ABSTRACT
The objective of this study was to determine the effectiveness of lactated Ringer's (LR) solution, sodium hydroxyethyl starch (hetastarch), and dopamine (DA) on diaphragm shortening (DS), diaphragm blood flow (DBF), diaphragm hydrogen peroxide (H2O2), and diaphragm apoptosis following hemorrhagic shock (HS). Sprague-Dawley rats were assigned to the following groups: HS, LR, LR plus DA, hetastarch, and hetastarch plus DA. After removing 40% of the blood volume, with exception of the HS group, an equal volume of resuscitation fluid was administered. The diaphragm was excised so that DBF, H2O2, and apoptosis could be measured. LR did not increase DBF and DS, whereas the other fluids increased DBF and DS. H2O2 and apoptosis decreased with LR administration. H2O2 and apoptosis were decreased to a much greater extent with LR plus DA, hetastarch, and hetastarch plus DA infusions. In conclusion, LR plus DA, hetastarch, and hetastarch plus DA maintained DS and DBF, which may be attributed to the decreases in reactive oxygen species as reflected by H2O2 and apoptosis.
Subject(s)
Diaphragm/physiopathology , Dopamine Agents/pharmacology , Dopamine/pharmacology , Fluid Therapy , Shock, Hemorrhagic/therapy , Animals , Apoptosis/drug effects , Blood Gas Analysis , Diaphragm/blood supply , Hydroxyethyl Starch Derivatives/administration & dosage , Male , Muscle Contraction/drug effects , Plasma Substitutes/administration & dosage , Rats , Rats, Sprague-Dawley , Shock, Hemorrhagic/physiopathologyABSTRACT
AIMS AND OBJECTIVES: the aim of this article is to provide a review of the literature regarding oxygen administration and the use of oxygen in patients experiencing haemorrhagic shock (HS). RESULTS: oxygen is administered to patients to assist them in maintaining oxygenation. The administration of oxygen is complex and varies significantly among patients. In order to optimize patient care, clinicians need to be aware of the potential effects, both beneficial and harmful, that oxygen can have on the body. INCLUSION AND EXCLUSION CRITERIA: literature inclusion criteria for this article was any article (1995 to present) pertaining to oxygen administration and HS. Also included were articles related to tissue injury caused by an overabundance of free radicals with the administration of oxygen. Articles related to oxygen and wound healing, pollution, aerospace, food and industrial uses were excluded. CONCLUSIONS: this review of the literature provides an overview of the use of oxygen in clinical practice and HS. The harmful effects of oxygen are highlighted to alert the clinician to this potential when there is an overabundance of oxygen. RELEVANCE TO CLINICAL PRACTICE: oxygen is one of the most common drugs used in the medical community; however, the effects of oxygen on the body are not well understood. The use of oxygen if not prescribed correctly can cause cellular damage and death. Clinicians need to be more aware of the effects of oxygen and the damage it may cause if not administered properly.
Subject(s)
Critical Care/methods , Oxygen Inhalation Therapy/methods , Shock, Hemorrhagic/therapy , Apoptosis , Cell Hypoxia/physiology , Humans , Hyperoxia/etiology , Hypoxia/etiology , Male , Monitoring, Physiologic/methods , Monitoring, Physiologic/nursing , Oxygen Consumption/physiology , Oxygen Inhalation Therapy/adverse effects , Oxygen Inhalation Therapy/instrumentation , Oxygen Inhalation Therapy/nursing , Reactive Oxygen Species/adverse effects , Reactive Oxygen Species/metabolism , Shock, Hemorrhagic/complications , Shock, Hemorrhagic/metabolism , Tissue Distribution/physiologyABSTRACT
There are many organelles within a cell, each with individual responsibilities required for life. Of these organelles, the mitochondria are the hemi of the cell, producing the energy necessary for cell function. Reactive oxygen species can cause mitochondrial dysfunction and contribute to many diseases often seen in emergency departments. When reactive oxygen species are produced, the mitochondria undergo functional and structural changes causing the release of cytochrome c. Cytochrome c is responsible for activating apoptotic pathways leading to cell death. Apoptosis, or programmed cell death, is needed to maintain homeostasis in the body; however, when this occurs prematurely by an increase in reactive oxygen species production, many pathological conditions can occur. Clinicians in emergency departments caring for patients with different diseases should consider that the mitochondria may play an important role in patients' recovery. For instance, myocardial infarctions and burns are two examples of altered physiologic states that play a role in mitochondrial dysfunction. Awareness of the different treatments that target the mitochondria will prepare emergency department clinicians to better care for their patients.
Subject(s)
Mitochondria/pathology , Mitochondria/physiology , Apoptosis/physiology , Cytochromes c/physiology , Free Radicals/metabolism , Humans , Mitochondria/metabolism , Mitochondrial Diseases/drug therapy , Mitochondrial Diseases/genetics , Mitochondrial Diseases/physiopathology , Oxidative Stress/physiology , Ubiquinone/analogs & derivatives , Ubiquinone/therapeutic useABSTRACT
Hemorrhagic shock is a severe life-threatening emergency affecting all organ systems of the body by depriving tissue of sufficient oxygen and nutrients by decreasing cardiac output. This article is a short review of the different types of shock, followed by information specifically referring to hemorrhagic shock. The American College of Surgeons categorized shock into 4 classes: (1) distributive; (2) obstructive; (3) cardiogenic; and (4) hemorrhagic. Similarly, the classes of hemorrhagic shock are grouped by signs and symptoms, amount of blood loss, and the type of fluid replacement. This updated review is helpful to trauma nurses in understanding the various clinical aspects of shock and the current recommendations for fluid resuscitation therapy following hemorrhagic shock.
