D.+3+" B  ,-.(/"(72".((F5"I3<-"7"2.5678"%8..D" =5'++F5'"72D"-:=.<'2+3.2"(72".((F5"I3<-.F<" +-.(/" J"
    • 4.5678"9-:+3.8.;:" ?3++F'"='5@F+3.2"3+"D53*'2"%:"%8..D"=5'++F5'" K8..D"95'++F5'"L">$"M"9NH" >$"O">75D37("$F<=F<" 9NH"O"9'53=-'578"N7+(F875"5'+3+<72('" P"
    • 4.5678"9-:+3.8.;:" >75D37("$F<=F<"L",N"M"QH" " ?-F+R"" " K8..D"95'++F5'"L",N"M"QH"M"9NH" " K8..D"95'++F5'"L",<5./'"N.8F6'"M"Q'75<"H7<'"M"9'53=-'578"N7+(F875"H'+3+<72('" S"
    • 4.5678"9-:+3.8.;:" •  ,<5./'"N.8F6'"L"N.8F6'".@"%8..D"=F6='D" %:"<-'"-'75<"DF532;"!"(75D37("(:(8'"" !"#$%&'($)*+&',-'.'/*012$0'$/'34."'/.1"$#-5' 67$1.#8,.)' 9$0"#.12),"7' :#&)$.8' !"#$%&' ($)*+&' ;<&#)$.8' Kathy, clker.com T"
    • ,-.(/"97<-.=-:+3.8.;:" U"
    • 9-:+3.8.;3(">.6='2+7).2" •  Q'75<"57<'"32(5'7+'+"7+"7"(.6='2+7<.5:"5'+=.2+'"<.",-.(/" •  C27D'EF7<'"+:+<'63(".G:;'2"D'83*'5:"7()*7<'+"7F<.2.63(" 5'+=.2+'+"<."6732<732"+:+<'63(".G:;'2"D'83*'5:" –  ,:6=7<-')("2'5*.F+"+:+<'6" •  4VR"'=32'=-532'R"D.=7632'R"72D"(.5)+.8"5'8'7+'" –  >7F+'+"*7+.(.2+<53().2R"32(5'7+'"32"QHR"72D"32(5'7+'".@"(75D37("(.2<57()83<:" W(75D37(".F<=F<X" –  H'232Y72;3.<'2+32"7G3+" •  Z7<'5"72D"+.D3F6"(.2+'5*7).2"72D"*7+.(.2+<53().2" •  C2(5'7+'"32"%8..D"*.8F6'"72D"%8..D"=5'++F5'" •  [.78"3+"<."6732<732"('5'%578"72D"(75D37("='5@F+3.2" –  N7+.(.2+<53().2".@"+=872(-23(R"6F+(F8.+/'8'<78R"72D"5'278" %8..D".I" ]"
    • ^F8)Y.5;72"0:+@F2().2" ,:2D5.6'"W^$0,X" •  C27%383<:".@"$#"<."6''<"6'<7%.83("D'672D+" D'+=3<'"7_'6=<+"7<"=-:+3.8.;3(78"(.6='2+7).2" 8'7D+"<."<537D".@"87()("7(3D.+3+R"(75D3.*7+(F875" 32+F`(3'2(:"72D"32(5'7+'D"6'<7%.83("D'672D+" •  0.I2I75D"+=3578"(.2)2F'+"I3<-"=5.;5'++3.2".@" =-:+3.8.;3("'a'(<+b" –  >75D37("D'=5'++3.2" –  H'+=357<.5:"D3+<5'++" –  H'278"@738F5'" –  03++'6327<'D"C2<57*7+(F875">.7;F87).2"W0C>X" •  H'+F8<"3+"'2D".5;72"@738F5'"72D"D'7<-"" !c"
    • >8323(78"95'+'2<7).2" •  Q3+<.5:" –  H'('2<"3882'++" –  d'*'5" –  >-'+<"=732R",$K" –  e%D.63278"=732" –  >.Y6.5%3D3)'+" –  ^'D3(7).2+" –  ?.G32+fC2;'+).2+" –  H'('2<"-.+=3<783g7).2" .5"+F5;'5:" –  K7+'832'"6'2<78"+<7<F+" •  9-:+3(78"'G76327).2" –  N3<78",3;2+" –  >4,"O"6'2<78"+<7<F+" –  ,/32"O"(.8.5R"<'6=R" 57+-'+R"+.5'+" –  >N"O"hN0R"-'75<"+.F2D+" –  H'+="O"8F2;"+.F2D+R"HHR" .G:;'2"+7<R"eK[" –  [C"O"7%D"=732R"53;3D3<:R" ;F75D32;R"5'%.F2D" –  H'278"O"F532'".F<=F<" !!"
