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Dec 6, 2023

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1. Explain why patients in septic shock often require a significant amount of fluids, even though distributive shock is primarily a "container" problem. Septic shock requires significant fluid resuscitation due to the pathophysiological process that occurs from the initial inflammatory response (adib-Conquy & Cavaillon, 2007) . What starts as a normal inflammatory process at the site becomes systemic and is widespread. Mast cells and other white blood cells are recruited to the site. This causes vasodilation and subsequently is why the skin becomes warm and red at the area if it is involved. The mast cells release histamine, which helps recruit other inflammatory factors to the area (adib-Conquy & Cavaillon, 2007) . At some point in the continuum this process gets out of control and these inflammatory factors start circulating through the blood stream. This causes systemic vasodilation thus leading to hypotension. Histamine also increases blood vessel permeability leading to the vessels being leaky (adib-Conquy & Cavaillon, 2007) . Therefore, much of the fluid that is given to a patient with sepsis ends up leaking out into the interstitial space giving them a puffy dough boy appearance. 2. If a patient is having an asthma attack and albuterol is ineffective in relieving it, why might the use of epinephrine be beneficial? Epinephrine is released during the fight or flight response and is maximizing the bodies abilities in critical situations. It causes blood to shunt to the core and essential organs, as well as relaxes the bronchioles to maximize respiratory function ( Epinephrine oral inhalation: Medlineplus Drug Information ) . If a patient does not respond to albuterol, inhaled epinephrine may be given in an attempt to relax and open the bronchioles. 3. What effect would an alpha agonist have on the diastolic blood pressure and why? Alpha agonists increase diastolic blood pressure because of the effects they have on the sympathetic nervous system. Stimulation of the alpha receptors leads to vasoconstriction thus increasing systemic vascular resistance ( et al., Alpha agonists 2015) . This in turn increases diastolic blood pressure. 4. Explain why a fluid infusion may be beneficial for some types of shock but detrimental to others. Fluid infusions would be beneficial in obstructive, distributive, and hypovolemic shock. Obstructive shocks results from something blocking adequate blood flow, like cardiac tamponade ( Respond to shock, 2022) . Cardiac tamponade resulting in decreased filling of the heart leading to decreased cardiac output. Fluids work by increasing preload and attempting to overcome the pressure being exerted on the heart. Distributive shock is seen
in septic shock. Fluids are essential in distributive shock ( Respond to shock, 2022) . Hypovolemic shock is just that, low volume. Fluids are beneficial in this to an extent. If the patient is hypovolemic due to hemorrhage, permissive hypotension may be allowed because further dilution of circulating blood volume could result in tissue hypoxia. Now, if the patient is extremely hypotensive benefit outweighs risk. Finally, cardiogenic shock should not be treated with fluids ( Respond to shock, 2022) . Cardiogenic shock results from decreased contractility of the heart. Essentially the heart can not squeeze properly. Fluid administration could result in fluid overload and lead to pulmonary edema ( Respond to shock, 2022) . 5. Some EMS systems are using "push-dose epinephrine" as an alternative to a vasopressor infusion. What are some benefits and concerns with this procedure? Epinephrine is a vasopressor that can be infused via a drip as well. Push dose epi could be beneficial as it reduces the risk of extravasation and tissue necrosis in the patient (Breyre & Hodroge, 2019) . It would also reduce the chance of medication error if an incorrect titration is performed. Concerns with this procedure would be the risk for large swings in patient blood pressure due to inadequate monitoring, incorrect mixture and concentration of the pushes, and lack of education in some ems agencies (Breyre & Hodroge, 2019) . 6. Name two disease processes that might cause a patient to present with both chest pain and dizziness, and how a paramedic would differentiate them in the field. If they cannot be differentiated in the field, how are they diagnosed in the hospital? Two disease processes that can result in chest pain and dizziness are pulmonary hypertension and arrythmias (Lee, Causes of chest pain and dizziness ) . Arrythmias could possibly be diagnosed in the field if the arrythmia is caught on ecg while the patient is being monitored. Some arrythmias are paroxysmal, meaning they come and go. Pulmonary hypertension is diagnosed by a heart catheterization (Lee, Causes of chest pain and dizziness ) . This is not something that would be diagnosable in the field. It would be important to note any assessment finding consistent with pulmonary hypertension, however definitively hospitalization would be required. 7. Name two disease processes (different from the ones used in the previous question) that might cause a patient to present with chest pain and dyspnea, and how you would differentiate them in the field. If they cannot be differentiated in the field, how are they diagnosed in the hospital? Chest pain and shortness of breath can be associated with the flu if the patient develops pleuritis or costochondritis ( Non-cardiac chest pain and shortness of breath ) . This is due to the
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