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N216 A/B > [216B] Shock > Flashcards

[216B] Shock Flashcards

1
Q

What are the 4 types of circulatory shocks?

A
  • Distributive
  • Hypovolemic
  • Cardiogenic
  • Obstructive
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2
Q

What are 3 defining characteristics of distributive shocks?

A
  • Loss of blood vessel tone
  • Vasodilation
  • Shift of vascular volume into extravascular space
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3
Q

What are the 3 types of distributive shock?

A
  • Septic
  • Anaphylactic
  • Neurogenic
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4
Q

Septic shock is a response to a ____
Anaphylactic shock is a response to a ____
Neurogenic shock is a response to a ____

A

pathogen
allergen
injury

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5
Q

What are 2 defining characteristics of septic shock?

A
  • Hypotension

- Organ hypoperfusion

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6
Q

What is the best tx against septic shock?

A

Empiric antimicrobial therapy ASAP

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7
Q

[Septic shock] Fluid resuscitation tx is a ____mL bolus (typically of ____)

A

500, NS (normal saline)

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8
Q

[Septic shock] What 3 adrenergics would be used as tx? What is the admin. route?

A

IV:

  • Norepinephrine
  • Dopamine
  • Dobutamine
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9
Q

[Septic shock] O2 sat. levels should be maintained >__%

A

92

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10
Q

What is source control?

A

Removing the source of infection/shock (ie. surgery)

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11
Q

What are 3 common PRN analgesics?

A
  • Tylenol
  • Ibuprofen
  • Moderate opioids
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12
Q

What are 4 complications of septic shock?

A
  • Renal failure
  • DIC
  • Metabolic acidosis
  • Hyperglycemia
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13
Q

Normal renal flow is __% of cardiac output and because of renal ischemia, renal fx can be affected within __-__ mins

A

20, 15-20

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14
Q

What is a s&s of renal failure?

A

Oliguria

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15
Q

What is the tx for renal failure due to septic shock?

A
  • Catecholamines (low dose)

- Fluid resuscitation

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16
Q

What are the 2 types of metabolic acidosis?

A
  • Lactic

- Keto

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17
Q

Lactic acidosis is increased amount of ____ in the blood meanwhile ketoacidosis is an increased of ____

A

lactate, ketones

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18
Q

What is the normal pH range for blood?

A

7.35-7.45

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19
Q

[Septic shock] What are the 3 reasons for decreased pH of the blood?

A
  • Anaerobic metabolism (lactic acid byproduct)
  • Decreased elimination of CO2 (lungs/breathing)
  • Decreased H+ clearance (renal failure)
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20
Q

What are the 4 txs for lactic acidosis due to septic shock?

A
  • Tx of root cause
  • Increased ventilation + oxygenation
  • Balance electrolytes
  • Sodium bicarbonate (only sometimes!! to increase pH)
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21
Q

What are 3 s&s of GI ischemia due to distributive shocks?

A
  • Nausea
  • Vomiting
  • Abdominal pain
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22
Q

What are 3 txs for GI ischemia due to distributive shocks?

A
  • Preserve GI fx (NG feed)
  • Decrease acidity (PPIs, H2 antagonists)
  • Alleviate N&V (antiemetics)
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23
Q

What is the 2 txs for hyperglycemia due to septic shock?

A
  • Insulin (IV)

- Enteral nutrition

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24
Q

What are the 2 steps in DIC becoming a complication for septic shock?

A
  1. Widespread coagulation

2. Depletion of platelets + clotting factors

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25
Q

What is the tx for step 1 DIC due to septic shock?

A

Fast acting anticoagulants (ie. Heparins)

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26
Q

What is the tx for step 2 DIC due to septic shock?

A

Blood products (ie. whole blood, platelets, Vit K)

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27
Q

What is the primary reason fever should be prevented while managing septic shock?

A

Increased metabolism burns through the body’s resources

28
Q

What bacteria is responsible for meningitis?

A

Nisseria meningitis

29
Q

Why is meningitis hard to recognize?

A

Non-specific initial s&s

30
Q

What are 3 tell-tale signs of meningococcemia?

A
  • Neck stiffness
  • Rash (petechial)
  • Seizures
31
Q

Anaphylactic shock is caused by ____ which is cause by an ____, which is why it is called a progressive allergic reaction

A

anaphylaxis, allergy

32
Q

What are 4 examples of allergies?

A
  • Drugs
  • Foods
  • Venom
  • Latex
33
Q

What are the 3 main stages of inflammation?

A
  1. Vascular vasodilation
  2. Phagocyte mobilization + chemotaxis
  3. Phagocytosis + endocytosis
34
Q

What is the main mediator of allergen triggered inflammation? Which receptor does it bind to on endothelial cells?

A

Histamine, H1

35
Q

What is an example of an intrinsic vasodilator that’s also a radical? What type of damage does it cause?

A

Nitric oxide (NO), epithelial damage

36
Q

What are 7 s&s of inflammation?