    • 037;2.+)("?..8+" B  9-:+3(78"'G76"" B  N,R"6'2<78"+<7<F+R"+/32"(.8.5R"<'6='57<F5'R"=F8+'+R"'<(" B  9),0,1.)'-,=0-'.08'-7+>"$+-'?.#7'8&>&08,0='$0'"4&' -&?&#,"7'$/'8,-&.-&'.08'&.#)7'#&1$=0,2$0',-'%&7'"$'8,.=0$-,-' .08',0"&#?&02$0' B  C2@'().F+"+.F5('" B  K7+3("i7%+b" B  B  B  B  B  B  >K>" >-'63+<53'+" i7(<7<'" >.7;F87).2"+<FD3'+" >F8<F5'+" eK[" !#"
    • eDD3).278"037;2.+)("?..8+" B  >?".@"-'7Df+32F+'+"@.5".((F8<"32@'().2+f 7%+('++'+" B  iF6%75"=F2(<F5'"@.5"6'232;3)+f'2('=-783)+" B  Z.F2D"(F8<F5'+"" B  e(F<'"7%D.63278"+'53'+" B  e%D.63278f='8*3(">?".5"j," B  d3%532.;'2R"d09+R"0YD36'5"3@"+F+=3(3.2"@.5"0C>" 3+"-3;-" !A"
    • C23)78"e==5.7(-"<."<-'"97)'2<"32",-.(/" •  eK>+" –  >75D3.5'+=357<.5:"6.23<.532;" –  9F8+'"$G36'<5:" –  ,F==8'6'2<78".G:;'2"" –  i75;'"%.5'"CN"7(('++"G"#" –  eK[R"87%+" –  d.8':"(7<-'<'5" –  N3<78"+3;2+"32(8FD32;"5'(<78"<'6='57<F5'" !J"
    • V+)67)2;"K8..D"95'++F5'"32"+-.(/" =7)'2<+" B  kF3(/"6'<-.D".@"'+)67)2;" <-'"%8..D"=5'++F5'"32" =7)'2<+" B  C@":.F"=78=7<'"7"=F8+'"32" <-'+'"5';3.2+R"<-'2":.F" /2.I"<-'",K9"3+"7<"8'7+<"<-3+" 2F6%'5b" @A' BA' CA' Anonymousgreek, Wikimedia Commons !P"
    • ,-.(/"?5'7<6'2<"[.78+" •  eK>0V" – e35I7:" – >.2<5.8"I.5/".@"K5'7<-32;" – $=)63g'">35(F87).2" – eD'EF7<'".G:;'2"0'83*'5:" – ^.23<.5"V2D"=.32<+".@"5'+F+(3<7).2" !S"
    • e35I7:" •  e++'++"735I7:"=7<'2(:"72D"32<'5*'2'"32"(53)(788:"388" =7)'2<+"<."D'(5'7+'"I.5/".@"%5'7<-32;"72D"+F==.5<" 735I7:"(.2<5.8" •  C2<F%7).2"72D"6'(-723(78"*'2)87).2"(72"323)788:" I.5+'2"-:=.<'2+3.2" –  ,'D7)*'+"@.5"H,C"(72"8.I'5"%8..D"=5'++F5'" –  9.+3)*'"=5'++F5'"*'2)87).2"D'(5'7+'+"=5'8.7D"" •  ^7:"2''D"7;;5'++3*'"*.8F6'"5'+F+(3<7).2"=53.5"<." 32<F%7).2"<."=5'*'2<"-'6.D:2763("(.887=+'" !T"
