[216B] Shock Flashcards
What are the 4 types of circulatory shocks?
- Distributive
- Hypovolemic
- Cardiogenic
- Obstructive
What are 3 defining characteristics of distributive shocks?
- Loss of blood vessel tone
- Vasodilation
- Shift of vascular volume into extravascular space
What are the 3 types of distributive shock?
- Septic
- Anaphylactic
- Neurogenic
Septic shock is a response to a ____
Anaphylactic shock is a response to a ____
Neurogenic shock is a response to a ____
pathogen
allergen
injury
What are 2 defining characteristics of septic shock?
- Hypotension
- Organ hypoperfusion
What is the best tx against septic shock?
Empiric antimicrobial therapy ASAP
[Septic shock] Fluid resuscitation tx is a ____mL bolus (typically of ____)
500, NS (normal saline)
[Septic shock] What 3 adrenergics would be used as tx? What is the admin. route?
IV:
- Norepinephrine
- Dopamine
- Dobutamine
[Septic shock] O2 sat. levels should be maintained >__%
92
What is source control?
Removing the source of infection/shock (ie. surgery)
What are 3 common PRN analgesics?
- Tylenol
- Ibuprofen
- Moderate opioids
What are 4 complications of septic shock?
- Renal failure
- DIC
- Metabolic acidosis
- Hyperglycemia
Normal renal flow is __% of cardiac output and because of renal ischemia, renal fx can be affected within __-__ mins
20, 15-20
What is a s&s of renal failure?
Oliguria
What is the tx for renal failure due to septic shock?
- Catecholamines (low dose)
- Fluid resuscitation
What are the 2 types of metabolic acidosis?
- Lactic
- Keto
Lactic acidosis is increased amount of ____ in the blood meanwhile ketoacidosis is an increased of ____
lactate, ketones
What is the normal pH range for blood?
7.35-7.45
[Septic shock] What are the 3 reasons for decreased pH of the blood?
- Anaerobic metabolism (lactic acid byproduct)
- Decreased elimination of CO2 (lungs/breathing)
- Decreased H+ clearance (renal failure)
What are the 4 txs for lactic acidosis due to septic shock?
- Tx of root cause
- Increased ventilation + oxygenation
- Balance electrolytes
- Sodium bicarbonate (only sometimes!! to increase pH)
What are 3 s&s of GI ischemia due to distributive shocks?
- Nausea
- Vomiting
- Abdominal pain
What are 3 txs for GI ischemia due to distributive shocks?
- Preserve GI fx (NG feed)
- Decrease acidity (PPIs, H2 antagonists)
- Alleviate N&V (antiemetics)
What is the 2 txs for hyperglycemia due to septic shock?
- Insulin (IV)
- Enteral nutrition
What are the 2 steps in DIC becoming a complication for septic shock?
- Widespread coagulation
2. Depletion of platelets + clotting factors
What is the tx for step 1 DIC due to septic shock?
Fast acting anticoagulants (ie. Heparins)
What is the tx for step 2 DIC due to septic shock?
Blood products (ie. whole blood, platelets, Vit K)
What is the primary reason fever should be prevented while managing septic shock?
Increased metabolism burns through the body’s resources
What bacteria is responsible for meningitis?
Nisseria meningitis
Why is meningitis hard to recognize?
Non-specific initial s&s
What are 3 tell-tale signs of meningococcemia?
- Neck stiffness
- Rash (petechial)
- Seizures
Anaphylactic shock is caused by ____ which is cause by an ____, which is why it is called a progressive allergic reaction
anaphylaxis, allergy
What are 4 examples of allergies?
- Drugs
- Foods
- Venom
- Latex
What are the 3 main stages of inflammation?
- Vascular vasodilation
- Phagocyte mobilization + chemotaxis
- Phagocytosis + endocytosis
What is the main mediator of allergen triggered inflammation? Which receptor does it bind to on endothelial cells?
Histamine, H1
What is an example of an intrinsic vasodilator that’s also a radical? What type of damage does it cause?
Nitric oxide (NO), epithelial damage
What are 7 s&s of inflammation?
- Swelling
- Heat
- Altered function
- Redness
- Pain
- Clotting
- Edema
Why is edema a s&s of inflammation?
