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1 Critical Care > 66 - Shock > Flashcards

66 - Shock Flashcards

1
Q

Shock

A

-decr tissue perfusion
-impaired cellular metab

characterized by hypoperfusion, HYPOXIA + inadeq cell functn

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2
Q

in shock, vessels are extremely ___ w extreme ___

A

dilates, permeability

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3
Q

Types of Shock

A

1 Cardiogenic
2 Hypovolemix
3 Distributive
4 Obstructive

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4
Q

Cardiogenic Shock

A

systolic or diastolic dysfunction of heart’s pumping action
»reduced CO, SV, BP

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5
Q

causes of cardiogenic shock

A

*acute MI
- cardiac tamponade
-vent hypertrophy,
-brady/tachy dysrhythmia
-stenosis

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6
Q

vent ischemia, structural problsm, + dysrhythmia in cardiogenic shock causes…

A

low SV> low CO
high pulmo pressure> pulmp edema> low O2
low tissue perfusion

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7
Q

systolic dysfunctions leads to….

A

ineffective FORWARD
poor stroke vol> poor CO> poor cell o2 supply> impaired cell metab

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8
Q

diastolic dysfunction leads to…

A

ineffective filling
incr pulmo pressure> pulmo edema> poor oxygentation> poor o2 cell supply> impaired cell metab

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9
Q

early signs of cardiogenic shock

A

-hypotension
-tachycardia
-narrow pulse pressure
-tachypneic
-crackles

-incr PAWP
-incr Stroke Vol Variation
-incr pulmo vasc resistance

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10
Q

increased systemic vasc resistance in cardiogenic shock leads to,.

A

incr workload of heart
>incr myocardial o2 consumption

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11
Q

Hypovolemic shock

A

inadeq fluid vol in intravascular space to support adeq perfusion

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12
Q

volume loss in hypovol shock may either be..

A

absolute or relative

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13
Q

absolute hypovolemia

A

fluid is lost thru…
hemorrhage
-GI loss (vomit/diarrhea)
-fistula drainage
-DI
-diuresis

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14
Q

relative hypovolemia

A

fluid vol moves out fr vasc space into extravasc space
aka 3rd spacing

like in BURNS

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15
Q

reduced intravasc vol results in…

A

-decr venous return to heart
poor preload
>poor SV
>poor CO
>poor cell o2 supply>
>impaired cell metabm

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16
Q

a pt may compensate for a loss of up to…

A

15% blood loss
(750 mL)

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17
Q

vol loss of ___ will results in activation of ______ such as___ and is generally reversible at this time w _______

A

15-30%

SNS activation
-incr HR
-incr CO
-incr resp rate + depth

crystalloid fluid replacement

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18
Q

hemodynamic findings of decr circulating blood vol

A

-decr in SV, central venous presure, and PAWP

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19
Q

after fluid vol loss of ____, ____ may begin to fail and ____ should be started ASAP

A

greater than 30%
compensatory mechanism
blood product replacement

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20
Q

loss of more than 40% fluid vol

A

-loss of autoregulation
-irreversible tissue destruction

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21
Q

common labs for hypovol shock

A

-H+H
-electr
-lactate
-abg
-SvO2
-hourly UO

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22
Q

Types of DISTRIBUTIVE shock

A

-neurogenic
-anaphylactic
-septic

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23
Q

Neurogenic Shock

A

hemodynamic phenomenon that happens 30 min after spinal cord injury
-lasts up to 6 wks

