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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
Q

neurogenic findings

A

-massive vasodilation w/o compensation bc of loss of SNS

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26
Q

neurogenic shock
classic manifestations

A

hypotension fr massive vasodilation

bradycardia fr unopposed parasympathetic stim

warm fr vasodil then hypothermic fr inability to reg temp [poikilothermia]

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27
Q

poikilothermia

A

taking on temp of environment

28
Q

anaphylactic shock

A

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
Q

anaphylactic shock can lead to resp distress d/t…

A

-laryngeal edema
-severe bronchospasms
-circulatory failur fr massive vasodilation

30
Q

anaphylactic shock s/s

A

-dizzy
chest pain
-incontinence
-swelling
-flushing
-pruritus
-urticaria
-angioedema
-anxious/impending doom
3RD Spacing

31
Q

Sepsis

A

life threatening syndrome in repsonse to an infection
-dysregulated response along w new organ dysfunction r/t infection

32
Q

septic shock

A

subset of sepsis
-incr mortality d/t profound circulatory, cellular, + metabolic abnormalities

33
Q

septic shock is characterized by

A

persistent hypotension despite adeq fluid resusc
-inadeq tissue perfusion

34
Q

when microorganism enters the body… norm response vs sepsis

A

normal: inflmmatory response

sepsis: exaggerated pro-inflammatory
+ anti-inflammatory response
+ incr coag
+ decr fibrinolysis
+ tumor necrosis factor

35
Q

cytokines

A

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
Q

3 major patho effects of septic shock

A

1 vasodilation
2 maldistribution of blood
3 myocardial depression

37
Q

in septic shock pt may be euvolemic, but bc of…

A

acute vasodilation + shifting of fluids,
relative hypovolemia + hypotension occurs

38
Q

in septic shock, the ejection fraction is ____. and then ____ to maintain SV

A

decreased for first few days after initial insult;

ventricles dilate

39
Q

during compensatory phase, pt ____ causing _____.
Once pt no longer compensates, pt is ______

A

hyperventilates> resp alkalosis

respiratory acidosis

40
Q

parasymph nervous response causes… in ….

A

bradycardia in neurogenic shock

41
Q

Obstructive Shock

A

physical obstruction to BF occurs w decr CO

42
Q

possible causes of obstructive shock

A

-restricted diastolic filling (cardiac tamponade, tension pneumothorax, sup vena cava synd)
-abdominal compartment synd
-PE
-

43
Q

obstructive shock findings

A

-decr CO
-INCR AFTERLOAD
-jug vein distention

44
Q

Stages of Shock

A

1 Initial Stage
2 Compensatory Stage
3 Progressive Stage
4 Refractory Stage

45
Q

Initial Stage

A

occurs at cellular level so no obvious s/s
-metab changes fr aerobic to anaerobic
-build up of lactic acid

46
Q

Compensatory Stage

A

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
Q

vasoconstrictions is to…

A

BF to heart + brian is maintained

BF to nonvital organs diverted/shunted (kidney, skin, GI, lungs)

48
Q

decr BF to lungs

A

incr dead space>
ventilation-perfusion mismatch>
arterial O2 decr>
incr rate + depth

49
Q

decr BF to GI

A

paralytic ileus

50
Q

decr BF to kidneys

A

trigger RAAS>
Na + H2O reabsorp>
K excretion>
oliguria>
stim ADH release>

> > > > incr CO + BP

51
Q

decr BF to skin

A

cool clammy
slow cap refiull

52
Q

Progressive Shock

A

begins when compensatory systm fails
change in mental status
**needs ICU*

53
Q

Progressive Shock
cardiovascular

A

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
Q

Progressive Shock
pulmonary

A

-first to display signs of critical dysfunction
-incr pulmo artery pressure fr vasocontriciton
-interstitial/alveoli edema
-tachypnea
-crackles/diffuse infiltrates

55
Q

Progressive Shock
GI

A

ischemia
-erosice ulcers
-GI bleed
-mvmt of bacteria to other areas
-malabsorption

56
Q

Refractory Stage

A

organ failures
-heart + brain no longer perfused
-incr waste product

57
Q

cornerstone therapy for SEPTIC, HYPOVOL, + ANAPHYLACTIC shock

A

vol expansion
thry IV cath or intraosseous (IO) device pr central venous cath

58
Q

drugs to incr SNS for septic, hypovol, +anaphylactic

A

vasopressors (epi, norepi, dopamine)
inotrope (dobutamine)

59
Q

____ must be achieved before vasopressors are admin

A

fluid resuscitation

60
Q

drugs for cardiogenic shocl

A

vasodilator to decr workload: nitroglyceryn
reduce preload: diuretics
decr afterload: vasodilators
decr HR + contractility: b BLOCKER

61
Q

trophic feeding

A

small amt of enteral feeding ASAP
>enhances GI perfusion + maintain gut mucosa integrity

62
Q

PN?

A

only used if EN is CI

63
Q

specific measures for cardiogenic shock

A

-cath lab to restore blood flow: angioplasty w stent, emergency revascularization, valve replacement
circulatory assist devices: intraaortic balloon pump + ventricular assist device

64
Q

hypovol fluid resusc 3:1 rule

A

3 ml crystalloid to 1 ml blood loss

65
Q

septic shock fluid resusc

A

30 ml/kg of isotonic fluid w albumin

66
Q

drugs for septic shock

A

-PPI: prevent ulcer
-abx w/i 1hr
-vasopressor incr BP
-dobutamine incr contractility + SV
-norepi incr BP + map
-VTE prophylaxis (blood thinner)

67
Q

anaphylactic shock meds

A

-epi: periph constriction + bronchodilation
-diphenhydramine + histamine blockers like famotidine: block ongoing release of histamine

1 Critical Care (17 decks)

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