A
  • Swelling
  • Heat
  • Altered function
  • Redness
  • Pain
  • Clotting
  • Edema
37
Q

Why is edema a s&s of inflammation?

A

Leakage of exudate (plasma) into tissues due to change in osmotic pressure

38
Q

Why is clotting a s&s of inflammation?

A

Stagnation of blood flow due to low BP due to vasodilation + platelet aggregation from mast cells

39
Q

What are 5 txs for allergic responses and their admin. route?

A
  • Antihistamine (TOP or PO)
  • Leukotrine antagonists (PO)
  • Glucocorticoids (TOP or IV if ER)
  • Xolair (Omalizumab) (SC)
  • Immunotherapy (SC or SL)
40
Q

What is the primary mediator for anaphylaxis?

A

IgE

41
Q

[True/False] Anaphylaxis includes inflammation of ALL soft tissue

A

True

42
Q

Anaphylactic shock can lead to ____ collapse if not treated

A

circulatory

43
Q

What are 3 s&s that an inflammatory response is progressing from local to systemic?

A
  • Swelling away from origin site (edema)
  • SOB
  • Tachycardia
44
Q

What are 3 drug classes and an example of each for tx of anaphylaxis and their admin. route?

A
  • Adrenergic: Epinephrine (IM) max: q 5min x 3 dose
  • Antihistamine: Benadryl (Diphenhydramine) (IV)
  • Glucocorticoids: Hydrocortisone/Methylprednisolone (IV), Prednisone (PO)
45
Q

What can be done to maintain ABCs during anaphylaxis tx?

A
  • Bronchodilators (ventolin nebulizer)
  • Intubation PRN
  • Oxygen @ 15L by non-rebreather
  • Fluid resuscitation (NS 500 mL bolus IV)
  • Continuous adrenergics
46
Q

Hypovolemic shocks are caused due to low ____ ____, approx. acute loss of __% or greater

A

blood volume, 20

47
Q

What are 2 causes of hypovolemic shock?

A
  • Blood loss (ie. hemorrhage)

- Low extracellular fluid (ie. dehydration)

48
Q

What are the 3 initial s&s of hypovolemic shock?

A
  • Tachycardia
  • Thirst
  • Cool peripheries
49
Q

What are 5 s&s of progressing hypovolemic shock?

A
  • Hypotension
  • Thready pulse
  • Low RR
  • Organ hypoperfusion (ie. oliguria, pallor, confusion)
  • Cellular dysfunction (ie. edema, hyperglycemia)
50
Q

What are 3 IV txs for hypovolemic shock?

A
  • Colloids (ie. albumin 5/25%, dextran, hetastarch)
  • Crystalloids (NS, LR)
  • Whole blood
51
Q

Cardiogenic shocks are caused due to low ____ ____

A

cardiac output

52
Q

What type of events can lead to cardiogenic shock? What is the most common one?

A

Any that cause heart failure, myocardial infarction (STEMI)

53
Q

What are 5 s&s of cardiogenic shock?

A
  • Cyanosis
  • Oliguria
  • Altered LOC
  • Narrow PP + low SBP
  • High JVP
54
Q

What are some s&s of left sided heart failure?

A
  • Cyanosis
  • Activity intolerance
  • Nocturnal dyspnea
  • Pulmonary congestion
55
Q

What are some s&s of right sided heart failure?

A
  • Ascites + edema
  • Anorexia + weight loss
  • Liver dysfunction
56
Q

What are 5 txs for cardiogenic shock?

A
  • Diuretics (ie. spironolactone, furosemide)
  • DAVs (ie. nitroprusside)
  • Nitroglycerine
  • Phosphodiesterase inhibitors (ie. milrinone)
  • Catecholamines (ie. dobutamine)
57
Q

What drug classes can be used in synergy to vasodilate in tx of cardiogenic shock?

A
  • ACE inhibitors
  • Adrenergic antagonists
  • Ca2+ channel blockers
58
Q

What is an intra-aortic balloon pump?

A

A temp. tx of cardiogenic shock; a balloon is inserted into descending aorta via catheter

59
Q

What are 2 causes of obstructive shocks?

A
  • Large embolisms

- Cardiac tamponade

60
Q

If an obstructive shock is caused by cardiac tamponade, what is the tx?

A

Pericardiocentesis

61
Q

If an obstructive shock is caused by large embolisms, what are the 2 txs?

A
  • Anticoagulants

- Thrombolytics

62
Q

What are 5 main complications of shock?

A
  • Lung failure (ARDS)
  • Renal injury or failure
  • GI injury
  • Multiple organ dysfunction (MODS)
  • DIC
63
Q

What is the tx for ARDS due to shock?

A
  • Supportive therapy

- Keep alveoli open via PEEP (peak end expiratory pressure)

64
Q

What is the tx for renal injury due to shock?

A
  • IV fluids

- Diuretics for synergy

65
Q

What are the 3 txs for GI injury due to shock?

A
  • NG tubes
  • PPI
  • H2 receptor blockers

N216 A/B (26 decks)

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