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Division 1 Introduction to Advanced Prehospital Care

Division 1 Introduction to Advanced Prehospital Care. Chapter 4 General Principles of Pathophysiology Part I How Normal Body Processes Are Altered by Disease and Injury. Topics. Disease Risk Hypoperfusion Shock Multiple Organ Dysfunction Syndrome. Pathophysiology.

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Division 1 Introduction to Advanced Prehospital Care

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  1. Division 1Introduction to AdvancedPrehospital Care

  2. Chapter 4General Principles of PathophysiologyPart I How Normal Body Processes Are Altered by Disease and Injury

  3. Topics • Disease Risk • Hypoperfusion • Shock • Multiple Organ Dysfunction Syndrome

  4. Pathophysiology • The study of how diseases alter the normal physiological processes of the human body • From the root “patho” meaning disease

  5. How Cells Respond to Change and Injury

  6. Cellular Adaptation • Cells, tissues, organs, and organ systems can adapt to both normal and injurious conditions. • Adaptation to external stressors results in alteration of structure and function. • Examples: Growth of the uterus during pregnancy, dilation of the left ventricle after an MI.

  7. Types of Cellular Adaptations(1 of 2) • Atrophy • Decreased size resulting from a decreased workload • Hypertrophy • An increase in cell size resulting from an increased workload

  8. Types of Cellular Adaptations(2 of 2) • Hyperplasia • An increase in the number of cells resulting from an increased workload • Metaplasia • Replacement of one type of cell by another type of cell that is not normal for that tissue • Dysplasia • A change in cell size, shape, or appearance caused by an external stressor

  9. Cellular Injury • Hypoxic • Chemical • Infectious • Immunologic/Inflammatory • Physical agents • Nutritional balances • Genetic factors

  10. Manifestation of Cellular Injury • When cells are injured metabolism is changed, causing substances to infiltrate or accumulate to an abnormal degree in cells.

  11. Cellular Swelling • Results from a permeable or damaged cellular membrane • Caused by an inability to maintain stable intra- and extracellular fluid and electrolyte levels

  12. Fatty Change • Lipids invade the area of injury. • Occurs most commonly in vascular organs, most frequently the liver. • Causes a disruption of the cellular membrane and metabolism and interferes with the vital functions of the organ.

  13. Signs and Symptoms of Cellular Change • Fatigue and malaise • Altered appetite • Fever • Increased heart rate associated with fever • Pain

  14. Cell Death (1 of 3) • Apoptosis • Injured cell releases enzymes that engulf and destroy the cell. • Cells shrink. • Eliminating damaged and dead cells allows tissues to repair and possibly regenerate.

  15. Cell Death (2 of 3) • Necrosis • A pathological process • Cells swell and rupture • Coagulative • Liquefactive • Caseous • Fatty

  16. Cell Death (3 of 3) • Gangrenous necrosis • Cell death over a wide area • Dry • Wet • Gas

  17. Fluids and Fluid Imbalances

  18. Water is the most abundant substance in the human body.

  19. Where the Water Is Found • Intracellular fluid—fluid inside the cells • Extracellular fluid—all the fluid outside the body cells • Intravascular fluid—fluid within the circulatory system • Interstitial fluid—fluid outside of the cell membranes but not within the circulatory system

  20. Edema • Accumulation of water in the interstitial space due to disruption in the forces and mechanisms that normally keep net filtration at zero

  21. Mechanisms That Cause Edema • A decrease in plasma oncotic force • An increase in hydrostatic pressure • Increased capillary permeability • Lymphatic channel obstruction

  22. Edema (1 of 2) • Can be local or within a certain organ system • Sprained ankle vs. pulmonary edema

  23. Edema (2 of 2) • Water in interstitial spaces is not available for metabolic processes. • Edema, therefore, can cause a relative condition of dehydration.

  24. Intravenous Therapy

  25. Blood Components

  26. The percentage of the blood occupied by the red blood cells is termed the hematocrit.

  27. Fluid Replacement

  28. Transfusion Reactions • Transfusion reactions occur when there is a discrepancy between the blood type of the patient and the type of the blood being transfused.

  29. Fever Chills Hives Hypotension Palpitations Tachycardia Flushing of the skin Headache Loss ofconsciousness Nausea Vomiting Shortness of breath Signs and Symptoms of Transfusion Reactions

  30. Treatment of Transfusion Reactions (1 of 2) • IMMEDIATELY stop the transfusion. • Save the substance being transfused. • Rapid IV infusion.

  31. Treatment of Transfusion Reactions (2 of 2) • Assess the patient’s mental status. • Administer oxygen. • Contact medical direction. • Be prepared to administer mannitol, diphenhydramine, or furosemide.

  32. Intravenous Fluids

  33. Hemoglobin-Based Oxygen-Carrying Solutions (HBOCs)   • Commonly referred to as “blood substitutes” • Compatible with all blood types • Do not require blood typing, testing, or cross-matching • PolyHeme • Hemopure

  34. Colloids • Colloids remain in intravascular spaces for an extended period of time and have oncotic force. • Plasma protein fraction (Plasmanate) • Salt-poor albumin • Dextran • Hetastarch (Hespan)

  35. Crystalloids • Crystalloid solutions are the primary compounds used in prehospital care. • Isotonic solutions • Hypertonic solutions • Hypotonic solutions

  36. The effects of hypertonic, isotonic, and hypotonic solutions on red blood cells

  37. Most Commonly Used Solutions in Prehospital Care

  38. Acid-Base Derangements

  39. Respiration = CO2 + H2O H2CO3 H+ + HCO3- Respiratory Acidosis Caused by abnormal retention of CO2 from impaired ventilation due to problems occurring in the lungs or respiratory center of the brain.

  40. Respiration = CO2 + H2O H2CO3 H+ + HCO3- Respiratory Alkalosis Caused by increased respiration and excessive elimination of CO2. The CO2 level is decreased and the pH is increased.

  41. H+ + HCO3- H2CO3 H2O + CO2 Metabolic Acidosis Results from the production of metabolic acids such as lactic acid. These acids consume bicarbonate ions. Can be the result of dehydration, diabetes, or medication usage.

  42. Compensation for metabolic acidosis begins with an increase in respirations.

  43. H+ + HCO3- H2CO3 H2O + CO2 Metabolic Alkalosis • The pH is increased and the CO2 level is normal. It is usually caused by administration of diuretics, loss of chloride ions associated with prolonged vomiting, and overzealous administration of sodium bicarbonate.

  44. Genetics and Other Causes of Disease

  45. Many Factors Combine to Cause Disease (1 of 3) • Genetics • Environment • Lifestyle • Age • Gender

  46. Many Factors Combine to Cause Disease (2 of 3) • Inherited traits are determined by molecules of deoxyribonucleic acid (DNA). • Each somatic cell contains 46 chromosomes. • Sex cells contain 23 chromosomes.

  47. Many Factors Combine to Cause Disease (3 of 3) • An offspring receives 23 chromosomes from the mother and 23 chromosomes from the father. • One or more chromosomes may be abnormal and may cause a congenital disease or a propensity toward acquiring a disease later in life.

  48. Most disease processes are multifactorial in origin.

  49. Disease Effects on Individuals • Host • Agent • Environment

  50. Disease Effects on Populations • Incidence • Prevalence • Mortality

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