    • K5'7<-32;" •  H'+=357<.5:"57<'"32(5'7+'+"I3<-"+-.(/"<." (.6='2+7<'"@.5"6'<7%.83("7(3D.+3+" •  H'+=357<.5:"6F+(8'+"(.2+F6'"7"+3;231(72<" 76.F2<".@".G:;'2"" •  ?7(-:=2'7"(72"@F5<-'5"'G7('5%7<'"87()(" 7(3D.+3+" •  ^'(-723(78"*'2)87).2"72D"+'D7).2"I388" D'(5'7+'"I.5/".@"%5'7<-32;"72D"36=5.*'" .*'5788"+F5*3*78" !U"
    • >35(F87).2" •  C+.<.23("(5:+<788.3D+"W4.5678",7832'".5" i7(<7<'D"H32;'5+X"3+".=)678"15+<Y832'"F3D" •  ?3<57<'"<.b" –  >N9"UY!#"66"Q;"3@":.F"-7*'"('2<578"*'2.F+"7(('++" –  ^732<732"F532'".F<=F<"clP"O"!lc"68f/;f-5"WAc"68f-5X"" –  C6=5.*'"-'75<"57<'"W[.78"QH"m"!ccX" •  $n'2"5'EF35'+"875;'"76.F2<+".@"F3D+".5" %8..D"=5.DF(<+""WoJYS"i3<'5+X" •  4."+F5*3*78".5"".F<(.6'"%'2'1<"@5.6" (.88.3D+" !]"
    • $G:;'2"0'83*'5:" •  0'(5'7+'".G:;'2"D'672D"@.5"=7)'2<+" –  95.*3D'"7278;'+37"72D"72G3.8:)(+"<."5'87G"6F+(8'+" –  e*.3D"+-3*'532;" •  ^732<732"72D"32(5'7+'"75<'5378".G:;'2"+7<F57).2" –  [3*'"+F==8'6'2<78".G:;'2" –  ^732<732"-'6.;8.%32"o"!c";fDi" •  ?3++F'".G:;'2"'G<57().2"(72"%'"6'7+F5'D"I3<-" +'5378"87(<7<'"8'*'8+".2"72"eK[".5"('2<578"*'2.F+" .G:;'2"+7<F57).2+"3@"'EF3=6'2<"3+"7*7387%8'" #c"
    • H'+F+(3<7).2"V2DY9.32<+" •  H'+F+(3<7).2";.78"3+"<."67G363g'"=7)'2<"+F5*3*78" 72D"632363g'"6.5%3D3<:" •  j+'".%&'()*'"-'6.D:2763("72D"=-:+3.8.;3(" =7576'<'5+"<.";F3D'"+='(31("<-'57=:" –  3l'l">-'(/"*3<78"+3;2+"72D"=-:+3.8.;3("675/'5+" @5'EF'2<8:" •  035'(<'D"=7576'<'5+"<."@.88.I" –  j532'".F<=F<"o"clP"6if/;f-5"W+36=8'+<"6'7+F5'X" –  >N9"UY!#"66Q;"W3@"('2<578"*'2.F+"7(('++"7*7387%8'X" –  ^e9"SP"<."]c"66Q;" –  >'2<578"*'2.F+".G:;'2"(.2('2<57).2"o"Tcp"W3@" ('2<578"*'2.F+"7(('++"7*7387%8'X" #!"
