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SHOCK HIPOVOLEMICO

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by MAGALY PENA on 10 October 2012

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Transcript of SHOCK HIPOVOLEMICO

DRA. MAGALY DENISE PENA ARRIAGA r3go SHOCK HIPOVOLEMICO INTRODUCCION Shock:
Estado fisiologico
Reduccion sistemica de perfusion tisular FISIOPATOLOGIA CLASIFICACION ATLS/ CUDARO CLINICO MANEJO Reconocer cuadro clínico
Restaurar volumen intravascular
Mantener adecuada oxigenacion
Laboratorios, usg, otros.
Reconocer fuente de sangrado
Limitar perdida sanguinea RESUCITACION INTRAVENOSA
Vias perifericas (16)
Via central
2 lt solución salina
Transfusion hemoderivados
PAM 65 mm/hg
Sistólica 90 mm/hg
PREVENCION Perfusion tisular -- gasto cardiaco y resitencia periferica.
Resistencia periferica
Gasto cardiaco Hipoxia y procesos bioquimicos criticos intracelulares
Cambios de pH, disfuncion endotelial, estado redox, etc.
Reversible ------ irreversible
Muerte celular, dano organico, falla organica, muerte. Shock hipovolemico Valoración preoperatoria
Corrección de anemia
Revision de pediculos vasculares, etc VALORACION PREOPERATORIA Historia clínica
Toma de medicamentos
Valoración de exámenes de laboratorio
Pruebas cruzadas (2 - 4 pg) controversial COLWELL CHRISTPPER UPTODATE AUG 2012 INITIAL EVALUATION AND MANAGMENT OF SHICK IN ADUKT TRAUMA COLWELL CHRISTPPER UPTODATE AUG 2012 INITIAL EVALUATION AND MANAGMENT OF SHICK IN ADUKT TRAUMA COLWELL CHRISTPPER UPTODATE AUG 2012 INITIAL EVALUATION AND MANAGMENT OF SHICK IN ADUKT TRAUMA COLWELL CHRISTPPER UPTODATE AUG 2012 INITIAL EVALUATION AND MANAGMENT OF SHICK IN ADUKT TRAUMA COLWELL CHRISTPPER UPTODATE AUG 2012 INITIAL EVALUATION AND MANAGMENT OF SHICK IN ADUKT TRAUMA COLWELL CHRISTPPER UPTODATE AUG 2012 INITIAL EVALUATION AND MANAGMENT OF SHICK IN ADUKT TRAUMA COLWELL CHRISTPPER UPTODATE AUG 2012 INITIAL EVALUATION AND MANAGMENT OF SHICK IN ADUKT TRAUMA COLWELL CHRISTPPER UPTODATE AUG 2012 INITIAL EVALUATION AND MANAGMENT OF SHICK IN ADUKT TRAUMA COLWELL CHRISTPPER UPTODATE AUG 2012 INITIAL EVALUATION AND MANAGMENT OF SHICK IN ADUKT TRAUMA TRANSFUSION 1:1:1 Paquete globular + Plasma fresco congelado + plaquetas.
Controlar hipotermia
O -
Sangrado mayor a 2 lt 60% mas de CID COLWELL CHRISTPPER UPTODATE AUG 2012 INITIAL EVALUATION AND MANAGMENT OF SHICK IN ADUKT TRAUMA TRATAMIENTOS COMPLEMENTARIOS PARA HEMORRAGIA Agentes hemostaticos
Antifribrinolisis (acido traxenaminico - bloquea lisina con plasmina)
Factor VII a COLWELL CHRISTPPER UPTODATE AUG 2012 INITIAL EVALUATION AND MANAGMENT OF SHICK IN ADULT TRAUMA SKINNER, CUASES AND MANAGMENT OF SHOCK SERVIER 2007 Los inotropicos y vasopresores se utilizan cuando la resucitacion no ha respondido a volumen.
Inotropicos : dobutamina, epinefrina
Vasopresores :norepinefrina, epinefrina SKINNER, CUASES AND MANAGMENT OF SHOCK SERVIER 2007
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