Leakage of exudate (plasma) into tissues due to change in osmotic pressure
Why is clotting a s&s of inflammation?
Stagnation of blood flow due to low BP due to vasodilation + platelet aggregation from mast cells
What are 5 txs for allergic responses and their admin. route?
- Antihistamine (TOP or PO)
- Leukotrine antagonists (PO)
- Glucocorticoids (TOP or IV if ER)
- Xolair (Omalizumab) (SC)
- Immunotherapy (SC or SL)
What is the primary mediator for anaphylaxis?
IgE
[True/False] Anaphylaxis includes inflammation of ALL soft tissue
True
Anaphylactic shock can lead to ____ collapse if not treated
circulatory
What are 3 s&s that an inflammatory response is progressing from local to systemic?
- Swelling away from origin site (edema)
- SOB
- Tachycardia
What are 3 drug classes and an example of each for tx of anaphylaxis and their admin. route?
- Adrenergic: Epinephrine (IM) max: q 5min x 3 dose
- Antihistamine: Benadryl (Diphenhydramine) (IV)
- Glucocorticoids: Hydrocortisone/Methylprednisolone (IV), Prednisone (PO)
What can be done to maintain ABCs during anaphylaxis tx?
- Bronchodilators (ventolin nebulizer)
- Intubation PRN
- Oxygen @ 15L by non-rebreather
- Fluid resuscitation (NS 500 mL bolus IV)
- Continuous adrenergics
Hypovolemic shocks are caused due to low ____ ____, approx. acute loss of __% or greater
blood volume, 20
What are 2 causes of hypovolemic shock?
- Blood loss (ie. hemorrhage)
- Low extracellular fluid (ie. dehydration)
What are the 3 initial s&s of hypovolemic shock?
- Tachycardia
- Thirst
- Cool peripheries
What are 5 s&s of progressing hypovolemic shock?
- Hypotension
- Thready pulse
- Low RR
- Organ hypoperfusion (ie. oliguria, pallor, confusion)
- Cellular dysfunction (ie. edema, hyperglycemia)
What are 3 IV txs for hypovolemic shock?
- Colloids (ie. albumin 5/25%, dextran, hetastarch)
- Crystalloids (NS, LR)
- Whole blood
Cardiogenic shocks are caused due to low ____ ____
cardiac output
What type of events can lead to cardiogenic shock? What is the most common one?
Any that cause heart failure, myocardial infarction (STEMI)
What are 5 s&s of cardiogenic shock?
- Cyanosis
- Oliguria
- Altered LOC
- Narrow PP + low SBP
- High JVP
What are some s&s of left sided heart failure?
- Cyanosis
- Activity intolerance
- Nocturnal dyspnea
- Pulmonary congestion
What are some s&s of right sided heart failure?
- Ascites + edema
- Anorexia + weight loss
- Liver dysfunction
What are 5 txs for cardiogenic shock?
- Diuretics (ie. spironolactone, furosemide)
- DAVs (ie. nitroprusside)
- Nitroglycerine
- Phosphodiesterase inhibitors (ie. milrinone)
- Catecholamines (ie. dobutamine)
What drug classes can be used in synergy to vasodilate in tx of cardiogenic shock?
- ACE inhibitors
- Adrenergic antagonists
- Ca2+ channel blockers
What is an intra-aortic balloon pump?
A temp. tx of cardiogenic shock; a balloon is inserted into descending aorta via catheter
What are 2 causes of obstructive shocks?
- Large embolisms
- Cardiac tamponade
If an obstructive shock is caused by cardiac tamponade, what is the tx?
Pericardiocentesis
If an obstructive shock is caused by large embolisms, what are the 2 txs?
- Anticoagulants
- Thrombolytics
What are 5 main complications of shock?
- Lung failure (ARDS)
- Renal injury or failure
- GI injury
- Multiple organ dysfunction (MODS)
- DIC
What is the tx for ARDS due to shock?
- Supportive therapy
- Keep alveoli open via PEEP (peak end expiratory pressure)
What is the tx for renal injury due to shock?
- IV fluids
- Diuretics for synergy
What are the 3 txs for GI injury due to shock?
- NG tubes
- PPI
- H2 receptor blockers