    • Z-7<"3@"<-':"D.2q<";'<"%'_'5r" B  ,'75(-"@.5".<-'5"(7F+'+".@"='5+3+<'2<" -:=.<'2+3.2"32(8FD32;b"" B C27D'EF7<'"*.8F6'"5'+F+(3<7).2" B $((F8<"%8''D32;" B 92'F6.<-.57G" B >75D37("<76=.27D'" B eD5'278"32+F`(3'2(:" B e88'5;3("5'7().2" ##"
    • ?:='+".@",-.(/"" B Q:=.*.8'63(fQ'6.55-7;3(" B ,'=)(" B >75D3.;'23("" B e27=-:87()(" B 4'F5.;'23("" B $%+<5F()*'" #A"
    • Q:=.*.8'63(",-.(/" B  Q'6.55-7;3("" B  B  B  B  B  ?57F67" [C"K8''D" ^7++3*'"Q'6.=<:+3+" eee"5F=<F5'" V(<.=3("=5';272(:".5"9.+<Y=75<F6"%8''D32;" B  B  B  B  B  N.63)2;f03755-'7"W[7+<5.'2<'53)+X" ,6788"72D"i75;'"K.I'8".%+<5F().2" 972(5'7))+" KF52+"" V2*35.26'2<78"W0'-:D57).2X" B  4.2Y-'6.55-7;3("" " #J"
    • >87++'+".@"Q:=.*.8'63(",-.(/" CLASS I II III IV BVL < 15% 15 - 30% 30 - 40% > 40% AMOUNT 750 cc 750 - 1500 cc 1500 - 2000 cc > 2000 cc PULSE <100 > 100 >120 >140 BP No change Narrowed pulse pressure Consistent decrease in SBP Decreased SBP and narrowed pulse pressure or no DBP RESP No change 20-30 30-40 >35 CNS No change Anxiety Anxious, confused Confused. lethargic Urine >30cc per hr 20-30cc per hr 5-15cc per hr negligible TX Replace fluid loss 2L NS IV 2 L NS IV, usually requires blood transfusion Rapid transfusion of blood and NS, requires immediate intervention to stop hemorrhage #P"
    • Q:=.*.8'63(",-.(/" B  eK>+R"CNf$#f^.23<.5" B  V+<7%83+-"#"875;'"%.5'"CN+".5"7"('2<578"832'" B  >5:+<788.3D+" B  4.5678",7832'".5"i7(<7<'"H32;'5+" B  j="<."A"83<'5+"32"7DF8<+" B  9'D37<53(+"L"#c"((f/;"%.8F+'+"W67:"2''D"6F8)=8'"%.8F+'+X" B  K8..D"95.DF(<+"WZ-.8'"K8..DR"9HK>q+fdd9f987<'8'<+X" B  $"2';7)*'".5"(5.++"67<(-'D"3@"<:='"+='(31("3+"2.<" 7*7387%8'" B  >.2<5.8"72:"+.F5('+".@"7()*'"%8''D32;" B  e5572;'"D'123)*'"32<'5*'2).2"@.5"-'6.55-7;3(" +-.(/"W$='57)2;"?-'7<5'X" #S"
    • Q:=.*.8'63(",-.(/" •  V*78F7<'"5'+=.2+'"<."<5'7<6'2<" Rapid Response Transient Response No Response Vitals Return to normal Transient Remain Abnormal improvement with return to previous Estimated Blood loss 10-20% 20-40% with ongoing likely Severe >40% Need for more Fluid Low High High Need for Blood Type and cross Type specific O neg Need for surgery Possible Likely Highly likely #T"
    • ,CH," ! ,:+<'63("C27667<.5:"H'+=.2+'",:2D5.6'" W,CH,X" –  0'12'D"%:"<-'"=5'+'2('".@"<I.".5"6.5'".@"<-'" @.88.I32;b" ! K.D:"<'6="m"AS"s>"W]T"sdX".5"o"AU"s>"W!cc"sdX" ! Q'75<"H7<'"o"]c"%=6" ! HH"o"#c"%=6" ! ZK>"m"JRccc"('88+f66A".5"o"!#Rccc"('88+f66A".5" ;5'7<'5"<-72"!cp"%72D+" #U"
    • ,'=+3+" B  ,'=+3+"L"0'12'D"7+",CH,"32"5'+=.2+'"<."7" (.2156'D"32@'().F+"=5.('++l"" B  ,'=)(",-.(/"L",'=+3+"=8F+"5'@57(<.5:"-:=.<'2+3.2" B  en'5"%.8F+".@"#cYJc"6ift;"=7)'2<"+)88"-7+".2'".@"<-'" @.88.I32;b" B ,K9"m"]c"66"Q;"" B ^e9"m"SP"66"Q;"" B 0'(5'7+'".@"Jc"66"Q;"@5.6"%7+'832'""""""""""""" #]"
    • ,'=+3+f,CH,"C2<'5@7('" Ac"
    • ,'=+3+"97<-.=-:+3.8.;:" 4;F:'2"Q"'<"78l",'*'5'",'=+3+"72D",'=)(Y,-.(/b"H'*3'I".@"<-'"i3<'57<F5'" 72D"V6'5;'2(:"0'=75<6'2<"^727;'6'2<"[F3D'832'+l"e22"V6'5;"^'Dl" #ccSuJ#b#UYPJl" A!"
