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Post by Barry on May 20, 2015 0:17:56 GMT
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Post by Barry on Jun 4, 2015 3:14:24 GMT
We have introduced the concept of perfusion, what does perfusion mean to you and how would you measure it?
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Post by ianman on Jun 5, 2015 2:13:53 GMT
Good to see you are starting with the easy questions boss....tui anyone?
Perfusion to me would mean looking at the way a patient presents with regard to good skin colour, warmth, quick capillary refill, good LOC and adequate BP-this would probably point to our patient not being too sick at the present time-where as a patient who is cool to touch, lowered LOC, slow capillary refill and pale skin could point towards the patient being a tad sick. Environmental conditions and event history also being taken into consideration......on the right track or miles away?
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Post by Kirsty C on Jun 7, 2015 6:42:45 GMT
I would have to concur with Ian. I would like to emphasize the importance of getting an overall picture in respect to fact that if you went to someone similar to my daughter, Olivia you would get an almighty fright when you looked at her feet. She spends much of her time in a wheelchair and even on a good day when her feet are toasty warm they are an alarming shade of purple. Her Cap refill is fine but again BP would be considered low as she is on medication but it is adequate for her well being. On a lighter note she is a university student in Wellington so her LOC would be questionable also on a Friday and Saturday night and subsequent mornings Lol
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Post by Gerald C on Jun 7, 2015 10:18:58 GMT
A patient's perfusion is one of the first vital signs that one can determine as one enters a scene; in addition to determining a quick LoC (is the pt concious, sitting up etc?) the pt's appearance in terms of peripheral colour etc can tell how sick the pt really is; cyanosed lips, pale, ashen complexion, diaphoresis etc - these at a glance will inform you how sick the pt potentially is and may determine, therefore, how long you 'stay and play', or how quickly you 'load and go'. Ian has listed the vital signs that measure the level of perfusion. It is important, therefore, that we become adept at
In our multi-ethnic society one has to be careful as some of the obvious signs of perfusion such as normal skin colour are not that straight forward to determine; For example I work with an Irishman who is normally incredibly pale. If we were to come across him in an incident it may appear that he not well perfused - we would need to check the range of vital signs (I can't imagine him being any paler than he already is!). Likewise, when working with darker skinned pts I would always ask, if possible, someone close to the pt whether the pt's skin appears normal or different. I am lead to understand that one could also check the inside of the lips or eyelids in this case too though have never seen this done in practice.
I concur that with Ian regarding being aware of the environmental conditions as these can skew our assessment of perfusion somewhat. We know that in the cold our body naturally constricts the peripheral blood vessels (capillary beds) to conserve heat to the body core, so a normal healthy pt may appear poorly perfused due to the environmental factors but in fact have nothing wrong (it is something that should be noted on the PRF especially if it is giving a skewed reading for a sign such as SpO2 or cap refill).
Have a graet week.
G
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Post by Gerald C on Jun 7, 2015 10:23:41 GMT
Apologies for a couple of errors of spelling and incomplete sentence (too tired): - should have finished writing that 'we become adept at assessing these vital signs.' - sp mistakes; conscious and great.
G
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Post by Brendoon on Jun 8, 2015 8:45:59 GMT
Hi everyone, hope you're all doing well out there! I smell something in the air, perhaps we all should go have a beer!!
So ... perfusion for me I guess means 'warm, pink and dry' this is to me a happy well perfused person?! Anyone who is not warm,pink and dry, then there is something going on in the perfusion department. When I read what perfusion means to me, my first thought was straight to the physiology, whats happening? So air comes in, gets mixed with blood, the blood carries oxygen around the body which needs it so badly. The blood flow feeds into smaller and smaller capillaries and these then 'soak' into the soft tissue or organs that need it?!
So if this doesn't happen as it should we see someone who is not warm,pink and/or dry. And that is how I can start to measure it, skin colour, temperature, how the skin feels and cap refill.... and obviously as pointed out by both Gerald and Kirsty everyone is different and environment changes things as well.
