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4093 1 Flashcards

1
Q

General definition of shock

A

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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2
Q

Most often shock is related to a ____ problem, but

A

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

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3
Q

A really important complication of shock is

A

MODS (multiple organ dysfunction syndrome)

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4
Q

the 4 kinds of shock (CHOD)

A

Cardiogenic
Hypovolemic
Obstructive
Distributive

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5
Q

Distributive shock includes 3 sub types:

A

Septic
Neurogenic
Anaphylactic

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6
Q

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

A

the body trying to compensate for not enough O2

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7
Q

What is the best measurement of tissue perfusion

A

MAP

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8
Q

MAP is affected by 3 things

A

Total blood volume
Cardiac Output
Size of the vascular bed

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9
Q

When a blood vessel dilates, the blood flow is

A

slower and decreases in pressure

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10
Q

Sympathetic tone

A

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

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11
Q

common ways to get Hypovolemic shock

A

bleeding and dehydration

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12
Q

Cardiogenic shock

A

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

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13
Q

Causes of Distributive shock

A

Anaphylaxis
Sepsis
Capillary Leak Syndrome (Loss of sympathetic tone)

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14
Q

What’s an endogenous chemical cause of distributive shock

A

Histamine

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15
Q

How does Anaphylaxis relate to shock

A

Anaphylaxis is an allergic reaction that happens very very quickly

It can cause distributive shock

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16
Q

How does Sepsis relate to shock

A

Sepsis is when microbes get in the blood

It can cause distributive shock

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17
Q

How does Capillary Leak Syndrome relate to shock

A

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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18
Q

Obstructive Shock

A

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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19
Q

No matter what type of shock (CHOD) …

A

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

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20
Q

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

A

blood toward vital organs

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21
Q

Normal MAP

A

70 to 100

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22
Q

Shunting means

A

redirecting blood

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23
Q

During shock, the cells have to start using anaerobic metabolism which makes lactic acid. Lactic acid build up gives you (2 things)

A

Acid-base imbalance

Electrolyte imbalance

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24
Q

the effects of shock of are temporary if its corrected within

A

1 or 2 hours

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25
Q

The 4 stages of hypovolemic shock

A

Initial
Non-progressive
Progressive
Refractory

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26
Q

In the initial stage of shock, the MAP is

A

down by 5 or 10

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27
Q

In the initial stage of shock, the body responds by (just name 2 things)

A

increasing HR

Mild vasoconstriction

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28
Q

In the non-progressive stage of the MAP is

A

down by 10 or 15

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29
Q

Manifestations of the non progressive stage: in addition to increased HR and vasoconstriction you start to see decreased ___ ___ and increased

A

decreased pulse pressure

increased Renin/ADH (so you’re not urinating as much)

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30
Q

Manifestations of the non progressive stage: Lab results

A

hyperkalemia

mild acidosis

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31
Q

In the progressive stage, the MAP is

A

down by 20

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32
Q

In the refractory stage you have n___, M___, and d____

A

necrosis, MODS, death

33
Q

What is the overall appearance of the person in the initial stage

A

they look pretty normal because the body is still able to compensate

34
Q

How might the patient feel during the non progressive stage

A

thirsty and anxious

35
Q

What is the POX during the non progressive stage

A

2 or 5 % lower than normal

36
Q

How might the patient look during the progressive stage

A

cyanotic or pale

37
Q

How does the patient’s skin feel during the progressive stage

A

cool and moist

38
Q

What is the POX during the progressive stage

A

5 or 20% lower than normal

39
Q

If your findings support that the patient is in the progressive stage…

A

note that it’s an emergency situation

40
Q

The refractory stage is i_____

A

irreversible

41
Q

How will they look in the refractory stage

A

Rapidly losing consciousness

42
Q

Name 3 things that you’ll find when you assess a patient in the refractory stage (besides LOC)

A

The POX is blank
You can’t feel the pulse
Breathing slows

43
Q

MODS

A

cell damage caused by all the toxic metabolites and enzymes

It causes micro clots (which decreases perfusion even more)

44
Q

____ is more likely to be the cause of shock in younger adults than in older adults

A

trauma

45
Q

How should the vital signs be measured for a shock patient

A

they should be measured by an RN

46
Q

POX of 70%

A

This is the refractory stage

47
Q

Musculo-skeletal assessment

A

weakness and messed up reflexes

48
Q

H and H levels

A

they depend on the cause (dehydration will increase levels, hemorrhage will decrease)

49
Q

After you make sure they have a clear airway, what is the next thing you do for a patient with shock

A

make sure they have an IV

50
Q

How do you position a patient with shock

A

Elevate the legs to promote venous return

The HOB should be flat or at most 30 degrees (also for perfusion)

51
Q

___ and ___ are the kinds of fluids used for fluid resuscitation during shock

A

Crystalloids and colloids

52
Q

The crystalloids you’ll use are ___ or ___

A

NS or Ringers lactate

53
Q

Crystalloid fluids are used for ___ ___

A

electrolyte imbalance

54
Q

The good thing about NS is that it can be infused with

A

any blood product

55
Q

The good thing about ringers lactate is

A

it buffers acidosis

56
Q

Ringers lactate is bad for

A

transfusions because it causes clotting

57
Q

If the patient lost a ton of blood and they’re not responding to fluids/blood products, you’ll probably need

A

drug therapy

58
Q

Drug therapy is going to be drugs that help with things like

A

contractility and dilation of heart vessels to increase perfusion

59
Q

The kind of blood product you use might depend on what the patient needs: explain

A

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

60
Q

With drug therapy, where do you want to dilate and where should you constrict

A

dilate heart vessels, constrict other areas to promote venous return

61
Q

An example of a drug used to increase perfusion to the heart by dilating blood vessels

A

Nitropress

62
Q

An example of a drug used to cause systemic constriction (to increase venous return)

A

DA

63
Q

2 drugs used to increase contractility

A

milrinone and Dobu

64
Q

Septic shock is a type of ___ shock

A

distributive

65
Q

Septic shock: by the time it gets serious, the main thing causing damage is

A

the body’s own inflammatory response

66
Q

Septic shock: a complication that worsens perfusion

A

micro clots

67
Q

Septic shock: if you suspect Systemic Inflammatory Response Syndrome

A

report to RRT

68
Q

In Sever Sepsis, the body gets so stressed that the pt becomes h____

A

hyperglycemic

69
Q

During Severe Sepsis, BP

A

could be elevated (unlikely all the other kinds of shock)

70
Q

During Severe Sepsis, the skin is

A

warm and normal colored (because during Severe Sepsis the BP increased)

71
Q

During Severe Sepsis, labs

A

WBC might not be elevated (which would’ve been expected for infection) because the body used them up already

72
Q

3 positive signs of Severe Sepsis

A

decreased POX
decreased Urine
AMS

73
Q

Septic Shock (which happens after Severe Sepsis) involves Multiple Organ Failure and

A

Bleeding

74
Q

During early sepsis and also in Septic Shock, the BP

A

is decreased

75
Q

Shock intervention: after ensuring an IV access

A

give O2

76
Q

Sepsis abx tx implications (2 things)

A

Take a blood sample BEFORE you give the abx

Give a broad spectrum abx within an hour of dx

77
Q

Sepsis: if the have hypotension or high serum lactate. give ___ or ___

A

crystalloids or colloids

78
Q

Sepsis: if the have hypotension or high serum lactate. give crystalloids or colloids. If that doesn’t work give

A

vasopressors

79
Q

Sepsis: give ___ to prevent clotting

A

heparin

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