    • ,'=)(",-.(/"O">8323(78" ^723@'+<7).2+" B  >8323(78"@'7<F5'+b"" B  Q:='5<-'5637".5"-:=.<-'5637" B  ?7(-:(75D37"WQH"o"!ccX" B  Z3D'"=F8+'"=5'++F5'" B  i.I"+:+<.83("%8..D"=5'++F5'"W,K9m]cX" B  ^'2<78"+<7<F+"(-72;'+" B  ,.6'"=7)'2<+"67:"=5'+'2<"32"(.6='2+7<'D" +-.(/"I3<-"7=='7572('".@"v2.5678w"%8..D" =5'++F5'" A#"
    • ,'=)(",-.(/"Y"037;2.+3+" B  >75D37("6.23<.5" B  9F8+'"$G36'<5:" B  i7%.57<.5:"?'+<+" B  B  B  B  B  B  B  B  B  B  >.6=8'<'"K8..D">.F2<" >-'63+<5:"=72'8"W'8'(<5.8:<'+"72D"Kj4f>5'7)232'" >.7;F87).2"=7576'<'5+" i3*'5"@F2().2"<'+<+" i3=7+'" j53278:+3+" eK["I3<-"87(<7<'"6'7+F5'6'2<" >F8<F5'+b"K8..D"(F8<F5'"G"#R"F532'"(F8<F5'" >-'+<"GY57:" d.8':"(7<-'<'5" AA"
    • ,'=)(",-.(/"Y"?5'7<6'2<" B  #"875;'"%.5'"CN+" B  4,"CNd"%.8F+Y"!Y#"i"I3D'".='2"W3@"2."(.2<5732D3(7).2+X"" B  ,F==8'6'2<78".G:;'2" B  V6=353("72)%3.)(+"7+"+..2"7+"=.++3%8'"72D"%7+'D".2" +F+='(<'D"+.F5('" B  ,F5*3*78"(.55'87<'+"I3<-"-.I"EF3(/8:"<-'"(.55'(<"72)%3.)(" D5F;"3+"7D6323+<'5'D" B  K5.7D"+='(<5F6"(.*'57;'"@.5"%.<-";576"=.+3)*'"72D" ;576"2';7)*'"%7(<'537" B  9'5+3+<'2<"Q:=.<'2+3.2"?5'7<6'2<" B  C@"2."5'+=.2+'"7n'5"#YA"i"CNdR"(.2+3D'5"+<75)2;"7" *7+.=5'++.5"W4.5'=32'=-532'R"0.=7632'R"'<(X"72D" )<57<'"<."^e9" B  [.78b""^e9"o"SP" B  >.2+3D'5"7D5'278"32+F`(3'2(:b""Q:D5.(.5)+.2'"!cc" 6;"CN" AJ"
    • V758:"[.78"035'(<'D"?-'57=:" B  ,'=)(",-.(/"?5'7<6'2<"e8;.53<-6R"H3*'5+"'<"78l" 4Vh^R"#cc!" B  ,<FD:"<-7<"'G7632'D"F+'".@"72"'758:";.78"D35'(<'D" <-'57=:"78;.53<-6"<."<5'7<"=7)'2<+"I3<-"+'=)("+-.(/"W7+" D'12'D"%:"5'@57(<.5:"-:=.<'2+3.2".5"87(<7<'"o"JX" B  #SA"=7)'2<+"572D.68:"7++3;2'D"<."'3<-'5"<5'7<6'2<"756" .5"<."+<72D75D"5'+F+(3<7).2"756+"W!Ac"*+l"!AAX" B  >.2<5.8"756"<5'7<'D"I3<-"+<72D75D"(75'"72D"7D63_'D"<." C>j" B  ?5'7<6'2<"756"@.88.I'D"=5.<.(.8"32"V0"@.5"S"-.F5+"72D" <-'2"7D63_'D"<."C>j" B  d32D32;+f$F<(.6'" B  ?5'7<6'2<";5.F="5'('3*'D"6.5'"F3D+"(.6=75'D"<." (.2<5.8";5.F="WP"i"*+l"AlP"iX" B  AlU"D7:+"8'++"32"-.+=3<78"@.5"<5'7<6'2<";5.F=" B  #"@.8D"8'++"(75D3.=F86.275:"(.6=83(7).2+"@.5"<5'7<6'2<" ;5.F=" B  D&).2?&'#&8*12$0',0'+$#".),"7'$/'EFGFH' AP"
