Question

Carlos Adams was involved in a motor vehicle crash and suffered blunt trauma to his abdomen. Upon presentation to the emergency department, his vital signs are as follows: temperature, 100.9°F; heart rate, 120 bpm; respiratory rate, 20 breaths/min; and blood pressure, 90/54 mm Hg. His abdomen is firm, with bruising around the umbilicus. He is alert and oriented, but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolemic shock.

The following prescriptions are written for the patient:

• Place two large-bore IVs and infuse 0.9% NS at 125 mL/hr/line
• Obtain complete blood count, serum electrolytes
• Oxygen at 2 L/min via nasal cannula
• Type and cross for 4 units of blood
• Flat plate of the abdomen STAT

1. Describe the pathophysiologic sequence of events seen with hypovolemic shock.

2. What are the major goals of medical management in this patient?

3. What is the rationale for placing two large-bore IVs?

4. What is the rationale for placing the patient in a modified Trendelenburg position?

Answer 1

Ans1) hypovolemic shock:- hypovolemia is a condition in which the fluid content of our body decrease it can be due to vomiting bleeding diarrhoea but when it comes to shock that is a life threatening condition in which our body will have less fluid content to meet the enough demand of organs for oxygen nutrients and removing the waste that may even cause death in some cases due to ischemic changes in vital organs of our body

pathophysiology:-

1. due to etiological factors fluid level will decrease in our body
2. That will lead to death of mitochondria due to lack of oxygen
3. If mitochondria is dead then there won't be synthesis of ATP
4. Body will try to compensate this by the production of lactic acid and NDA
5. Hemodynamically our heart will try to pump as blood as it can to meet the demand that leads to increase in heart rate and decrease in BP
6. If fluid restoration is not done timly this hypovolemia will convert in a shock that may lead to into shock condition and the sympathetic system will get activated
7. This will lead to compromise in the blood supply of peripheral organs and iit will lead to ischemic changes in those areas.

Ans 2) major goal of medical treatment is to restore the volume that has been lost due to haemorrage

Ans 3)large bore cannula will provide excess amount of fluid to the patient as required by him while if we will put small bore cannula it will give fluid drop by drop that will not meet the requirements of patient and he will go in ischemic changes

Ans4) modified trendlenberg position means only legs elevated that will lead to increase in cardiac output and bp of the patient

Answer 2

3. What is the rationale for placing two large-bore IVs?The bigger the diameter of the IV tubing, the more fluid you will be able to infuse into the patient at a faster rate.

4. What is the rationale for placing the patient in a modified Trendelenburg position?

   This position where the patient is positioned in a manner whereby the legs are raised helps improve circulation.