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24
Q

neurogenic shock is assoc w __ + __ injury, or ____ drugs

A

cervical + thoracic

opioids + benzos bc decr vascocontrictor tones

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25
neurogenic findings
-massive vasodilation w/o compensation bc of loss of SNS
26
neurogenic shock classic manifestations
hypotension fr massive vasodilation bradycardia fr unopposed parasympathetic stim warm fr vasodil then hypothermic fr inability to reg temp [poikilothermia]
27
poikilothermia
taking on temp of environment
28
anaphylactic shock
acute life threatening hypersensitivity (allergy) to substance >massive vasodilation fr release of vasoactive mediators >incr massive permeability> fluid moves fr vasc to interstitial space
29
anaphylactic shock can lead to resp distress d/t...
-laryngeal edema -severe bronchospasms -circulatory failur fr massive vasodilation
30
anaphylactic shock s/s
-dizzy **chest pain** -incontinence -swelling -flushing -pruritus -urticaria -angioedema -anxious/impending doom **3RD Spacing**
31
Sepsis
life threatening syndrome in repsonse to an infection -dysregulated response along w new organ dysfunction r/t infection
32
septic shock
subset of sepsis -incr mortality d/t profound circulatory, cellular, + metabolic abnormalities
33
septic shock is characterized by
persistent hypotension despite adeq fluid resusc -inadeq tissue perfusion
34
when microorganism enters the body... norm response vs sepsis
normal: inflmmatory response sepsis: exaggerated pro-inflammatory + anti-inflammatory response + incr coag + decr fibrinolysis + tumor necrosis factor
35
cytokines
when microbes secrete endotoxins which trigger release of cytokines -forms microthrombi> obstruction of mirovasc -damage to endothelium -vasodilation -incr capillary permeability -netrophil + pltlt aggregtn -adhesion to endothelium
36
3 major patho effects of septic shock
1 vasodilation 2 maldistribution of blood 3 myocardial depression
37
in septic shock pt may be euvolemic, but bc of...
acute vasodilation + shifting of fluids, relative hypovolemia + hypotension occurs
38
in septic shock, the ejection fraction is ____. and then ____ to maintain SV
decreased for first few days after initial insult; ventricles dilate
39
during compensatory phase, pt ____ causing _____. Once pt no longer compensates, pt is ______
hyperventilates> resp alkalosis respiratory acidosis
40
parasymph nervous response causes... in ....
bradycardia in neurogenic shock
41
Obstructive Shock
physical obstruction to BF occurs w decr CO
42
possible causes of obstructive shock
-restricted diastolic filling (cardiac tamponade, tension pneumothorax, sup vena cava synd) -abdominal compartment synd -PE -
43
obstructive shock findings
-decr CO -INCR AFTERLOAD -jug vein distention
44
Stages of Shock
1 Initial Stage 2 Compensatory Stage 3 Progressive Stage 4 Refractory Stage
45
Initial Stage
occurs at cellular level so no obvious s/s -metab changes fr aerobic to anaerobic -build up of lactic acid
46
Compensatory Stage
**drop in BP** (fr decr CO + narrow pulse) -baroreceptors trigger SNS >>vasoconstrict fr epi/norepi >>incr O2 demand by vasodilation to incr HR + contractility -still reversible
47
vasoconstrictions is to...
BF to heart + brian is maintained BF to nonvital organs diverted/shunted (kidney, skin, GI, lungs)
48
decr BF to lungs
incr dead space> ventilation-perfusion mismatch> arterial O2 decr> incr rate + depth
49
decr BF to GI
paralytic ileus
50
decr BF to kidneys
trigger RAAS> Na + H2O reabsorp> K excretion> oliguria> stim ADH release> >>>>incr CO + BP
51
decr BF to skin
cool clammy slow cap refiull
52
Progressive Shock
begins when compensatory systm fails ***change in mental status*** **needs ICU*
53
Progressive Shock cardiovascular
CO falls> -decr BP, -decr in coronary, cerebral, periph perfusion ***altered capillary permeability*** (fluid + protein leak out of intravasc space> decr circ vol + incr systemic interstitial edema) -weak periph pulse distal ischemia
54
Progressive Shock pulmonary
-first to display signs of critical dysfunction -incr pulmo artery pressure fr vasocontriciton -interstitial/alveoli edema -tachypnea -crackles/diffuse infiltrates
55
Progressive Shock GI
ischemia -erosice ulcers -GI bleed -mvmt of bacteria to other areas -malabsorption
56
Refractory Stage
organ failures -heart + brain no longer perfused -incr waste product
57
cornerstone therapy for SEPTIC, HYPOVOL, + ANAPHYLACTIC shock
vol expansion thry IV cath or intraosseous (IO) device pr central venous cath
58
drugs to incr SNS for septic, hypovol, +anaphylactic
vasopressors (epi, norepi, dopamine) inotrope (dobutamine)
59
____ must be achieved before vasopressors are admin
fluid resuscitation
60
drugs for cardiogenic shocl
vasodilator to decr workload: nitroglyceryn reduce preload: diuretics decr afterload: vasodilators decr HR + contractility: b BLOCKER
61
trophic feeding
small amt of enteral feeding ASAP >enhances GI perfusion + maintain gut mucosa integrity
62
PN?
only used if EN is CI
63
specific measures for cardiogenic shock
-cath lab to restore blood flow: angioplasty w stent, emergency revascularization, valve replacement circulatory assist devices: intraaortic balloon pump + ventricular assist device
64
hypovol fluid resusc 3:1 rule
3 ml crystalloid to 1 ml blood loss
65
septic shock fluid resusc
30 ml/kg of isotonic fluid w albumin
66
drugs for septic shock
-PPI: prevent ulcer -abx w/i 1hr -vasopressor incr BP -dobutamine incr contractility + SV -norepi incr BP + map -VTE prophylaxis (blood thinner)
67
anaphylactic shock meds
-epi: periph constriction + bronchodilation -diphenhydramine + histamine blockers like famotidine: block ongoing release of histamine

1 Critical Care (17 decks)

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