Hypovolemic Shock Question for the EMS vets...
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Shishkabob
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They don't. Bodies are built the same, they just have more fat whilst having a relatively smaller amount of circulating blood to body mass.
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Well, this question was posed my my professor. So, you pointed something out thats interesting. If there is less blood then can we blouse a typical protocol amour for say trams?(500cc). Surely the fact that there is less blood would contribute to a slightly different mechanism of compensation...
abckidsmom
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I find them to show signs of early shock longer and more mildly before the crash. And we rationalize their tachycardia longer and we discard their out of breath panting from the beginning.
In my experience of course. I think we miss a lot of early shock and that makes us think that they behave differently when they really don't except for the baseline adrenal fatigue and high cortisol levels.
In my experience of course. I think we miss a lot of early shock and that makes us think that they behave differently when they really don't except for the baseline adrenal fatigue and high cortisol levels.
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How would less blood cause a different means of compensation? So how does a normal person compensate for hypovolemia. What else do you think an obese person is capable of doing?
Shishkabob
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Depends on what you're looking for then. As she stated above, there are different clues, however, scientifically speaking, compensation is compensation.
Pedi's compensate the same physiologically, however they tend to chug along a lot more 'normal' (compensated) for a lot longer due to muscle tone and the like, but when fatigue sets in, they crash hard and fast. Hence, the same, yet different.
So I guess I just need to understand what you mean by "compensate differently".
mycrofft
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Don't know about once they've started bleeding, but mechanically speaking it can take more to get lethal with a 400 lb man than a 87 lb kid. Had a patient who was shot with a .25 popgun into a fold in his panniculum (fat apron) and didn't know it. Shanks need to be longer and stronger too.
Don't morbidly obese individuals have a larger omentum? If so, that will act as a cofferdam against non-catastrophic intra-abdominal bleeds (and infection) for a tad, the more movement the less so.
And obesity tends to promote hypertension, so....(finish the sentence).
Don't morbidly obese individuals have a larger omentum? If so, that will act as a cofferdam against non-catastrophic intra-abdominal bleeds (and infection) for a tad, the more movement the less so.
And obesity tends to promote hypertension, so....(finish the sentence).
EpiEMS
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And the corrections RN emerges
The OP's question is actually a question I was considering, so thanks for asking it!
Depends on where in the course of shock you are at.
The obese can suffer from "relative" hypovolemia because of their increased size. So they may actually have "normal" looking vitals and be in shock. This can lead to problems identifying the patient is in shock as well as undertreating it.
In obesity there are also endocrinological components secreted from the fat tissue, some of which are shown to be antiapoptotic, (therefore beneficial in both ischemic and inflammatory pathophys of shock.) like estrogen. But anything that couples with an estrogen receptor would do the same.
Shock is a complicated puzzle and there is much to understand about it. It affects every body system in various phases.
The original surgical terms used to describe the changes in physiology were called "ebb and flow" but today are more widely known as "catabolic and anabolic" phases. Some simplify it to "early and late" shock, and some even go with clinically insignificant terms like compensated, decompensated, and irreversible.
The obese can suffer from "relative" hypovolemia because of their increased size. So they may actually have "normal" looking vitals and be in shock. This can lead to problems identifying the patient is in shock as well as undertreating it.
In obesity there are also endocrinological components secreted from the fat tissue, some of which are shown to be antiapoptotic, (therefore beneficial in both ischemic and inflammatory pathophys of shock.) like estrogen. But anything that couples with an estrogen receptor would do the same.
Shock is a complicated puzzle and there is much to understand about it. It affects every body system in various phases.
The original surgical terms used to describe the changes in physiology were called "ebb and flow" but today are more widely known as "catabolic and anabolic" phases. Some simplify it to "early and late" shock, and some even go with clinically insignificant terms like compensated, decompensated, and irreversible.
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Brandon O
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Assessment is challenged as well. The CTD patient who's lost radial and brachials pulses may otherwise present obviously, but in the obese patient, it's tough to say if they're absent or simply buried per usual.
Shock question restated
Ok guys. Thanks a lot for those who took time to respond. So, after reading some of the responses I'd like to pose a new, yet similar, questionHow do obese pts compensate from hypovolemic shock differently than non-obese?. How about this: when dealing with an obese trauma patient, what should the attending emergency medical provider keep in mind? Better yet, I'll try to recall the actual selections provided on the exam. 1. Obese patients handle blood loss better due to the fact that even though ischemic, much of the tissue is in important. 2. They handle a hypovolemic better due to the amount of blood contained, proportionate to their bodies. There were 2 more, but I'm unable to remember. The just of the question is simply what is an important factor the provider must always keep in mind when dealing with obese trauma pts. That differs from others?
Ok guys. Thanks a lot for those who took time to respond. So, after reading some of the responses I'd like to pose a new, yet similar, questionHow do obese pts compensate from hypovolemic shock differently than non-obese?. How about this: when dealing with an obese trauma patient, what should the attending emergency medical provider keep in mind? Better yet, I'll try to recall the actual selections provided on the exam. 1. Obese patients handle blood loss better due to the fact that even though ischemic, much of the tissue is in important. 2. They handle a hypovolemic better due to the amount of blood contained, proportionate to their bodies. There were 2 more, but I'm unable to remember. The just of the question is simply what is an important factor the provider must always keep in mind when dealing with obese trauma pts. That differs from others?
Keep in mind they do not show early signs of shock.
Relative hypovolemia means that by the numbers they are normal but that number is actually too low for them.
It is similar to relative bradycardia. Technically not brady by the numbers, but not sufficent for that person.
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