4093 1 Flashcards by Richard smith

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

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Most often shock is related to a ____ problem, but

cardiovascular problem, but it can be related to anything where there’s not enough O2

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A really important complication of shock is

MODS (multiple organ dysfunction syndrome)

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the 4 kinds of shock (CHOD)

Cardiogenic
Hypovolemic
Obstructive
Distributive

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Distributive shock includes 3 sub types:

Septic
Neurogenic
Anaphylactic

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The manifestations that we see from shock are mostly the result of

the body trying to compensate for not enough O2

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What is the best measurement of tissue perfusion

MAP

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MAP is affected by 3 things

Total blood volume
Cardiac Output
Size of the vascular bed

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When a blood vessel dilates, the blood flow is

slower and decreases in pressure

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Sympathetic tone

refers to the sympathetic nervous system continuously keeping blood vessels a little constricted to maintain BP

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common ways to get Hypovolemic shock

bleeding and dehydration

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Cardiogenic shock

The heart isn’t pumping effectively, specifically because there’s something wrong with the Muscle itself.

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Causes of Distributive shock

Anaphylaxis
Sepsis
Capillary Leak Syndrome (Loss of sympathetic tone)

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What’s an endogenous chemical cause of distributive shock

Histamine

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How does Anaphylaxis relate to shock

Anaphylaxis is an allergic reaction that happens very very quickly

It can cause distributive shock

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How does Sepsis relate to shock

Sepsis is when microbes get in the blood

It can cause distributive shock

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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

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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

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No matter what type of shock (CHOD) …

the manifestations will be similar because what you’re seeing is the body’s response

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When the MAP goes down by 5 or 10, the body starts to respond by directing

blood toward vital organs

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Normal MAP

70 to 100

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Shunting means

redirecting blood

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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

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the effects of shock of are temporary if its corrected within

1 or 2 hours

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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)

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