850-IP8-Shock Flashcards
1
Q
SHOCK
A
- Systemic hypoperfusion caused by a reduction in cardiac output or blood volume
- Hypotension –> inadequate tissue perfusion –> cellular injury and dysfunction –> multiple organ failure
- 3 main types: Hypovolemic, Cardiogenic, Distributive
2
Q
HYPOVOLEMIC SHOCK:
A
- Decreased cardiac output due to inadequate blood or plasma volume - Common causes: hemorrhage, burns, trauma
- Presentation:
- Thirst, nausea, anxiousness, weakness, light-headedness, dizziness, decreased urine output
- Severe volume loss may result in tachycardia, elevated RR, hypotension, mental status changes/unconsciousness
3
Q
HYPOVOLEMIC SHOCK TREATMENT:
A
- Non-pharmacologic: control of inciting event, surgery, fractures stabilization, control of blood loss, etc.
- Pharmacologic: Fluids (crystalloids vs. colloids), blood products (packed red blood cells, FFP, platelets)
4
Q
Hypovolemic shock
Crystalloids fluids
A
- Normal Saline (NS)
- Lactated Ringers (LR)
- 5% Dextrose in Water (D5W)
- Hypertonic (3%) Saline
5
Q
Hypovolemic shock
Colloids fluids
A
- Albumin
- Hydroxyethyl starch
- Dextrans
6
Q
Hypovolemic shock
Blood Products fluids
A
- Packed red blood cells (pRBC)
- Fresh frozen plasma (FFP)
- Platelets
7
Q
Hypovolemic shock
Crystalloids considerations for use
A
- Preferred initial fluid
- Consider D5W for dehydration w/minor s/s of volume depletion
- Consider hypertonic saline (in addition to NS/LR) for head trauma; caution due to osmolarity, risk of cellular crenation and damage
8
Q
Hypovolemic shock
Colloids considerations for use
A
- Potential longer intravascular retention time vs. crystalloids
- No evidence of reduced mortality compared with crystalloids; benefits may exist with certain subsets of patients
- Hydroxyethyl starch: FDA warning for increased mortality, severe renal injury and risk of bleeding – do not use in critically ill patients
- Dextrans: increased risk of anaphylaxis, may aggravate bleeding, and cause renal dysfunction
9
Q
Hypovolemic shock
Blood Products considerations for use
A
- pRBC: increase the oxygen carrying capacity in the blood
- FFP: replacement of clotting factors
- Platelets: administer for thrombocytopenia
10
Q
CARDIOGENIC SHOCK:
A
- End-organ hypoperfusion due to cardiac failure (i.e. dysfunctional pump)
- Common causes: myocardial ischemia, arrhythmia, outflow obstruction, mechanical abnormalities
- Occurs in 5-8% of STEMI patients and 2.5% in NSTEMI - Presentation:
- AMS, pulmonary edema, hypotension, weak pulses, cool extremities, decreased urine output - Diagnostic criteria:
- Sustained hypotension (SBP<90) and a reduced CI (<2.2 l/min/m2) in the presence of elevated PCWP>18
11
Q
CARDIOGENIC SHOCK Treatment:
General Treatment
A
- Fluid resuscitation unless frank pulmonary edema is present (conservative 250-500 ml bolus) o Considerdiuresis(furosemide)forpulmonaryedema
- Correction of rhythm abnormalities or electrolyte (magnesium/potassium) disturbances
- Avoid beta-blockers and calcium channel blockers due to negative inotropic effects
- Individualized vasopressors therapy; use of dopamine may be associated with excess hazard
12
Q
CARDIOGENIC SHOCK Treatment:
For STEMI patients
A
- Emergent revascularization with either PCI or CABG if due to pump failure after STEMI
- Fibrinolytic therapy for patients who are unstable for PCI or CABG
- Intra-aortic balloon pump counterpulsation unstable patients after pharmacologic therapy (Class IIa)
- Alternative LV assist devices for circulatory support may be considered in refractory cardiogenic
shock
13
Q
DISTRIBUTIVE SHOCK
A
- Excessive vasodilation resulting in impaired distribution of blood flow
- Common types:
- Septic
- Neurogenic
- Anaphylactic
14
Q
Septic:
A
Excessive inflammation due to infectious source
15
Q
Neurogenic:
A
Not associated with blood loss, but rather a disruption of autonomic regulation in the spinal
cord resulting in decreased SVR and pooling of blood in the periphery