    • V758:"[.78"035'(<'D"?-'57=:" H3*'5+"V"'<"78l"V758:";.78YD35'(<'D"<-'57=:"32"<-'"<5'7<6'2<".@"+'*'5'"+'=+3+"72D" +'=)("+-.(/"4"V2;8"h"^'Dl"#cc!bAJPb!ASUY!ATTl" " AS"
    • e27=-:87()(",-.(/" B  e27=-:87G3+" B  ,'*'5'"+:+<'63(" -:='5+'2+3)*3<:"5'7().2" B  >-757(<'53g'D"%:" 6F8)+:+<'6"32*.8*'6'2<"" B  C;V"6'D37<'D" B  e27=-:87(<.3D"5'7().2" B  >8323(788:"32D3+)2;F3+-7%8'" @5.6"727=-:87G3+" B  0.'+"2.<"5'EF35'"7" +'2+3)g32;"'G=.+F5'" Justin Beck, Flickr B  4.<"C;V"6'D37<'D" AT"
    • e27=-:87()(",-.(/"O">8323(78" ^723@'+<7).2+" •  >8323(78",='(<5F6" –  d35+<",:6=<.6+b"" •  H3+/"@7(<.5+"@.5"@7<78" 727=-:87G3+"" –  95.;5'++3.2b"" •  H'.((F55'2('"57<'+" –  ,'*'5'",:6=<.6+b""" •  ^.+<"(.66.2"(7F+'+" •  95F53<F+" •  d8F+-32;" •  j5)(7537" •  •  •  •  •  ?-5.7<"@F882'++" e2G3'<:" >-'+<");-<2'++" ,-.5<2'++".@"%5'7<-" i3;-<-'7D'D2'++" •  e8<'5'D"6'2<78"+<7<F+" •  H'+=357<.5:"D3+<5'++" •  >35(F87<.5:"(.887=+'" –  9..58:"(.2<5.88'D"7+<-67""" –  95'*3.F+"727=-:87G3+"" " –  JcYScp"@.5"32+'(<"+)2;+" –  #cYJcp"@.5"57D3.(.2<57+<" 7;'2<+" –  !cY#cp"@.5"='23(38832" " –  e2)%3.)(+" –  C2+'(<+" –  d..D"" AU"
    • e27=-:87()(",-.(/"Y"037;2.+3+" •  >8323(78"D37;2.+3+" –  0'12'D"%:"735I7:"(.6=5.63+'R"-:=.<'2+3.2R".5" 32*.8*'6'2<".@"(F<72'.F+R"5'+=357<.5:R".5"[C"+:+<'6+" B  ^38DR"8.(783g'D"F5)(7537"(72"=5.;5'++"<."@F88"727=-:87G3+" B  ,:6=<.6+"F+F788:"%';32"I3<-32"Sc"632F<'+".@"'G=.+F5'" B  d7+<'5".2+'<".@"+:6=<.6+"L"6.5'"+'*'5'"5'7().2" B  K3=-7+3("=5'+'2<7).2".((F5+"32"F="<."#cp".@"=7)'2<+" B  ,:6=<.6+"I388"5'<F52"AYJ"-.F5+"7n'5"323)78"5'7().2"-7+"(8'75'D" •  i../"@.5"'G=.+F5'"<."D5F;R"@..DR".5"32+'(<" •  i7%+"-7*'"2."5.8'" A]"