Here to learn and share
B
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Post by modeliciousbaby on Jun 9, 2015 1:49:26 GMT
So...if you think of your blood stream, like all the aeteries and veins are like highways and roads. Then there are cars travelling along the roads...things like red blood cells, different types of white blood cells, haemoglobin, insulin etc. Haemoglobin is actually a taxi and picks up its passenger oxygen to take it where it is required around the body. If a body is well perfused then the oxygen is getting to all the right places and none of the roads or highways are blocked or damaged. We measure this by using a SATS monitor (or oximeter) measures the percentage of taxis (haemoglobin) in the blood. And because these particular taxis carry oxygen we can assume that the percentage relates to oxygen as well.
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Post by Janell on Jun 9, 2015 22:53:57 GMT
Hey Everyone!
Perfusion to me equals well oxigenated blood circulating to the brain, vital organs and extremeties. Well perfused equals good skin colour, warm and dry to touch, capillary refill of less than 2 secs, GCS of 15, good radial pulses and good limb baselines.
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Post by Barry on Jun 12, 2015 0:12:14 GMT
Hi Team, Some great answers here so let me pose this with you all; does this mean we are all in the homeostatic state when we are perfused well? Look forward to your answers Barry
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Post by Gerald C on Jun 12, 2015 9:52:15 GMT
That's an interesting question to ponder. AT a base level one can state that if we are in a homeostatic state then it would follow that we would be well perfused. However, if we are well perfused it doesn't follow that we would necessarily be in a homeostatic state. My reasoning for this? Not all imbalances of our bodies necessarily impact on our perfusion. Some do but otheres don't. If, as a start, we consider a positive feedback mechanism such as childbirth. The body goes into imbalance with the production of oxytocin to cause the uterus to contract. The body then goes into the mode of producing more oxytocin until bubby and placenta are delivered and oxytocin production is ceased. However, during this process, Mum generally remains well perfused even though technically she would not be considered to be in a state of homeostasis (Dad might be less well perfused as he goes into a state of shock and faint at the sight(s) or having the life squeezed out of his hand while being sworn at "coz it's all his fault"!). With another positive feedback system; haemostasis, for something like,say, a small laceration or similar where the body doesn't necessarily loose a significant volume of blood the pt can/should remain well perfused even though the body would not be in a perfect homeostatic state. If we consider body systems such as the urinary system - there could be something causing an imbalance with taht system but won't necessarily impact on the perfusion of a pt. The endocrine system which controls glucose regulation can be out of balance (diabetic issues) but the pt can still be well perfused. So, in my understanding, the ststement "we are all in the homeostatic state when we are perfused well" doesn't hold true. I stand to be corrected and look forward to what others think. In the meantime I will be off air for a few days while shifting house so keep dry, warm and well perfused!
G
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Post by kirstyc on Jun 13, 2015 9:39:12 GMT
In short, no. If we think about the "normal" person walking down the street we can assume that being well perfused does indeed mean they are in a homeostatic state but unfortunately we don't attend "normal" people, we attend people who have had some event that has led them to call for help. You can be well perfused and having a mild asthmatic episode,or be well perfused with a fractured femur. Perfusion is one indicator of many and should be taken into consideration with other signs and symptoms.
K
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Post by Cathy on Jun 16, 2015 1:30:53 GMT
Hi there No just because someone is perfused well does not mean that they are in homeostatic state. Some one definitely can be perfused well and have other health issues going on. When we do an assessment of a patient we are looking for a variety of indicators to show what may be happening to this person. It would be dangerous to just look at one factor of homeostatis C
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Post by Brendoon on Jun 16, 2015 7:46:28 GMT
Hiya, Good question, I think homeostasis is a number of our bodies incredible systems working together as hard as it can to maintain this homeostatic state. So if these systems can keep us well perfused, yes it is doing well, but that is not to say it is letting us down in other areas.
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Post by janell on Jun 17, 2015 11:37:31 GMT
Hi guys!
So...my thinking is..... No. Because there are multiple systems when it comes to the regulation of the internal environment (homeostasis). Perfusion is only one of many outcomes of these systems operating correctly but does not independently prove our body is in total homeostatic state. i.e. A post op knee patient maybe presenting with infection at the site but is well perfused (limb and overall), other systems will be fighting infection causing a non homeostatic state.
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