4093 1 Flashcards
General definition of shock
widespread abnormal cellular metabolism that happens when there’s not enough O2 and perfusion
or you could think of it as the response of your entire body to decreased O2
Most often shock is related to a ____ problem, but
cardiovascular problem, but it can be related to anything where there’s not enough O2
A really important complication of shock is
MODS (multiple organ dysfunction syndrome)
the 4 kinds of shock (CHOD)
Cardiogenic
Hypovolemic
Obstructive
Distributive
Distributive shock includes 3 sub types:
Septic
Neurogenic
Anaphylactic
The manifestations that we see from shock are mostly the result of
the body trying to compensate for not enough O2
What is the best measurement of tissue perfusion
MAP
MAP is affected by 3 things
Total blood volume
Cardiac Output
Size of the vascular bed
When a blood vessel dilates, the blood flow is
slower and decreases in pressure
Sympathetic tone
refers to the sympathetic nervous system continuously keeping blood vessels a little constricted to maintain BP
common ways to get Hypovolemic shock
bleeding and dehydration
Cardiogenic shock
The heart isn’t pumping effectively, specifically because there’s something wrong with the Muscle itself.
Causes of Distributive shock
Anaphylaxis
Sepsis
Capillary Leak Syndrome (Loss of sympathetic tone)
What’s an endogenous chemical cause of distributive shock
Histamine
How does Anaphylaxis relate to shock
Anaphylaxis is an allergic reaction that happens very very quickly
It can cause distributive shock
How does Sepsis relate to shock
Sepsis is when microbes get in the blood
It can cause distributive shock
How does Capillary Leak Syndrome relate to shock
The syndrome is when the body responds to some kind of bio mediator, which causes leaking.
One trigger can be burns
Obstructive Shock
This has to do with the heart not pumping effectively but its not directly because of the muscle. Instead this one is due to something blocking the heart, like tamponade
No matter what type of shock (CHOD) …
the manifestations will be similar because what you’re seeing is the body’s response
When the MAP goes down by 5 or 10, the body starts to respond by directing
blood toward vital organs
Normal MAP
70 to 100
Shunting means
redirecting blood
During shock, the cells have to start using anaerobic metabolism which makes lactic acid. Lactic acid build up gives you (2 things)
Acid-base imbalance
Electrolyte imbalance
the effects of shock of are temporary if its corrected within
1 or 2 hours
The 4 stages of hypovolemic shock
Initial
Non-progressive
Progressive
Refractory
In the initial stage of shock, the MAP is
down by 5 or 10
In the initial stage of shock, the body responds by (just name 2 things)
increasing HR
Mild vasoconstriction
In the non-progressive stage of the MAP is
down by 10 or 15
Manifestations of the non progressive stage: in addition to increased HR and vasoconstriction you start to see decreased ___ ___ and increased
decreased pulse pressure
increased Renin/ADH (so you’re not urinating as much)
Manifestations of the non progressive stage: Lab results
hyperkalemia
mild acidosis
In the progressive stage, the MAP is
down by 20
In the refractory stage you have n___, M___, and d____
necrosis, MODS, death
What is the overall appearance of the person in the initial stage
they look pretty normal because the body is still able to compensate
How might the patient feel during the non progressive stage
thirsty and anxious
What is the POX during the non progressive stage
2 or 5 % lower than normal
How might the patient look during the progressive stage
cyanotic or pale
How does the patient’s skin feel during the progressive stage
cool and moist
What is the POX during the progressive stage
5 or 20% lower than normal
If your findings support that the patient is in the progressive stage…
note that it’s an emergency situation
The refractory stage is i_____
irreversible
How will they look in the refractory stage
Rapidly losing consciousness
Name 3 things that you’ll find when you assess a patient in the refractory stage (besides LOC)
The POX is blank
You can’t feel the pulse
Breathing slows
MODS
cell damage caused by all the toxic metabolites and enzymes
It causes micro clots (which decreases perfusion even more)
____ is more likely to be the cause of shock in younger adults than in older adults
trauma
How should the vital signs be measured for a shock patient
they should be measured by an RN
POX of 70%
This is the refractory stage
Musculo-skeletal assessment
weakness and messed up reflexes
H and H levels
they depend on the cause (dehydration will increase levels, hemorrhage will decrease)
After you make sure they have a clear airway, what is the next thing you do for a patient with shock
make sure they have an IV
How do you position a patient with shock
Elevate the legs to promote venous return
The HOB should be flat or at most 30 degrees (also for perfusion)
___ and ___ are the kinds of fluids used for fluid resuscitation during shock
Crystalloids and colloids
The crystalloids you’ll use are ___ or ___
NS or Ringers lactate
Crystalloid fluids are used for ___ ___
electrolyte imbalance
The good thing about NS is that it can be infused with
any blood product
The good thing about ringers lactate is
it buffers acidosis
Ringers lactate is bad for
transfusions because it causes clotting
If the patient lost a ton of blood and they’re not responding to fluids/blood products, you’ll probably need
drug therapy
Drug therapy is going to be drugs that help with things like
contractility and dilation of heart vessels to increase perfusion
The kind of blood product you use might depend on what the patient needs: explain
if they lost a lot of fluid, you could give whole blood, but if they already have enough fluid you could just give packed RBCs
With drug therapy, where do you want to dilate and where should you constrict
dilate heart vessels, constrict other areas to promote venous return
An example of a drug used to increase perfusion to the heart by dilating blood vessels
Nitropress
An example of a drug used to cause systemic constriction (to increase venous return)
DA
2 drugs used to increase contractility
milrinone and Dobu
Septic shock is a type of ___ shock
distributive
Septic shock: by the time it gets serious, the main thing causing damage is
the body’s own inflammatory response
Septic shock: a complication that worsens perfusion
micro clots
Septic shock: if you suspect Systemic Inflammatory Response Syndrome
report to RRT
In Sever Sepsis, the body gets so stressed that the pt becomes h____
hyperglycemic
During Severe Sepsis, BP
could be elevated (unlikely all the other kinds of shock)
During Severe Sepsis, the skin is
warm and normal colored (because during Severe Sepsis the BP increased)
During Severe Sepsis, labs
WBC might not be elevated (which would’ve been expected for infection) because the body used them up already
3 positive signs of Severe Sepsis
decreased POX
decreased Urine
AMS
Septic Shock (which happens after Severe Sepsis) involves Multiple Organ Failure and
Bleeding
During early sepsis and also in Septic Shock, the BP
is decreased
Shock intervention: after ensuring an IV access
give O2
Sepsis abx tx implications (2 things)
Take a blood sample BEFORE you give the abx
Give a broad spectrum abx within an hour of dx
Sepsis: if the have hypotension or high serum lactate. give ___ or ___
crystalloids or colloids
Sepsis: if the have hypotension or high serum lactate. give crystalloids or colloids. If that doesn’t work give
vasopressors
Sepsis: give ___ to prevent clotting
heparin
