Peripheral venous filling

Introduction Peripheral venous fistula is a clinical manifestation of septic shock. In addition to actively controlling infection, peripheral venous venous support should be given to supplement the blood volume, correct acidosis, adjust vasomotor function, eliminate blood cell aggregation to prevent microcirculation stasis, and maintain important organs.

Cause

The cause of peripheral venous venous: peripheral venous fistula is suffering from septic shock.

an examination

Related inspection

Blood routine central venous pressure measurement (CVP) urine routine

Diagnosis of peripheral venous fistula:

1. Consciousness and mental state (reflecting the blood flow of the central nervous system) After initial agitation, it turns into depression and apathy, and even coma, indicating that the reactive excitability of nerve cells is inhibited, and the condition changes from mild to severe. In patients with cerebral arteriosclerosis or hypertension, even if the blood pressure drops to 10.64/6.65 kPa (80/50 mmHg), the reaction can be slow; while those with good original physique are more tolerant to hypoxia, but also Very short.

2. Respiratory frequency and amplitude (reflecting the presence of acid-base balance disorders or pulmonary and central nervous system insufficiency) See "shock metabolism" changes, acid-base balance disorders, and important organ dysfunction.

3. Skin color, temperature and humidity (reflecting peripheral perfusion) The skin is pale, purpura with plaque contraction, and microcirculation perfusion is insufficient. The filling of the capillary in the nail bed can also be used as a reference. If there is a sputum or ecchymosis on the chest or abdominal wall, it may indicate DIC.

4. Jugular vein and peripheral vein filling situation The venous collapse suggests insufficient blood volume, over-confidence indicates that the heart function is not good or the infusion is excessive.

5. Pulse before the blood pressure has not decreased in the early stage of shock, the pulse has seen a fine speed, and even can not understand. As the shock improves, the pulse intensity tends to recover earlier than the blood pressure.

6. Urine volume (reflecting visceral perfusion) When the blood pressure is above 10.6 kPa (80 mmHg), the average urine volume is 20-30 ml/h, and the urine volume is >50 ml/h, indicating that the renal blood perfusion is sufficient.

7. A wrinkle microcirculation eye examination under the low magnification microscope to observe the number of capillary folds, diameter, length, clarity and appearance, blood color, blood flow rate, uniformity and continuity, red blood cell aggregation, vasomotor Shrinking state and god clarity. In shock, it can be seen that the number of capillary folds of the nail fold is reduced, the diameter of the tube is thin and shortened, the line is broken, the filling is poor, the blood color becomes purple, the blood flow is slow and the uniformity is lost, and in severe cases, blood coagulation occurs. Fundus examination showed small arteriolar spasm, venous stasis, arteriovenous ratio from normal 2:3 to 1:2 or 1:3, severe retinal edema. Increased intracranial pressure can be seen in papilledema.

Differential diagnosis

Differential diagnosis of peripheral venous fistula:

Septic shock should be differentiated from hypovolemic shock, cardiogenic shock, anaphylactic shock, and neurogenic shock. Hypovolemic shock is caused by massive hemorrhage (internal or external bleeding), loss of water (such as vomiting, diarrhea, intestinal obstruction, etc.), loss of plasma (such as extensive burns, etc.), resulting in a sudden decrease in blood volume. Cardiogenic shock is caused by low blood pressure in the heart, often secondary to acute myocardial infarction, acute pericardial occlusion, severe arrhythmia, various myocarditis and cardiomyopathy, acute pulmonary heart disease. Anaphylactic shock is often caused by an allergic reaction to certain drugs (such as penicillin) or biological products. Neurogenic shock can be caused by trauma, severe pain, cerebrospinal injury, anesthesia, etc., due to nerve action, the external peripheral blood vessels are dilated, and the effective blood vessel volume is relatively reduced.

diagnosis:

1. Consciousness and mental state (reflecting the blood flow of the central nervous system) After initial agitation, it turns into depression and apathy, and even coma, indicating that the reactive excitability of nerve cells is inhibited, and the condition changes from mild to severe. In patients with cerebral arteriosclerosis or hypertension, even if the blood pressure drops to 10.64/6.65 kPa (80/50 mmHg), the reaction can be slow; while those with good original physique are more tolerant to hypoxia, but also Very short.

2. Respiratory frequency and amplitude (reflecting the presence of acid-base balance disorders or pulmonary and central nervous system insufficiency) See "shock metabolism" changes, acid-base balance disorders, and important organ dysfunction.

3. Skin color, temperature and humidity (reflecting peripheral perfusion) The skin is pale, purpura with plaque contraction, and microcirculation perfusion is insufficient. The filling of the capillary in the nail bed can also be used as a reference. If there is a sputum or ecchymosis on the chest or abdominal wall, it may indicate DIC.

4. The jugular vein and peripheral veins are full of venous collapse, suggesting that the blood volume is insufficient, and the over-capacity indicates that the heart function is not good or the infusion is excessive.

5. Pulse before the blood pressure has not decreased in the early stage of shock, the pulse has seen a fine speed, and even can not understand. As the shock improves, the pulse intensity tends to recover earlier than the blood pressure.

6. Urine volume (reflecting visceral perfusion) When the blood pressure is above 10.6 kPa (80 mmHg), the average urine volume is 20-30 ml/h, and the urine volume is >50 ml/h, indicating that the renal blood perfusion is sufficient.

7. A wrinkle microcirculation eye examination under the low magnification microscope to observe the number of capillary folds, diameter, length, clarity and appearance, blood color, blood flow rate, uniformity and continuity, red blood cell aggregation, vasomotor Shrinking state and god clarity. In shock, it can be seen that the number of capillary folds of the nail fold is reduced, the diameter of the tube is thin and shortened, the line is broken, the filling is poor, the blood color becomes purple, the blood flow is slow and the uniformity is lost, and in severe cases, blood coagulation occurs. Fundus examination showed small arteriolar spasm, venous stasis, arteriovenous ratio from normal 2:3 to 1:2 or 1:3, severe retinal edema. Increased intracranial pressure can be seen in papilledema.

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