    • e27=-:87()(",-.(/"Y"?5'7<6'2<" •  eK>q+" –  H'+=357<.5:"(.6=5.63+'"5'EF35'"366'D37<'" 32<F%7).2" •  •  •  •  CNR">75D37("^.23<.5R"9F8+'"$G36'<5:" CNdq+R"$G:;'2" V=32'=-532'"@.5"e27=-:87G3+f,-.(/" ,'(.2D"832'"?-'57=3'+" –  >.5)(.+<'5.3D+" –  Q!"72D"Q#"%8.(/'5+" Jc"
    • e27=-:87()(",-.(/"Y"?5'7<6'2<" •  V=32'=-532'" –  clA"6;"C^".5",>".@"!b!ccc"D38F).2"@.5"727=-:87G3+"" –  H'='7<"'*'5:"PY!c"632"7+"2''D'D" –  >7F).2"3@"=7)'2<".2"%'<7"%8.(/'5+"DF'"<." F2.==.+'D"78=-7"+)6F87).2"72D"5'+F8<72<"+'*'5'" -:='5<'2+3.2" –  d.5">N"(.887=+'"W3l'l"(75D37("755'+<XR"!"6;"CN".@" !b!cRccc"W+76'"7+"e>i,"0.+'X" –  C@"5'@57(<.5:"-:=.<'2+3.2"72D"+-.(/R"+<75<"CN"D53=" J!"
    • e27=-:87()(",-.(/"Y"?5'7<6'2<" •  >.5)(.+<'5.3D+" –  ^'<-:8=5'D23+.8.2'"!#P"6;"CN"" –  95'D23+.2'"Sc"6;"9$" •  e2)-3+<7632'+" –  Q!"%8.(/'5Y"03=-'2-:D57632'"#PYPc"6;"CN" –  Q#"%8.(/'5Y"H723)D32'"Pc"6;"CN" •  K5.2(-.D387<.5+" –  e8%F<'5.8"2'%F83g'5" –  e<5.*'2<"2'%F83g'5" –  ^7;2'+3F6"+F8@7<'"#";"CN".*'5"#c"632F<'+"" " J#"
    • B  0'12'D"7+b" >75D3.;'23(",-.(/" B  ,K9"m"]c"66Q;" B  >75D37("C2D'G"m"#l#"if6f6#" B  9F86.275:">7=38875:"Z'D;'" 95'++F5'"W9>Z9X"o"!U" 66Q;" Patrick J. Lynch, Wikimedia Commons B  ^.5<783<:"=53.5"<."5'='5@F+3.2" <-'57=:"L"PcYUcp" B  ,3;2+b" B  B  B  B  B  B  B  >..8R"6._8'D"+/32" ?7(-:=2'7" 9F86.275:"*7+(F875"(.2;'+).2"" Q:=.<'2+3.2" e8<'5'D"6'2<78"+<7<F+" 4755.I'D"=F8+'"=5'++F5'" H78'+R"6F56F5" JA"
    • >75D3.;'23(",-.(/"" •  >75D3.;'23(",-.(/"V).8.;:" –  e(F<'"^:.(75D378"C2@75().2"We^CX" –  ,'=+3+" –  ^:.(75D3)+" –  ^:.(75D378">.2<F+3.2" –  e(F<'"e.5)("C2+F`(3'2(:" –  e.5)(".@"^3<578",<'2.+3+" –  Q:='5<5.=-3(">75D3.6:.=7<-:" JJ"
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    • >75D3.;'23(",-.(/"Y"037;2.+3+" •  Vt[" •  >MH" •  i7%.57<.5:b"" –  >.6=8'<'"K8..D">.F2<" –  >-'63+<5:"972'8"WV8'(<5.8:<'+R"Kj4f>HX" –  >75D37("'2g:6'+"W^:.;8.%32R">tR">tY^KR"?5.=.232X" –  >.7;F87).2"+<FD3'+" •  V(-.(75D3.;576" JS"
