Dr. Ali’s Uworld Notes For Step 2 CK
Surgery
,Trauma
Hemorrhagic Shock - Hemorrhagic shock may be divided into four classes
based on the amount of blood loss.
Patients with class I hemorrhage have lost less than 15% of their
intravascular volume (or less than 750 cc) and are generally alert. The blood
pressure is normal and the major organs are satisfactorily perfused as
evidenced by a normal urine output. The patient compensates for blood loss
through a sympathetic response that induces mild tachycardia and
peripheral vascular constriction. Capillary refill is maintained (< 2 seconds).
Patients with a class II hemorrhage have lost between 15 and 30% of their
blood volume (or 750-1500 cc) and are generally more anxious and agitated.
,Pulse rate will be more than 1 DO/min. While the mean arterial blood
pressure remains normal, the pulse pressure is narrowed and the blood
pressure starts to trend downward. Urine output is slightly decreased and the
skin is cool and moist. Capillary refill may be delayed. All of these
manifestations can be attributed to further increases in sympathetic
discharge and shunting of blood from less critical vascular beds such as the
skin, leading to skin vasoconstriction.
Patients with class Ill hemorrhage have lost 30-40% of their blood volume (or
1500-2000 cc) and can no longer maintain their blood pressure at normal
levels despite further increases in heart rate and peripheral vascular
constriction. These patients will begin to have a decreased level of
consciousness and a further decrease in urine output due to poor cerebral
and renal perfusion, respectively.
Class IV hemorrhage is defined as a blood loss of more than 40% of the blood
volume (or > 2000 cc). The patient appears lethargic, tachypneic and has
markedly decreased urine output. At this point, circulatory failure and death
are imminent without therapeutic intervention.
When hemorrhage occurs, tachycardia and peripheral vascular constriction
are the first physiological changes. These responses act to maintain the
blood pressure within normal limits until severe blood loss has occurred.
Tetanus Immunization -
All patients with traumatic wounds should be assessed for the need of
tetanus prophylaxis. Tetanus immune globulin (TIG) provides passive,
temporary, and immediate immunity. Tetanus-diphtheria toxoid (Td) provides
active, prolonged, and delayed immunity. Wounds at high risk for vegetative
Clostridium fefani growth are those that provide an anaerobic environment
for growth, such as puncture wounds, projectile wounds, wounds containing
foreign bodies, sites of active infection by other organisms, and wounds
containing necrotic tissue.
, Tetanus immune globulin (TIG) provides passive, temporary and immediate
immunity. Tetanus-diphtheria toxoid (Td) provides active, prolonged and
delayed immunity. Wounds at high risk for vegetative Clostridium teeani
growth are those that provide an anaerobic environment for growth, such as
puncture wounds, Projectile wounds, wounds containing foreign bodies, sites
of active infection by other organisms and wounds containing necrotic tissue.
A Td booster should be administered to individuals with more severe or
dirty wounds (e.g .. puncture wounds and wounds contaminated with dirt.
feces. or saliva) who received their latest dose more than 5 years ago and
those with clean minor wounds who received their latest dose more than
10 years ago.
A TIG injection should be administered to individuals who have received less
than three doses of tetanus vaccine and those with a more severe or dirty
wounds who have an unknown immunization status.
Glasgow Coma Scale - All trauma patients should be first assessed using
the GCS, which estimates the severity of the patient's neurologic injury for
triage. The GCS can also give some prognostic information when used in
conjunction with the patient's age and presence of concomitant adverse
clinical findings, such as hypoxia, cardiovascular compromise, increased
intracranial pressure, and radiographic evidence of a midline shift of the
brain. Calculation of GCS score is shown below.
Surgery
,Trauma
Hemorrhagic Shock - Hemorrhagic shock may be divided into four classes
based on the amount of blood loss.
Patients with class I hemorrhage have lost less than 15% of their
intravascular volume (or less than 750 cc) and are generally alert. The blood
pressure is normal and the major organs are satisfactorily perfused as
evidenced by a normal urine output. The patient compensates for blood loss
through a sympathetic response that induces mild tachycardia and
peripheral vascular constriction. Capillary refill is maintained (< 2 seconds).
Patients with a class II hemorrhage have lost between 15 and 30% of their
blood volume (or 750-1500 cc) and are generally more anxious and agitated.
,Pulse rate will be more than 1 DO/min. While the mean arterial blood
pressure remains normal, the pulse pressure is narrowed and the blood
pressure starts to trend downward. Urine output is slightly decreased and the
skin is cool and moist. Capillary refill may be delayed. All of these
manifestations can be attributed to further increases in sympathetic
discharge and shunting of blood from less critical vascular beds such as the
skin, leading to skin vasoconstriction.
Patients with class Ill hemorrhage have lost 30-40% of their blood volume (or
1500-2000 cc) and can no longer maintain their blood pressure at normal
levels despite further increases in heart rate and peripheral vascular
constriction. These patients will begin to have a decreased level of
consciousness and a further decrease in urine output due to poor cerebral
and renal perfusion, respectively.
Class IV hemorrhage is defined as a blood loss of more than 40% of the blood
volume (or > 2000 cc). The patient appears lethargic, tachypneic and has
markedly decreased urine output. At this point, circulatory failure and death
are imminent without therapeutic intervention.
When hemorrhage occurs, tachycardia and peripheral vascular constriction
are the first physiological changes. These responses act to maintain the
blood pressure within normal limits until severe blood loss has occurred.
Tetanus Immunization -
All patients with traumatic wounds should be assessed for the need of
tetanus prophylaxis. Tetanus immune globulin (TIG) provides passive,
temporary, and immediate immunity. Tetanus-diphtheria toxoid (Td) provides
active, prolonged, and delayed immunity. Wounds at high risk for vegetative
Clostridium fefani growth are those that provide an anaerobic environment
for growth, such as puncture wounds, projectile wounds, wounds containing
foreign bodies, sites of active infection by other organisms, and wounds
containing necrotic tissue.
, Tetanus immune globulin (TIG) provides passive, temporary and immediate
immunity. Tetanus-diphtheria toxoid (Td) provides active, prolonged and
delayed immunity. Wounds at high risk for vegetative Clostridium teeani
growth are those that provide an anaerobic environment for growth, such as
puncture wounds, Projectile wounds, wounds containing foreign bodies, sites
of active infection by other organisms and wounds containing necrotic tissue.
A Td booster should be administered to individuals with more severe or
dirty wounds (e.g .. puncture wounds and wounds contaminated with dirt.
feces. or saliva) who received their latest dose more than 5 years ago and
those with clean minor wounds who received their latest dose more than
10 years ago.
A TIG injection should be administered to individuals who have received less
than three doses of tetanus vaccine and those with a more severe or dirty
wounds who have an unknown immunization status.
Glasgow Coma Scale - All trauma patients should be first assessed using
the GCS, which estimates the severity of the patient's neurologic injury for
triage. The GCS can also give some prognostic information when used in
conjunction with the patient's age and presence of concomitant adverse
clinical findings, such as hypoxia, cardiovascular compromise, increased
intracranial pressure, and radiographic evidence of a midline shift of the
brain. Calculation of GCS score is shown below.