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    • $%+<5F()*'",-.(/" B  ?'2+3.2"=2'F6.<-.57G" Delldot, Wikimedia Commons Source: www.meddean.luc.edu/lumenMedEd/medicine/ pulmonar/cxr/pneumo1.htm B  e35"<57=='D"32"=8'F578"+=7('"I3<-"!" I7:"*78*'R"735f=5'++F5'"%F38D+"F=" B  ^'D37+)2F6"+-3n'D"36='D32;" *'2.F+"5'<F52" B  >-'+<"=732R",$KR"D'(5'7+'D"%5'7<-" +.F2D+" B  4."<'+<+"2''D'Df(8323(78"D37;2.+3+" B  ?5'7<6'2<b"4''D8'"D'(.6=5'++3.2" @.88.I'D"%:"(-'+<"<F%'" P#"
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    • $%+<5F()*'",-.(/" •  9F86.275:"'6%.83+6" –  N35(-.I"<537Db"" •  Q:='5(.7;F87%8'" •  N'2.F+"32&F5:" •  N'2.+<7+3+" –  ,3;2+b"" •  ?7(-:=2'7"" •  ?7(-:(75D37" •  Q:=.G37" –  i.I"53+/b"0YD36'5" –  Q3;-'5"53+/b">?"(-'+<".5"Nk" +(72" –  ?5'7<6'2<b""Q'=7532" Hellerhoff, Wikimedia Commons •  >.2+3D'5"<-5.6%.8:)(+"3@"+-.(/" @5.6"9V" PJ"
    • $%+<5F()*'",-.(/" B  e.5)("+<'2.+3+" B  H'+3+<72('"<."+:+<.83("'&'().2"(7F+'+"D'(5'7+'D" (75D37("@F2().2" B  >-'+<"=732"I3<-"+:2(.='" B  ,:+<.83("'&'().2"6F56F5" B  0'123)*'"D37;2.+3+"I3<-"'(-." B  N7+.D387<.5+"W4?[X"I388"D5.="=5'++F5'" B  ?5'7<6'2<b"e.5)("*78*'"+F5;'5:" PP"
    • Z-3(-"=5'++.5"+-.F8D"C"(-..+'r" !  Q:=.*.8'63("+-.(/" –  Fluids and Blood !  >75D3.;'23("+-.(/" –  Dobutamine - !1 agonist ! Increases squeeze and heart rate !  4'F5.;'23("+-.(/" –  Fluids, phenylephrine, Levophed, look for another type of shock if it is persistent !  e27=-:87()("+-.(/" –  Fluids and epinephrine !  ,'=)("+-.(/" –  Neosynephrine - alpha agonist ! Increases SVR by arteriolar constriction –  Norepinephrine/Levophed - alpha and beta agonists !  0.=7632'" –  Low Dose - increases renal blood supply –  Medium Dose - beta effects (increases heart rate and squeeze) –  High Dose - alpha effects (arteriolar constriction) PS"
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